What are the Legal California Residency Requirements to

Qualify for

Medicare, Medicare Advantage Plan or Medi Gap – Supplemental,

 Part D Rx and under 65  Covered CA – Obama Care?

Medicare #Advantage 

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 shield EOC  CMS allows each State to determine the rules for residency in their state. 

Definition Residency

  • to dwell permanently or continuously occupy a place as one's legal domicile  Webster *
  • the act or fact of dwelling in a place for some time
  • the place where one actually lives as distinguished from one's domicile or a place of temporary sojourn Webster *

Links & Resources


Potential Cancellation if not a CA Resident

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 Residency Guidelines #FTB1031  2021

guidelines to determine residency

  • See our webpage on lawful presence & public charge
  • 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/)

  • Sanjiv Gupta CPA reviews rules related to residency in California 

Covered CA & Individual Residency Requirements

Blue Shield – Covered CA Individual & Family
EOC Evidence of Coverage 

residency definition

Blue Shield under 65 residency verification

Blue Shield under 65 residency verification


Must Reside in the Service Area

eligibility requirement

What is a  #Service area
A geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit which doctors and hospitals you may use, it’s also generally the area where you can get routine (non-emergency) services. The plan may disenroll you if you move out of the plan’s service area. Medicare.Gov
Special Enrollment Period

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 MAPD Rules  *  Medi GapCovered CA & Direct QuotesIndividual & Family Enrollment Periods

Medicare A & B if you don't #live in USA
Publication 11871

Medicare if you live outside usa



Medicare just visiting Out of County Publication # 11037

Medicare Coverage outside USA


*********Social Security*****

Payments if you are living outside of USA # 10137

Social Security outside of usa

  • What if you work in two or more different Countries?
  • International Social Security agreements,  “Totalization agreements,”  have two main purposes.
    • First, they eliminate dual Social Security taxation, the situation that occurs when a worker from one country works in another country and is required to pay Social Security taxes to both countries on the same earnings.
    • Second, the agreements help fill gaps in benefit protection for workers who have divided their careers between the United States and another country.
    • Payments Abroad Screening Tool  
  • Learn More

Our Webpages on:

Buy Travel & International Insurance – Geo Blue – Insubuy

Residency FAQ’s #a41


  • Question – Is it legal to be with Covered CA since I am traveling for about 4 months and also not working for rest of the year?
    • Background
      • I am visiting India at the moment. Because of my current situation wanted your guidance regarding continuation of my Covered CA health insurance.
        • I worked in LA , this year, 2023, till Feb 10th.
        • Due to personal reasons, I may have to stay back here in India for another 2-3 months and after that I will be going to Michigan in June-July 2023 to help my daughter for the rest of the 2023.
        • My income this year may be $ 10,000 + my husband’s Social security of $14000. for 2023.
  • Answer
    • If you can earn say $28k or more, for the year, then you would earn enough to stay in Covered CA – See the Income Chart
    • When you report lower income 138% of FPL Federal Poverty Level to Covered CA, they would put you in Medi Cal.
    • Medi Cal and Covered CA only cover Urgent Care and Emergencies outside of CA – Service Area – Check your EOC Evidence of Coverage 
    • If you don’t have Medi Cal or Covered CA, you’re not outside the USA long enough to get an exemption from the CA Tax Penalty.
    • You might want to consider  Travel Coverage while you are in India, better service, not have to pay upfront and cover non emergencies.
      • We really need to double check your actual EOC
    • When you are in Michigan you can check with Medicaid if under $28k and their version of Covered CA and get coverage there, so that you are not limited to emergencies and urgent care.
      • Read over the residency requirements…  it shouldn’t be a problem.
      • I’ll be in CA next week and can research more thoroughly then.




Out of Country Residence 


  • I live in Italy. I would like to buy and maintain guaranteed issue Medi gap (probably F – high deductible).
    • However, if I read your other pages on your website,  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.
    • 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 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.

6 comments on “Residency – CA, USA – Covered CA & Medicare

  1. My husband and I are thinking about moving to Washington State for 6 months (maybe longer) in June .

    We are currently insured through Blue Shield of CA. BS of CA considers provider visits, in other states, out of network.

    Should we change our coverage to Washington State – or – should we keep the coverage in CA and buy some sort of supplement (if one exists) to cover any “out of network” expenses while living in Washington?

    If one exists – what sort of policy would that be?

    Do you offer such policies?

  2. 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.

    • 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

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