If you spend the winter in Palm Beach County and the rest of the year somewhere else, the Medicare choices you make each fall matter more than they do for someone who stays in one place. The key questions are simple: can you see the doctors you want in both places, and can you fill your prescriptions in both places without surprises.

This article explains how the main parts of Medicare treat a two-state life. It is general information, not advice about your plan. Your plan documents and Medicare itself have the final word.

Original Medicare travels with you

With Original Medicare (Part A and Part B), Medicare.gov says you can use any doctor or hospital that takes Medicare, anywhere in the U.S. In most cases you do not need a referral to see a specialist (Medicare.gov). For people with two homes, that national reach is the main appeal.

The tradeoff is cost. For Part B services you usually pay 20% of the Medicare-approved amount after the deductible, and Original Medicare has no yearly cap on out-of-pocket costs. Many people add a Medicare Supplement Insurance (Medigap) policy to help with those costs, according to the same Medicare.gov comparison.

Medicare Advantage depends on the network and service area

Medicare Advantage plans are offered by private companies and work differently. Medicare.gov notes that you may need to use doctors and other providers in the plan’s network and service area for non-emergency care, and you may need a referral to see a specialist. Some plans offer out-of-network coverage for non-emergency care, but it may cost more.

To join a Medicare Advantage plan, you must live in its service area, and the official Medicare & You handbook explains that plans can, and in some cases must, disenroll you if you move out of it. For a seasonal resident, the practical questions to put to any plan are:

  • Which address does the plan treat as my permanent residence?
  • If I am in Florida for several months, are my routine visits here covered, or only emergency and urgent care?
  • Are the doctors and hospitals I use in each state in the network?
  • Does the plan offer any coverage for members who are away from the service area for part of the year, and what are its limits?

Get the answers in writing if you can. Plan rules and networks can change from year to year.

Part D: pharmacies matter as much as drugs

Medicare drug coverage (Part D) is offered by private companies approved by Medicare, either as a separate drug plan or built into most Medicare Advantage plans (Medicare.gov). Each plan has a list of covered drugs and a network of pharmacies.

Medicare’s own guide to drug coverage suggests asking whether you spend part of each year in another state, since that can matter if a plan requires you to use certain pharmacies. It also notes that using in-network pharmacies usually costs less, that a plan’s network may include a mail-order program, and that you can ask your plan about a two- or three-month supply of drugs you take regularly.

For a two-state life, it is worth checking that the plan has in-network pharmacies near both homes, or that mail order will reach you at each address.

Dates to know

According to the Medicare & You handbook, the Open Enrollment Period runs from October 15 to December 7 each year. During that window you can join, switch or drop a Medicare health or drug plan, with coverage starting January 1. If you are already in a Medicare Advantage plan, you can also make one change between January 1 and March 31, either to a different Medicare Advantage plan or back to Original Medicare with a separate drug plan.

Seasonal residents often arrive in Florida in the middle of Open Enrollment. If your plan has served you poorly in one of your two states, this is the time to look again. Free, unbiased counseling is available through your State Health Insurance Assistance Program (SHIP), which Medicare’s guide recommends for help with these decisions.

Where a concierge practice fits

A concierge membership does not replace Medicare. Medicare.gov states that Medicare does not cover concierge fees, and that doctors who accept assignment cannot charge you extra for services Medicare already covers (Medicare.gov). We explain this in more detail in does Medicare cover concierge medicine?.

At Legacy Medical, insurance, including Medicare, is billed for visits, labs and tests, and the annual concierge fee is separate. You can read more on our insurance and fees page and our page for seasonal residents.

If you are weighing your options this fall and want to see how a concierge practice would work alongside your coverage, a complimentary meet and greet with Dr. Shtern is a good place to talk it through.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.