We hope you’ll never have to worry about getting Medicare benefits when there’s an emergency. If there’s a hurricane, earthquake, tornado, terrorist attack, or other disaster, Medicare coverage might extend beyond usual restrictions in certain cases.
Are Medicare benefits the same during a disaster?
Ordinarily, there are certain rules and limits that apply to your Medicare benefits. But if disaster strikes, Medicare may stretch benefits to accommodate your health-care coverage in some situations. Because there may be limited resources – like hospital beds and doctors – the government might make Medicare benefit requirements more flexible in a disaster. For example:
- Medicare benefits might cover your stay in a skilled nursing facility without requiring that you first stay at least 3 days in the hospital as an inpatient.
- If you’ve used up your Medicare skilled nursing facility benefits, the government might extend these Medicare benefits for you without making you start a new benefit period.
- The Center for Medicare & Medicaid Services (CMS) may waive some rules to prevent gaps in coverage.
- Medicare might cover certain medical services from a doctor even if he or she doesn’t accept Medicare assignment.
- Medicare may allow more than the usual limit of 25 patient beds in critical access hospitals, and might let you stay there beyond the normal 96-hour (4-day) maximum.
Medicare might also ease certain administrative requirements for providers in times of crisis as well. Please note that CMS may temporarily waive requirements as described above on an event-by-event basis; Medicare benefit rules in effect for one emergency might not apply during a different disaster.
How does the government help you get Medicare benefits during a disaster?
According to Section 1135 of the Social Security Act, the Secretary of the Department of Health & Human Services (DHHS) can waive or change certain Medicare benefit coverage requirements when a disaster strikes. Each of the following situations has to be true:
- The President declares a state of emergency or disaster (under either of two specific laws).
- The DHHS Secretary declares a public health emergency (under the Public Health Service Act).
- Government officials may have some flexibility regarding which rules may be temporarily relaxed or changed.
For example, this is how CMS responded to Hurricane Sandy in 2012 to help deliver Medicare benefits:
- Medicare Advantage plans had to deliver covered medical services at certain Medicare-approved hospitals that weren’t in their networks. The plans had to cover these out-of-network services at the same rates as their in-network services.
- Medicare Advantage plans didn’t require referrals in certain situations that would normally require them.
- Medicare Prescription Drug Plans had to make sure prescriptions were dispensed at in-network prices if members couldn’t easily access these drugs at their plan network pharmacies.
- Medicare Prescription Drug Plans had to remove certain restrictions on prescription renewals.
According to the Department of Health & Human Services, the National Disaster Medical System (NDMS) provides medical services when disaster strikes. The NDMS needs to be summoned by officials such as federal, state, or tribal agencies. Medicare benefits might extend to care provided by NDMS health-care providers.
Being prepared before disaster strikes
If you live in a part of the country that sometimes has floods, earthquakes, tornadoes, hurricanes, or other natural disasters, you may want to stay prepared so you can stay as safe as possible. The Centers for Disease Control (CDC) website has extensive tips on staying safe before and during disasters – so that maybe you won’t need Medicare benefits.
And although most of us don’t like to think about it, terrorist attacks may be possible. Another CDC website has advice about preparedness.
I hope you never need Medicare benefits because of a disaster, but if reading this article made you curious about Medicare plan options, I can explain how they work. The Compare Plans or Find Plans buttons can show you some of the Medicare plan options in your area. Click the links below to request a phone call or personalized email.