What Does a Zip Code Have to Do with Medicare Benefits?

Where you live can have a massive effect on your Medicare plan options and how much you pay for certain plans.

In this article, we’re uncovering everything you need to know about zip codes and Medicare benefits.

Zip Codes and Original Medicare Benefits

Original Medicare, or Medicare Parts A and B, is not affected by what zip code you live in. Traditional Medicare benefits are the same for everyone who is enrolled in the program.

Additionally, your monthly Medicare premiums are not affected by where you live.

The only reason Medicare premiums differ from person to person is due to income. If you have a higher income, you may pay more for Medicare Part B.

Read More: Are Medicare Costs Based On Your Income?

Zip Codes and Medicare Advantage Plans

Zip codes have a major impact on Medicare Advantage plans.

These plans, which are an alternative to Original Medicare and sold by private insurance companies, are county-based.

The plans available in your county may not be available in another county.

These plans can also be very regional, meaning a plan in Chicago may work specifically with doctors and physicians in Chicago, but not anywhere else.

Your plan choices, and thus your coverage options and monthly premiums, will depend entirely on your zip code. This is the zip code of your primary residence.

Access to Competitive Plans

Some parts of the country have more Medicare Advantage plan options than others. As an example, 82% of all Medicare beneficiaries in Monroe County, NY are enrolled in an MA plan. However, in a state like Wyoming, the average across the state is just 17% (KFF).

In general, highly populated areas have lots of great Medicare Advantage options, while rural locations are less likely to be as competitive.

Zip Codes and Medicare Supplement Plans

While Medicare Supplement plan benefits are standardized by the government, premiums definitely vary from place to place.

Your zip code will factor into your Medicare Supplement premium.

As an example, a Plan G might cost $175 in Los Angeles while the same exact plan from the same company costs $116 in a rural area of Alabama.

Community-rated states

Additionally, some states use the community-rated model to price their Medicare Supplement plans, which makes them much more expensive for most. Community-rated means everyone pays the same monthly premium, regardless of age.  

States like New York, Maine, and Vermont are community-rated. A Medicare Supplement premium in New York is over $450, or more than 3x higher than the premiums in Los Angeles.

Real estate agents often talk about location, location, location! The same sentiment holds true for Medicare Supplement insurance agents.

Zip Code and Health Outcomes

Social determinants of health, including factors like poverty, education, and access to healthcare services, can also vary by zip code and have a significant impact on health outcomes.

Studies have shown that a patient's zip code can be a determining factor in their life expectancy.

Rural areas tend to have less access to certain types of care, such as telehealth services. However, The Centers for Medicare & Medicaid Services (CMS) is working to ensure that patients in rural or remote areas have access to cutting-edge medical care.  

Conclusion

Your zip code can definitely impact your access to high-quality and affordable healthcare after age 65.

However, no matter where you live, our team here at Medicare Allies can help you discover your options and make an informed decision about your insurance coverage.

Give us a call at 833-801-7999 today or schedule an appointment right on our calendar here.