Medicare Frequently Asked Questions
Here’s a list of questions typically asked by people looking for Medicare health insurance. If this list doesn’t answer all the question that you have, we’re here to help. Call 833-987-0765 to speak with a licensed agent.
Medicare Advantage Plans (also called Medicare Part C) are a type of Medicare health plan offered by a private company to provide all your Part A and Part B benefits. CareFirst BlueCross BlueShield Medicare Advantage plans include prescription drug benefits and extras like vision, hearing, dental and health and wellness programs. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. You can only see doctors and providers that are included in our high-quality network.
Medicare Supplement (also called Medigap) plans are designed to supplement Original Medicare coverage by paying for healthcare costs that original Medicare doesn’t pay. Medicare will pay its share, then your Medicare Supplement plan will pay its share. You’re able to visit any provider that accepts Medicare.
Medicare Advantage (Part C) plans: If you are age 65 or older, reside in our geographic service area, are enrolled in Medicare Part B, you are eligible to enroll during certain enrollment periods set by the Centers for Medicare and Medicaid (CMS). People under 65 with end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS) are eligible, too.
Medicare Supplement (Medigap) plans: If you are age 65 or older, reside in our geographic service area and are enrolled in Medicare Parts A and B, you’re eligible to enroll in Medicare Supplement plans during certain enrollment periods set by the Centers for Medicare and Medicaid (CMS). Additionally, those that have been diagnosed with end-stage renal disease or Lou Gehrig’s disease (ALS) are eligible to enroll in Medicare Supplement plans.
To find out if your doctor is in our Medicare Advantage network, use our Find a Doctor tool. Search our network of providers and hospitals using your doctor's last name.
Medicare Supplement plans are good at any doctor’s office that accepts Medicare. To see if your doctor accepts Medicare, find out here.
You can enroll in a Medicare Advantage plan during your initial enrollment period, during Medicare's Annual Election Period and during a qualifying special enrollment period. Go here for more information on the many enrollment periods.
You can enroll in a Medicare Supplement plan at any time. If you enroll within six months of your Medicare Part B effective date, your coverage will be guaranteed. That means you won’t have to go through medical underwriting—a series of questions related to your health. Learn more about the process here.
An HMO plan is short for Health Maintenance Organization plan. With an HMO plan, you select a primary care provider (PCP) from our network and that doctor coordinates all your care. Your PCP will refer you to specialists or hospitals if you require additional or specialized care. You must get your care from providers that are in the Plan name network.
Our CareFirst BlueCross BlueShield Medicare Advantage plans include prescription drug coverage. Our MedPlus Medicare Supplement plans do not include prescription drug coverage.
You may be able to get help with your premiums and other costs. Visit the Social Security Administration’s website (www.ssa.gov) to see if you qualify for assistance. Maryland residents may also be eligible for The Senior Prescription Drug Assistance Program (SPDAP). Visit their website for more information.
The donut hole, or coverage gap, starts when your total drug costs—including what you and your plan have paid for drugs—reaches $4,130 for the calendar year. When you enter the donut hole, the amount you pay for your prescriptions will increase. Because of this, you are eligible for discounts to help you pay for your drugs. You will pay 25% for generics drugs and 25% for brand name drugs. Discounts vary depending on the drug and your plan’s Formulary.
DSNP FAQ
Generally, your coverage will begin on the first day of the month after your completed enrollment form is received. If you enroll in our plan during the Annual Enrollment Period (October 15 through December 7), your effective date will be January 1 of the following calendar year.
Generally, you must receive care from a network provider. Please refer to our Online Provider Directory for a list of doctors in our network.
Most people can only enroll in a new plan during certain times of the year.
- Between October 15 and December 7 anyone can join, switch or drop a Medicare plan.
- In certain situations, you may be able to join, switch or drop a Medicare plan during a Special Enrollment Period.
Examples include:- If you move out of your plan’s service area
- If you have Medicaid
- If you qualify for Extra Help
- If you live in an institution (like a nursing home)
There are only certain times during the year when you may voluntarily end your membership in our plan. The key time to make changes is the Medicare fall open enrollment period (also known as the “Annual Election Period”), which occurs every year from October 15 through December 7. This is the time to review your healthcare and drug coverage for the following year and make changes to your Medicare health or prescription drug coverage. Any changes you make during this time will be effective January 1.
