Managing Your Medicare Advantage Plan During Emergency Situations
In times of emergency or disaster, Medicare Advantage (MA) plans are designed to ensure that their members continue to have access to essential medical care and prescription drugs. This is achieved by temporarily waiving many usual restrictions, such as cost-sharing, network, referral, and prior authorization rules [1][5].
These special rules are triggered by a formal emergency or disaster declaration from federal or state authorities or a Public Health Emergency declared by the HHS Secretary [1][5].
Key specific rules for Medicare Advantage members during disasters include:
- Network Restrictions: MA plans must allow access to care at out-of-network facilities and providers as if they were in-network, enabling members to get needed care even if displaced from their usual areas [1][5].
- Cost-Sharing: Members pay the same cost-sharing amounts for services obtained from out-of-network providers as they would for in-network providers during the emergency period, effectively waiving extra out-of-pocket costs [1][5].
- Referrals and Authorizations: Any normally required prior authorizations or referrals are waived during the disaster, allowing direct access to specialists or necessary procedures without delay [5].
- Prescription Drugs: The usual refill restrictions are waived, allowing emergency prescription refills and access to medications even at out-of-network pharmacies if needed. This ensures continuity of life-sustaining medication [1][5].
- Duration: These emergency rules generally last for at least 30 days following the disaster declaration but can be extended depending on the ongoing situation. Members should contact their MA plan promptly to confirm current rules and assistance [1].
- Special Election Period (SEP): Those affected by a disaster may qualify for a special enrollment period to change MA or Part D plans, available during and sometimes up to 14 months after the emergency, depending on official dates [3].
In summary, Medicare Advantage plans provide flexible, no extra cost access to care and drugs outside the network with waived referrals and authorizations during disaster emergencies, ensuring members retain needed care with minimal financial and administrative barriers [1][3][5].
For more information and assistance, beneficiaries can visit the Centers for Medicare and Medicaid Services' current emergencies page [2].
- During emergency situations, the Medicare Advantage (MA) plans accommodate medical-conditions by abolishing usual cost-sharing responsibilities for services gained from out-of-network providers, promoting health-and-wellness for members without additional financial burdens.
- In the event of a disaster, Medicare Advantage members can continue treating science-related medical-conditions as normal rules for network, referrals, authorizations, prescription drugs, and cost-sharing are temporarily waived, ensuring Medicare coverage remains an accessible resource during such challenges.
