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Medicare Advantage Dual Prime
(HMO-SNP) Plans

CareFirst BlueCross BlueShield Medicare Advantage Dual Prime (HMO-SNP)

The Dual Prime (HMO-SNP) plan is a Medicare Advantage with prescription drug plan. It’s for those with both Medicare and Medicaid (Maryland Medical Assistance Program) as a Qualified Medicare Beneficiary (QMB) or a Full Benefit Dual Eligible (FBDE). Benefits of this plan focus on improving your overall health. All-in-one Dual Prime plans combine your medical, hospital and prescription drug coverage with extra services and personalized programs.

To be eligible for the Dual Prime (HMO-SNP) plan, you must also have Medicare Parts A & B and reside in one of the following Maryland counties: Anne Arundel, Baltimore, Baltimore City, Caroline, Carroll, Cecil, Charles, Dorchester, Howard, Harford, Kent, Montgomery, Prince Georges, Queen Anne’s and Talbot.

 

Enrolling is easy

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Enroll by Phone

Call us toll free to enroll over the phone or schedule a meeting with a licensed sales agent:

Phone: 844-811-6334 (TTY:711)
October 1-March 31 | 8 a.m.-8 p.m. ET | 7 days a week
April 1-September 30 | 8 a.m.-8 p.m. ET | Monday–Friday

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Enroll by Mail

Download a copy of our Enrollment Form, fill it out, sign and date it and mail it to us at:

Attention: Sales Department
PO Box 915
Owings Mills, MD 21117

 

2021 Dual Prime Plan (HMO-SNP)

The 2021 Dual Prime plan (HMO-SNP) is a Medicare Advantage Prescription Drug Plan for those with both Medicare and Medicaid (Maryland Medical Assistance Program) as a Qualified Medicare Beneficiary (QMB) or a Full Benefit Dual Eligible (FBDE). This plan combines your Medical, Hospital and Prescription Drug coverage with extra services and personalized programs focused on improving your health.

To be eligible for the Dual Prime (HMO-SNP) plan, you must also have Medicare Parts A & B and reside in the following Maryland counties: Anne Arundel, Baltimore, Baltimore City, Caroline, Carroll, Cecil, Charles, Dorchester, Howard, Harford, Kent, Montgomery, Prince Georges, Queen Anne’s, and Talbot.

How much you pay for covered services

How much you pay for covered services
Benefits What you pay with Dual Prime
Monthly Plan Premium $0 - $32.30 (Depending on your level of extra help)
Maximum Out-of-Pocket $7,550
Part B Benefits Deductible $0
Primary Care Physician Visit $0 or 20% coinsurance**
Specialist Visit $0 or 20% coinsurance**
Inpatient Hospital Care
  • Days 1-60: $0 per day
  • Days 61-90: $0 per day
  • Days 91-150: $0 per Lifetime Reserve Day
Emergency Care $0 or 20% coinsurance**
Durable Medical Equipment $0 or 20% coinsurance**

Part D Deductible

$0

Prescription Drug Coverage
(30-day supply)

  • For generic drugs (including brand drugs treated as generic), you pay either: $0, $1.30, or $3.70 copay.**
  • For all other drugs, you pay either: $0, $4, or $9.20 copay.**

