- Written by Terry Turner
Senior Financial Writer and Financial Wellness Facilitator
Terry Turner has more than 35 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).Read More
- Edited BySavannah Pittle
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Savannah Pittle is a professional writer and content editor with over 16 years of professional experience across multiple industries. She has ghostwritten for entrepreneurs and industry leaders and been published in mediums such as The Huffington Post, Southern Living and Interior Appeal Magazine.Read More
- Reviewed ByAflak Chowdhury
Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.Read More
- Published: October 26, 2020
- Updated: April 27, 2023
- 13 min read time
- This page features 15 Cited Research ArticlesKey Takeaways
- Original Medicare is the only coverage that does not vary by state. Medigap, Medicare Advantage and Part D prescription drug plans are all sold privately and vary by state.
- Larger states typically have more plan options available than less populated states.
- Medigap plans offer the same benefits across most states.
How Do Medicare Plans Differ by State?
Original Medicare — Medicare Part A and Part B — is a federal program. You can use it anywhere in the United States if you are traveling or move to another state.
But states may make their own Medicare rules — as long as they meet basic Medicare requirements.
In addition, Medicare Advantage, Medigap and Medicare Part D prescription drug plans are sold by private insurers. The insurers are regulated by the state where they are located. This means the rules for these plans vary from state to state.
If you move to another state — or even a different part of your state — you may have to replace your Medicare Advantage, Medigap or Part D plan.Medicare Advantage plans that offer a national network are typically known as PPO plans while those offering a local network are usually HMO plans.
Some of the most common state-specific rules relate to enrollment in Medicare plans. Not all states have these rights, and the rules vary between states that do have them.Examples of State-Specific Rules for Medicare Plans
- Guaranteed Issue Rights
- Guaranteed issue rights allow you to buy a Medigap policy outside the usual open enrollment. Guaranteed issue rights also let you enroll in a Medigap plan without having to answer questions about your health — a process insurers call underwriting.
- Annual Guaranteed Issue
- Some states have annual guaranteed issue rights that are limited to a short period every year. Missouri allows you to switch to similar coverage for 30 days before and after your policy anniversary each year.
- No Health Underwriting Year-Round
- Some states — such as Connecticut and New York— never require you to go through medical underwriting to buy a Medigap plan. Vermont bars underwriting for UnitedHealthcare and Mutual of Omaha plans only.
- Open Enrollments
- Different states have special open enrollment periods. These may include specific months of the year or varying periods of time around your birthday.
State Differences in Medicare Advantage
Medicare Advantage plans are private policies that you can buy to replace Original Medicare coverage.
The federal government requires them to cover everything Original Medicare covers in all 50 states. But Medicare Advantage plans may also offer benefits beyond what Original Medicare covers, such as dental, vision, prescription drug and hearing benefits.
The federal government requires an annual open enrollment for Medicare Advantage in every state that coincides with Original Medicare enrollment. This happens every year from Oct. 15 to Dec. 7.
Since 2019, the federal government has also allowed a second open enrollment period for Medicare Advantage from Jan. 1 through March 31. This period allows people with Medicare Advantage to switch to another Medicare Advantage plan or to switch to Original Medicare.
The number of Medicare Advantage plans and their prices vary from state to state. Larger states typically have more options available.
Popularity by State
Nationally, Medicare Advantage has become increasingly popular as an alternative to Original Medicare — accounting for 48% of Medicare coverage in the United States as of 2022, according to the Kaiser Family Foundation.
Because Medicare prices, benefits and population vary from state to state, Medicare Advantage may be a popular alternative to Original Medicare in some states compared to others.States with Highest and Lowest Medicare Advantage Penetration vs. Original Medicare
6 Highest Ranking States Medicare Advantage Share 6 Lowest Ranking States Medicare Advantage Share Puerto Rico 93% Montana 26% Hawaii 59% Maryland 21% Alabama 57% South Dakota 12% Connecticut 56% North Dakota 9% Florida 56% Wyoming 7% Michigan 56% Alaska 1%Source: Kaiser Family Foundation
As a percentage of the population, only about 1% of Alaskans enrolled in Medicare had Medicare Advantage plans in 2018. But 56% of Medicare beneficiaries in Minnesota were enrolled in a Medicare Advantage plan that same year.Don't Leave Your Health to ChanceFind a local Medicare plan that fits your needs by connecting with a licensed insurance agent.
How Medicare Part D Prescription Drug Plans Differ Between States
Medicare Part D prescription drug plans are private insurance plans that work with Original Medicare to help cover the costs of your prescription medicine. Many Medicare Advantage plans also provide prescription drug coverage.
