National vs. Local Medicare Plans: What’s the Difference?

When choosing a Medicare plan, there’s a lot to consider: Premiums. Prescriptions. The difference between Medicare Advantage and Original Medicare. Another factor to consider is whether your plan is from a national or a local insurance company. While big-name recognition might feel reassuring, there are significant advantages to choosing a health plan that’s rooted in your community. 

Understanding your healthcare landscape

Healthcare isn’t one-size-fits-all. While national plans create standardized products designed to work coast-to-coast, a local plan understands: 

• Regional health challenges and seasonal health concerns specific to your area
• Local healthcare infrastructure and how different systems connect
• Cultural considerations and language needs of your community
• Where people actually go for care and why certain facilities are preferred

Local insurance carriers consider these factors when designing plans specifically tailored for your area. 

“Local” doesn’t mean “limited”

When choosing between Original Medicare and Medicare Advantage, the main factors people consider are affordability and service area. While Original Medicare has a nationwide service area, Medicare Advantage coverage depends on each carrier’s relationship with health systems across the country. You may expect that a local carrier won’t have coverage out of your state—or won’t have out-of-network coverage in your state—but that’s a misconception.

Choosing a local plan doesn’t mean sacrificing coverage when you travel. Regardless of whether you choose a local or national plan, all Medicare Advantage plans cover emergency and urgent care anywhere in the U.S. and often worldwide. You’re never without coverage when you need it. 

What differs is the provider network for routine, non-emergency care—and this is where local plans often shine. Some local plans have a limited out-of-state network for non-emergent care. Others, like BSW SeniorCare Advantage PPO and HMO-POS, do in fact have nationwide coverage and an extensive provider network that extends beyond the Baylor Scott & White name.

Affordability is another reason why a local plan may have more allure than a national one. National plans are generally more expensive because their coverage networks are evaluated at the national rather than the regional level. They may not offer coverage at local hospitals or clinics despite that wider network. In contrast, a local plan can often provide a more concentrated network at lower premiums and out-of-pocket costs. They also have the unique opportunity to tailor their products to their local communities, considering everyday healthcare needs and the cost of living in the areas they serve.

The power of local connections

A national plan won’t have the same ties to the community that a local company does—even one with local branches. Local health plans are able to build tighter relationships with providers, engage with the community and provide customer service more efficiently.

When it comes to your provider network, you can expect stability. Baylor Scott & White Health Plan is integrated with the Baylor Scott & White Health system—that means Baylor Scott & White doctors will always be in network, and you’ll also have access to doctors outside BSW as well.

Local plans also have a better understanding of the community’s needs. Baylor Scott & White Health Plan actively supports philanthropic organizations to help address issues beyond medical care. Throughout the year, we also host multiple in-person events, like our annual SeniorCare Celebration, to better connect with our members and learn ways to better serve you.

As a local carrier, Baylor Scott & White Health Plan offers local customer service as well. Local representatives:

• Live in or understand your community’s healthcare landscape
• Are familiar with local providers and facilities
• Can help resolve issues quickly
• Provide personalized support to your needs

Additionally, local plans tend to be more flexible when it comes to prior authorizations and formulary requests. Flexibility depends on the type of plan you have, with PPO plans being more flexible than HMOs; however, a local plan may offer even more flexibility based on local market dynamics than a national plan. While all health plans can accept special requests for uncovered medications or prior authorizations, depending on the plan’s specific rules, a local plan may be more willing to accept such requests. Local plans can adapt benefits to reflect what their members actually need:

• Extra benefits focused on local resources (specific gyms, local transportation services)
• Dental and vision networks built around area providers
• Wellness programs designed for regional preferences and needs
• Flexibility to adjust based on feedback from local members and providers

National plans must navigate regulations and member needs across multiple states, making them less agile when tailoring benefits to your specific area.

If you need more help deciding on the right plan, speaking to a licensed broker can help you compare specific plans available in your area and find the one that fits your needs and budget. Contact a Baylor Scott & White Health Plan licensed insurance agent for a consultation on your options and guidance on finding a plan that’s best for you or your loved ones at 1.833.975.0841 (TTY: 711).