Medicare Advantage Travel Coverage and the Snowbird Problem: When Part-Time Residency Creates Coverage Gaps

Many retirees split the year between two states. If you’re one of them and you’re in a Medicare Advantage plan, it’s worth knowing what your plan covers in your second home before you need care there. The answer depends on your plan type, how long you’re away, and whether your plan offers a travel benefit.

How Medicare Advantage Coverage Works Geographically

Medicare Advantage plans are built around a service area, usually a county or group of counties where the plan has a provider network. The rules away from home depend on the plan type.

• HMOs generally cover non-emergency care only from in-network providers.

• PPOs also pay for out-of-network care, at higher cost-sharing.

• Every plan must cover emergency care and urgently needed care anywhere in the U.S. Urgently needed care means care for a sudden illness or injury that can’t wait until you get home.

Routine care isn’t urgent. A blood pressure check or a quarterly diabetes follow-up doesn’t qualify. So an Ohio HMO enrollee wintering in Florida likely has no in-network access to routine primary care there.

The Six-Month Rule Most Snowbirds Miss

Time away matters as much as distance. If you’re outside your plan’s service area for more than six months in a row, the plan must disenroll you. You’d get a Special Enrollment Period to pick a new Medicare Advantage plan. If you don’t, you’re moved to Original Medicare.

Some plans offer a visitor or traveler program that lets you stay enrolled for up to 12 months away. These programs often cover only certain areas, may not cover every service, and can cost more outside the plan’s network. If your Evidence of Coverage doesn’t mention a visitor or traveler benefit, assume the six-month limit applies to you.

The Chronic Condition Problem

Without ongoing health conditions, a four-month absence is manageable with planning:

• Schedule check-ups before you leave and after you return.

• Bring enough of your medications to last the season.

• Find out where to get urgent care near your winter home.

Diabetes, heart failure, COPD, or regular cancer follow-ups change the picture. Months without in-network access can disrupt care, not just raise costs. Before you leave, check whether your plan covers pharmacies near your winter home and whether it offers mail order for a longer supply.

PPO vs. HMO for Seasonal Residents

A Medicare Advantage PPO gives seasonal residents more room, because out-of-network care is covered. It costs more, though.

In 2026, a plan’s in-network out-of-pocket limit can’t exceed $9,250. For PPOs, the combined limit for in-network and out-of-network care can’t exceed $13,900. KFF found the average combined limit for PPO enrollees in 2026 is $9,825. A season of out-of-network specialist visits counts toward that higher number.

Don’t take “national network” language at face value. Use the plan’s provider directory to look up specific doctors and hospitals near your winter address before you enroll.

The Original Medicare and Medigap Alternative

Original Medicare has no network. Any provider in the U.S. that accepts Medicare will take your coverage. A Medigap policy pays most or all of Original Medicare’s cost-sharing and works anywhere Medicare pays. Medigap Plans C through G, M, and N also cover 80% of emergency care abroad.

The trade-off is premium. Among current policyholders, Plan G averaged $194 a month in 2025, from $164 in New Mexico to $257 in New York, according to KFF. Plan G premiums rose 13% from 2024 to 2025. You’d also need a separate Part D drug plan.

For someone who truly lives in two places and needs steady care in both, that cost may be worth it compared with out-of-network bills and gaps in care.

Switching From Medicare Advantage to Original Medicare

You can switch from Medicare Advantage to Original Medicare during two windows each year:

• Fall Open Enrollment: October 15 through December 7

• Medicare Advantage Open Enrollment Period: January 1 through March 31

Getting a Medigap policy after you switch is the hard part. Outside of guaranteed issue periods, Medigap insurers in most states can review your health history. They can charge you more or turn you down. KFF found that 74% of Medicare Advantage enrollees had a pre-existing condition in 2023 that could lead to a Medigap denial. Among enrollees 85 and older, the share was 88%.

There are some protections:

• Trial right: If you joined Medicare Advantage when you were first eligible at 65, you can switch back to Original Medicare within the first 12 months. You then have a guaranteed right to buy a Medigap policy. A similar trial right applies if you dropped a Medigap policy to try Medicare Advantage for the first time.

• State rules: Connecticut, Massachusetts, Maine, and New York require insurers to offer Medigap continuously or once a year, regardless of health. Rhode Island and Delaware added annual guaranteed issue rights for Medicare Advantage enrollees in 2025. Minnesota added annual rights for people ages 65 to 70 in August 2026.

Outside those situations, the plan you choose at 65 can be hard to undo later. If you split your year between two states, weigh that before you enroll.

Sources

1. Medicare Rights Center, Medicare Interactive. “Medicare coverage when traveling.” https://www.medicareinteractive.org/?p=11601

2. KFF. “Medicare Advantage Out-of-Pocket Limits: Variation and Trends.” May 28, 2026. https://www.kff.org/medicare/medicare-advantage-out-of-pocket-limits-variation-and-trends/

3. KFF. “Key Facts About Medigap Enrollment and Premiums for Medicare Beneficiaries.” October 13, 2026. https://www.kff.org/medicare/key-facts-about-medigap-enrollment-and-premiums-for-medicare-beneficiaries/

4. KFF. “Nearly Three-Quarters of Medicare Advantage Enrollees Could be Denied a Medigap Policy Due to a Pre-Existing Condition.” October 13, 2026. https://www.kff.org/medicare/nearly-three-quarters-of-medicare-advantage-enrollees-could-be-denied-a-medigap-policy-due-to-a-pre-existing-condition/

5. Medicare Rights Center, Medicare Interactive. “How to switch Medicare Advantage Plans or switch from Medicare Advantage to Original Medicare.” https://www.medicareinteractive.org/understanding-medicare/health-coverage-options/changing-medicare-coverage/how-to-switch-medicare-advantage-plans-or-switch-from-medicare-advantage-to-original-medicare