Managing Your Medicare Advantage Policy During Emergency Situations
In times of emergency or disaster, Medicare Advantage (MA) plans must adjust their usual restrictions to ensure beneficiaries can continue accessing care and prescription drugs smoothly.
Key rules and benefits include:
- Coverage for emergency care anywhere in the U.S. MA plans must cover emergency services regardless of whether the provider is in the plan’s network or out of network, with no prior authorization required for true emergencies like heart attack or stroke.
- Waiving usual restrictions and authorizations: During emergencies, MA plans are required to waive many normal rules and restrictions that might otherwise limit access to care or medications. This means beneficiaries can get necessary care and prescriptions even out of network without extra cost or hurdles.
- Special Enrollment Periods (SEPs): If a natural disaster or emergency interrupts your ability to manage your Medicare plans, you may qualify for a disaster-related SEP. This allows enrollment changes like switching plans or enrolling anew during the emergency period.
- Access to prescription drugs: MA plans must facilitate refills and continued access to prescription medications, including allowing early refills or access through out-of-network pharmacies if necessary during the emergency.
- These rules generally apply for at least 30 days following the official emergency declaration but may vary. Beneficiaries are encouraged to contact their MA plan providers promptly to get help and minimize out-of-pocket expenses.
- Note that original Medicare does not have network or geographic limitations, so beneficiaries with original Medicare generally face fewer access issues during emergencies than those with MA plans.
- The Secretary of the Department of Health and Human Services can declare a Public Health Emergency, which can allow for the waiver or modification of Medicare Advantage requirements.
- Medicare Advantage plans must allow members in affected areas to continue accessing care and prescription drugs during a disaster or emergency.
- If you pay full costs for prescription drugs at an out-of-network pharmacy during a disaster, save your receipts for a potential refund from your plan.
The special rules are triggered by a formal declaration of emergency or disaster by a federal or state government. The Centers for Medicare and Medicaid Services (CMS) has a current emergencies page to assist beneficiaries.
Stay informed, and stay safe.
- In emergencies, Medicare Advantage (MA) plans are required to waive many normal rules and restrictions, ensuring beneficiaries can access necessary care and prescriptions, even out of network, without extra cost or hurdles.
- During a disaster or emergency, Medicare Advantage plans must facilitate refills and continued access to prescription medications, including allowing early refills or access through out-of-network pharmacies if necessary.
