Candace Nakamoto joins producer/host Coralie Chun Matayoshi to how to access your Medicare benefits in a disaster including what doctors, hospitals, and pharmacies you can use outside of your usual area, what to do if you’re under dialysis or cancer treatment, replacing or repairing medical equipment damaged in the disaster, Special Enrollment Periods, and how to make sure that Medicare plan premiums get paid to avoid getting disenrolled.
Candace Nakamoto is the Volunteer Coordinator for the Hawaii State Health Insurance Assistance Program (SHIP) and Director of the Medicare Improvements for Patients and Provider Act (MIPPA). She has worked with both programs for over six years. The SHIP program is a federally funded, volunteer program, administered by the Hawaii State Department of Health-Executive Office on Aging that provides free, local, unbiased Medicare information and assistance.
Q. It’s hurricane season and if you’re on Medicare, would you know how to access your Medicare benefits and what’s covered? What happens to my Medicare coverage if a disaster or public health emergency is declared in my area?
If the President, HHS Secretary, or your governor declares an emergency/disaster, Medicare temporarily alters certain rules so you can continue accessing care, even if you’re displaced
Q. Can I see doctors or go to hospitals outside my usual area?
With Original Medicare you can visit any provider that accepts Medicare—no network restrictions apply (this is true even if you have to leave your city or state). With Medicare Advantage (Part C) you may access out-of-network providers at in-network cost-sharing, with waived referrals and permissions, depending on your plan’s disaster policy
Q. Can I transfer my prescriptions to a different pharmacy during a disaster?
Yes. You can usually move your prescriptions to another in-network pharmacy, and back to your regular one after the emergency ends. Contact your Medicare plan for help finding the nearest in-network option.
Q. What information do I need to provide to the new pharmacy?
Be ready to share the name of your usual pharmacy and the names of the medications you need refilled.
Q. What if I lost my Medicare plan card and don’t know how to contact my plan?
Call 1-800-MEDICARE (1-800-633-4227) for help finding your plan’s contact information. TTY users can call 1-877-486-2048.
Q. Can I use an out-of-network pharmacy during an emergency?
Possibly. You’ll need to contact your Medicare Advantage or drug plan directly to ask about their out-of-network rules in emergency situations. The rules for Original Medicare are slightly different. If you have a Medicare Part D plan, there are network pharmacies, and typically, you’ll pay more if you use an out-of-network pharmacy. However, in an emergency, Medicare Part D may cover drugs filled at out-of-network pharmacies if you can’t reasonably access an in-network one. You might need to pay out-of-pocket initially and seek reimbursement later.
Q. Will I have to pay full price at an out-of-network pharmacy?
Likely yes. Save your receipts – you may be able to request reimbursement from your plan (excluding usual out-of-network cost-sharing). Ask your plan how to submit a claim.
Q. What if I’m displaced for an extended period? Can I get more medication at once?
Yes. Some plans offer 60- or 90-day supplies. Check with your plan to see if extended supplies are available and which pharmacies can provide them.
Q. How do I find contact info for my Medicare drug plan?
Look on your plan membership card, search online, or call 1-800-MEDICARE for assistance.
Q. I have Original Medicare and need dialysis during a disaster. Who can help me?
Your regional ESRD (End-Stage Renal Disease) Network can assist with locating dialysis services, supplies, medications, transportation, and even emergency financial support.
Q. How do I contact my ESRD Network?
Visit esrdnetworks.org to find your network’s contact information.
Q. I have a Medicare Advantage Plan. Who should I contact for dialysis support?
Contact your Medicare Advantage Plan directly. They can help you locate dialysis facilities and explain what coverage or rules may change during an emergency.
Q. If I have Original Medicare and need cancer treatment during a disaster, who do I contact?
Reach out to the National Cancer Institute (NCI) for help locating alternative cancer care providers. Call 1‑800‑4‑CANCER (1‑800‑422‑6237), Monday–Friday, 9:00 a.m.–4:30 p.m. ET. TTY users: 1‑800‑332‑8615.
Q. What support does the NCI Cancer Information Service (CIS) provide during emergencies?
The Cancer Information Service offers help preparing for disasters, staying informed of evacuation and care options, and referrals to cancer centers or NCI Community Oncology Research Program (NCORP) sites .
