The Medicare Advantage Hidden Trap Snowbirds Often Miss

Millions of seniors count on Medicare Advantage to help them control health care costs during retirement.

Yet, this program quietly fails some retirees who divide their time between living in two states. If you hope to avoid money mistakes, it's important to understand this potential flaw in your Medicare Advantage coverage.

What is Medicare Advantage?

Medicare Advantage is an alternative to Original Medicare. Private companies approved by the government offer this coverage.

In recent years, Medicare Advantage has become increasingly popular among retirees. Today, about 55% of eligible seniors get their Medicare coverage through this option.

The hidden Medicare Advantage trap for snowbirds and others

Original Medicare has a consistent framework and set of rules that is unchanging regardless of where you are in the country. Many doctors in every part of the country accept this type of coverage.

On the other hand, Medicare Advantage services are built around a county, or a group of several counties or even a cluster of states. This is known as a service area.

As long as you seek medical services within the area, it typically should be considered an in-network service and covered as such.

But travel outside the region, and it is possible that your visits won't be covered on an in-network basis. Instead, you are treated as an out-of-area traveler.

What this means for you

If you seek services somewhere outside your service area, you could potentially be on the hook for some or all of the costs of your care.

There are some caveats to this rule. For example, federal rules state that Medicare Advantage plans must cover emergency and urgently needed care regardless of where you seek it.

In addition, some Medicare Advantage plans might cover some non-emergency care that is out of network.

However, you should not count on this being the case. If you are a snowbird or someone else who divides your time between two states, make sure you clearly understand the rules before seeking medical care.

What might not be covered

If you seek services somewhere outside your service area, you could potentially be on the hook for some or all of the cost of routine, scheduled care, including a specialist follow-up, imaging, or physical therapy.

In addition, if you have a particularly bad health year and need a lot of services in the state outside your Medicare Advantage service area, you could potentially be responsible for a lot of bills.

Services a plan denies as noncovered typically do not count toward your out-of-pocket maximums. For the record, in 2026, the federally mandated out-of-pocket limit for a Medicare Advantage plan tops out at $9,250 for in-network services and $13,900 for in-network and out-of-network services combined.

Again, some Medicare Advantage plans may cover out-of-network services through a visitor program, national network, point-of-service benefit, or PPO coverage. But it is your responsibility to know your plan's rules before seeking care.

How this differs from Original Medicare

Those who have Original Medicare have much less to worry about if they split their time between two or more states.

For such enrollees, Medicare covers services from any provider that accepts Medicare regardless of where you are in the U.S.

In addition, your coverage extends to places such as:

• Puerto Rico
• The U.S. Virgin Islands
• Guam
• American Samoa
• The Northern Mariana Islands

This does not mean you won't owe any costs when seeking care, however.

In 2026, the deductible for Original Medicare Part B coverage is $283. But more importantly, even though you typically do not pay more than 20% of the cost of services, there is no annual limit on what you pay out of pocket.

Fortunately, you mitigate this cost by also purchasing a Medigap policy that helps pick up these extra expenses.

What to do to better ensure coverage

Many people prefer Medicare Advantage coverage and are fine with carefully managing their doctor's visits so they only occur in the Medicare beneficiary's home state.

However, if you are concerned that you might get caught paying high bills for seeking care in a second state, you have options.

For many people, this may involve switching from Medicare Advantage to Original Medicare, most likely during the Medicare open enrollment period that runs from Oct. 15 to Dec. 7.

If you make this change, beware that getting Medigap coverage might be tricky. There is a six-month Medigap open enrollment period that begins at age 65 when you enroll in Part B. During this time, insurers are not allowed to use medical underwriting when offering you a policy.

After that window closes, you are still allowed to apply for Medigap coverage. However, insurers are allowed to use underwriting. That means you might be denied coverage or charged a higher premium if you have a medical issue such as a history of cancer, diabetes, or heart problems.

Note that simply owning a second home does not give you the right to a Medigap policy. Even if you get a policy with a high deductible, that doesn't mean you avoid underwriting.

Bottom line

If you are worried that enrollment in Medicare Advantage might leave you to cope with increasing bills, perhaps it's time to change up your retirement plan.

Before switching to Original Medicare, create a checklist:

• Ask your current Medicare Advantage plan to explain in writing about travel and out-of-network coverage
• Secure written Medigap approval before dropping your Medicare Advantage plan and switching to Original Medicare
• Coordinate effective dates with Original Medicare and a standalone Part D prescription drug plan

If you cannot secure a Medigap policy, compare Medicare Advantage PPOs during the annual Medicare Advantage open enrollment period and line up health care providers near both of the places you plan to live in during 2027.

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