Managing Your Medicare Advantage Plan During Emergency Situations
During a disaster or emergency, Medicare Advantage (MA) plans adapt to ensure beneficiaries can continue accessing necessary medical care and prescription drugs. These special rules are typically triggered by a formal declaration of emergency or disaster by federal or state authorities.
Access to Medical Care
In times of crisis, MA plans waive their usual network restrictions, allowing beneficiaries to receive medical care from any provider, including those outside their network, without additional costs. This ensures that individuals can get the necessary care without worrying about higher out-of-pocket expenses. Beneficiaries can also continue to access life-sustaining medical care and supplies, even if they are displaced or receiving care outside their usual network.
Prescription Drugs
During a disaster, MA plans must ensure that beneficiaries can continue to access their prescription medications, even if they are displaced or need to seek care outside their network. The rules often waive additional costs for accessing prescription drugs from out-of-network pharmacies, ensuring that beneficiaries do not face increased expenses.
Special Enrollment Periods
A Special Enrollment Period (SEP) is available for Medicare beneficiaries affected by a disaster or emergency. This SEP allows individuals to enroll in, disenroll from, or switch Medicare Advantage or prescription drug plans if the disaster prevented them from doing so during a regular enrollment period. To qualify for a disaster-related SEP, beneficiaries must attest that the emergency or disaster impacted them and prevented enrollment during a regular enrollment period. The SEP typically continues for a specified period after the disaster incident, allowing affected individuals time to manage their coverage changes.
These special rules are essential for ensuring that Medicare Advantage beneficiaries can maintain access to essential medical care and prescription drugs during times of crisis. The Secretary of the Department of Health and Human Services can declare a Public Health Emergency, which allows for the waiver or modification of MA requirements. The Centers for Medicare and Medicaid Services (CMS) has created a current emergencies page to assist beneficiaries.
During a disaster, your MA plan must allow you to get care from other health care providers at Medicare-certified facilities, even if they aren't in your plan's network. If you can't reasonably get to an in-network provider, your plan must allow you to receive care from out-of-network providers at Medicare-certified facilities. However, if you need to buy your prescription drugs at an out-of-network pharmacy during a disaster, you'll probably have to pay full cost for the drugs, but you should save your receipts for a potential refund.
- In the event of a disaster or emergency, individuals under Medicare Advantage (MA) plans can receive medical care from any provider, including those outside their network, without additional costs, due to the waiving of usual network restrictions.
- To ensure uninterrupted access to prescription drugs during a disaster, MA plans must allow beneficiaries to access their medications from out-of-network pharmacies, albeit with potential increased expenses until a possible refund.
