With Original Medicare
Original Medicare has no network. You can see any doctor, hospital or other provider in the U.S. that accepts Medicare, whether you're home in Asheville or evacuated to another state. A Medigap policy pays its share wherever Medicare pays. A hurricane doesn't change this.
With Medicare Advantage: the disaster rule
Federal rule 42 CFR 422.100(m) applies when both of these are true:
- A disaster or emergency is declared by the President (Stafford Act or National Emergencies Act), the HHS Secretary (public health emergency) or the Governor of North Carolina, and
- access to health care in the plan's service area is disrupted.
Then your Medicare Advantage plan must:
- Cover care at non-contracted facilities. Part A, Part B and supplemental benefits at Medicare-certified facilities outside the network.
- Drop referral requirements in full.
- Charge in-network cost sharing for that care.
- Make helpful changes right away, without the usual 30-day notice.
Medicare.gov adds that the care doesn't have to be an emergency, and that you should contact your plan for help finding a provider. If you pay more than the in-network rate, save the receipt and ask for a refund.
How this played out with Helene
For Hurricane Helene, FEMA's major disaster declaration DR-4827-NC covered an incident period of September 25 to December 18, 2024, and an earlier federal emergency declaration, EM-3617, covered the whole state. That is the kind of presidential declaration that brings the Medicare Advantage rule into play wherever access to care is disrupted. In a future storm, ask your plan whether it is applying the rule in your county.
Practical tips
- Keep your plan card or a photo of it. If you lose it, 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) can give you your plan's contact information.
- Ask the provider to bill your plan, and call the plan if a claim is denied as out of network during a declared disaster.
- For dialysis, call your plan and ESRD Network 6 at 1-800-238-3773.
If network limits worry you, compare your options before December 7. To review plans from the companies they work with, you can request a call from a licensed insurance agent. Full guide: hurricanes, floods and Medicare in North Carolina.
Related questions
What happens to my Medicare after a hurricane?
What changes after a declaration.
Is there a special enrollment period after a disaster?
Who qualifies and when it ends.
Will Medicare replace equipment lost in a flood?
Wheelchairs, oxygen and supplies.
Sources
- eCFR — 42 CFR 422.100(m), special requirements during a disaster or emergency
- eCFR — 42 CFR 422.113, emergency and urgently needed services
- Medicare.gov — Getting care in a disaster or emergency
- FEMA — DR-4827-NC, Tropical Storm Helene
More questions in this guide
- Can I get an early prescription refill before a hurricane in North Carolina?
- Is there a Medicare special enrollment period after a disaster in North Carolina?
- What happens to my Medicare after a hurricane in North Carolina?
- Will Medicare replace my wheelchair or oxygen lost in a flood?
Part of the guide: Hurricanes, Floods and Your Medicare in North Carolina · All questions
Frequently asked questions
How long do the Medicare Advantage disaster rules last?
Until 30 days after all the declarations for your area end, or until access to care is no longer disrupted, whichever comes first (42 CFR 422.100(m)(3)).
Does a county emergency declaration count?
Not for these network rules. They apply to presidential, HHS public health emergency and governor declarations. A local declaration can still count for the disaster special enrollment period.
What if I paid more than my in-network cost?
Medicare.gov says to save your receipt and ask your plan to refund the difference between what you paid and the in-network rate.
Is emergency care covered out of network even without a declaration?
Yes. Medicare Advantage plans must cover emergency and urgently needed services in or out of network, without prior authorization (42 CFR 422.113).
Medicare in your North Carolina county
Plans, local agents and help, county by county: Wake · Mecklenburg · Guilford · Forsyth · Durham · Cumberland · Buncombe · Union · Johnston · Cabarrus · New Hanover · Gaston · Onslow · Iredell · Alamance · Pitt · Davidson · Brunswick · Catawba · Rowan · All 100 counties →