During the Medicare Advantage Open Enrollment Period (MA OEP) from January 1 - March 31, you can leave your plan and switch to another Medicare Advantage Plan or a Medicare Advantage only plan, or Original Medicare with or without a standalone Part D plan. If you switch to Original Medicare during this period, you’ll have until March 31 to also join a standalone prescription drug plan to add drug coverage. The effective date of the new plan is the first of the month following receipt of the enrollment request.
The MA OEP does not provide an opportunity for an individual enrolled in Original Medicare to join an MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in standalone Part D plans. The MA OEP is not available for those enrolled in Medicare Savings Accounts or other Medicare health plan types (such as cost plans or PACE). Certain individuals, such as those with Medicaid, those who get Extra Help, or those who move in or out of a plan’s service area, can make changes at other times.
You can also disenroll from our plan if you are eligible for a Special Enrollment Period. Examples that qualify you for a special enrollment include:
- You move in or out of a plan’s service area
- You have Medicaid
- You are eligible for Extra Help with Medicare prescriptions
- You live in an institution (such as a nursing home)
Generally, your membership will end on the last day of the month after we get your request to switch to Original Medicare or another plan. If you choose to enroll in a Medicare prescription drug plan, your membership in the drug plan will begin the first day of the month after the drug plan gets your completed enrollment request.
You may use any of the following ways to disenroll from our Medicare Advantage plans:
- Write a letter or fill out a disenrollment form.
- Please fax the form to our Enrollment Department through our secure fax at 410-779-9932 or toll-free at 844-329-1085 OR
- Mail it to our Enrollment Department at:
CareFirst Medicare Advantage
Attention: Enrollment Department
P.O. Box 915
Owings Mills, MD 21117 - Call Member Services–410-779-9932 or toll-free at 844-386-6762 (TTY users please call 711), 8 a.m. to 8 p.m. ET, seven days a week from October 1 through March 31 and Monday through Friday, April 1 through September 30.
- Call 800-MEDICARE (800-633-4227) (TTY/TDD users should call 1-877-486-2048) 24 hours a day, seven days a week.
Helpful Disenrollment Hints:
Completed disenrollment forms must be received and processed by the end of the month for the disenrollment to be effective for the 1st of the following month. If you are requesting a disenrollment after the 15th of the month, it is suggested that the form be faxed to ensure it is received and processed before the end of the month. Our fax number is 844-329-1085.
If you want to be disenrolled, please file your disenrollment in one of the defined manners above, please do not quit paying your plan premiums and assume that you will be disenrolled.
You will receive a letter from your plan confirming that your disenrollment/cancellation request has been approved, denied or if additional information is needed.If you would like to cancel your recent enrollment and it’s prior to your effective date, you do not need to fill out a disenrollment form, you can verbally request a cancellation of your enrollment by calling. Member Services at 844-386-6762, 8 a.m. to 8 p.m. ET, seven days a week from October 1 through March 31 and Monday through Friday, April 1 through September 30.
You must live in our service area to remain a member of our plan. Please notify us immediately if you move. If you move outside of a plan’s service area you will be disenrolled for the 1st of the following month.
In an effort to ensure that our records are as accurate as possible, please complete and return the form. Completing this form will help ensure there is no interruption to your coverage. You may also respond to our request for information by calling us.
You can’t use (and can’t be sold) a Medicare Supplement insurance (Medigap) policy while you’re in a Medicare Advantage plan. If you already have a Medigap policy and join a Medicare Advantage plan, you’ll probably want to drop your Medigap policy. If you drop your Medigap policy, you may not be able to get it back. Before giving up your Medigap policy, you should consider discussing your particular circumstance with your State’s Health Insurance Assistance Program (SHIP) office. A listing of offices is available by calling 800-MEDICARE (TTY/TDD users should call 877-486-2048) available 24 hours a day, 7 days a week or by visiting the www.medicare.gov website. The services are free.
Yes. There are instances in which we are required to end your membership in our plan. Examples include: if you are away from our service area for more than six months, loss of continuous Medicare Part A and Part B coverage, if you become incarcerated, commit fraud and/or participate in disruptive behavior against the plan.
As long as you still qualify, your TRICARE, VA, or FEHB prescription drug coverage is not changing. You should contact your benefits administrator or FEHB insurer for information about your TRICARE, VA, or FEHP coverage before making any changes. It will almost always be to your advantage to keep your current coverage without any changes.
