Medicare disaster policy

When Medica determines a disaster or emergency has caused a disruption to our eligible Medicare members’ ability to access health care, we will ensure our members have access to their health plan benefits. Disasters and emergencies include a:

  • Presidential disaster or emergency declaration (under the Stafford Act or National Emergencies Act)
  • Declaration of emergency or disaster by a state governor
  • Public health emergency declaration by the Secretary of Health and Human Services (under section 319 of the Public Health Service Act)

We will continue to provide access to health care benefits for 30-days after whichever of the following occurs first: 1) all sources that declared a disaster or emergency for the impacted service area have ended, 2) no end date was identified and all applicable emergencies or disasters declared for the area have ended, including through expiration of the declaration or any renewal of such declaration, or 3) there is no longer a disruption of access to health care.

Medicare Advantage Plans

During a qualified disaster or emergency, Medicare Advantage members have access to: 

  • Coverage of Medicare Parts A, B, and supplemental Part C plan benefits at non-contracted facilities. 
  • Waiver of applicable requirements for gatekeeper referrals. 
  • Access to the same cost sharing at non-contracted facilities as they would at plan-contracted facilities. 
  • Effectuation of the benefit changes right away without the 30-day notice requirement. 

In the event that our health plan cannot resume normal operations by the end of the public health emergency or state of disaster, we will notify the Centers of Medicare & Medicaid Services (CMS). 

Medicare Part D Prescription Drug Plans

We will decide how the refill-too-soon edits are lifted during a disaster or emergency, as long as access to the Part D drug is given at the point-of-sale. We may continue to lift these edits until the end of a public health emergency, or the end of a declared disaster or emergency. In the case of a public health emergency, it ends when the emergency no longer exists or at the end of the 90-calendar-day period starting from the initial declaration, whichever occurs first.

For major disasters or emergencies, we will:

  • Pay attention to the closure of disaster or emergency incident periods listed on the Federal Emergency Management Agency (FEMA) website. If after 30-calendar-days from the initial declaration the incident period has not officially closed, we are not required to extend the implementation of the refill-too-soon edits, but may consider an extension. We will work with our members who inform us they are still impacted by the disaster or emergency.
  • Make sure members have access to covered Part D drugs dispensed at out-of-network pharmacies if it is not reasonable the member to get covered Part D drugs at an network pharmacy, and when such access is not routine.
  • Allow affected members to get the maximum extended day supply, if requested and available at the time of refill.

View our Medicare disclaimer.