Medicare Blog

what states does medicare cover

by Prof. Myrtis Schaden MD Published 1 year ago Updated 1 year ago
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Medigap plans are standardized nationwide. However, three states offer distinct types of Medigap plans. These states are Wisconsin, Massachusetts, and Minnesota.

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.

Full Answer

What states have the best Medicare coverage?

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Do states pay for Medicare?

States pay Medicare Part B premiums each month for over 10 million individuals and Part A premium for over 700,000 individuals. This process promotes access to Medicare coverage for low-income older adults and people with disabilities, and it helps states ensure that Medicare is the first and primary payer for Medicare covered services for dually eligible beneficiaries.

Do Medicare benefits vary by state?

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.

What services are covered by Medicare?

  • When they had a medical problem but did not visit a doctor
  • Skipped a needed test, treatment, or follow-up
  • Did not fill a prescription for medicine
  • Skipped medication doses

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Does my Medicare cover me in other states?

If you have Original Medicare, you have coverage anywhere in the U.S. and its territories. This includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. Most doctors and hospitals take Original Medicare.

Does Medicare cover nationwide?

Original Medicare provides nationwide coverage, whereas Medicare Advantage plans have provider networks that can be limited to a local area.

Do you lose Medicare if you move out of the country?

Remember, you can have Medicare while you live abroad, but it will usually not cover the care you receive. Most people qualify for premium-free Part A, meaning you will pay nothing for coverage. If you must pay a premium for Part A, be aware of the high monthly cost for maintaining Part A coverage.

Is Medicare the same in all 50 states?

Original Medicare (Part A and Part B) is a federal program so your coverage, costs and benefits will not be different from state to state. Medicare Advantage, Medicare Part D and Medigap plans are available through private insurers. These optional Medicare plans are regulated by each state and tend to vary.

What will Medicare not pay for?

In general, Original Medicare does not cover: Long-term care (such as extended nursing home stays or custodial care) Hearing aids. Most vision care, notably eyeglasses and contacts. Most dental care, notably dentures.

Do I need to notify Medicare if I move to another country?

If you have Original Medicare — Medicare Part A and Part B — you can take your coverage with you if you move within the United States, but you should still notify Medicare before you move. Many Medigap plans will also transfer with you.

Does Medicare work in Canada?

In general, Medicare only covers recipients while in the United States. This means that if you have Medicare and you travel to Canada, your healthcare costs will not be covered, even if the services or medications provided would normally be covered in the United States.

Do I need to notify Medicare if I move?

If you're enrolled in Original Medicare, Part A and Part B, you don't need to make changes to your coverage if you're moving, either to a new address in your state or out of state. Original Medicare doesn't have provider networks; instead, you can use any hospital or doctor throughout the country that takes Medicare.

Which state has the lowest Medicare coverage?

None of the ten states with the most retirees made it into the top ten for Medicare coverage. 2. Washington, DC, received the lowest coverage in the nation at 77.29%. The only state that fell below the 80% mark was Utah, with coverage at 78.74%.

How much of Medicare will be burdened?

While health care costs in the US continue to rise, most Medicare beneficiaries can expect Medicare to shoulder 80–90% of the burden. But depending on the procedure, your bill could still be in the thousands. People over 65 and those approaching retirement would do well to sock away some extra savings for medical costs if possible—even if they’re perfectly healthy today.

When is Medicare going to be rising?

Licensed Insurance Agent and Medicare Expert Writer. February 25, 2020. It's painfully obvious: the cost of health care in the US is rising. You feel it every time you visit the doctor, pick up a prescription, and pay your insurance premiums.

What states require community rating for Medigap?

As of 2018, eight states (Arkansas, Connecticut, Massachusetts, Maine, Minnesota, New York, Vermont, and Washington) required carriers to use community rating.

How many seniors will be covered by Medicare in 2021?

July 7, 2021. facebook2. twitter2. comment. Medicare is a federal program, covering more than 63 million seniors and disabled Americans throughout the country. Medicare beneficiaries in most areas have the option to get their coverage via private Medicare Advantage plans, and more than four out of ten do so.

How long does Medicare coverage last?

Medigap coverage is guaranteed issue for six months, starting when you’re at least 65 and enrolled in Medicare Parts A and B.

When is Medicare Part D open enrollment?

Federal guidelines call for an annual open enrollment period (October 15 to December 7) for Medicare Advantage and Medicare Part D coverage in every state. And as of 2019, there’s also a Medicare Advantage open enrollment period (January 1 through March 31) that allows people who already have Medicare Advantage to switch to a different Advantage plan or switch to Original Medicare. But while these provisions apply nationwide, plan availability and prices are different from one state to another.

How many Part D prescriptions will be available in 2021?