Medicare plan prices and plan availability varies from state to state, but all states are required to have open enrollment in Medicare Part D plans at the same time as open enrollment for Original Medicare — Oct. 15 to Dec. 7 every year.
The availability of Medicare Part D plans vary from state to state. The number of plans available in any state in 2022 ranges from 19 choices in New York to 27 choices in Arizona, according to the Kaiser Family Foundation.
How Does Medicare Part D Vary from State to State?
The biggest difference between Medicare Part D prescription drug plans from state to state are the premium prices of plans and the number of plans available.
Most states have more than 20 plans for beneficiaries to choose from. But U.S. territories typically have only one to six to choose from.
More significant differences are between the plans themselves. Different formularies — the list of drugs a Part D plan covers — may have a greater impact on whether a particular plan is your best choice.
Popularity by State
Since Medicare Part D prescription drug coverage took effect in 2006, it has become increasingly popular.
In 2022, 49 million of the 65 million people — or more than 75% of all Medicare beneficiaries in the United States and its territories — had Part D coverage, according to the Kaiser Family Foundation.
Beneficiaries can choose to enroll in a standalone Medicare Part D prescription drug plan or in a Medicare Advantage plan that includes Part D coverage.
In 2023, 801 plans were available nationwide — a 5% increase over the number available in 2022, according to the Kaiser Family Foundation.
All plans are not available in all states. The numbers range from 19 in New York to 28 in Arizona. Americans living in U.S. territories have fewer to choose from — just one in most territories to six in Puerto Rico.
Medicare Advantage and Part D Costs by State
Monthly premiums and the number of Medicare Advantage and Medicare Part D plans available vary widely across the states.
For example, monthly premiums for a Medicare Advantage plan average $0 in Alaska where there are only two to choose from. But the average is more than $16 with nearly 500 to choose from in California.Medicare Advantage and Part D Plans, Cost & Availability for 2023
State or Territory Average Monthly Premium for Medicare Advantage Medicare Advantage Plans Available Lowest Monthly Premium for Medicare Part D Plans Medicare Part D Plans Available Alabama $11.24 108 $7.40 24 Alaska $0.00 2 $5.30 21 American Samoa N/A N/A $66.70 1 Arizona $12.00 157 $5.40 28 Arkansas $11.16 85 $7.60 23 California $16.42 492 $4.50 26 Colorado $13.71 100 $3.50 23 Connecticut $17.66 65 $6.80 24 Delaware $12.66 33 $7.60 22 District of Columbia $30.38 17 $7.60 22 Florida $9.41 627 $8.40 23 Georgia $14.37 166 $7.30 24 Guam N/A N/A $48.90 1 Hawaii $43.72 38 $5.80 20 Idaho $20.45 80 $5.10 23 Illinois $11.39 173 $4.90 24 Indiana $12.50 146 $4.80 24 Iowa $9.13 70 $4.70 24 Kansas $6.17 90 $2.80 23 Kentucky $10.11 102 $4.80 24 Louisiana $15.78 108 $7.70 21 Maine $11.25 54 $4.20 24 Maryland $34.86 55 $7.60 22 Massachusetts $44.26 113 $6.80 24 Michigan $23.38 207 $3.20 24 Minnesota $70.77 106 $4.70 24 Mississippi $17.68 69 $4.70 22 Missouri $7.67 135 $5.80 23 Montana $23.06 26 $4.70 24 Nebraska $13.62 39 $4.70 24 Nevada $3.58 103 $7.90 23 New Hampshire $17.41 43 $4.20 24 New Jersey $14.98 92 $6.80 24 New Mexico $11.98 72 $8.80 24 New York $26.02 288 $10.90 19 North Carolina $14.05 150 $4.20 24 North Dakota $35.86 27 $4.70 24 Northern Mariana Islands N/A N/A $56.50 1 Ohio $16.03 216 $5.10 24 Oklahoma $14.42 89 $7.10 24 Oregon $33.74 124 $1.60 24 Pennsylvania $30.05 262 $5.20 26 Puerto Rico $0.12 69 $15.00 6 Rhode Island $26.91 39 $6.80 24 South Carolina $12.30 97 $5.70 25 South Dakota $16.30 30 $4.70 24 Tennessee $17.08 129 $7.40 24 Texas $8.94 385 $6.60 27 U.S. Virgin Islands N/A N/A $95.80 1 Utah $15.77 54 $5.10 23 Vermont $18.43 25 $6.80 24 Virginia $12.80 147 $5.10 24 Washington $30.50 153 $1.60 24 West Virginia $21.05 53 $5.20 26 Wisconsin $27.28 126 $6.60 23 Wyoming $36.46 16 $4.70 24Source: U.S. Centers for Medicare & Medicaid Services
Differences in Medigap Plans Between States
Medicare Supplement insurance — also known as Medigap — policies help you cover your out-of-pocket expenses if you have Original Medicare. It’s the only private Medicare-related insurance for which the federal government does not set a mandatory open enrollment period.
