Dual Residency
Enrollment When You Have Two Residences
If you don't live in the same state all year (e.g., you spend the winter in a different state or you have a child attending college out of state), there are some things to consider when enrolling in a health plan.
You must select coverage based on your primary residence. You're required to enroll in a plan available in the ZIP Code of this residence, even if you own a second home in a different part of the country. When you contact Via Benefits Insurance Services to enroll, one of our licensed benefit advisors* can help determine your primary residence.
The criteria for determining your primary residence may include:
Address on file with Social Security
IRS address (where you pay taxes)
Voter registration address
Mailing address
Time spent at each location per year
Medicare
Selecting a Medicare plan that provides coverage in both of your residences is important. You, most likely, want to enroll in a Medicare Supplement Insurance (Medigap) policy or a Medicare Advantage Preferred Provider Organization (PPO) plan.
Medicare Supplement Insurance (Medigap)
If you keep Original Medicare Parts A and B, your hospital and medical benefits stay the same when you travel to another state. A Medigap works along with Original Medicare to help pay for out-of-pocket health costs you have with Original Medicare, such as copayments and deductibles. For a Medigap to pay, Medicare has to pay first. If a provider bills for something not covered by Medicare, the Medigap doesn't pay. Medigaps don't have networks of doctors and service providers in the traditional sense. A standard Medigap works with any doctor that accepts Medicare and is accepting new patients.
Note: If you take prescription drugs, consider adding a Medicare Prescription Drug plan (PDP), as well. A PDP helps pay for out-of-pocket prescription drug costs.
Medicare Advantage PPO
Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by Original Medicare, but they don't have to cover every benefit in the same way. The two more common Medicare Advantage plan types are Health Maintenance Organization (HMO) and PPO.
HMO plans require you to receive care within the plan's network of doctors and facilities, except in an emergency. By closely managing health care costs, they're able to keep their premiums low and often have lower out-of-pocket costs when compared to other options. Most HMO plans require you to select a primary care physician (PCP) to manage your care and to refer you to other specialists.
PPO plans allow you to receive care from providers both in and out of their network. When receiving care from an in-network (preferred) provider, out-of-pocket costs are usually less than when receiving care from an out-of-network (non-preferred) provider, except in an emergency. Most PPO plans don't require the selection of a PCP, nor do they require referrals to see specialists.
Because an HMO requires you to see doctors and facilities in its provider network, it's better to select a PPO if you want to see providers both in and out of its network of doctors and facilities.
Moving back and forth between residences doesn't qualify you for a Special Enrollment Period (SEP).
Individual and Family Plan
When selecting a plan, consider whether the plan has a narrow network of doctors, such as an HMO or Exclusive Provider Organization (EPO). These plans may require you and everyone else on your plan to see doctors and facilities within its provider network. HMO and EPO plans, while often the right choice for coverage, only cover you out-of-network in case of emergency. Plan types that have coverage outside of the network include PPO and Point of Service (POS).
Where available, consider choosing a PPO or POS plan that includes out-of-network benefits for the secondary location. Be advised, costs are higher when receiving services out of network.
If you're concerned about the level of out-of-network coverage, ask a benefit advisor about additional solutions, such as Protection plans. If you're looking for additional benefits, we offer vision and dental coverage.
It can be challenging to select a plan when you or your family members live in multiple locations. Our benefit advisors can assist you in choosing a plan that fits your needs and budget. Call us at 1-866-322-2824 to speak with a benefit advisor and discuss coverage options for your multi-resident household.
*Our licensed benefit advisors specialize in health insurance for retirees. They go through annual training and certification to ensure they can help you make an informed and confident decision.