Out-of State Health Insurance Coverage

What to Know About Out-of-State Health Insurance Coverage

Medicaid and Medicare Out-Of-State Guidelines

Out-of-State Health Insurance Coverage Frequently Asked Questions (FAQs)

Bottom Line

All health insurance plans regardless of the state of purchase will cover emergency services at any hospital in the United States, with the exception of Hawaii. However, non-emergency care, like primary care visits, might not be covered. Health emergencies and accidents can happen at any time, including during vacation or business trips. It is important to know if your health insurance will cover your care outside of your home state when traveling both domestically and internationally.

Out-of State Health Insurance Coverage

With summer vacation quickly approaching and remote jobs allowing for greater flexibility in travel, having a health insurance plan that provides out of state coverage is an essential safeguard for your health.

Every health plan regardless of city or state has a ‘network’ of healthcare providers and healthcare facilities. Generally speaking, your health plan will pay for a larger amount of the total cost when you visit in-network providers. On the contrary, if you seek care “out-of-network”, you may be faced with greater out-of-pocket costs. Furthermore, some insurance plans place restrictions on out-of-network care coverage.

Out of State Coverage by Types of Health Insurance Plans

Type of Plan	Does it Cover Out-of-Network Care?	Additional Plan Details
Preferred Provider Organization (PPO)	YES	Most flexibility with accessing in-network care Copays and coinsurance are significantly less with in-network providers Can seek out-of-network care at an additional cost
Health Management Organization (HMO)	NO	Most affordable plan with low premiums, deductible and copays Largest amount of care restrictions No out-of-network care coverage Can only access specialty care with referral from PCP
Exclusive Provider Organization (EPO)	NO	No out-of-network care coverage No referrals to access specialty care and specialist visits
Point of Service Plans (POS)	YES, at an additional cost	Access to in-network providers at a low cost Need a referral to see a specialist Access to out-of-network care at an additional cost

Source: Aetna

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Originally from Houston, Texas, Alexandra is currently getting her Master's in Public Health with a health policy certificate at Columbia University. One of her life goals is to own her own art gallery!

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