You have six months starting with your 65th birthday — and once you’re enrolled in Medicare Part B — to buy a Medigap policy available in your area.
After that, you’re often locked into the Medigap plan you choose. It is difficult or extremely expensive to switch to another Medigap plan in most states.
State-Specific Medicare Plans
While Medigap plans are standardized across most of the U.S., there are three states — Wisconsin, Massachusetts and Minnesota — that have different sets of standardized plans allowed by a federal waiver.Waiver State Medigap Plans
- Massachusetts offers three Medigap plans: Core Plan, Supplement 1 Plan and Supplement 1A Plan. All three provide the same basic benefits, but each plan offers varying levels of benefits.
- Minnesota offers five Medigap plans available in most states, along with Medicare Select plans available in some states and three plans unique to Minnesota.
- Wisconsin offers four different Medigap plans — the Basic plan and three others with varying levels of cost sharing. All four provide the same core benefits.
State-Specific Medicare Supplement Rules
Medigap plans are standardized across most states, meaning they offer the same benefits. The exceptions are Wisconsin, Minnesota and Massachusetts. Plans in those states may have options that differ from Medigap plans in other states.Examples of Rare State Rules for Medigap
Rule State(s) Medigap plan prices are community-rated, meaning policies typically charge the same premiums regardless of your age or sex. Arkansas, Connecticut, Massachusetts, Maine, Minnesota, New York, Vermont, Washington A “birthday rule” allows you to switch Medigap plans within 30 days of your birthday each year without costly medical underwriting. California, Oregon Two states have “guaranteed issue” rights year-round in which companies must offer you certain Medigap policies in certain situations. Connecticut, New York One state allows you to switch Medigap plans at any time during the year so long as the new policy has the same or lesser benefits. Maine One state has an Anniversary Guaranteed Issue Period meaning if you have a Medigap plan, you have a 60-day period around your plan’s anniversary date every year to switch to the same plan from a different insurance company. Missouri
Medicare does not require states to guarantee access to Medigap plans for people under 65 who qualify for Medicare due to a disability such as end-stage renal disease or ALS (also known as Lou Gehrig’s disease). But most states have some type of rule in place giving people with these conditions access.
Medigap Cost and Enrollment Facts
Medigap plan costs vary widely from state to state — and even within each state. Nationally, the average cost of Medigap premiums was $178 in 2022, and the average deductible was $181, according to Consumer Reports.
State insurance rules affect how Medigap plans are priced in individual states. A state’s cost-of-living may also play a role in a plan’s cost.
Nearly 14.5 million Americans had Medicare Supplement insurance, according to a 2021 study by AHIP, a political advocacy and trade association of health insurance companies.`States With Highest and Lowest Medigap Enrollment
States With Highest Enrollment Total Enrollment States With Lowest Enrollment Total Enrollment California 1,069,299 Vermont 53,092 Florida 922,604 Rhode Island 51,442 Texas 911,802 Alaska 17,064 Illinois 798,778 Hawaii 12,083 Pennsylvania 711,230 District of Columbia 11,546Source: AHIP
Medigap Medicare Excess Charges
Medicare Part B excess charges are additional charges — up to 15% — above the Medicare-approved amount for services. Doctors or other health care providers who do not accept Medicare assignments may bill you for excess charges that Original Medicare will not cover.
The only Medigap plans that cover excess charges are Plan F and Plan G. However, no one enrolled in Medicare on or after Jan. 1, 2020, can purchase Plan F. So, if excess charges are a major concern, Plan G is the only option for coverage against the charges if you are a new Medicare enrollee.
But, eight states ban excess charges. You won’t have to worry about them if you live in these states:
- New York
- Rhode Island
Medigap Plans for Those Younger Than 65 on Disability
People with certain disabilities can enroll in Medicare before they turn 65. But, federal law does not require insurers to provide Medigap policies to those under 65.
However, most — not all — require insurers to provide at least one plan to people under 65 who qualify for Medicare because of their disability.
- New Mexico
- North Dakota
- Rhode Island
- South Carolina
- West Virginia
Even though these states may not require insurers to provide Medigap coverage to people with disabilities younger than 65, insurers in these states may do so anyway. You can find out if you qualify for Medigap coverage by contacting the State Health Insurance Assistance Program — SHIP — in your state.
Using Medicare in Other States
If you have Original Medicare, then you will be covered anywhere in the U.S.
