Key Takeaways:
Medicare Advantage plans restrict coverage to defined service areas, and retirees who split time between two states can face thousands in uncovered medical bills.
Medicare Advantage covers about 55 percent of eligible seniors, but service-area limits can leave snowbirds facing out-of-network costs up to $13,900.
Federal rules require Medicare Advantage plans to cover emergency and urgently needed care regardless of location, according to the Centers for Medicare & Medicaid Services. Non-emergency care outside a plan's service area is typically treated as out-of-area and may be only partially covered or not covered at all.
Medicare Advantage plans are built around a service area — a county, group of counties, or cluster of states. Care sought outside that region is treated as out-of-area. In 2026, the federally mandated out-of-pocket limit for Medicare Advantage tops out at $9,250 for in-network services and $13,900 for in-network and out-of-network services combined. Services a plan denies as noncovered typically do not count toward those limits.
For snowbirds who divide time between two states, the exposure is real. A health year requiring specialist visits, imaging, or physical therapy in a second state could produce thousands in uncovered bills. Original Medicare, by contrast, covers services from any provider that accepts Medicare anywhere in the U.S., though it carries a $283 Part B deductible in 2026 and 20 percent coinsurance with no annual out-of-pocket cap.
Medigap policies can fill the gap left by Original Medicare's lack of an out-of-pocket cap, but enrollment timing matters. There is a six-month Medigap open enrollment period that begins at age 65 when you enroll in Part B. During this window, insurers cannot use medical underwriting. After it closes, insurers can deny coverage or charge higher premiums based on medical history — a history of cancer, diabetes, or heart problems could trigger higher rates or denial.
Simply owning a second home does not grant Medigap eligibility. Even a high-deductible policy does not bypass underwriting.
For retirees concerned about out-of-state coverage gaps, the Medicare open enrollment period from Oct. 15 to Dec. 7 allows switching from Medicare Advantage to Original Medicare. Before making the change, verify Medigap availability and compare Medicare Advantage PPO plans that may offer broader out-of-network coverage through visitor programs or national networks.
The decision hinges on whether the flexibility of Original Medicare plus Medigap justifies potentially higher premiums versus the lower upfront costs of Medicare Advantage. Retirees who split time between states should review their plan's service-area rules before the Oct. 15 to Dec. 7 enrollment window closes.
This article is for informational reference only and does not constitute professional advice.
