General FAQs

Medicare Advantage is also known as Medicare Part C and it combines your hospital (Part A), doctor (Part B) and sometimes drug coverage (Part D) all in one plan. These plans follow all of the rules and cover all the benefits covered by Original Medicare and are offered by private insurance companies like CareFirst. Under a Medicare Advantage plan, CareFirst can offer additional supplemental benefits like a nurse line, fitness program, telehealth benefits and in home assessments that are not covered by Medicare Part A or Part B.

Yes, to be enrolled in any of these three Medicare Advantage Group PPO Plans, Medicare beneficiaries must be enrolled in Medicare Part A and Part B and continue to pay their Part B premium. For higher income retirees, if assessed with Part B and Part D Income Related Monthly Adjustment Amounts (IRMAA), will need to continue to pay your Part B and Part D IRMAA premiums.

Unfortunately, the Centers of Medicare and Medicaid Services (CMS) will ask CareFirst to dis-enroll you from the CareFirst Medicare Advantage plan. You would need to work with Social Security to determine how you can be reinstated with Medicare and will not have drug or medical coverage through CareFirst during that time.

You will receive a welcome kit and a CareFirst ID card for your Medicare Advantage plan. Your new Medicare Advantage ID card will be needed to ensure that claims will be filed correctly by your providers, and they can access your benefits accurately. Make sure you keep your Original Medicare card somewhere safe, but you will not need to show it to your doctors.

Yes, there are copays based on the service you receive. Some benefits may have coinsurance, please refer to the materials mailed to you for common cost shares. Once available, you can refer to your Evidence of Coverage (EOC), Chapter 4 Medical Benefits Chart, for detailed benefit information.

Yes, and while we encourage you to visit network providers, you can go to any provider, hospital, or facility that accepts Medicare and is willing to bill CareFirst or their local Blues plan if the provider is outside of MD or DC. In and out of network medical cost-sharing are the same under this plan.

If your provider is in the CareFirst Medicare Advantage PPO network (visit www.carefirst.com/findadocmappo), you can continue to see them. If they are not in the network, if they accept Medicare and are willing to bill CareFirst or their local Blues plan, you can continue to see them. If you do not see your provider in our directory, please contact them directly and ensure they are willing to bill CareFirst before your visit.

With a Medicare Advantage PPO plan, you will have access to a national provider network through the Blue Cross and Blue Shield Association. However, if your doctor is not in the network, if they accept Medicare and are willing to bill CareFirst or their local Blues plan for the services they provide to you, your medically necessary services will be covered. The good news is that your out-of-pocket expense or medical cost-sharing will be the same for doctors who are in and out of network.

No, this plan does not require referrals.

Yes. If you obtain some prescriptions from the VA, you may continue to do so. This is a separate benefit, and may have separate formularies, copays, and restrictions in place.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs. For more information about Extra Help, contact your local Social Security office or call Social Security at 800-772-1213. TTY users should call 800-325-0778. You can also apply for Extra Help online at https://www.cms.gov/medicare/eligibility-and-enrollment/lowincsubmedicareprescov.

CareFirst ID Cards and Welcome Kits will be received prior to your effective date. Retirees and Medicare eligible dependents will each receive their own card. Please note that each enrollee may not receive their plan information on the same day. This is normal.

The Coverage Summaries are policies based on existing current Medicare National Coverage Determinations, Local Coverage Determinations, CareFirst Medical Policies, and applicable CareFirst BlueCross BlueShield Medicare Advantage Plans EOCs and SOBs intended to provide benefit coverage information and guidelines specific to CareFirst BlueCross BlueShield Medicare Advantage Plans.