Since Original Medicare is a federal program, it provides blanket coverage across the country. But, even in another state, you still have to receive treatment from a doctor who is enrolled in Medicare.
If you have Medicare Advantage, then it will depend on your specific plan. Some plans require you to stay within a network or use certain doctors, limiting you if you travel outside of your network.
Transferring Medicare to Another State
If you move to another state or region, you may need to find a new Medicare Advantage plan available in that area. According to CNBC, you will have two months to change and update your plan after you’ve arrived in your new state of residence.
If you have Original Medicare, all you need to do if you move is give Medicare your new address and location info.
The term “snowbird” typically refers to a retiree from the north who lives there in the summers but moves each year to a warmer, southern state during the winter months. Original Medicare will cover their hospital and medical expenses in either state of residence. Medigap plans — which supplement Original Medicare — also work throughout the United States.
But it can be more complicated with Medicare Advantage and Medicare Part D coverage. That’s because you may be limited to using doctors, hospitals and pharmacies in the plans’ networks.
There are Medicare Advantage and Part D plans with national networks. Check with the plan to make sure you have provider options in both areas where you plan to live.
Frequently Asked Questions About Nationwide Medicare CoverageIs Medicare different in each state?Since it is a federal program, Original Medicare is the same everywhere in the U.S. This is not the case for Medicare Advantage. Since Medicare Advantage plans are purchased from private insurers, they are offered regionally and often include plan networks that limit your coverage to a general area.How do you transfer Medicare to another state?If you have Original Medicare, then your coverage isn’t affected if you move to another state. Since Medicare Advantage plans are often limited by networks, you will likely need to find a new plan when you move rather than transferring your coverage.
Editor Samantha Connell contributed to this article.Last Modified: April 27, 2023
15 Cited Research Articles
- Wang, P. (2022, November 3). The Pros and Cons of Medicare Advantage. Retrieved from https://www.consumerreports.org/medicare/pros-and-cons-of-medicare-advantage-a6834167849/
- Kaiser Family Foundation. (2022, October 9). An Overview of the Medicare Part D Prescription Drug Benefit. Retrieved from https://www.kff.org/medicare/fact-sheet/an-overview-of-the-medicare-part-d-prescription-drug-benefit/
- U.S. Centers for Medicare & Medicaid Services. (2022, September 29). 2023 Fact Sheet. Retrieved from https://www.cms.gov/files/document/2023-medicare-advantage-and-part-d-state-state-fact-sheets.pdf
- Kaiser Family Foundation. (2022, August 25). Medicare Advantage in 2022: Enrollment Update and Key Trends. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/
- U.S. Centers for Medicare & Medicaid Services. (2021, December 21). CMS Releases Latest Enrollment Figures for Medicare, Medicaid and Children’s Health Insurance Program (CHIP). Retrieved from https://www.cms.gov/newsroom/news-alert/cms-releases-latest-enrollment-figures-medicare-medicaid-and-childrens-health-insurance-program-chip
- AHIP. (2021, May). The State of Medicare Supplement Coverage. Retrieved from https://www.ahip.org/documents/AHIP_IB-Medicare-Supp-Cvg-Report.pdf
- U.S. Centers for Medicare & Medicaid Services. (2021, March 23). A Snapshot of Sources of Coverage Among Medicare Beneficiaries in 2018. Retrieved from https://www.kff.org/medicare/issue-brief/a-snapshot-of-sources-of-coverage-among-medicare-beneficiaries-in-2018/
- U.S. Centers for Medicare & Medicaid Services. (2020, February 13). Medicare Part D Enrollment: Part D Enrollees by Type of Plan, Low Income Subsidy (LIS) and Retiree Drug Subsidy, Calendar Years 2013-2018. Retrieved from https://www.cms.gov/files/document/2018-mdcr-enroll-d-1.pdf
- Davis, K., Schoen, C., & Bandeali, F. (2015, April). Medicare: 50 Years of Ensuring Coverage and Care. Retrieved from https://collections.nlm.nih.gov/master/borndig/101659299/Medicare_50_years_coverage_care.pdf
- Kaiser Family Foundation. (n.d.). Medicare. Retrieved from https://www.kff.org/state-category/medicare/medicare-advantage/enrollment/?currenttimeframe=0&sortmodel=%22colid%22:%22location%22,%22sort%22:%22asc%22
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Contact Medicare. Retrieved from https://www.medicare.gov/talk-to-someone
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How Do Medicare Advantage Plans Work? Retrieved from https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How To Compare Medigap Policies. Retrieved from https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Advantage Plans. Retrieved from https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health-plans/medicare-advantage-plans
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Your Medicare Coverage Choices. Retrieved from https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices
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