Medicare Advantage and Part D plans must work to maintain access to health care services and prescription drugs during emergencies for plan members living in affected areas. Plans must meet certain requirements following the declaration of a disaster, emergency, or public health emergency.
In these cases, Medicare Advantage Plans must:
- Allow you to receive health care services at out-of-network doctors’ offices, hospitals, and other facilities.
- Waive referral requirements.
- Charge in-network cost-sharing amounts for services received out of network
- Suspend rules requiring 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.
In these cases, Part D plans must:
- Cover formulary Part D drugs filled at out-of-network pharmacies o Part D plans must do this when you cannot be expected to get covered Part D drugs at an in-network pharmacy o Remove restrictions that stop you from getting refills too soon
- Cover the maximum supply of your refill if you request it
After the disaster, emergency, or public health emergency ends, plans can stop following these requirements. The government will typically indicate when the emergency has ended.
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