Preventive Services

$0 copayment

Routine Podiatry
  • Medicare Covered Services: $0
  • Routine Foot Care: 4 visits per year $0 copay
Transportation $0 copayment for 24 one-way trips per year
Preventive Dental $0 copayment
  • Oral exams: every 6 months
  • Comprehensive oral exam: every 36 months
  • Prophylaxis: every 6 months
  • Fluoride treatment: every 6 months
  • Palliative treatment: 3 every 12 months
  • Bitewing x-ray: once per 12 months
  • Panoramic x-ray: once every 36 months
  • Vertical bitewing x-ray: once every 36 months
  • Intraoral imaging: once every 36 months
Comprehensive Dental Coverage limit is $1,000 every year. Member is responsible for all costs over $1,000 annual maximum. $0 copay for the following:
  • Restorative services: 1 restoration per tooth once every 24 months
  • Endodontics: 1 per lifetime, per patient, per tooth
  • Crowns: once per tooth per 60 months
  • Simple Extractions
  • Periodontics: 1 per quadrant of scaling every 36 months
  • Dentures: once every 60 months (not included under $1,000 dental allowance)
  • Denture repairs: once every 12 months
  • Denture relines/rebase: once every 36 months
  • Denture adjustments: 2 per 12 months
Routine Hearing and Hearing Aids
  • Medicare-covered exam to diagnose and treat hearing and balance issues: $0 copay
  • Routine hearing exam (1 per year): $0 copay
  • 1 fitting and evaluation with 3 follow up visits within the first year from date of initial fitting: $0 copay
Our plan pays up to $1,350 every 3 years for hearing aids
Routine Vision
  • Medicare-covered exam for diagnosis and treatment of diseases and injuries of the eye: $0 copay
  • Routine Eye Exam (1 per year): $0 copay

Our plan pays up to $150 annually towards the purchase of eyewear
Over-The-Counter $90 quarterly allowance through the plan's OTC Catalog
Health & Wellness Program $0 copay - 1 at-home fitness kit per quarter

Personal Emergency

Response System (PERS) 		$0 copay - available to select members living with a disability or chronic condition such as COPD, CHF, Diabetes, or ESRD
Meals with Medical Nutrition Therapy $0 copay - 12 consecutive weeks of meals for members with COPD, CHF, Diabetes, or ESRD. Members will also receive up to 4 medical nutrition therapy sessions
Readmission Prevention $0 copay - 14 meals per 1-week period for members post-discharge from an inpatient stay. PERS will also be available to select members upon discharge for a defined period of time.
Bathroom Safety Devices $0 copay for 2 devices each year ordered through the plan's Bathroom Safety Catalog
Healthy Rewards Program $15 reward cards for completing select preventive services

**If Medicaid status changes from Full Benefit Dual Eligible (FBDE) or Qualified Medicare Beneficiary (QMB), your copays and coinsurances will increase to 20% of the total cost of the service and 25% of the total cost of the Part D drug.

Download 2021 Enrollment Form

Plan documents for members

For specific information on your benefits, services, cost shares and health plan operations please review the plan documents linked below. You can also download a PDF to save on your computer or print out a copy for your records.

The Summary of Benefits is an easy-to-understand list of selected plan benefits, services and costs.

The Annual Notice of Change tells you how your benefits and costs will change for the new year (to be effective in January).

The Evidence of Coverage gives you details about what the plan covers, how much you pay, how to use the health plan services and much more.

2021

Health Evaluation Icon Summary of Benefits (PDF)
Health Evaluation Icon Annual Notice of Change (PDF)
Health Evaluation Icon Evidence of Coverage (PDF)
 
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Find A Doctor

Choose from a large local network of physicians and providers that includes over 9,000 local providers and 31 major hospital affiliations. Need help finding a doctor? Call Member Services at 410-779-9932 or toll-free at 844-386-6762 (TTY: 711).

Find A Doctor
Drug Icon

Search Pharmacy Directory

You can use this Pharmacy Locator tool to locate a network pharmacy or to determine if your pharmacy is in the network, or you can call our Medicare Part D Member Services at 1-844-786-6762, 24 hours a day, 7 days a week. TTY users, please call 711.​

Search Our 2021 Online Pharmacy Directory
 

Out-of-network providers

You must receive your care from a network provider

In most cases, care you receive from an out-of-network provider (a provider who is not part of our plan’s network) will not be covered. Here are three exceptions:

  • The plan covers medical emergency care or urgently needed services that you get from an out-of-network provider. For more information about this, and to see what emergency or urgently needed services means below.
  • If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. Authorization must be obtained from the plan prior to seeking care. In this situation, we will cover these services as if you got the care from a network provider.
  • The plan covers kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside CareFirst Medicare Advantage’s service area.

Medical emergencies

A “medical emergency” is when you, or any other prudent layperson with an average knowledge of health and medicine, believe that you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse.

