The question of whether a person can see a doctor in another state is complicated because the answer depends on two separate, but equally important, systems in the United States. The first system is legal, concerning the state-by-state medical licensing requirements that grant a physician the permission to practice medicine. The second system is financial, involving the structure of a person’s health insurance coverage that determines who will pay for the care. A successful visit to an out-of-state doctor requires navigating both the legal permissions and the financial policies simultaneously. The ability to receive care across state lines relies on balancing these state laws and individual insurance policies.
State Medical Licensing Requirements
The fundamental restriction on seeing a doctor in another state is medical licensing, which is regulated by individual state medical boards. These boards operate independently, meaning a license granted in one state does not automatically permit a physician to practice in any other state. For a doctor to legally provide care, they must be licensed in the specific state where the patient is physically located during the consultation.
This arrangement establishes state jurisdiction over the practice of medicine. If a patient travels from State A to State B, the doctor they see in State B must hold a medical license issued by State B’s medical board. Seeking care from a physician not licensed in the state where the patient is located is considered practicing medicine without a license, which is prohibited.
In the past, there was little automatic reciprocity between state medical boards, forcing doctors to complete an individual application process for each state. Physicians often face delays of several months when applying for new state licenses due to the necessary investigation of their credentials.
Navigating Health Insurance Coverage Across State Lines
Even if a physician holds the necessary out-of-state license, the primary practical hurdle for the consumer is securing health insurance coverage. Health plans are generally structured around local or regional provider networks, and a patient’s coverage for out-of-state care often depends heavily on the type of plan they hold. The difference between in-network and out-of-network care becomes especially relevant when crossing state boundaries.
Health Maintenance Organizations (HMOs) typically offer the least flexibility for out-of-state care, restricting coverage to providers within a defined, local network. If an HMO member seeks routine or specialized care outside of this network, they will likely have no coverage and must pay the entire cost themselves. The main exception to this strict rule is for true medical emergencies, where federal laws and plan rules often mandate coverage regardless of network status.
Preferred Provider Organizations (PPOs) offer significantly more flexibility and often include national networks, which can make them better suited for frequent travelers. PPO plans allow members to see out-of-network providers, including those in other states, without a referral. However, this flexibility comes at a cost, as members will typically face higher co-pays, higher deductibles, and a larger portion of the bill compared to receiving in-network care.
Before seeking non-emergency care in another state, a person with a PPO should contact their insurer to confirm the out-of-state provider’s network status and to understand the specific cost-sharing obligations. A call to the insurance company can help determine if the care will be covered partially or not at all, preventing unexpected and substantial medical bills.
Special Circumstances for Interstate Care
Specific situations exist where the typical regulations governing licensing and insurance are temporarily waived or altered, offering exceptions to the general rules. One of the most common exceptions involves emergency medical situations, where federal law mandates that a patient must be stabilized regardless of their health insurance network status. For a true emergency, an individual is generally covered for the necessary stabilization care, even if the hospital or doctor is out-of-state and out-of-network.
Federal health programs often operate on a national scale, providing members with broader access to care across state lines. Programs like TRICARE for military personnel and veterans’ benefits through the VA system frequently have established national networks. These programs typically allow beneficiaries to receive care at authorized facilities regardless of the state they are currently in.
In times of widespread public health crises, such as the COVID-19 pandemic, many states temporarily waived their licensing requirements to allow out-of-state physicians to practice. Some states have adopted the Uniform Emergency Volunteer Health Practitioner Act (UEVHPA), which allows licensed volunteer health practitioners to practice during a declared statewide emergency. These temporary measures are designed to ensure that licensed medical personnel can quickly cross borders to address staffing shortages.
Remote Care Through Telemedicine
The rise of telemedicine has changed the logistics of interstate care, but it has not eliminated the fundamental legal requirement that a physician must be licensed in the patient’s location. For a virtual visit, the location of the patient at the time of the consultation is the determining factor for licensing jurisdiction. Therefore, a doctor must still be licensed in the state where the patient is physically receiving the remote care.
To streamline this process, the Interstate Medical Licensure Compact (IMLC) was established as an agreement among participating states. The IMLC simplifies the process for qualified physicians to obtain licenses in multiple member states, which facilitates the provision of virtual care across state lines. As of late 2024, the Compact includes over 40 states, the District of Columbia, and Guam, allowing eligible physicians to practice in all those jurisdictions with a single, expedited application.
The IMLC does not include every state, and physicians must meet specific criteria, such as holding a full, unrestricted license in a participating state, to be eligible. For states that are not part of the Compact, physicians must still navigate the traditional, time-consuming licensing process. The legal requirement for state-level licensure remains the controlling factor.