Here’s a list of questions typically asked by people looking for Medicare health insurance. If this list doesn’t answer all the questions that you have, we’re here to help. Call 833-987-0765 to speak with a licensed agent.
Medicare Basics
Medicare Advantage Plans (also called Medicare Part C) are Medicare health plans offered by private companies to provide your Part A and Part B benefits. CareFirst BlueCross BlueShield Medicare Advantage plans may include extra vision, hearing, dental, and health and wellness benefits. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan.
Medicare Supplement (also called Medigap) plans supplement Original Medicare by helping pay health care costs that Original Medicare doesn’t cover. Medicare pays its share, then your Medicare Supplement plan pays its share. You can visit any provider that accepts Medicare.
PPO stands for Preferred Provider Organization. A Preferred Provider Organization is a network of doctors, hospitals and healthcare providers who agree to provide care at a certain rate. Unlike an HMO, in a PPO you are not limited to providers who are in network, though your copay or out-of-pocket cost for out-of-network visits may be higher than for in-network providers.
CareFirst BlueCross BlueShield Medicare Advantage Essential, Complete and Signature (PPO) plans include prescription drug coverage. MedPlus Medicare Supplement plans and CareFirst BlueCross BlueShield Advantage Salute (PPO) do not include prescription drug coverage.
Eligibility & Enrollment
Medicare Advantage (Part C) plans: If you are age 65 or older, reside in our geographic service area and 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 also eligible.
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). People under 65 with end-stage renal disease (ESRD) or Lou Gehrig’s disease (ALS) are also eligible.
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 these 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.
Providers
To find out if your doctor is in our Medicare Advantage network, use our Find Care 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.
Participating Providers
These are doctors who accept Medicare and always accept the full payment of a Medicare-approved amount for health services.
Non-Participating Providers
These 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.
Go to the doctor’s front desk or hospital admissions desk and ask if they accept Medicare.
Costs & Financial Assistance
Travel Coverage
Medicare and Travel in the United States
Yes, Medicare may provide coverage while you're traveling.
See which parts and plans of Medicare can travel with you and what coverage is available away from home.
Before traveling, it's a good idea to identify doctors and hospitals near your destination that accept Medicare.
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.
To pay the lowest out-of-pocket cost while traveling, choose Medicare-participating doctors or hospitals whenever possible. Participating providers accept Medicare-approved payment amounts, while non-participating and opt-out providers may result in higher costs.
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 a Medicare Supplement (Medigap) plan, you can use it in any state and at any doctor or hospital that accepts Medicare.
When 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 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 and B don’t pay for care outside the United States. Medicare can cover care in U.S. territories, including Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and 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 only for emergency care, it can help reduce your out-of-pocket costs. Before traveling, check with your Medicare Advantage plan to make sure you can use your coverage in a foreign country.
Primary Care Provider (PCP)
There are two possible reasons:
- During enrollment, you didn’t choose a PCP, so one was automatically assigned to you.
- During enrollment, you may have selected a PCP who:
- Is no longer accepting new patients
- Isn’t categorized as a PCP
- May not be an in-network provider for your plan
You can request a PCP change in 3 ways:
- Go to My Account and update your PCP directly.
- Complete the PCP change form found on our website.
- Visit carefirst.com/mddsnp. Click on the Resources tab.
- Under DualPrime Resources, select Plan Documents & Forms.
- Click on the Medical Forms tab, then choose the PCP Change Request Form.
- Download the form and follow the instructions.
- Call Member Services at:
844-386-6762 (TTY: 711).
Hours: 8 a.m.-8 p.m. ET
7 days a week October 1-March 31
Monday-Friday April 1-September 30
You can see an in-network PCP at any time— unless that provider requires that they be listed on your card. If this is the case, you’ll need to request a new card. Typically, it takes 7–10 business days from the time of your request to issue a new card.
Coverage and ID Cards
Yes, it’s a good idea to keep all three cards with you when you visit a provider or pharmacy. You should only show your CareFirst Medicare Advantage card for any Medicare-covered services. You should only show your Medicaid card, when accessing Medicaid-covered services. To learn more about CareFirst Medicare Advantage benefits, refer to Chapter 4 in your Evidence of Coverage. For information about your Maryland Medical Assistance (Medicaid) benefits, go to the Maryland Health Connection website at marylandhealthconnection.gov/after-youenroll/medicaid/what-medicaid-covers/.
First, be sure to check that what you’ve received is actually a bill and not a Statement of Account. A Statement of Account is provided for your reference but doesn’t require payment.
If you did receive a bill, there may be several reasons:
- The provider may not be aware that they need to submit the balance to Medicaid. Contact your provider and make sure they have your Medicaid ID number on file.
- Providers may try to bill members for charges that either exceed the allowed amount or are for a non-covered service/ item. This is known as balance billing, and it’s prohibited
- If you think you’re being balance billed, please call Member Services at 844-386-6762 (TTY: 711).
Your provider can confirm coverage on your behalf. You can also call Member Services at 844-386-6762 (TTY: 711) for confirmation. Be sure to get a CPT code for the procedure from your provider before calling.
Providers
The Pharmacy and Provider directory can be found on the CareFirst BlueCross BlueShield Medicare Advantage webpage under Plan Documents & Forms:
- Visit carefirst.com/mddsnp and select the Resources tab.
- Under DualPrime Resources, choose Plan Documents & Forms.
- Click on either Pharmacy Directory or Provider Directory.
Benefits & Rewards
There are two ways to activate your card:
- Visit your personalized MyBenefits portal at dualprime.nationsbenefits.com/activate.
- Call 844-479-6334 (TTY: 711), 8 a.m.-8 p.m. ET, 7 days a week.
Support
To authorize a representative, you’ll need to fill out the form found in the Medical Forms section of our website:
- Visit carefirst.com/mddsnp and select the Resources tab.
- Under DualPrime Resources, choose Plan Documents & Forms.
- Click Medical Forms and select Appointment of Representative.
- Download the form and follow the instructions.
CareFirst may communicate to you through various methods, including:
- Emails
- Phone calls
- Text messages on your phone
Call Member Services at 844-386-6762 (TTY: 711) for assistance with complaints, appeals or grievances. We are here to help!
DualPrime Health Benefits
410-779-9932 or 844-386-6762 (TTY: 711)
8 a.m.-8 p.m. ET
7 days a week October 1-March 31
Monday-Friday, April 1-September 30
Vision Benefits (Superior Vision)
844-475-6334 (TTY: 711)
8 a.m.-8 p.m. ET
Monday-Friday
Dental Benefits (DentaQuest)
844-474-6334 (TTY: 711)
8 a.m.-8 p.m. ET
Monday-Friday
Hearing (Nations Hearing)
877-438-9544 (TTY: 711)
8 a.m.-8 p.m. ET
Monday-Friday
Transportation (SafeRide)
844-476-6334
8 a.m.-8 p.m. ET
7 days a week October 1-March 31
Monday-Friday, April 1-September 30