Welcome to Medicare School Daily, where we help you understand Medicare, save money, avoid
mistakes, and above all else, get the most out of your Medicare benefits. Now, today's topic is,
can I use my Medicare plan anywhere in the U.S.? Well, that really depends upon how you choose to
use your Medicare benefits. Remember, when you go on Medicare, you only have two choices for
using your benefits. One is to do an advantage plan. The other is to do a supplemental plan.
So depending upon which way you choose to use your Medicare benefits will determine how this question
is going to be answered. And so let's deal, first of all, with that question as it relates
to advantage plans. Can you use it anywhere in the U.S.? Well, it really just depends upon what
kind of care you need. If you're on an advantage plan, if you find yourself in a situation where
you need to go to an emergency room, where you have to go to an urgent care type of facility,
the answer to the question is yes. Anywhere in America that takes Medicare, you can go and get
care if you're on an advantage plan in an emergency or urgent care situation. Now,
if you find yourself in a non emergency situation, the answer to a question depends upon the network
that you have selected with your advantage plan, because there's two types of networks. We have HMO
and PPO. And so if you're in a non-emergency situation, which means you'd like to go see a
primary care doctor, maybe a specialist, maybe you want a second opinion, maybe you're going through
cancer treatment or something like that. And if you're on an HMO, can you go anywhere in the U.S.?
And the answer is no. OK? The only time on an HMO that you can get care outside the network,
if it's an emergency or urgent care, otherwise you have to stay in your network. You don't have
out of network privileges. And that's what the HMO stipulation is. The restriction is you must
stay in your network unless it's emergency or urgent care. So, no, you can't. Now,
the PPO plan, the answer is yes. So the way it works is this: if I'm on an advantage plan,
and my network is a PPO, preferred provider organization, you can go out of the network.
But what happens is this: you're going to pay substantially more than you were than if you were
in the network. So out of the network anywhere in the US, you can go, but you're going to spend
about 40 to 50 percent of the Medicare approved amount expenses. And then they'll put a limit on
that out of network in the neighborhood of about ten thousand dollars. So, yes, you can go out of
your network on a PPO. You'll pay a little bit more of a percentage because remember,
if you’re in your network, you would pay a very low percentage, but all the networks pay more.
And then, of course, that will max out at ten thousand dollars. So if the bill is $100,000, it
won’t matter. You just have to pay the max that's set for out of network benefits for that year.
All right? So that's the way it works anywhere in the U.S. if you're on an advantage plan.
Now, let's suppose that you choose to stay in original Medicare,
and you get a supplemental plan or a Medigap policy to fill those gaps that Medicare
did not cover. So back to our scenarios, depending upon what situation you find yourself
in. If you're in an emergency situation or an urgent care, can you go anywhere in the U.S.?
And the answer is absolutely yes. As long as that provider, that hospital, that doctor,
that facility takes Medicare, you go anywhere you want in the U.S. So, yes. How about if we
find ourselves in a non-emergency situation? Again, the answer is always yes. Okay? As long
as the provider takes Medicare. Why is that? Well, remember the advantage plan we were restricted to
what kind of network that we were in, but when it comes to original Medicare and supplemental plans,
we have no network at all. Medicare is our network. So as long as that provider,
the hospital, the doctor, the cancer facility, the urgent care, anywhere that would take Medicare is
going to take our supplemental plan because that supplemental plan is nothing more than
the secondary payer. Medicare pays first, the secondary plan will pay after Medicare pays,
and there's no network involved at all with supplemental plans. All right?
And so that's the answer to the question, if you have a supplemental plan. So can you use your plan
anywhere in the U.S.? Just depends on the coverage that you have chosen for your Medicare benefits.