Where Do I Buy Health Insurance if I Work or Live in Two States?

We live in an age of increasing geographic mobility. People drive across state lines to their jobs. Technology allows us to work from different time zones. Snowbirds who retire early continue to split their summers and winters between climates. More people in general are buying vacation homes. A National Association of Realtors report found increasing demand for vacation homes, driving up prices 36% between 2013 and 2018.

If your life’s borders blur, you may wonder where to buy a health insurance plan. As a general rule:

• If you live in one state and work in another, you should usually buy health insurance in the state where you live.
• If you split your time between multiple states, you should buy health insurance in the state where you live most of the year.

But what if you spend a substantial amount of time in more than one state? You should still buy health insurance in the one where you legally reside—that means the state where you pay taxes or register to vote.¹

And what if you divide your time fairly evenly between two places? Again, buy health insurance in your state of residence. What if you have medical conditions that require ongoing care or take prescription drugs long-term?

Then, when shopping for your next health insurance plan, whether it’s by calling a health insurance website or searching a private marketplace, do the following:

Investigate plan networks. Kaiser recommends looking at insurers that use a national provider network or have arrangements with other insurers to cover care in their networks as in-network.

Know how out-of-network care is covered. Look at the various benefits categories (i.e., testing, mental health benefits, provider office visits, medical devices) and if and how out-of-network care is covered in each. It will not likely be the same across the board. In general, HMOs will not typically cover out-of-network care and PPOs typically will, but you will pay more out-of-pocket.

Get the lowdown on prescription refills. Will you be able to refill prescriptions at a network pharmacy when you are away from your home state? Do you have the option to refill them by mail order or receive a few months’ supply in advance?

Remember: Emergency services are an essential health benefit, but there are nuances. That means you can receive out-of-network emergency medical care without getting preauthorization or being subjected to out-of-network penalties. Your health insurance plan cannot charge you a higher copayment or coinsurance for out-of-network emergency room services. Cost-sharing will be the same both in and out of network. This only applies if you have a qualified health insurance plan created or issued on or after March 23, 2010; it does not apply to grandfathered plans.

This can offer peace of mind, but try to receive emergency care from in-network hospitals if at all possible. You may still be subject to balance billing, which means you will have to pay the difference between the amount billed by the out-of-network provider and the amount paid by your health insurance plan. Providers are likely to charge you a lot more if you are out-of-network than they would if you were in-network. Furthermore, out-of-network care is not subject to the Affordable Care Act’s (ACA) annual out-of-pocket spending limits.²

Understand that a multi-state plan may not offer in-network coverage out of state.

Multi-state health insurance plans are available through some of the state-based and federally facilitated health insurance exchanges and approved by the U.S. Office of Personnel Management, which administers the health insurance plan for federal government employees. They qualify as minimum essential coverage, include essential health benefits and even qualify for subsidies. You can only buy multi-state health insurance plans through the ACA’s, or Obamacare’s, state-based and federally facilitated health insurance exchanges. They are not available in the private marketplace.

By name, these plans sound as though they will provide in-network benefits across state lines. That’s not necessarily so. They were designed, according to Kaiser, “to provide people with additional coverage options in the health insurance Marketplace.” In 2014, Blue Cross Blue Shield Association offered multi-plans. These plans may or may not count care received from BCBS network providers in other states as in-network.

Multi-state plans are available in 35 states as of 2020. Check with a health insurance website for the most up-to-date multi-plan availability, and read plan details carefully to understand their networks and benefits.

Thinking of skipping health insurance to avoid the hassle? It will cost you. Medical costs have increased for years, making it a risky decision to jump between doctors in two states.