Declaration of Disaster or Emergency for Medicare Members

If the Colorado Governor, the U.S. Secretary of Health and Human Services,  the Centers for Medicare & Medicaid Services (CMS), or the President of the United States declares a state of disaster or emergency in our geographic service area, Denver Health Medical Plan will make every effort to keep our facilities, medical offices and pharmacies open to care for you.

In the event of a disaster, we will post information, as it becomes available, on our website.

During a declared state of disaster or emergency, if you need care and you can't make it to an in-network facility, medical office or pharmacy – or if we are closed:

  • Part A, Part B and supplemental Part C plan benefits that are medically necessary may be covered at out-of-network facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities)
    • You are always covered at any urgent care or emergency room in the U.S.
  • Where applicable, requirements for referrals are waived in full
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced
  • The 30-day notification requirement to members for the temporary plan changes listed above is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member
  • Communication will be sent via a pharmacy network broadcast to all network pharmacies within the disaster area and contiguous states notifying them that the plan will allow use of the Emergency Preparedness Overrides 
  • If a member needs to access an out of network pharmacy during a declared emergency, members will be able to submit a direct member reimbursement claim

If the authorized source that declared a disaster or emergency hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.
Out-of-network/non- contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Health Plan Services at 1-877-956-2111 (TTY 711) or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.