When will my plan coverage become effective?
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 1st of the following calendar year.
Can I continue to go to my current doctors?
Generally, you must receive care from a network provider. Please refer to our Online Provider Directory for a list of doctors in our network
I already belong to another Medicare Advantage plan. Can I switch to a CareFirst Medicare Advantage plan?
Most people can only enroll in a new plan during certain times of the year.
What if I decide I no longer want my coverage from CareFirst Medicare Advantage?
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 health care 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 stand-alone Part D Plan. If you switch to Original Medicare during this period, you’ll have until March 31 to also join a stand-alone Prescription Drug Plan to add drug coverage. The effective date of the new plans 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 a MA plan. It also does not allow for Part D changes for individuals enrolled in Original Medicare, including those enrolled in stand-alone 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/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:
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:
Helpful Disenrollment Hints:
What if I move out of my plan’s service area?
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.
What if I receive a survey from CareFirst Medicare Advantage about a move out of the service area and I haven’t moved?
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.
Will I need to keep my Medigap policy?
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 1-800-MEDICARE (TTY/TDD users should call 1-877-486-2048) available 24 hours a day, 7 days a week or by visiting the www.medicare.gov website. The services are free.
Can I be involuntarily disenrolled from my plan?
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 6 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.
What do I need to know if I have drug coverage from TRICARE, the Department of Veteran’s Affairs (VA), or the Federal Employee Health Benefits?
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.
Can I change my Primary Care Physician once I’m enrolled?
Yes, you can change your primary care provider. Please refer to our Online Provider Directory for assistance in locating a primary care provider.
What isn’t covered by my plan?
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:
Can my plan's benefit package change after I enroll?
Medicare allows plans to make some changes to their formulary throughout the year. If we remove a drug from our formulary or a negative maintenance change is made, we will notify affected members of the change at least 60 days before the change becomes effective. If the Food and Drug Administration (FDA) determines a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary for your safety and provide notice to members who take the drug shortly after the removal.
What happens when I purchase a Part D covered drug at a network pharmacy at a special price (for example $2 pharmacy special)?
When you get your prescription filled, always show your CareFirst Medicare Advantage ID card and ask the pharmacist to report your cost to your plan. These payments count toward your out-of-pocket costs and help qualify you for catastrophic coverage. Pharmacies have the ability to report that price electronically to us.
Can I use a discount card with my Part D prescription drug benefits?
No, you cannot use a discount card with your Part D prescription drug benefits. However, if you have a Part D deductible on your CareFirst Medicare Advantage plan, or are in the coverage gap stage of the benefit, you can use your discount card to reduce your out-of-pocket costs for the drug. Remember to send in your receipts because these payments count toward your out-of-pocket costs and help qualify you for catastrophic coverage.
Where can I find a blank copy of the Personal Medication List used in the MTMP?
Here is a blank copy of the Personal Medication List.
Are all pharmacists in the CareFirst Medicare Advantage network also MTMP Pharmacists?
Not all pharmacists in the CareFirst Medicare Advantage network are MTMP Pharmacists. MTMP Pharmacists have finished a special training course in order to be able to provide these extra services. This course is open to any pharmacist. Ask your regular pharmacist if they participate in the MTMP.
Can I use my regular pharmacy and still visit an MTMP Pharmacist too?
Yes. Your MTMP Pharmacist is an added value of membership. You may continue to use any CareFirst Medicare Advantage participating pharmacy for your prescriptions.
Will I pay additional costs for using an MTMP Pharmacist?
No. These services are offered at no additional cost to you.
Do I need an MTMP Pharmacist?
While MTMP Pharmacists are available to all members, those with diabetes, high blood pressure, or other conditions treated with multiple medications may see greater benefit.
Can an MTMP Pharmacist save me money?
Yes. Similar medications that an MTMP Pharmacist may suggest to you can have large cost differences. Your MTMP Pharmacist can help you get situated with the least costly, most effective medications.
Will my doctor know if any changes need to be made to my prescriptions through the MTMP program?
Yes. Your MTMP Pharmacist may make recommendations to you and your doctor(s), but only your doctor can change your prescription.
Will I be required to use an MTMP Pharmacist?
No. Your MTMP Pharmacist is an added benefit of membership. They are there to help, but you are not required to utilize their services.
How do I get started with the MTMP?
Contact an MTMP Pharmacist in your area to schedule your Comprehensive Medication Review (CMR).