Part D prescription drug plan availability differs from state to state as well, with the number of plans for sale in 2021 varying from 25 to 35, depending on the region. The number of available premium-free (“benchmark”) prescription plans for low-income enrollees varies from five to ten, depending on the state.

Does Alaska have Medicare Advantage?

Not surprisingly, the popularity of Medicare Advantage plans varies significantly from one state to another, with only one percent of the Medicare population enrolled in Advantage plans in A laska. (There are no individual Medicare Advantage plans available at all in Alaska.

Can you switch to a different Medigap plan in Maine?

In Maine, Medigap enrollees can switch to a different Medigap plan with the same or lesser benefits at any time during the year, and all carriers must designate one month each year when Medigap Plan A is available on a guaranteed issue basis to all enrollees.

How many stars does Medicare have?

Quality is important to consumers, and in eight states, at least 75% of their MAPD plans score four stars or better for quality measures by the Centers for Medicare and Medicaid Services.

How many people are in Medicare Advantage?

22 million Medicare beneficiaries (34% of all Medicare enrollees) are enrolled in a type of private Medicare plan called a Medicare Advantage plan. Another 20.6 million are enrolled in a stand-alone Medicare prescription drug plan (PDP).

How much is the MAPD premium in Arizona?

Arizona’s MAPD premium average of $16.35 is just half of the national average and the $138.71 drug deductible is nearly $30 lower than average. Plan selection is on the high side (71) while quality is on the low end (just 38% of the plans are rated four stars or higher for plan quality).

What is the average MAPD premium in Arkansas?

Arkansas’ average MAPD premium of $22.35 is about $11 below the national average. However, the average drug deductible of $207.36 is among the highest in the country and not a single one of the state’s 49 plans registered four stars or higher for plan quality, the only state to record a zero in this category.

How many MAPD plans are there in Washington?

Also, there are 118 MAPD plans available in Washington (the average is 62 per state), and nearly 70% of all MAPD plans in Washington are ranked 4 stars or higher by Medicare (the average is 59% of plans in each state).

How much does Medicare Part D cost?

Medicare Part D Prescription Drug Plan beneficiaries in the state pay an average monthly premium of $37.84 for their drug coverage. This dollar amount is right around the national average, and the average PDP deductible is roughly $44 higher than the national average at $366.80.

How much is the MAPD deductible?

The $137.50 average MAPD drug deductible is some $30 lower than the nationwide average. This general affordability of plans is in addition to having 65% of the state’s plans being rated four stars or higher for quality by Medicare, which is comfortably above the national average of 59%.

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Best States For Medicare: Overview

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In this report, we determine where Medicare beneficiaries have access to the widest range of quality private Medicare plans at the most affordable prices. To do this, we compared plan data from the Centers for Medicare & Medicaid Services (CMS) for the 50 states, using two primary factors: 1. Affordability We factored th…
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2022 National Average Medicare Premiums, Deductibles and Quality

  • MAPD plans and Prescription Drug Plans are both reasonably affordable in 2022. 1. The average 2022 MAPD premium is $62.66 per month, though many areas may offer plans that feature $0 monthly premiums. The average deductible for the drug coverage offered by MAPD plans is $292.98 for the year. 2. The average PDP premium is $47.59 per month in 2022, with an averag…
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Best States For Medicare: 2022 Average Medicare Costs by State

  • Factors in Medicare Advantage Premiums
    The national average cost of a Medicare Advantage Prescription Drug plan in 2022 is $62.66 per month. But as you can see from the table above, the cost of an MA-PD plan can vary quite dramatically by location. 1. In Massachusetts, Michigan, Rhode Island and the Dakotas, average …
  • Medicare Advantage Plan Quality by State
    Every year, the Centers for Medicare & Medicaid Services rates all Medicare Advantage plans according to a five-star scale based on various quality metrics. Three stars represents a plan of average quality, while four stars is considered above average and five stars is excellent. The met…
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Expert Analysis

  • As of October 15, millions of American seniors have the opportunity to purchase a private Medicare insurance plan for the first time or switch to a new coverage option during the Medicare Annual Enrollment Period (AEP). This period, also called the fall Medicare Open Enrollment period, lasts until December 7. We asked a panel of experts for their insight on what Medicare beneficia…
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Methodology

  • This project used data provided by the Centers for Medicare & Medicaid Services (CMS). The 2022 MA Landscape Source Files and 2022 PDP Landscape Source Fileswere used for analysis.
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Fair Use Statement

  • Of course we would love for you to share our work with others. We just ask that if you do, please grant us the proper citation with a link to this study so that we may be given credit for our efforts.
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Research and Reports

  • Our research reports analyze a number of issues important to seniors, from health perceptions, medical communication, health habits, and more. 1Every year, Medicare evaluates plans based on a 5-star rating system.
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