Is Medicare the Same in All 50 States?
Medicare is a federal program, but Medicare Advantage, Medicare Part D prescription drug plans and Medigap policies are all sold through private insurers. They are regulated by your state’s insurance commission and can differ in coverage, cost and benefits from state to state.
How Do Medicare Plans Differ by State?
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.
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.
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 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.
Medicare Advantage Popularity by State
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.
|5 Highest Ranking States||Medicare Advantage Plans||5 Lowest Ranking States||Medicare Advantage Plans|
|Florida||1,910,338||District of Columbia||15,525|
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.
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.
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.
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.
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.
|Medigap plan prices are community-rated, meaning policies typically charge the same premiums regardless of your age or gender.||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.
13 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2020, February 13). 2018 Medicare Enrollment Section. Retrieved from https://www.cms.gov/research-statistics-data-systems/cms-program-statistics/2018-medicare-enrollment-section
- U.S. Centers for Medicare & Medicaid Services. (2020, February 13). Total Medicare Enrollment: Total, Original Medicare, and Medicare Advantage and Other Health Plan Enrollment, Calendar Years 2013-2018. Retrieved from https://www.cms.gov/files/document/2018-mdcr-enroll-ab-1.pdf
- 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
- U.S. Centers for Medicare & Medicaid Services. (2015, April). What’s a Medicare Advantage Plan? https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans
- Davis, K., Schoen, C., and 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
- 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
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Find Contact Information. Retrieved from https://www.medicare.gov/contacts/
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Advantage Plans. Retrieved from https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans
- 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.). Your Guide to Prescription Drug Coverage. Retrieved from https://www.medicare.gov/Pubs/pdf/11109-Your-Guide-to-Medicare-Prescrip-Drug-Cov.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How to Compare Medigap Policies. https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies
- Kaiser Family Foundation. (n.d.). Medicare Advantage: Total Enrollment. Retrieved from https://www.kff.org/medicare/state-indicator/ma-total-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
- Kaiser Family Foundation. (n.d.). Medicare Prescription Drug Plans (PDPs). Retrieved from https://www.kff.org/medicare/state-indicator/prescription-drug-plans-pdps/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Overall%22,%22sort%22:%22desc%22%7D