Here and There

5 tips for snowbirds juggling medical care across multiple systems

For retirees who split time between Illinois and somewhere warmer — Florida or Arizona, for example — managing two medical systems can create gaps in communication. It can also lead to medication confusion and delays in follow-up care, particularly for people with chronic conditions.

“When care is split between two medical systems, there’s often no single provider overseeing the full picture. Each move essentially becomes a transition of care, one of the highest-risk periods for older adults,” says Ketsia Levasseur, a gerontologist and founder of Premier Concierge Care Management in Plantation, Florida, and Newburgh, Indiana.

Here’s how you can help yourself or the snowbird in your life transition safely between states.

1. Create centralized records

Jill Poser, founder of Life Care Concierge of South Florida, recommends creating digital or physical records that include information about medications, diagnoses, and provider contacts.

“You cannot rely on providers to transfer records because transfers are often incomplete or delayed,” Poser says.

Request medical records directly by calling the hospital’s medical records department or going to the facility. Records can often be sent digitally, but Poser says you should make sure you know:

• Which records you’re requesting
• Whether you’re getting all records or just recent notes
• How far back testing goes

“It’s important to proactively request and personally verify that records were sent and received, rather than assuming,” she says. “Specialty records like cardiology, oncology, and urology are often the most delayed, so they need extra attention.”

Families should also maintain a portable medical summary. “A shared digital folder can help, but that requires understanding how to set it up,” Poser says. If you’re not sure how to get started, check with a librarian at your local library.

2. Plan ahead with prescriptions

Take steps to reduce medication errors by planning ahead for refills, maintaining an accurate medication list and coordinating between providers.

“Medication reconciliation after each move is also crucial to avoid prescription disruptions,” Levasseur says.

Confirm dosages and make sure you are no longer taking any medications that have been discontinued. “Sometimes people pull information from bottles or different providers, and that doesn’t always reflect what’s current,” she says.

While filling medications at a national pharmacy chain and scheduling refills before traveling can help, Poser says there are state-to-state differences in prescribing laws, especially for controlled substances. Refill rules also vary between states, which can cause issues during transitions.

“New providers may require updated evaluations before refilling medications, which can cause delays,” Poser says.

These issues become especially serious for certain conditions such as heart disease and Parkinson’s disease.

“For example, with Parkinson’s, medications must be taken multiple times a day at the same time. Even small delays or changes can have significant effects,” Poser says.

Additionally, insurance formularies can differ between states, leading to unexpected substitutions. “In some cases, pharmacies cannot transfer prescriptions across state lines without a new prescriber, which creates further delays,” Poser says.

3. Designate one provider to oversee everything

Select one provider to oversee the full picture and review care after each transition. This can reduce the risk of missed information and medical errors, Levasseur says.

“Families should also consider care coordination support for older adults, particularly for individuals with multiple chronic conditions and a history of frequent hospitalizations,” she says.

Poser suggests engaging one care manager in both locations to communicate and share updates in real time and consistently transfer records and progress notes.

“Ultimately, the most effective approach is to treat care as one integrated system across two locations, rather than two separate systems,” Poser says. “That usually requires someone with medical or clinical knowledge to coordinate records, medications, and communication, so patients and families are not left trying to manage everything on their own.”

For families who can afford it, she says having a concierge physician can make coordination between states easier, especially with record transfers and communication.

4. Prepare for emergencies

Emergency planning is typically localized, but snowbird lifestyles aren’t, Levasseur says.

“Families need to plan proactively because in emergencies or end-of-life situations, advance directives may not be immediately available to treating providers, and requirements for DNR [do not resuscitate] or other medical-order forms can differ from state to state,” Levasseur says. “Emergency providers may also lack access to critical medical history, which can lead to delays, confusion, or care that does not align with the patient’s wishes.”

Set up a portable emergency plan in the form of a physical folder that includes a one-page medical summary, medication list, provider contacts, and advance directives. This information can be crucial in an emergency.

“Another issue is that people often assume they can just go back to their doctors in Illinois, but if an emergency happens in Florida, they still need care locally [for follow-up care],” Poser says.

5. Understand insurance coverage

Insurance coverage may differ depending on the state you’re in when you need care. For example, Medicare Advantage plans may work differently depending on the state, Poser says.

Because Medicare Advantage plans tend to be HMOs or PPOs with regional networks, they may have high out-of-network costs and may not cover routine care when a snowbird is in their secondary state.

A Medigap (Medicare Supplement) plan may be another option. It covers out-of-pocket costs like deductibles, coinsurance, and copayments. These private plans may also provide nationwide coverage, so snowbirds can get care in both states from providers who accept Medicare.

No matter which state you’re in, preparing for the unexpected and keeping up with your medical appointments is key. A little work ahead of time can save you a mountain of trouble later.