The ability to see a doctor outside your home state depends on two distinct factors: your health insurance coverage and the physician’s legal licensure. For scheduled, non-emergency care, your health plan determines if and how much you will pay for the service. For all care, the medical professional must be legally authorized to treat you in the physical or virtual location where you are receiving the service.
Understanding Your Health Plan Coverage Outside Your State
The financial implications of seeing a doctor in another state are dictated by the type of health plan you possess. Preferred Provider Organizations (PPOs) generally offer the most flexibility for planned, out-of-state care. PPOs establish a network of preferred providers but also cover a portion of costs if you choose an out-of-network provider, albeit at a higher out-of-pocket rate. You should expect to pay more in the form of higher deductibles, copayments, and coinsurance for out-of-network services in another state.
Conversely, Health Maintenance Organizations (HMOs) are the most restrictive regarding out-of-state coverage. HMOs are typically structured around a specific geographic service area and generally do not cover services received outside that area unless it is a medical emergency. For non-emergency, out-of-state care, an HMO may require a referral from your primary care physician and pre-authorization from the plan. Coverage may still be denied if the service is available within your home service area.
Other plan types, such as Exclusive Provider Organizations (EPOs) and Point-of-Service (POS) plans, fall along a spectrum between PPOs and HMOs. EPOs often function similarly to HMOs, covering only in-network providers. POS plans typically offer a mix of HMO-like restrictions, such as requiring a primary care physician, with PPO-like flexibility for out-of-network care at a higher cost. Checking the plan’s Summary of Benefits and Coverage document is the only way to confirm the specific financial rules for planned, non-emergency care outside your primary coverage area.
When Licensing Rules Allow Treatment Across State Lines
A fundamental principle of medical practice in the United States is that physicians are licensed by individual state medical boards. This means a doctor must hold a license in the state where the patient is physically located at the time of service. This regulation applies to in-person visits, where a doctor cannot physically practice in a state where they are not licensed. This state-by-state licensure system historically presented a substantial barrier to receiving care from a doctor in a different state, even if the patient traveled there for a consultation.
The rise of Telehealth has complicated this concept, as virtual care still requires the physician to be licensed in the patient’s state. To streamline this process for physicians in good standing, the Interstate Medical Licensure Compact (IMLC) was established. The IMLC is an agreement among 40 states, the District of Columbia, and Guam that creates an expedited pathway for eligible physicians to obtain licenses in multiple member states.
This compact significantly reduces the administrative burden and time required for a physician to become licensed in several jurisdictions, expanding access to specialists and virtual care across state lines. Since its inception, the IMLC has processed over 150,000 new licenses, indicating its growing role in interstate medical practice. While the IMLC facilitates full licensure, some states also offer limited Telehealth registration for out-of-state providers who only intend to deliver virtual care.
What to Know About Emergency and Urgent Care While Traveling
Seeking unplanned medical attention while traveling involves different rules than planned care, as federal law provides specific protections for emergency situations. A medical emergency is defined as a sudden and serious medical condition that puts a person’s health in serious jeopardy without immediate medical attention. Urgent care, in contrast, is for conditions that require prompt attention but are not life-threatening, such as a minor sprain or a severe cold.
For a true medical emergency, the federal No Surprises Act, enacted in 2022, mandates that your insurance plan must cover the service regardless of whether the hospital or emergency room is in-network or out-of-network. This law protects patients from “balance billing,” which is when an out-of-network provider bills the patient for the difference between their billed charge and the amount the insurer pays. Under this protection, you are only responsible for the in-network cost-sharing amount, such as your copayment or deductible, even if the facility is out-of-network.
These surprise billing protections also extend to certain post-stabilization services and out-of-network air ambulance services, ensuring a patient is not financially penalized for receiving emergency care from the nearest facility. However, this protection does not generally apply to ground ambulance services or non-emergency urgent care. For urgent care needs, you should contact your insurer or check your plan documents to find a local in-network urgent care facility to avoid higher out-of-pocket costs.