2024 DualPrime (HMO-SNP)

Prospective Member: 1-844-811-6334 (TTY: 711) October 1 – March 31 | 8 am – 8 pm EST | 7 days a week
April 1 – September 30 | 8 am – 8 pm EST | Monday – Friday

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2024 CareFirst BlueCross BlueShield Advantage DualPrime Plan (HMO-SNP)

The 2024 CareFirst BlueCross BlueShield Advantage DualPrime plan (HMO-SNP) is a Medicare Advantage Prescription Drug Plan for those with both Medicare and Medicaid (Maryland Medical Assistance Program) as a Qualified Medicare Beneficiary (QMB) or a Full Benefit Dual Eligible (FBDE). This plan combines your Medical, Hospital and Prescription Drug coverage with extra services and personalized programs focused on improving your health.

To be eligible for CareFirst BlueCross BlueShield Advantage DualPrime (HMO-SNP), you must also have Medicare Parts A & B and reside in any county in Maryland.

$0 - $28.20 Monthly Plan Premium.
Depending on Medicaid eligibility, you may have lower or $0 cost sharing for Medicare-covered services.
CY 2024 Low Income Subsidy Monthly Premium Summary (English) | Low Income Subsidy Monthly Premium Summary (Spanish)

How Much You Pay for Covered Services

Benefits	What You Pay with CareFirst BlueCross BlueShield Advantage DualPrime*
Monthly Plan Premium	$0 - $28.20 (Depending on your level of extra help)
Deductible	No Deductible
Maximum Out-of-Pocket (MOOP)	$8,850 annually (This is not a deductible)
Inpatient Hospital Coverage¹	Days 1-5: $0 per day Days 6-90: $0 per day
Doctor Visits	Primary care physician visit: $0 copay Specialist visit: $0 copay
Preventive Care	$0 copay
Emergency Care	$0 copay
Hearing Services	Medicare-covered exam: $0 copay Routine hearing exam (1 per year): $0 copay 1 fitting and evaluation with 3 follow up visits within the first year from date of initial fitting: $0 copay Our plan pays up to $1,950 every 3 years for hearing aids
Preventive Dental Services	Preventive Dental Services: $0 copay Oral exam & cleaning: every 6 months Comprehensive oral exam: every 36 months Fluoride treatment: every 6 months Palliative treatment: 3 every 12 months Bitewing x-ray: once every 12 months Panoramic x-ray: once every 36 months Vertical bitewing x-ray: once every 36 months Intraoral imaging: once every 36 months
Comprehensive Dental Services	Comprehensive Dental Services: $0 copay $3,000 annual allowance towards services (member is responsible for all costs over allowance) Restorative services: 1 per tooth once every 24 months Endodontics: 1 per lifetime, per patient, per tooth Crowns: once per tooth per 60 months Simple extractions Periodontics: 1 per quadrant of scaling every 36 months Periodontal maintenance: once every 3 months Denture repairs: once every 12 months Denture relines/rebase: once every 36 months Denture adjustments: 2 every 12 months
Denture Coverage	Denture Coverage: $0 copay Upper, lower, partial, or any combination Once every 60 months Does not apply to comprehensive dental allowance
Vision Services	Medicare-covered exam: $0 copay Medicare-covered eyewear after cataract surgery: $0 copay Routine eye exam: $0 copay—Limited to 1 exam per year $150 annual allowance towards eyewear, includes contact lenses, eyeglass frames and lenses
Transportation	$0 copay for 24 one-way trips per year
Part D Deductible	No Deductible
Prescription Drug Coverage	Generics: $0, $1.55, $4.50 copay (depending on your level of Extra Help) All other drugs: $0, $4.60, $11.20 copay (depending on your level of Extra Help)
24-Hour Nurse Advice Line	Members pay a $0.00 copay for services provided by the 24- Hour Nurse Advice Line.
Durable Medical Equipment¹	$0 copay
Foot Care (Podiatry Services)	Medicare Covered Services: $0 copay Routine visit: $0 copay—Limited to 4 visits per year
Meals with Medical Nutrition Therapy¹	$0 copay—12 consecutive weeks of meals for members with COPD, CHF, Diabetes, or ESRD. Members will also receive up to 4 medical nutrition therapy sessions. Limited to 4 benefit periods per year.
Readmission Prevention¹	$0 copay—14 meals per 1 week period for members post-discharge from an inpatient stay. Limited to 8 benefit periods per year. PERS will also be available to select members upon discharge for a defined period of time.
Personal Emergency Response System (PERS)¹	$0 copay—available to select members living with a disability or chronic condition such as COPD, CHF, Diabetes, or ESRD
Flex Benefit	$100 monthly allowance. Use towards mail order Over-The-Counter (OTC). Members with some qualifying conditions can use all or a portion toward OTC, groceries, or utilities
Bathroom Safety Devices	$0 copay—Limited to 2 devices each year through the plan’s catalog
Healthy Rewards	Members can receive $15 in healthy rewards for completing select preventive screenings and tests.
Lower-Cost Internet Service	The Affordable Connectivity Program (ACP) is a government program run by the Federal Communications Commission (FCC) to help CareFirst Medicare Advantage DualPrime members pay for internet service and internet-connected devices.

*If your Medicaid status changes from Full Benefit Dual Eligible (FBDE) or Qualified Medicare Beneficiary (QMB), your copays and coinsurances may increase to 20% of the total cost for your medical benefits, the applicable Medicare Part A cost-shares, and 25% of the total cost of your Part D prescription drugs.

¹May require prior authorization

2024 ENROLLMENT FORM

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