Can NY residents w Medicare and supp. see a Dr in Lakewood?

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Forum -> Inquiries & Offers -> Lakewood, Toms River & Jackson related Inquiries

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amother

Sun, Jun 18 2023, 9:55 pm

Can NY residents w Medicare and supplemental insurance (UHC for NYS Employees), who are temporarily in New Jersey, see a Dr (Dermatologist) in Lakewood?

If yes, who's a good Dermatologist for athletes foot related issues, located in the Lakewood area, thats easy to get an appointment with?

tia

amother

Mon, Jun 19 2023, 6:16 am

bump

amother

Topaz

Mon, Jun 19 2023, 6:18 am

I think Medicare is National, and Medicaid is state based, but I could be wrong.

cbsdbs

Mon, Jun 19 2023, 7:03 am

Medicare is exclusive to the state you applied it. Some people have out of state coverage built into their plan. Call your plan or your insurance broker to find out if you have out of state coverage before you schedule your appointment.

amother

Mon, Jun 19 2023, 6:05 pm

Update: Dr accepted my Medicare card.

Cheiny

Mon, Jun 19 2023, 7:29 pm

Glad it worked out. I think NJ Dr’s usually accept NY Medicare.

amother

Hosta

Mon, Jun 19 2023, 8:39 pm

Happy it worked out.
Medicare is national.
You can use Medicare in ANY State regardless of where you live as long as the provider accepts Medicare.
A managed Medicare plan is different. Some of them are State specific, may require referrals, and may not have out of network benefits.
United Healthcare, the supplemental plan you mentioned is probably accepted in most States.

miami85

Mon, Jun 19 2023, 8:42 pm

Cheiny wrote:

Glad it worked out. I think NJ Dr’s usually accept NY Medicare.

Medicare does not cross states. It also doesn't cover as much as Medicaid. I know that if we wanted to move my mother back to the NY-tristate area we'd have a problem getting her services until she got her medicare transferred.

amother

Zinnia

Mon, Jun 19 2023, 8:49 pm

If the NY resident has a Medicare Supplement plan they can go anywhere in the US. If their medicare coverage is through a Medicare Advantage plan (a/k/a Medicare Part C) then that is managed care with a limited network, which MAY have coverage outside the resident State albeit limited and high out of pocket.
I suggest verifying the type of Medicare coverage you are enrolled on as it can be structured on two very different ways.

Amarante

Mon, Jun 19 2023, 9:25 pm

cbsdbs wrote:

This is not correct

Straight Medicare can be used in any of the fifty states. It is not like Medicaid which is a state based program.

It is one of the reasons people like Medicare so much - virtually every provider takes Medicare and there are no networks with "straight" Medicare.

nylon

Tue, Jun 20 2023, 2:17 am

Original Medicare is accepted nationally. Regular Medigap should be also.

Medicare advantage can have a locally restricted network.

Some retiree plans have much more specific rules and their coverage can trump Medicare's rules. I know someone with a retiree plan (these are getting rarer) who was restricted to staying within New York. Because she had retiree coverage she didn't have regular Part B so she couldn't have used it to see someone elsewhere.

Amarante

Tue, Jun 20 2023, 3:03 am

nylon wrote:

Yes. The Advantage plans are not really Medicare. Most of them are HMO with all the issues of an HMO including limited networks.

They are marketed to people as being less expensive because you don’t need to purchase a Medical plan. Anyone transitioning to being 65 should really understand what these are. The private insurance companies like them because they are profitable to them.

The New York City retirement plans can be used nationwide without problems. I know people who retired and moved to other states and had no limitations. They essentially just operated as a Medigap policy.

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