Disaster support for Medicare Advantage
When the president, governor or secretary of Health and Human Services declares a disaster or a public health emergency, we take actions to ensure our Medicare Advantage members in the affected areas can get the medical care they need.
The actions we take include:
- Covering Medicare Parts A and B services and supplemental Part C plan benefits at non-network hospitals and other medical facilities
- Waiving all requirements for primary care physician (PCP) referrals
- Providing enrollees with the same cost-sharing they would get at an in-network facility
- Beneficiaries located in an area of declared emergency will have access to immediate refills of Part D medications for the period of the emergency declaration in accordance with CMS guidance. Upon reques from a participating pharmacy, Pharmacy Help Desk represenatatives are authorzed to override early refill edits for the days supply requested by the beneficiary, as available at the time of refill, up to the maximum extended-days supply defined by your plan in your benefit setup.
- Impacted members within the emergency area taking specialty medications will be contacted to discuss alternate delivery arrangements if needed. The use of courier services will be engaged as necessary. If an override is needed for a Specialty medication, Specialty operations will contact account management for approval.
- Beneficiaries may request that retail pharmacies proactively transfer refill orders to other pharmacies that are located outside of the affected area. They are also allowed to obtain prescriptions at out-of-network pharmacies. For reimbursement of all eligible out-of-network expenses, beneficiaries are advised to submt paper claims. There are no changes to this out-of-network process for beneficiaries residing in an emergency area during the cours of a declared emergency. It is however expected that beneficiaries will have access to network pharmacies in light of our national pharmacy network coverage.
- UPS has stopped pickups and deliveries in the following ZIP codes on Wednesday, September 12.
- VA-23529, 27950
- Mail Order has placed the following ZIP Codes on hold Tuesday, September 11:
- VA - 23301-304, 306-308, 310, 313-316, 320-328, 336, 337, 341, 345, 347, 350, 354, 356-359, 389, 395-399, 23401, 404, 405, 407-410, 412-424, 426, 427, 429-443, 450-467, 471, 479, 480, 482, 483, 486-488, 23601-609, 612, 628, 630, 651, 661-670, 681, 690-694, 696, 23701-705, 707-709, 23801, 803-806, 821, 822, 824, 827-834, 836-847, 850, 851, 856, 857, 860, 866-868, 870, 872-876, 878, 879, 881-885, 887-891, 893, 894, 897-899
For Part D questions, please call Customer Care at 1-866-494-9927, 24 hours a day, seven days a week. The number can also be found on the back of your member ID card.
All of those changes become effective immediately.
These actions remain in effect until:
- The president, governor or secretary of Health and Human Services declares the public health emergency or disaster has ended; or,
- 30 days have passed since the disaster or emergency was declared, and no end date was identified.
If Piedmont is also affected by the disaster and cannot resume operations by the end of the disaster or public health emergency, we will notify the Center for Medicare and Medicaid Services (CMS) and will update the Piedmont website, when and if we are able, to provide information about Piedmont’s operational capabilities.
Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Last updated: 09/12/2018