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. 

• 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 Gap *  Covered CA & Direct Quotes *  Individual & Family Enrollment Periods *} 
  • Enrollment Periods Publication # 11219 Page 7 
  • Individual & Covered CA Special Enrollment
  • Email us [email protected] or navigate this website with your specific questions & proposals if moving to or from CA.

Covered CA & Individual Residency Requirements

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

• Covered CA rules – Lawful Presence
• 
• FAQ intends to reside for Individual Plans Specials Enrollment  CFR

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.

FAQ  

Puerto Rico

• Question  What is the status of Puerto Rico for Medi-Gap and Prescription Coverage?
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• Answer  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