Retiree benefits

Group Medicare Advantage Frequently Asked Questions

General Questions

What is a Medicare Advantage with Prescription Drug (MAPD) Plan?
  • Medicare Advantage is also known as Medicare Part C, and it combines your hospital (Part A), doctor (Par B), and drug coverage (Part D) all in one plan.
  • These plans follow the rules, cover all the benefits of Original Medicare, and are offered by private insurance companies like CareFirst. Under a Medicare Advantage Plan, CareFirst can offer additional supplemental benefits like a nurse line, fitness program, telehealth benefits, and in-home assessments that are not covered by Medicare Part A or B.
How much do I have to pay for the plan?

You will receive the rates before starting your Open Enrollment.

Your Benefits

How are the benefits different from my current CareFirst Medicare Supplemental Plan?

You will be moving from a Medicare Supplement plan to a Medicare Advantage plan.

*CareFirst Blue Cross Blue Shield Medicare Advantage is a PPO with a Medicare contract. Enrollment in CareFirst Blue Cross Blue Shield Medicare Advantage is the business name of CareFirst Advantage PPO, inc., and an independent licensee of the Blue Cross and Blue Shield Association. BLUE CROSS® BLUE SHILED® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shields Plans.

How does Medicare Advantage work?
  • With the Medicare Advantage plan, your medical and drug coverage is bundled together, so you only need to show one ID card when you get care. You will need to show your id card to your doctors and pharmacist.
  • Your Medicare Advantage ID card will be needed to ensure that claims will be filed correctly by your providers and that they can access your benefits accurately.
  • Make sure you keep your Original Medicare card safe, but you will not need to show it to your doctors.
Is there a Part A and Part B deductible?

No, there is no part A or Part B deductible.

Are there Coinsurance or Copays?

Yes, there are copays based on the service you receive. Some benefits may have coinsurance; please refer to your Evidence of Coverage.

Your Network of Providers

Is Medicare Advantage Plan an HMO or PPO?

Your Medicare Advantage plan is a PPO Plan. Your plan has a nationwide network of doctors, other health care providers, and hospitals. Your plan adds more value as it is considered a Passive PPO, where your copays are the same whether you visit in-network or out-of-network providers.

Does this plan have a network?

Yes, and while we encourage you to visit network providers, you can go to any provider, hospital, or facility that accepts Medicare and is willing to bill CareFirst. In and out-of-network benefits are the same under this plan.

Can I go to my current providers?

If your provider is in the CareFirst Medicare Advantage PPO network (visit www.carefirst.com/findadocmappo), you can continue to see them. If they are not in the network and accept Medicare and are willing to bill CareFirst, you can continue to see them. If you do not see your provider in their directory, please contact the provider to ensure they are willing to bill CareFirst before your visit.

Will I need to switch doctors?

With a Medicare Advantage PPO Plan, you will have access to a national provider network through the Blue Cross and Blue Shield Association. However, if your doctor is not in the network, if they accept Medicare and are willing to bill CareFirst for their services, your medically necessary services will be covered. Your out-of-pocket expense or copay will be the same for doctors in and out of network.

What if my provider says they do not accept this plan?

If your provider is unwilling to accept the plan, contact CareFirst Medicare Advantage Member Services at 1-888-320-2664 (TTY:711), and they will contact your provider on your behalf to explain how the plan works.

Does this plan require referrals?

No, this plan does not require referrals.

Does this plan require Prior Authorization?

Some services may require pre-certification/prior authorizations. Your Evidence of Coverage, member contract, will provide you with information on the services that require pre-certification/prior authorizations.

Your Prescription Drug

Is there a Prescription Deductible?

No, there is no prescription deductible.

Is there a Donut Hole Coverage?

Yes, this plan has full donut hole coverage, meaning you will continue to pay the same copays as the initial coverage phase.

Is there additional Catastrophic Coverage?

Yes, this plan has catastrophic coverage, meaning you will pay no more than the copays in the initial coverage phase.

Can I go to the Retail Pharmacy?

