Medicare Supplement Pre-Enrollment Checklist
1. Identify what you want from your Medicare coverage?
How much you pay—check one.
- Pay a higher insurance premium for access to any provider that accepts Medicare with lower out-of-pocket costs.
- Pay a lower insurance premium for access to CareFirst’s select provider network with a higher out-of-pocket cost.
Added benefits—check all that are important to you.
- Prescription drug coverage (Medicare Part D)
- Preventative dental coverage
- Routine eye exam and eyewear coverage
- Hearing exams and hearing aid coverage
- Fitness classes
2. What doctors do you see?
List all the doctors you visit. This will help us connect you with the right provider network.
List all the doctors you visit. This will help us connect you with the right provider network.
Primary Care Provider (your general practitioner, family doctor, generalist, etc.)
Name____________________________________
Address__________________________________
Specialists
Name____________________________________
Address__________________________________
Name____________________________________
Address__________________________________
Hospitals
Name____________________________________
Address__________________________________
3. What medications do you take?
List out each of your prescriptions along with dosage and how often you take them.
Medication name | Dosage | How often?
4. Call CareFirst BlueCross BlueShield.
Licensed Sales Agents are here to help you pick a plan that’s right for you. We’re also available to help you understand the many parts of Medicare and what they offer. Please have this checklist available for our call. Speak to a Licensed Sales Agent at 833-987-0764.