Getting Medical Care and Prescription Drugs in a Disaster or Emergency Area


Getting Medical Care and Prescription Drugs in a Disaster or Emergency Area

If you live in an area that’s been declared an emergency or disaster, the usual rules for your medical care may change for a short time.

Affected areas are ones where either:
•The President has declared it an emergency or disaster. Visit the Federal Emergency Management Agency (FEMA) online, at www.fema.gov, or call 1-800-621-FEMA (1-800-621-3362) to see if your area is affected. TTY users should call 1-800-462-7585.
•A governor has declared it an emergency or disaster. Visit your state government’s official Web site to find out if your area is affected.
•The Secretary of the Department of Health and Human Services (HHS) has declared a public health emergency. Visit HHS online, at www.phe.gov, or call 1-800-MEDICARE (1-800-633-4227) to find out if your area is affected. TTY users should call 1-877-486-2048.

Seeing doctors or other providers

If you’re in Original Medicare, you may always see any doctor who accepts Medicare. Some rules may change for an emergency or disaster area in certain instances—for example, you may be able to get Medicare-covered services at an airport from a military provider.

If you’re in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, contact your plan to see if it temporarily changes its rules
during an emergency or disaster.
•You may be able to see certain doctors or go to certain hospitals that accept Medicare patients, even if the doctor or hospital isn’t in your plan’s network and your health care need isn’t an emergency. If you have problems using an out-of-network doctor or provider, contact your plan for help.
•You may not have to meet your plan’s prior authorization rules for out-of-network services.
•If you usually pay more for out-of-network or out-of-area care, your plan may apply the in-network rate during the emergency or disaster period. If your plan agrees to apply the in-network rate and later on you go to an out-of-area or out-of-network provider and pay more for the service, save the receipt and ask your plan if it will give you a refund for the difference.

Getting your prescription drugs

If you have a Medicare Prescription Drug Plan and your state has issued a warning of a potential emergency or disaster:
•In general, you won’t be required to go to your usual network pharmacy to replace your prescription drugs if you had to leave your home without your prescription drugs, or your prescription drugs have been damaged or lost because of the emergency or disaster. Contact your Medicare drug plan to find another network pharmacy nearby.
•If you can’t reasonably get to a network pharmacy, your plan can help you get drugs during an emergency or disaster at an out-of-network pharmacy. You may pay more for prescription drugs you get at an out-of-network pharmacy.

Using in-network pharmacies
•You’ll be able to move most prescriptions from one network pharmacy to another, and back to your regular pharmacy when the emergency or disaster ends. If you need help finding the closest network pharmacy, call your Medicare drug plan.
•You’ll need to tell the new pharmacy the name of your regular pharmacy and which drugs you need refilled.
•If you lost your Medicare drug plan card and don’t know your plan’s phone number, call 1-800-MEDICARE (1-800-633-4227) to get your plan’s contact information. TTY users should call 1-877-486-2048.

Using out-of-network pharmacies
•Contact your plan for information about their out-of-network rules.
•When you buy your drugs at an out-of-network pharmacy, you’ll probably have to pay full cost for the drugs at the time you fill your prescriptions.
•To get a plan payment, submit a paper claim to your plan. Ask your plan where you should send your claim.
•If you paid full cost for the drugs, save your receipts so you can ask your prescription drug plan if it will refund you for the out-of-network cost sharing amount.

Additional (extended-day) supplies
If you think you won’t be able to return home for a long time, you may want to get an extended-day supply (a 60- to 90-day supply) of your prescription drugs. Ask your plan whether it offers extended-day supplies and which pharmacies you can use to get them.

Paying your plan’s premium
If you’re in a Medicare Advantage Plan, other Medicare health plan or Medicare Prescription Drug Plan:
•And you pay your plan’s premium directly to the plan each month, you’re still responsible for paying your premium on time each month.
•Generally, plans don’t change their normal rules for payment of monthly premiums during an emergency or disaster. Many plans have rules about disenrolling customers if they don’t pay their premiums on time.
•To make sure you’re still making timely payments on your monthly premiums during an emergency or disaster, ask your plan about signing up for premium withholding from your Social Security check or paying the plan by electronic funds transfer through your bank.
•If your plan disenrolls you for not paying your monthly premiums and you didn’t pay on time because of the emergency or disaster, you may be able to ask Medicare to reconsider the decision and get your coverage back. Contact 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048.

Getting dialysis treatments
If you’re in Original Medicare, your End-Stage Renal Disease (ESRD) Network can help you: •Get your dialysis treatments.
•Find out who to contact for your supplies, drugs, transportation to dialysis services, and emergency financial assistance if you need it.

Call 1-800-MEDICARE to get your ESRD Network’s contact information.

If you’re in a Medicare Advantage Plan or other Medicare health plan and have ESRD, contact your plan first to see if it temporarily changes its rules in an emergency or disaster. Even though your ESRD Network can help you find facilities that give dialysis services, your plan may not have a contract with an ESRD facility in the area where you’re staying temporarily.

Getting chemotherapy or other cancer treatments
If you’re in Original Medicare, the National Cancer Institute (NCI) can help you find other cancer care providers. Call 1-800-4CANCER (1-800-422-6237) between 9:00 a.m. and 4:30 p.m., Monday through Friday. TTY users should call 1-800-332-8615.

If you’re in a Medicare Advantage Plan or other Medicare health plan, contact your plan to see if it temporarily changes its rules in an emergency or disaster.

Replacing a lost Medicare card or Medicare plan membership card

If you’re in Original Medicare, you can replace a lost or damaged Medicare card by visiting Social Security online, at www.socialsecurity.gov, or by calling 1-800-772-1213. TTY users should call 1-800-325-0778. Also, contact Social Security if you temporarily or permanently change your address.

If you’re in a Medicare Advantage Plan, other Medicare health plan, or a Medicare Prescription Drug Plan, contact your plan to replace a lost or damaged membership card. You can get your plan’s contact information by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Replacing lost or damaged durable medical equipment or supplies that Medicare paid for

If you have Original Medicare and it already paid for durable medical equipment (like a wheelchair or walker) or supplies (like diabetic supplies) damaged or lost due to an emergency or disaster:
•In certain cases, Medicare will cover the cost to repair or replace your equipment or supplies.
•Generally, Medicare will also cover the cost of rentals for items (such as wheelchairs) during the time your equipment is being repaired.

If you’re in a Medicare Advantage Plan or other Medicare health plan, contact your plan directly to find out how it replaces durable medical equipment or supplies damaged or lost in an emergency or disaster.

For more information

•If you have Original Medicare and want more information about getting care from doctors or other providers during an emergency or disaster, call 1-800-MEDICARE.
•If you’re in a Medicare Advantage Plan or other Medicare health plan, contact your plan to get more information about getting care from doctors or other providers during an emergency or disaster. You can get your plan’s contact information by calling 1-800-MEDICARE.
•If you have a Medicare Prescription Drug Plan and want more information on getting prescription drugs during an emergency or disaster, contact your plan, or call 1-800-MEDICARE.
•You can also call your State Health Insurance Assistance Program (SHIP) for free personalized health insurance counseling. To get the phone number for your SHIP, visit www.medicare.gov/contacts, or call 1-800-MEDICARE.