Finding a doctor and managing healthcare as a snowbird

Healthcare is the one part of snowbird life you really don’t want to improvise. The good news is that with a little planning, getting care in Miami is straightforward. The catch is that the rules depend heavily on which kind of coverage you have, so this guide explains how the main options work across two states and what to set up before you head south.

A quick word before we start: this is general information, not advice for your situation. Coverage details vary from plan to plan and change from year to year. Before you rely on anything here, call your plan and confirm it, and consider talking to a licensed Medicare counselor or your insurance advisor.

If you’re under 65: check your plan’s network first

Most working-age snowbirds are covered through an employer plan or a plan bought on the Health Insurance Marketplace. Many of these plans, especially HMOs and EPOs, are built around a local network in your home state. Out of that area they often cover emergencies but not routine visits.

Before you head south, call the number on your card and ask:

• Does my plan have in-network doctors in Miami-Dade County, or a national network (sometimes called a travel or out-of-area benefit)?
• What’s covered for urgent care and telehealth while I’m out of state for several months?
• Do I need a referral or prior approval for care in Florida?

If the answers are thin, telehealth with your home doctors and in-network urgent care can bridge a season. Some people also switch to a plan with a national network at their next open enrollment. The rest of this guide focuses on Medicare, which covers most snowbirds 65 and older, but the habits in it (records, prescriptions, a local urgent care) apply to everyone.

Original Medicare vs. Medicare Advantage when you live in two states

For American snowbirds 65 and older, the biggest healthcare decision is the type of Medicare you choose. It matters more for you than for someone who stays in one place all year.

Original Medicare

According to Medicare.gov, with Original Medicare you can use any doctor or hospital that takes Medicare, anywhere in the U.S. There’s no local network. In most cases you also don’t need a referral to see a specialist.

That’s why Original Medicare is popular with seasonal residents. Your cardiologist back home and a cardiologist in Coral Gables are equally covered, as long as both accept Medicare. Drug coverage comes from a separate Part D plan.

Medicare Advantage

Medicare Advantage plans (Part C) are run by private insurers. Medicare.gov notes that these plans may require you to use doctors and other providers in the plan’s network and service area for non-emergency care, and you may need referrals for specialists. Most include drug coverage.

What that means for a snowbird:

• Emergency and urgent care are covered anywhere in the U.S. Medicare’s booklet on Medicare Advantage says HMO plans still cover emergency care, out-of-area urgent care and temporary out-of-area dialysis, and PPO members are always covered for emergency and urgent care.
• Routine care in Miami may not be. If your plan is an HMO in Ohio, your annual physical, follow-up visits and specialist care in Miami may not be covered, or may cost more.
• PPOs are more flexible. PPO members can generally see out-of-network providers for covered services, but usually pay more.

The six-month rule and travel programs

This one surprises people. According to Medicare Interactive, run by the nonprofit Medicare Rights Center, if you’re outside your Medicare Advantage plan’s service area continuously for more than six months, most plans will disenroll you, and you’ll be moved to Original Medicare if you don’t choose another plan.

Some plans offer a visitor or travel program that lets you stay enrolled while you’re away for up to 12 months, sometimes with access to providers in other areas. These programs vary a lot. Ask your plan:

• Do you have a visitor or travel program, and does it include Miami-Dade County?
• Which doctors and hospitals in Miami are in network for me?
• Is routine and follow-up care covered while I’m in Florida, or only emergencies?
• How long can I be away before I’m disenrolled?

If you change your permanent address, Medicare.gov explains that moving outside your plan’s service area gives you a Special Enrollment Period to switch plans, starting when you move and continuing for two full months after. If you’re thinking about making Florida your legal home, read our guide to Florida residency and the 183-day rule too.

Medigap

Medigap is supplemental insurance sold by private companies that helps pay costs Original Medicare doesn’t, like the 20% coinsurance. Medicare.gov is clear that Medigap works with Original Medicare only. You can’t use it with a Medicare Advantage plan.

Because it rides along with Original Medicare, a Medigap policy follows you to any provider that accepts Medicare, whether you’re in Michigan or Miami. For many snowbirds, Original Medicare plus Medigap plus a Part D drug plan is the simplest combination. It’s not automatically the cheapest, and Medicare’s Medigap guide explains that outside your Medigap open enrollment period, and without a guaranteed issue right, an insurer can charge more or even deny you a policy based on your health. Get advice before you change anything.

Prescriptions across states and pharmacy chains

Prescriptions are where small hassles add up. A few steps make it easier:

• Check your drug plan’s pharmacy network. Medicare.gov notes that some drug plans only cover drugs, or give a discount, at network pharmacies. Make sure there’s a network pharmacy near your Miami place.
• Ask about a 90-day supply. Medicare.gov suggests asking your plan whether you can get a two- or three-month supply of drugs you take regularly. Many snowbirds fill a 90-day supply right before leaving home.
• Consider mail order. If your plan offers it, ask whether it can ship to your Florida address for part of the year.
• Transfers work across state lines. Florida law allows a prescription to be transferred from a pharmacy in another state, and puts the responsibility on the Florida pharmacist to verify the other pharmacy is licensed. Certain controlled substances have extra rules, so plan early for those.
• Using a national chain can make transfers easier, since your records may already be in the same system. Confirm with the pharmacist.

