Medicare private plans must work to continue access to health care services and prescription drugs during emergencies for people with Medicare living in affected areas. Private plans must follow the following requirements following a federal declaration of a Disaster or Public Health Emergency.
Medicare Advantage plans must:
- Allow you to receive health care services at out-of-network doctor’s offices, hospitals and other facilities
- Waive requirements for primary care provider referrals
- Reduce out-of-network cost-sharing amounts to in-network cost-sharing amounts
- Remove rules making you to tell plans before you get certain kinds of care or prescription drugs if failing to contact the plan ahead of time could raise your costs or limit your access to care
Part D plans must:
- Cover formulary Part D drugs filled at out-of network pharmacies
- Part D plans must do this when you cannot be expected to get covered Part D drugs at an in-network pharmacy
- Remove restrictions that stop you from getting refills too soon
- Cover the maximum supply of your refill if you request it
After the disaster or public health emergency ends, plans can stop following these requirements. The federal government will typically indicate when the disaster or public health emergency ends.