What you need to know
You'll have access to your benefits during a public health emergency or state of disaster. When one of these events is declared, and until it ends, we will:
- Cover out-of-network services, benefits and prescriptions at network rates
- Waive referral requirements, where applicable
- Make changes that benefit you effective immediately, without the required 30-day notice
- Make sure you can fill your prescription(s), even if it's too soon for a refill
Who declares a disaster or public health emergency?
The Centers for Medicare and Medicaid Services (CMS) states that a disaster declaration for a geographic area may be made by:
- A Presidential declaration of disaster or emergency under either:
- The Stafford Act
- The National Emergencies Act
- An announcement of a public health emergencyby the Secretary of Health and Human Services
- A declaration of emergency or disaster by a state governor
If the president declares a disaster, the Secretary of Health and Human Services may also authorize waivers or modifications under Section 1135 of the Public Health Service Act.
When does a disaster or public health emergency end?
The public health emergency or state of disaster ends when any of the following occur:
- The source that declared the public health emergency or state of disaster say it's over
- CMS declares that the public health emergency or state of disaster is over
- Thirty days have passed since the presidential emergency or state of disaster was declared
- Ninety days have gone by since the beginning of the public health emergency
We'll let CMS know if we can’t resume normal operations by the end of the public health emergency or state of disaster.
What else should you know?
As your Medicare plan, we'll:
- Work closely with you if you’re still affected by a declared disaster after it ends
- Let you get the maximum extended day supply of your drug if it’s available and you ask for it when you refill your prescription
CMS also requires us to:
- Explain your payment terms and conditions if you live in a disaster area and get care from an out-of-network provider during a declared emergency or disaster
- Notify you each year of any special requirements that are in effect during a disaster or emergency
- Share these special requirements with you on our website
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.
Participating doctors, hospitals and other health care providers are independent contractors. They're neither agents nor employees of Aetna. The availability of any particular provider can't be guaranteed. Provider network make-up is subject to change.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.