Medicare Disaster Policy

Accessing Benefits During a Disaster or Emergency

If you’re affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services and you experience a disruption of access to health care, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities).
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member;
  • Part D drugs to be dispensed at out-of-network pharmacies when the Part D drug cannot be obtained at an in-network pharmacy, and when such access is not routine;
  • Maximum extended day supplies allowed for affected enrollees if requested available at time of refill;
  • “Refill-too-soon” edits may be lifted on Part D drugs.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration or when there is no longer a disruption of access to health care.

Last Updated on November 14, 2022