Medicare Frequently Asked Questions

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 $4,600 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.

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.

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.

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.

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.