What are the Legal Residency Requirements to Qualify for Medicare, Medicare Advantage Plan or Medi Gap - Supplemental, Part D Rx and ObamaCare?
You are eligible to enroll in an Medicare Advantage plan if you permanently reside in the service area (where the plan has doctors and hospitals signed up) of the plan. Vacations or temporary moves do not count. (CMS 20.3) Blue Cross PPO Full Policy CMS allows each State to determine the rules for residency in their state.
CA Residency Guidelines Publication 1031 pdf
Medicare Advantage Plans or Supplement may cancel you when you move out of their service area for more than six months. (Freedom Blue EOC) Check out the rules to keep your current coverage for up to one year. §20.3
See our FAQ’s or ask Questions?
Members Who Change Residence
MA organizations may offer (or continue to offer) extended “visitor” or “traveler” programs to members of coordinated care plans who have been out of the service area for up to 12 months. The MA organizations that offer such programs do not have to disenroll members in these extended programs who remain out of the service area for more than 6 months but less than 12 months. …Organizations offering MA-PFFS plans may allow continued enrollment of individuals absent from the plan service area for up to 12 months,…50.2.1
MA organizations offering plans without these programs must disenroll members who have been out of the service area for more than 6 months.
CA Guidelines for Determining (Medicare) Residency and
Factors to consider FTB # 1031
A California resident is one who is in California for other than a temporary or transitory purpose; or Domiciled in California, but outside California for a temporary or transitory purpose. (ftb.ca.gov).
- Amount of time you spend in California versus amount of time you spend outside California;
- Location of your spouse and children;
- Location of your principal residence;
- Where your driver’s license was issued;
- Where your vehicles are registered;
- Where you maintain your professional licenses;
- Where you are registered to vote;
- Location of the banks where you maintain accounts;
- Location of your doctors, dentists, accountants, and attorneys;
- Location of the church, temple or mosque, professional associations, or social and country clubs of which you are a member;
- Location of your real property and investments;
- Permanence of your work assignments in California; and
- Location of your social ties.
In using these factors, it is the strength of your ties and closest connections not just the number of ties, that determines your residency (ftb.ca.gov/)
When you move within a state, state to state or return to USA, you are entitled to a SEP (Special Enrollment Period) where you may choose another Medi Gap or Advantage plan, with NO MEDICAL QUESTIONS. 50.2.1 Enrollment Periods Publication # 11219 Page 7 Email us or navigate this website with your specific questions & proposals if moving to or from CA (Other 49 states).
Links & Resources
11037-Medicare-Coverage-Outside-United-States
Blue Cross MAPD PPO Full Policy
Medicare Advantage Plans Enrollment and Disenrollment 2017 pdf 271 pages
Social Security Payments when you are out of Country
Enrollment Dates for MAPD – Medicare Advantage Moving – change residency counts
InsuBuy International Medical Coverage – Instant Quotes & Enrollment
Travel Medical Insurance
Medicare and You 2019 #10050 - Everything you want to know * See their section on closing the donut hole
I live in Italy. I would like to buy and maintain guaranteed issue Medigap (probably F – high deductible).
However, if I read your comments correctly, on this page https://wp.me/P50DOs-25g that will not be possible because I don’t have CA residency.
And even if I managed to buy such a policy, it would probably not be maintainable without an ongoing CA address.
Am I right so far?
Let’s review the Blue Shield HI F Evidence of Coverage to take an example. I don’t see any mention of residency there.
In googling my own webpage on residency comes up # 4
I don’t see residency mentioned in the application.
At “EVERY” seminar I’ve ever been to, Medi Gap is touted as the solution to those who have grandchildren out of state for when they visit or those who travel in an RV Recreational Vehicle. PBS.org states that once you have a Medi Gap Plan, you can keep it, no matter where you live.
I don’t see any mention of residency in Publication 2110 Medicare Medi Gap Guide
The AARP 2017 Confidential Producer handbook page 10 states one must be a resident of the state in which they are applying. If they are going to cancel you for moving… it would have to be in their evidence of coverage. It’s not in Blue Shields.
