How to access coverage in the event of a disaster or local emergency
In the event of an emergency or natural disaster, Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is committed to helping you continue to access care easily. In a time of crisis, we will:
- Allow Part A and Part B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities (note that Part A and Part B benefits must, per 42 CFR §422.204(b)(3), be furnished at Medicare certified facilities)
- Waive in full, requirements for gatekeeper referrals where applicable
- Temporarily reduce plan-approved out-of-network cost-sharing to in-network cost sharing amounts
- Waive the 30-day notification requirement to enrollees as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the enrollee
- Allow you to fill medications sooner than usual to ensure you have what you need during the emergency
These actions will be in effect through the emergency declaration period. Disasters/Emergencies may be declared by the U.S. Government, the Federal Emergency Management Agency (FEMA), or the Governor of any state.
Typically, the source which declares the disaster will clarify when the disaster or emergency is over. If however, the disaster or emergency timeframe has not been closed 30 days from the initial declaration, and if the Centers for Medicare & Medicaid Services (CMS) has not indicated an end date to the disaster or emergency, we will resume normal operations 30 days from the initial declaration.