The CareFirst Medicare Advantage Prescription Drug (MAPD) Plan has over 66,000 pharmacies in the network. Generally, you do NOT need new prescriptions for retail pharmacy fills. Check to see if your pharmacy is in the network by visiting www.carefirst.com/findadocmappo and selecting Medicare Pharmacy Directory under Helpful Links at the bottom of the page.

Will my mail order transfer, or will I need to re-enroll?

Your mail-order prescriptions will transfer, but you should alert the pharmacy of your new coverage.

Will I need new prescriptions?

If you have active prescriptions with refills at either the retail pharmacy or mail order, you will NOT need new prescriptions. However, you should alert the pharmacy of your new coverage and show them your new id card.

Will my prescriptions be covered?

The CareFirst plan covers basic Medicare Part D medications and some Medicare Part D excluded medications. This includes weight loss, erectile dysfunction, and vitamins. You can visit www.carefirst.com/madrugsearch to search for your prescription drugs on the formulary or call CareFirst Member Services at 1-888-320-2662 (TTY:711) to get help looking up your medications, see if there are any restrictions, and learn your copay price.

Can I still go to the VA for my prescriptions?

If you obtain some prescriptions from the VA, you may continue to do so. This is a separate benefit and may have separate formularies, copays, and restrictions.

 

*As a participant in the Medicare Advantage plan, you have access to the following additional supplemental Benefits:

  • The Silver Sneakers program gives you access to at-home classes and workshops live or on-demand and the opportunity to enroll in gyms and fitness locations.
  • routine eye exam, a diabetic eye exam, preventive glaucoma screening each year, and allowances to purchase frames or elective contact lenses.
  • You will have access to a 24-hour nurse advice line when you have questions about your health, help you decide when to visit your doctor or go to an Urgent Care or ER, help you understand your medications, assist with finding network doctors, and prepare for an appointment, and learn about preventive care.
  • Through CareFirst’s Video Visit program can securely connect with a doctor anytime, day or night through your phone, tablet, or computer and get treatment for urgent care or make an appointment with a licensed physician for behavioral health services.
  • you can also get an in-home or virtual annual comprehensive health assessment with an advanced practice clinician.

Inflation Reduction Act’s Implications for Medicare Part D

Download the Inflation Reduction Medicare Part D Chart for more info.

Retirees Frequently Asked Questions

I wanted to know if I am eligible for retiree health benefits when I retire and the same for my wife, who is on the policy?

If the member was hired before January of 2010, they are eligible for retiree health benefits, and any applicable dependents already on the plan will also be covered.

Is there a minimum amount of time you must have health insurance through METRO before you retire to keep the policy after retirement?

If the member was hired before January of 2010, they are eligible for retiree health benefits, and any applicable dependents already on the plan will also be covered.

If I should happen to pass before I retire and before my wife passes, will she be able to keep the health insurance policy?

Yes, the widow/widower will be on their plan if they were covered on the member’s plan before they passed away. If the spouse is over 65 years old, the spouse will be covered for two more years. If the spouse is under 65 years of age, the spouse will be covered until the end of the month they turn 65.

If I wanted to drop my current dental and vision coverage because we may use my wife from her new job, could I do that and keep medical, or would I have to wait until open enrollment?
  • Vision coverage goes hand in hand with medical, so you cannot terminate that benefit. You can remove your dental benefit if you are a retiree-only (anytime during the year).
  • All active employees have a medical, dental, vision, prescription, and life insurance packages. You must opt out during our yearly open enrollment. If you opt-out, you keep your life insurance.
How do I get statements for “Transit Employee Retirement Plan Local 689” where funds are being taken from my pay? Also, can I change that from tax-deferred to investment?
  • This is a question for the Local 689 Union. You can call 301-568-6899 and ask for the Financial Treasurer or whoever handles retiree 2010’s pension.
  • If you were hired before January 1, 2010, and are fully vested (10 years of service), you will receive a pension projection yearly statement from the pension office in mid-July or early August. You can call 202-962-1076 for further information.
Is Local 689 retiree health plan deduction from my pension a certain percentage of my salary?

The percentage is negotiated by Local 689 Bargaining Agreement and WMATA.

 

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