4. Medicare disaster policy

Medicare disaster policy

When a disaster or emergency has disrupted your ability to access health care, we'll ensure you have access to your benefits.

Disasters and emergencies include:

  • Presidential disaster or emergency declaration (under the Stafford Act or National Emergencies Act)
  • Declaration of emergency or disaster by a state governor
  • Public health emergency declaration by the Secretary of Health and Human Services (under section 319 of the Public Health Service Act)

You'll have access to your benefits for 30-days after whichever of the following occurs first:

  1. The disaster or emergency is declared over by all sources that made the initial disaster or emergency declaration.
  2. No end date was identified and all applicable emergencies or disasters declared for the area have ended, either through an expiration of the declaration or any renewal of such declaration.
  3. Health care access is no longer disrupted.

Medicare Advantage plans

During a qualified disaster or emergency, Medicare Advantage members have access to: 

  • Coverage of Medicare Parts A, B, and supplemental Part C plan benefits at non-contracted facilities. 
  • Waiver of applicable requirements for gatekeeper referrals. 
  • The same cost sharing at non-contracted facilities as they would at plan-contracted facilities. 
  • Effectuation of the benefit changes right away without the 30-day notice requirement. 

In the event that we cannot resume normal operations by the end of the public health emergency or state of disaster, we'll notify the Centers of Medicare & Medicaid Services (CMS).

Medicare Part D Prescription Drug plans

We'll decide when the refill-too-soon edits should be lifted during a disaster or emergency, as long as access to the Part D drug is given at the point-of-sale. We may continue to lift these edits until the end of a public health emergency, or the end of a declared disaster or emergency. In the case of a public health emergency, it ends when the emergency no longer exists or at the end of the 90-calendar-day period starting from the initial declaration, whichever occurs first.

For major disasters or emergencies, we will:

  • Pay attention to the closure of disaster or emergency incident periods listed on the Federal Emergency Management Agency (FEMA) website. If, after 30-calendar-days from the initial declaration, the incident period has not officially closed, we are not required to extend the implementation of the refill-too-soon edits, but may consider an extension. If you let us know you're still impacted by the disaster or emergency, we can work with you.
  • Make sure you have access to covered Part D drugs dispensed at out-of-network pharmacies if it's not reasonable for you to get these drugs at an in-network pharmacy or such access isn't routine.
  • Allow affected members to get the maximum extended day supply, if requested and available at the time of refill.