Can I Get Health Insurance in Another State?

Navigating health insurance across state lines is complex. The specifics depend on individual circumstances, the type of health plan, and state regulations. Understanding these factors is crucial for maintaining continuous healthcare coverage. The U.S. health insurance system is primarily state-regulated, influencing how plans operate and how coverage applies outside a plan’s home state.

Residency Requirements for Coverage

Establishing residency in a new state is a requirement for obtaining new health insurance, especially for marketplace plans or state programs like Medicaid. States define residency by factors like obtaining a new driver’s license, registering a vehicle, or establishing utility accounts. Without demonstrating residency, an individual may not be eligible for new state health plans.

A permanent move to a new state is a “qualifying life event” (QLE), triggering a “Special Enrollment Period” (SEP) for marketplace plans. This allows enrollment outside the annual Open Enrollment Period. The SEP lasts 60 days from the move date, providing a limited window to select a new plan. Initiate this process promptly to avoid coverage gaps.

During a SEP, apply for new health insurance through HealthCare.gov or your new state’s marketplace. Proof of residency, like a new lease or utility bill, may be required to verify SEP eligibility. This confirms relocation and validates the need for new coverage. Failing to enroll within 60 days may result in being uninsured until the next Open Enrollment Period.

How Different Health Plans Handle Out-of-State Care

The ability of a health plan to provide coverage across state lines varies significantly depending on the plan type. Employer-sponsored plans, individual marketplace plans, short-term health plans, Medicaid, and Medicare each have distinct rules regarding out-of-state medical services. Understanding these differences is important for individuals anticipating a move or needing care while away from their primary residence.

Employer-sponsored plans often fall into two main categories: Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). PPOs offer broader coverage for out-of-network or out-of-area care, often with higher out-of-pocket costs, making them more flexible for individuals who travel or live in different locations than their plan’s primary network. National employers frequently offer PPO plans with extensive networks that span multiple states, allowing employees to access care in various locations. HMOs are more geographically restrictive, requiring members to use a specific network of providers within a defined service area and often requiring referrals for specialist care. Non-emergency care outside an HMO’s service area may not be covered at all.

Individual marketplace plans, often referred to as Affordable Care Act (ACA) plans, are state-specific and must be purchased through the marketplace of the state where the individual resides. While these plans are mandated to cover emergency care received out-of-state, routine or non-emergency care may not be covered, or coverage may be severely limited, unless the plan explicitly includes a multi-state network arrangement. Some plans may offer limited out-of-network benefits, but these often come with higher deductibles and coinsurance. Relying on an ACA plan from a previous state for regular care in a new state is not advisable.

Short-term health plans are regulated and offered on a state-by-state basis, and their availability and benefits can vary widely. These plans often have more restrictive networks and may offer limited or no coverage for non-emergency care received outside their designated service area. Medicaid, a joint federal and state program, is strictly state-specific; coverage does not transfer across state lines except in very limited emergency situations. Individuals moving to a new state must reapply for Medicaid in their new state of residence.

Original Medicare (Parts A and B) offers national coverage, allowing beneficiaries to access care from any provider nationwide that accepts Medicare. Medicare Advantage (Part C) plans, offered by private companies, are county- or state-specific and often have network restrictions similar to HMOs or PPOs. Beneficiaries with Medicare Advantage plans need to switch plans if they move to a new service area to maintain in-network coverage.

Getting New Coverage After Moving

Once residency is established in a new state, secure new health insurance. Procedures vary by plan type. For those previously in a marketplace plan, the process involves using the qualifying life event of a permanent move.

Visit HealthCare.gov or your new state’s marketplace portal to enroll. Report the move as a qualifying life event, opening a Special Enrollment Period, allowing 60 days to select a new plan. During this period, compare plans, review benefits and costs, and choose a plan that fits your needs. Required documentation, like a new lease or utility bill, may be necessary to verify the move and SEP eligibility.

For those starting a new job, enrollment in an employer-sponsored plan occurs through the new employer’s benefits administration. New employees are eligible for coverage shortly after their start date, often within 30 to 90 days, with enrollment managed by the employer.

If your existing employer allows continued coverage in the new state, especially with a PPO, notify HR to confirm network availability and updates. Individuals seeking Medicaid in their new state must apply directly through that state’s Medicaid agency or online portal. The application assesses income, household size, and other eligibility criteria specific to the new state’s program. This application is distinct from marketplace enrollment and requires a separate eligibility determination. Begin this application as soon as possible after establishing residency to minimize coverage gaps.

Coverage for Non-Resident Scenarios

Some situations require out-of-state coverage without new residency, such as for remote workers, students, or dependents on a parent’s plan. Understanding how plans manage these scenarios ensures continued access to care. Plan networks and portability, discussed previously, apply to these circumstances.

For remote workers, employer-sponsored plans often provide coverage based on the employer’s national network, especially with a PPO. Remote employees should confirm their plan’s network includes providers in their state of residence, even if the employer is based elsewhere. If the plan is an HMO, the remote worker might face limitations accessing routine care outside the HMO’s service area. Many employers offer plan choices for geographically dispersed employees.

Students attending college out-of-state often have several coverage options. Many universities offer student health plans covering the school’s geographical area. Alternatively, students may remain on their parents’ employer-sponsored health plan, especially if it’s a PPO with a broad national network or covers dependents away at school. Verify network availability and coverage limits for non-emergency care in the student’s college town.

Dependents on a parent’s health plan can access care in a different state if the plan has an adequate network or out-of-network benefits. This is common for children attending boarding school or visiting relatives out-of-state. Coverage depends on plan type, with PPOs offering more flexibility than HMOs. Parents should review their plan’s summary of benefits to understand coverage when a dependent is out of the plan’s primary service area.

For temporary travel, standard health insurance policies cover emergency medical care nationwide. If an individual experiences a sudden illness or injury while traveling out-of-state, their plan should cover necessary emergency services. However, non-emergency or routine care, like scheduled doctor visits, may not be covered or may incur higher out-of-pocket costs outside the plan’s network.