Medicare by State

Medicare is a federal program, meaning that its eligibility and coverage are mostly the same across the U.S. It’s important to remember that this distinction is only the case for Original Medicare, which includes Parts A and B. If you have Original Medicare, there is essentially no difference in coverage depending on where you live.

This is not true of Medicare Advantage plans, which vary significantly by the state in cost and coverage. Medicare Advantage plans, or Medicare Part C, are provided by private insurers and include additional benefits and coverage beyond the scope of Original Medicare.

Medicare Part D, an optional benefit to cover prescription drugs, also varies by state and region.

Even though it’s a federal program, Medicare coverage, costs and benefits can vary widely from state to state. Medicare covered nearly 60 million Americans in 2018, the most recent year numbers are available from the U.S. Centers for Medicare & Medicaid Services.

More than 64 percent of those people were covered by Original Medicare — Medicare Part A and Part B. It’s managed by the federal government and is the same from state to state.

But there are also Medicare Advantage plans, Medicare Part D drug plans and Medigap policies that either overlap with or replace Original Medicare for millions of people on Medicare. These are private plans sold by insurance companies.

These private plans are regulated by state insurance commissions and they differ from state to state.

Upwards of 35 percent of people on Medicare — 21.3 million — were enrolled in Medicare Advantage plans. These are private plans that replace Original Medicare coverage.

More than 44 million people were enrolled in a Medicare Part D prescription drug plan in 2018. About 18 percent of people on Medicare also had a Medigap policy in 2015, according to a report from the Commonwealth Fund. These plans can be added to Original Medicare coverage.

The number of Medicare Advantage plans and their prices vary from state to state. Larger states typically have more options available.

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 October 15 to December 7.

Since 2019, the federal government has also allowed a second open enrollment period for Medicare Advantage from January 1 through March 31. This period allows people with Medicare Advantage to switch to another Medicare Advantage plan or to switch to Original Medicare.

Because prices, benefits and population vary from state to state, Medicare Advantage may be more popular alternatives to Original Medicare in some states compared to others.

As a percentage of the population, only about one percent of Alaskans enrolled in Medicare had Medicare Advantage plans in 2018. But 56 percent of Medicare beneficiaries in Minnesota were enrolled in a Medicare Advantage plan that same year.

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.

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 — October 15 to December 7 every year.

The availability of Medicare Part D plans vary from state to state. The number of plans available in any state in 2019 ranged from 22 choices in Alaska to 30 choices in California, Pennsylvania and West Virginia, according to the Kaiser Family Foundation.

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.

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.

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.

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.

If you move to another state or region, you will 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.