Blue Cross Agent Support per email says you must be a resident when you purchase coverage. Blue Shield said the same thing. BS did suggest contacting Medicare for ideas… I don’t know anyone at Medicare. I’ll try HICAP
A Medi Gap wholesaler said the Insurance Companies go by the address on file with Medicare. They also point out, that Medicare is VERY limited outside USA. You might want to check out travel policies.
**************
Reply from CA HICAP:
Thanks for contacting California Health Advocates.
A Medigap company can’t issue coverage out of the country, they aren’t licensed to do that outside the U.S. A Medigap can’t be used out of the country, except for the Medigap emergency benefit and that is not available to someone who lives outside the country.
It sounds like he is trying to preserve his open enrollment opportunities and I don’t see a way for him to do that. If he has no serious health care conditions when he returns to the U.S., assuming he intends to return, he won’t have a guaranteed issue option but many insurers will sell him coverage at an underwritten rate.
If he intends to ever return to the U.S., or visit frequently, he needs to apply for, and keep Medicare to ensure he has coverage when he returns, and that he will not be subject to any later premium penalties. If he is eligible for premium free Part A there are no premiums or late enrollment penalties for that part of Medicare, but there are for Part B, and even for Part C, the prescription drug benefit. Although this means he will pay premiums, even though Medicare will not pay for his care outside the U.S., these are serious premium penalties for delaying enrollment.
He needs to consider what health care options he will have where he lives now if he intends to stay there, and whether that benefit will cover any care he might receive in the U.S. The consult or embassy where he lives may have some helpful information.
I hope this information is helpful.
—
Bonnie Burns
Training and Policy Specialist
California Health Advocates
We are moving from Texas to California, and my husband is on Medicare.
I’m wondering how to make sure he has continued coverage during the relocation process, and what I should do first.
So he has Medicare A Hospital & B Dr. Visits right? Here’s instructions to change your address with Medicare. You can do it online, visit them or call. Personally, I would do online.
What about Medi-Gap, Medicare Advantage or Part D Rx? What Insurance Companies are you with now? We can help you transfer that coverage. Check the menu above or site map for the plans that we have. What County in CA are you moving to?
What is the status of Puerto Rico for Medi-Gap and Prescription Coverage?
The “U.S.” includes the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the
Northern Mariana Islands, and American Samoa Medicare & You Page 57
I like to document everything I say. So, I know that a Medi-Gap policy simply pays based on what Medicare Pays, let’s find that in the policy. Blue Shield “N.” Table of contents is on page 6. Page 12 is benefits
1. Blue Shield will pay the following:
a) Coverage of Part A Medicare Eligible Expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare Benefit Period;
b) Coverage of Part A Medicare Eligible Expenses incurred for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used. Each Medicare beneficiary is given sixty (60) lifetime reserve days which begin from the 91st day and after;
c) Upon exhaustion of the Medicare hospital inpatient coverage including the sixty (60) lifetime reserve days, coverage for the Medicare Part A Eligible Expenses for hospitalization will be paid at the appropriate standard of payment which has been approved by Medicare, subject to a lifetime maximum benefit of an additional 365 days (except that psychiatric care in a psychiatric hospital participating in the Medicare program is limited to 190 days during the Subscriber’s lifetime);
d) Room and board charges shall be no more than the charge for a semi-private accommodation in the Hospital of confinement, unless confinement in a subacute skilled nursing facility or private room is certified as medically necessary by an attending Physician.
Thus, Medi-Gap pays based on Medicare. Medicare covers Puerto Rico, so will Medi-Gap. Let me see if I can find another expert who agrees with me.
Medicare.Gov agrees: If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
I know I’ve been told that once you have a Medi-Gap plan you can keep it anywhere in the USA. I don’t see any residence requirements in the policy, nor agent guide, which does state you must live in the service area to get a Medicare Advantage plan. Thus, one can keep their Medi-Gap plan, anywhere, anytime.
You can check with Medicare.gov to check what PDP Rx plans are available. Please verify your zip code.
In the Blue Shield confidential agent guide, PDP Rx can only be sold in the service area – State. Thus, you would need to get coverage for Puerto Rico from a local agent or Medicare.Gov. You can do that at open enrollment or when you move. That would be a special enrollment period.
Check out publication # 10521 Medicare in Puerto Rico