Welcome
Welcome to the CareFirst Medicare Advantage website for DC Government. Use this site to find doctors in our network, access your Summary of Benefits, check to see if your drugs are on the formulary, and review other information about your plan.
CareFirst BlueCross BlueShield Group Advantage (PPO) Plan Information
Below you’ll find plan documents to help you understand what your benefits cover and how to use them. Read through each for important benefit details, prescription drug coverage, and more.
Have a question?
- For eligibility and premium questions, contact DC Government’s Benefits Office at 202-442-7627 (Monday-Friday, 8:30 a.m. – 5 p.m. ET).
- For plan and benefit questions, call CareFirst Medicare Advantage Member Services at 833-320-2664, TTY: 711 (Monday-Friday, 8 a.m. – 6 p.m. ET)
General Plan Information
2024 Documents
2025 Documents
Your Evidence of Coverage - Detailed Plan Benefits
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EOC (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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EOC (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
Medical Benefits/Materials
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Summary of Benefits (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Medical Provider Directory (PDF) EnglishThis link opens in a new window. |
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Network FAQs (PDF)This link opens in a new window. |
2025 Documents
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Summary of Benefits (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Medical Provider Directory (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Network FAQs (PDF)This link opens in a new window. |
Prescription Drug Information - For the CareFirst BlueCross BlueShield Group Advantage (PPO) Plan only
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Formulary (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Formulary Changes (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Standard Enhanced Drug List (PDF) English | Spanish |
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Pharmacy Directory (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Step Therapy Criteria (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Prior Authorization Criteria (PDF) English | Spanish |
2025 Documents
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Formulary (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Formulary Changes (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Standard Enhanced Drug List (PDF) English | Spanish |
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Pharmacy Directory (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Step Therapy Criteria (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Prior Authorization Criteria (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
Vision Benefits/Materials
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Vision Directory (PDF) EnglishThis link opens in a new window. |
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Vision Directory (PDF) EnglishThis link opens in a new window. | Spanish This link opens in a new window. |
Hearing Benefits/Materials
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Hearing Directory (PDF) EnglishThis link opens in a new window. |
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Hearing Directory (PDF) EnglishThis link opens in a new window. | Spanish This link opens in a new window. |
Forms
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Enrollment Application (PDF) English This link opens in a new window. | Spanish This link opens in a new window. |
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Reconsideration Request Form (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Mail Order Pharmacy Enrollment Form (PDF) This link opens in a new window. |
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Coverage Determination Form (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Coverage Redetermination Form (PDF) EnglishThis link opens in a new window. | SpanishThis link opens in a new window. |
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Designation of Personal Representative Form (PDF) This link opens in a new window. |
Search for your Prescriptions
Find out if your prescription is covered.
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