When a disaster or emergency strikes, dealing with your healthcare needs can be stressful. This guide provides essential information about Medicare coverage and enrollment options for beneficiaries affected by a federally declared disaster.

Medicare natural disaster SEP

If a disaster disrupts your Medicare enrollment for Original Medicare or Medicare Advantage (through MA open enrollment period), you may qualify for a Special Enrollment Period (SEP), allowing you to make changes to your coverage outside of the standard enrollment windows. This could include enrolling in Medicare, switching plans, or changing your existing coverage. A local, state, or federal (FEMA) government must have declared the situation an emergency to be eligible. 

Paying your Medicare premiums during an emergency

Even during a disaster, your Medicare premiums are still due as usual. However, there’s flexibility if you’re facing financial hardship. If you’re having trouble making payments, you can request that your premiums be deducted directly from your Social Security check. Contact the Social Security Administration for assistance with this process.

Accessing prescription medications in affected areas

If your usual pharmacy is closed or inaccessible due to the disaster, here’s what you can do:

• Find an In-Network Pharmacy: Call your Medicare Part D plan provider and ask for a list of in-network pharmacies near your current location.
• Temporary Pharmacy Change: Request a temporary change of your preferred pharmacy to a location that’s convenient and accessible during the emergency.

Medicare Advantage plans and disaster rules

Medicare Advantage plans have special rules to ensure you have access to care during emergencies.

• Contact Your Plan: Reach out to your plan provider as soon as possible after a disaster for the most up-to-date and specific guidance.
• Expanded Network Access: Your plan must allow you to receive care from any Medicare-certified facility, even if it’s out-of-network. This applies even for non-emergency situations.
• Referral Requirements Waived: You won’t need a referral to see out-of-network specialists during the emergency period.
• Consistent Cost-Sharing: Your plan must charge you the in-network rate for any care you receive, even if it’s out-of-network. Keep your receipts and request a refund from your plan if you’re overcharged.
• Long-Term Medication Supplies: If you’re displaced or unable to return home, your plan must allow you to fill 60- or 90-day supplies of your medications.

Important: Always keep your plan’s contact information readily available and don’t hesitate to contact them with any questions or concerns.