Telehealth

Telehealth is a real help for snowbirds. Medicare.gov says that through December 31, 2027, Medicare covers telehealth services you can get from anywhere in the U.S., including your home. Medicare Advantage plans may offer more.

There’s one catch for video visits with your doctor back home. Florida’s Department of Health says an out-of-state provider must be registered with the department to provide telehealth to patients located in Florida, with some exceptions, such as emergencies. Ask your doctor’s office before you leave whether they can see you by video while you’re in Miami.

Establishing with a doctor in Miami

If you spend three months or more a year here, it’s worth having a local doctor who knows you. When something comes up in February, you’ll want a familiar office to call, not a walk-in clinic.

Your options:

• A primary care doctor who takes your coverage. Use your plan’s directory or Medicare’s “Care Compare” tool to find doctors accepting Medicare and new patients. Book a “new patient” visit early in the season, since popular practices can have waits.
• A concierge practice. These practices charge an annual membership fee on top of your insurance in exchange for longer visits, same-day appointments and direct access to the doctor. Some snowbirds find the cost worth it for the peace of mind. Ask exactly what the fee covers, whether the doctor accepts Medicare, and whether there’s a seasonal option.
• A hospital system’s primary care network. The large Miami systems below all run primary care offices around the county.

Urgent care vs. the emergency room

MedlinePlus, from the National Library of Medicine, offers a clear rule: if a person could die or be permanently disabled, it’s an emergency. Call 911 for things like chest pain or pressure, severe trouble breathing, sudden weakness on one side, loss of speech or vision, a seizure, or heavy bleeding.

For problems that aren’t life-threatening but can’t wait for your doctor, such as a cold or flu, a sprain, a minor cut or burn, or a low-grade fever, urgent care is usually faster and much less expensive. Check that the urgent care center accepts your coverage before you go if you can.

Miami’s major hospital systems

You’ll hear these names often. All are well established in Miami-Dade:

• Jackson Health System is a nonprofit academic system governed by the county’s Public Health Trust. Its flagship, Jackson Memorial Hospital, is home to the Ryder Trauma Center, and the system also runs Jackson North, Jackson South and Jackson West medical centers.
• University of Miami Health System (UHealth) is the academic medical system of the University of Miami, with UHealth Tower as its flagship hospital. It includes Sylvester Comprehensive Cancer Center, which UHealth describes as South Florida’s only NCI-designated cancer center, and Bascom Palmer Eye Institute.
• Baptist Health South Florida runs several hospitals in the area, including Doctors Hospital in Coral Gables, along with urgent care and primary care locations.
• Mount Sinai Medical Center describes itself as the only hospital on Miami Beach and the largest private, independent, not-for-profit teaching hospital in South Florida.

Check which of these are in your plan’s network. If you’re choosing where to live, nearby hospitals are worth factoring in. Our best Miami neighborhoods for snowbirds guide can help.

Keeping your medical records portable

Under HIPAA, you have the right to a copy of your health information. The U.S. Department of Health and Human Services says your doctor normally has up to 30 days to provide it, often sooner, and in most cases you can get it the way you want, such as by email. You can also ask your doctor to send records directly to another provider.

Before you leave home each fall:

• Sign up for your doctors’ online patient portals, so you can see results and notes from anywhere.
• Carry a one-page summary: diagnoses, medications and doses, allergies, and your doctors’ names and phone numbers.
• Ask your doctors to send recent records to your Miami doctor before your first visit.
• Keep copies of your insurance cards and a list of your plan’s Miami in-network providers.

For Canadian snowbirds

Canadians face a different and more serious gap. Your provincial or territorial health plan covers very little of the cost of care in the U.S.

The Government of Canada’s travel site warns that your provincial or territorial plan may cover none, or only a small part, of medical costs abroad, and will never pay your bills up front. It recommends buying travel insurance before you leave, even for a day in the United States.

Ontario is a good example. According to Ontario.ca, OHIP pays up to $400 Canadian per day for emergency inpatient care at the highest levels (such as intensive care) and $200 per day for other inpatient care, plus up to $50 per day for emergency outpatient services. A U.S. hospital stay can cost far more. Ontario strongly recommends buying private health insurance before you leave, including coverage for medical transport home. Other provinces have their own limits and absence rules, so check with yours.

When you buy a policy:

• Get written confirmation that your pre-existing conditions are covered. Canada’s travel site warns that a claim could otherwise be refused.
• Make sure the policy covers your full stay, including any extension.
• Read the fine print on medical evacuation and repatriation.

Your province also sets how long you can be away and keep coverage. Ontario, for example, has specific rules for absences of more than seven months. Confirm your province’s rules before booking a long season.

Before you head south

Put these on your snowbird checklist:

• Call your Medicare plan or insurer and confirm what’s covered in Miami-Dade County.
• Refill prescriptions and set up a Florida pharmacy or mail order.
• Book a new-patient visit with a Miami doctor if you plan to come back each year.
• Download records and portal logins.
• Canadians: buy travel medical insurance and keep the policy number with you.

If you’re still working out the bigger picture, our complete guide to becoming a Miami snowbird ties it all together.