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.

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 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:

• 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 1-844-329-1085 OR
  • Mail it to our Enrollment Department at:
    CareFirst Medicare Advantagedu
    Attention: Enrollment Department
    1966 Greenspring Drive, Suite 100
    Timonium, MD 21093.
  • Note, all disenrollment requests must be signed by the member or the member’s legal representative for them to be processed.
• Call Member Services – 410-779-9932 or toll-free at 1-844-386-6762 (TTY users please call 711), 8 AM to 8 PM EST, 7 days a week from October 1 through March 31 and Monday through Friday, April 1 through September 30.
• Call 1-800-MEDICARE (1-800-633-4227) (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 in order to ensure that it is received and processed before the end of the month. Our fax number is 1-844-329-1085.
• 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 1-844-386-6762, 8 AM to 8 PM EST, 7 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 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. 

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. 

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

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. 

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.

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.

Here is a blank copy of the Personal Medication List.

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.

Yes. Your MTMP Pharmacist is an added value of membership. You may continue to use any CareFirst Medicare Advantage participating pharmacy for your prescriptions.

No. These services are offered at no additional cost to you.

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.

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.

Yes. Your MTMP Pharmacist may make recommendations to you and your doctor(s), but only your doctor can change your prescription.

No. Your MTMP Pharmacist is an added benefit of membership. They are there to help, but you are not required to utilize their services.

Contact an MTMP Pharmacist in your area to schedule your Comprehensive Medication Review (CMR).