Urgently needed services

“Urgently needed services” are non-emergency, unforeseen medical illness, injury, or condition that requires immediate medical care. Urgently needed services may be furnished by network providers or by out-of-network providers when network providers are temporarily unavailable or inaccessible. The unforeseen condition could, for example, be an unforeseen flare-up of a known condition that you have.

You are covered only for emergency services, urgently needed care, and kidney dialysis services when you are temporarily traveling outside the plan’s service area. The plan does not cover routine health care services or follow-up health care services for while you are outside of the service area. This means outside the Maryland counties of Anne Arundel, Baltimore, Baltimore City, Caroline, Carroll, Cecil, Charles, Dorchester, Harford, Howard, Kent, Montgomery, Prince Georges, Queen Anne’s, and Talbot.

The plan will continue to provide coverage for your Part D prescription drugs so long as you continue to purchase them from network pharmacies. Our network of pharmacies spans across the United States, so contact our Member Services Department at 1-844-786-6762 (TTY users please call 711), 24 hours a day, 7 days a week to see if the pharmacies in the area you are traveling to are in our network.

If you have a second home located outside of the plan’s service area that you travel to each year for a couple months, you are covered only for emergency services, urgently needed care, and kidney dialysis services when you are temporarily traveling outside the plan’s service area. The plan does not cover routine health care services or follow-up health care services for while you are outside of the service area.

The plan will continue to provide coverage for your Part D prescription drugs so long as you continue to purchase them from network pharmacies.  Our network of pharmacies spans across the United States, so contact our Member Services Department at 1-844-786-6762 (TTY users please call 711), 24 hours a day, 7 days a week to see if the pharmacies in the area you are traveling to are in our network.

It is important to understand that if you take a long trip and are going to be outside the plan’s service area for more than six (6) months, the plan must end your membership in accordance with federal regulations.

In order to receive all of your covered benefits, you must be within the plan’s service area and receive the care from our network of hospitals, providers, and ancillary vendors. Our service area includes the following Maryland counties: Anne Arundel, Baltimore, Baltimore City, Caroline, Carroll, Cecil, Charles, Dorchester, Harford, Howard, Kent, Montgomery, Prince Georges, Queen Anne’s, and Talbot.

You are only covered for emergency services, urgently needed care, and kidney dialysis services when you are temporarily traveling outside the plan’s service area.

When you are outside the service area and cannot get care from a network provider, CareFirst Medicare Advantage will cover urgently needed services that you get from any provider.

We will cover prescriptions filled at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgently needed care. In this situation, you will have to pay the full cost (rather than paying just your copayment) when you fill your prescription. You can ask us to reimburse you for our share of the cost, if applicable, by submitting a paper claim.

CareFirst Medicare Advantage is a health maintenance organization, also known as a HMO with a Medicare contract. In HMO Plans, you can't get your health care from any doctor, other health care provider, or hospital. You generally must get your care and services from doctors, other health care providers, or hospitals in the plan's network (except emergency care, out-of-area urgent care, or out-of-area dialysis) with whom the plan has contracted to provide all covered services. This enables the plan to pass on cost-savings to its members.

You should always try to obtain urgently needed services from network providers. However, if providers are temporarily unavailable or inaccessible and it is not reasonable to wait to obtain care from your network provider when the network becomes available, we will cover urgently needed services that you get from an out-of-network provider.

Our service area

CareFirst offers Medicare Advantage Dual Prime (HMO-SNP) Plans coverage to residents of the following Maryland counties:

Plan Year 2021

  • Anne Arundel
  • Baltimore
  • Baltimore City
  • Caroline
  • Carroll
  • Cecil
  • Charles
  • Dorchester
  • Howard
  • Harford
  • Kent
  • Montgomery
  • Prince Georges
  • Queen Anne’s
  • Talbot

Plan Year 2022

  • Anne Arundel
  • Baltimore
  • Baltimore City
  • Calvert
  • Caroline
  • Carroll
  • Cecil
  • Charles
  • Dorchester
  • Frederick
  • Howard
  • Harford
  • Kent
  • Montgomery
  • Prince Georges
  • Queen Anne’s
  • St. Mary’s
  • Somerset
  • Talbot
  • Wicomico
  • Worcester