service area

What is a Medicare plan service area?

A service area refers to the geographical area where a person must live to be eligible to enroll in a health plan, and where the plan has in-network medical providers. Medicare Advantage plans and Medicare Part D plans have limited service areas,¹ whereas Original Medicare has a nationwide service area² and the vast majority of medical providers in the U.S. accept Medicare.³

Medicare Advantage plan service areas can be a small as a single county or as large as multiple states.⁴ Medicare Part D plan service areas are based on regions, which can be just one state or a group of states.⁵

Some Medicare Advantage plans (PPOs, for example), will allow enrollees to use out-of-network medical providers who are outside their service area for non-emergency care. But enrollment is always limited to people who live within the plan’s service area. If you move out of the plan’s service area, you will need to switch to a different plan that has a service area that includes your new address. Moving out of your Part D or Medicare Advantage plan’s service area will trigger a special enrollment period that will allow you to enroll in a plan available in your new location.

Medigap plans are different: They have service areas in terms of where a person has to live to enroll initially; you can only buy a Medigap plan that’s sold in your state.⁶ But except for Medicare SELECT plans, Medigap plans can be used with any medical provider who accepts Original Medicare, nationwide. And if you move to a different state, you can keep your Medigap policy (although your premium may change due to your new zip code).⁷ So, moving to a new state will generally NOT trigger a special enrollment period to pick a new guaranteed-issue Medigap plan.