Q. Can the NCI CIS guide me if I’m displaced to a new location?
Yes—they can provide tailored resources and refer you to nearby cancer care facilities, ensuring your treatment continues uninterrupted .
Q. Are there additional resources to help cancer patients prepare for emergencies?
The NCI offers printable wallet cards, checklists (including treatment summaries and provider contacts), and references to resources from CDC, Ready.gov, and the American Cancer Society .
Q. Does Medicare cover replacement of equipment or supplies damaged in a disaster?
Yes—if you have Original Medicare and it previously paid for the item (e.g., wheelchair, walker, diabetic supplies), Medicare will generally cover repair or replacement, as long as it’s obtained from a Medicare‑approved supplier
Q. What about temporary equipment rental while repairs are done?
If your equipment is damaged and needs repair (like a wheelchair), Medicare usually pays for a rental during the repair period .
Q. Are there any rules for repairs exceeding certain limits?
Repairs are covered up to the replacement cost of the item . For beneficiary-owned equipment, Medicare pays 80% of the approved repair cost if the supplier accepts assignment.
Q. What qualifies as a replacement?
A replacement must be identical—or nearly identical—to the lost or irreparably damaged item. Medicare won’t cover upgrades, like switching a manual wheelchair to a motorized one .
Q. How does Medicare define ‘irreparable damage’?
It includes loss, theft, or damage beyond repair—such as during a natural disaster (flood, fire)—or accidents.
Q. Is a new doctor’s order required during a disaster?
Usually yes—but during declared emergencies, face-to-face visit and new order requirements may be waived. The supplier must still document the need and emergency context.
Q: What documentation is needed for replacement?
Suppliers must submit a narrative explaining why replacement is needed, note the item’s loss or damage, and may need supporting documents like police or insurance reports.
Q. Am I still responsible for paying my Medicare plan premiums during a disaster?
Yes. Whether you have a Medicare Advantage (Part C), Part D, or other Medicare health plan, you’re required to pay your premiums on time, even during emergencies. Failure to pay may lead to plan disenrollment
Q. What happens if my plan disenrolls me for non-payment during a disaster?
If you miss a payment, your plan may disenroll you, resulting in loss of coverage. It’s important to set up reliable payment methods to prevent this .
Q. How can I ensure my premiums are paid on time?
You can request your plan to withhold payments directly from your Social Security check, or you can set up online bill pay, electronic funds transfer, or automatic bank withdrawals (like Medicare Easy Pay). Contact your plan to explore their available options.
Q. Can my Part C or Part D premiums also be deducted from my Social Security benefits?
Yes. While Part B premiums are typically automatically deducted, many Part C and Part D plans also allow tax-free premium withholding from Social Security. You’ll need to request this through your plan—Social Security doesn’t directly manage those deductions.
Q. What are other convenient payment options for my Medicare plan premiums?
Common alternatives include:
· Medicare Easy Pay: automatic deduction from a bank account
· Online bill-pay via your bank or the plan’s website
· Mail-in payments (check or money order)
Each plan has its own options—confirm with yours
Q. What is a Special Enrollment Period (SEP) in the context of Medicare?
An SEP allows individuals to enroll in or make changes to their Medicare coverage outside the standard enrollment periods due to specific circumstances, such as a disaster or emergency.
Q. How does a disaster or emergency affect my ability to enroll in Medicare?
If you live in an area where a federal, state, or local government has declared an emergency or disaster, and this event prevented you from enrolling or making changes during another qualifying enrollment period, you may qualify for a Special Enrollment Period.
Q. What actions can I take during this Special Enrollment Period?
Depending on your situation, you may be able to:
· Enroll in Medicare Part B and/or premium Part A (for Original Medicare).
· Join, switch, or drop a Medicare Advantage (Part C) or Medicare drug plan (Part D).medicareinteractive.org
Q. How long does this Special Enrollment Period last?
The SEP begins on the date the emergency or disaster is declared and lasts for six months after the end date of the declaration.
Q. How can I apply for this Special Enrollment Period?
To make enrollment changes or for more information, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Q. What documentation do I need to provide?
You may need to provide proof that you reside in the affected area during the period covered by the disaster or emergency declaration.
To learn more about this subject, tune into this video podcast.
Disclaimer: this material is intended for informational purposes only and does not constitute legal advice. The law varies by jurisdiction and is constantly changing. For legal advice, you should consult a lawyer that can apply the appropriate law to the facts in your case.