If you lose your TRICARE, VA, or FEHB coverage and you join a Medicare Advantage Prescription Drug Plan, in most cases you won’t have to pay a penalty, as long as you enroll within 60 days of losing the TRICARE, VA, or FEHB coverage.
Yes, you can change your primary care provider. Please refer to our online provider directory for assistance in locating a primary care provider.
Each plan is different so it’s important you refer to the plan’s Evidence of Coverage (EOC). The EOC serves as the legal contract between the member and the plan and will provide specific information on benefits and coverage. While not a complete list, below are the most common exclusions about which we are asked.
Exclusions:
- Services and equipment which are not reasonable or medically necessary to treat an illness
- Plastic or cosmetic surgery, unless medically necessary
- Personal convenience items or services
- Immunizations for travel or employment
- Special duty nurses, unless medically necessary
- Private hospital room, unless medically necessary and approved by your plan in advance
- Custodial care
- Benefits and services not covered by Medicare unless specifically described as a covered service in your plan materials
If I travel, does Medicare still cover me?
See which parts and plans of Medicare can tag along.
Medicare and Traveling in the United States
Yes, you can use your Medicare plan anywhere in the country.
When traveling, all Original Medicare (Parts A & B) benefits apply, but only for care by U.S. providers who accept Medicare. It’s important to understand provider types because it can affect your out-of-pocket costs.
PROVIDER TYPES
Participating Providers
These are doctors who accept Medicare and always accept the full payment of a Medicare-approved amount for health services.
Non-Participating ProvidersThese are doctors who accept Medicare. However, they DO NOT accept the full payment. These providers can charge up to 15% more than the Medicare-approved amount.
Opt-Out Providers
These are doctors who do not accept Medicare at all. You will be responsible for 100% of the bill.
To pay the lowest out-of-pocket cost while traveling, choose Medicare-participating doctors or hospitals. That way you’ll be responsible only for copays or deductibles.
Go to the doctor’s front desk or hospital admissions desk and ask if they accept Medicare.
Also, when planning your trip, it’s always a good idea to do a search for doctors and hospitals that accept Medicare near your destination.
In the event of an emergency or necessary treatment, please get the care you need while traveling. That means you may have to visit a non-participating provider or one that doesn’t accept Medicare. It may also mean paying more out-of-pocket or even the full bill. But your health is too important to delay or ignore getting the care you need.
If you have Medicare Supplement (Medigap), you can use it in any state and at any doctor or hospital that accepts Medicare.
If you have a Medicare Advantage (Part C) plan that’s an HMO, your plan only pays for care from in-network providers. Before traveling, check with your plan to make sure you can use your coverage in another state.
If your Medicare Advantage plan is a PPO, you may pay more to receive care outside your network than you would pay to see an in-network provider. Generally, these plans are less restricted than HMOs in terms of which doctors you may see. Again, before traveling, check with your plan to make sure you can use your coverage in another state.
Your Medicare Part D prescription drug plan may cover you. However, many plans feature a pharmacy network that you must use for coverage, or for the lowest out-of-pocket prices. Check with your Medicare Part D plan provider. They’ll let you know your options for refilling or picking up medications while traveling.
Medicare and Foreign Travel
In most cases, Medicare Parts A & B won’t pay for the care you get outside the United States. This excludes Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands.
- Medicare will cover you in a foreign hospital if:
- You live in the United States, and
- The foreign hospital is closer than the nearest U.S. hospital
Medicare may cover you in Canada if: - You have a medical emergency while traveling on a direct route, without unreasonable delay*, between Alaska and another U.S. state, and
- The Canadian hospital is closer than the nearest U.S hospital
- Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis
- Medicare will cover necessary treatment while you’re on a cruise ship if:
- The ship is in U.S. waters or a U.S. port, or
- Within six hours of arrival or departure from a U.S port, and
- The doctor treating you is legally allowed to provide medical care on a cruise ship
Remember, in these situations, Medicare will pay only for the Medicare-covered services.
Some Medicare Supplement (Medigap) and Medicare Advantage (Part C) plans offer protection in foreign countries. While this coverage is still only for emergency care, they can help to reduce your out-of-pocket costs. Before traveling, check with your Medicare Advantage plan to make sure you can use your coverage in foreign country.