Medicare disaster and emergency policy

Getting care during a disaster or emergency for Medicare Advantage and Prescription Drug Plan members

When health care is disrupted during a disaster or emergency, Blue Shield will act in your best interest. We will respond quickly to members in need. We will also follow all of the Center for Medicare and Medicaid Services (CMS) requirements. In an emergency, we will send information to members on accessing healthcare in many ways. These may include direct outreach through phone calls, mail, email, webpage, member portal, and more. This will depend on member preference and CMS requirements.

A disaster will be declared in one of these ways:

  • Presidential declaration of a disaster or emergency under the Stafford Act of National Emergencies
  • Secretarial declaration of a public health emergency under section 319 of the Public Health Service Act
  • Declaration by the governor of a state or protectorate

When a disaster or emergency is declared and access to care is disrupted:

  • Blue Shield of California will cover benefits furnished to you by out-of-network providers.
  • You will not need referrals or prior authorization.
  • You will have the same cost-sharing as if the benefit was furnished by an in-network provider.
  • You can refill prescriptions early if needed.

When the disaster has ended, it will be declared in one of these ways:

  • The source that declared the public health emergency or state of disaster declares an end.
  • The Center for Medicare and Medicaid Services (CMS) declares an end to the public health emergency or state of disaster.
  • If thirty (30) days have passed since the declaration of the public health emergency or state of disaster, and no end date was identified by the original source of CMS, it will be considered the end of the disaster.

If you have any questions, please contact Blue Shield of California Customer Service for your specific plan:

Medicare Advantage Prescription Drug Plans  
Phone: (800) 776-4466 (TTY: 711) - 8 a.m. to 8 p.m., seven days a week
 

Dual Special Needs Plans
Phone: (800) 452-4413 (TTY: 711) - 8 a.m. to 8 p.m., seven days a week
 

Medicare Prescription Drug Plans
Phone: (888) 239-6469 (TTY: 711) - 8 a.m. to 8 p.m., seven days a week

Y0118_23_565A1_C 08312023
H2819_23_822E_C Accepted 12042023
Page Last Updated: 1/1/2024

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For Blue Shield Medicare Advantage Plans: Blue Shield of California is an HMO, HMO D-SNP, PPO and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Blue Shield of California depends on contract renewal.

 
 
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