Medicare Disaster Policy
Learn about our policy for continued health coverage during disasters.
In the event of a disaster, HealthSpring is here to help and will ensure health plan benefit coverage and lift the “refill-too-soon” edits on Part D drugs. “Disasters” include a:
Presidential emergency declaration
Declaration of emergency or disaster by a Governor
Presidential (major) disaster declaration
Public health emergency announcement by the Secretary of Health and Human Services
Medicare Advantage Plans
The following considerations are made for HealthSpring members who live in a disaster area and are experiencing a disruption of access to health care due to the disaster:
Coverage of Medicare Parts A, B and Supplemental plan benefits will be supplied at non-contracted facilities.
Applicable requirements for gatekeeper referrals will be waived in full.
Members will get the same cost sharing at non-contracted facilities as they would at plan-contracted facilities.
Changes that help the member will be effective right away without the 30-day notice requirement.
We will consider exceptions when typically required policy, contract or other rules are not met as a result of the disaster, such as when a member is displaced from their home and is not able to get non-emergency health care from a network health care provider.
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 for Medicare & Medicaid Services (CMS).
Medicare Part D Prescription Drug Plans
HealthSpring will decide as to how the “refill-too-soon” edits are lifted during a disaster or emergency, as long as access to Part D drugs is given at the point-of-sale. HealthSpring will 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, HealthSpring 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, HealthSpring is not required to extend the implementation of the “refill-too-soon” edits but may consider an extension. We will work as needed, with 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 for members to get covered Part D drugs at a 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.