What happens if a member lives outside the defined service area of a Medicare Advantage plan?

If a member lives outside the defined service area of a Medicare Advantage plan, they may not be eligible for coverage. Medicare Advantage plans are designed to provide services within specific geographic areas, and if a member's residence falls outside of this area, they may not have access to the plan's benefits. This limitation is essential, as these plans often negotiate rates and networks that are geographically contained.

It is important to understand that while Medicare itself may offer coverage regardless of location, the specific Medicare Advantage plan is bound by its service area. Therefore, members need to reside within this area to maintain their eligibility for the coverage offered by that specific plan. If they move outside the service area, they would typically need to look for a different plan that serves their new location.