Will Grandma’s HMO Plan Cover Emergency Care Out of State?

Seeking Advice
1

Hi everyone,

I’m helping my grandma with her Medicare Advantage plan, and we found an HMO option that has really low copays and seems like a good fit. I know that HMO plans usually only cover you within a specific network, but what would happen if she were to visit family out of state and ended up needing to go to the ER or urgent care? Would she have to pay for everything out of pocket, or would the HMO still cover her and she’d just pay the usual emergency copay?

Thanks for any help!

3

Most HMO plans limit coverage to specific networks, but emergency care is different. Medicare Advantage HMO plans must cover emergency care anywhere, even if it’s out of network or out of state.

4

For life-or-death emergency care, yes, it’ll be covered.

Urgent care, though, may not be covered out of network, so check the specific plan details. Most likely, it would be out-of-pocket.