Navigating Access to Medicare Advantage Providers and Pharmacies During Emergencies and Disasters

By Brian Krantz - June 1, 2023

nyc medicare agent

Emergencies and disasters can disrupt access to essential healthcare services, including those provided by Medicare Advantage (MA) plans. During these challenging times, it’s crucial to understand your rights and options for accessing care. In this article, we’ll explore how to maintain access to providers and pharmacies during a disaster or public health emergency.

Exception rules during a disaster or public health emergency

During emergencies, Medicare may relax certain rules to ensure beneficiaries can access necessary healthcare services. These exceptions typically apply to both Original Medicare and MA plans. Some of the relaxed rules include:

  • Waiving prior authorization requirements
  • Allowing access to out-of-network providers at in-network cost-sharing rates
  • Extending deadlines for appeals and grievances

Accessing out-of-network providers

If you have an MA plan and cannot access in-network providers during an emergency, the plan must cover care from out-of-network providers at in-network cost-sharing rates. This rule ensures that you can receive the care you need without facing additional financial burdens.

Prescription drug coverage during emergencies

During a disaster or public health emergency, Medicare Part D and MA plans with prescription drug coverage must allow you to access prescription medications from any pharmacy, even those outside the plan’s network. In addition, plans must:

  • Lift restrictions on the quantity of medication you can obtain (e.g., 30-day supply)
  • Waive prior authorization and step therapy requirements
  • Cover medications that are not typically on the plan’s formulary if medically necessary

Utilizing telehealth services

Telehealth services can be an invaluable resource during emergencies, allowing you to receive care remotely. During a disaster or public health emergency, Medicare may expand telehealth coverage, enabling you to access a broader range of services from your healthcare providers.

Special enrollment periods for affected individuals

If you’re affected by a disaster or public health emergency and missed your initial enrollment period or want to switch plans, Medicare may offer a Special Enrollment Period (SEP). This SEP allows you to enroll in or change your MA or Part D plan outside the regular enrollment periods.

Emergencies and disasters can create uncertainty and challenges for Medicare beneficiaries. Understanding your rights and options for accessing care during these times is crucial. Remember that Medicare may relax certain rules, cover out-of-network providers, and expand prescription drug and telehealth coverage to ensure you receive the care you need. Stay informed about your options and communicate with your local NYC Medicare agents like the team at Plan Medicare to navigate these situations effectively.

Speak to a Licensed Advisor in Medicare today

Book an Appointment Call: 516-900-7877