Group Medicare Advantage Frequently Asked Questions
General Questions
- Medicare Advantage, also referred to as Medicare Part C, consolidates your hospital coverage (Part A), doctor visits (Part B), and prescription drug coverage (Part D) into a single plan.
- These plans adhere to Medicare regulations and provide all the benefits of Original Medicare. They are offered by private insurance companies like CareFirst. Additionally, under a Medicare Advantage Plan, CareFirst can offer extra supplemental benefits such as access to a nurse line, fitness programs, telehealth services, and in-home assessments, which are not covered by Medicare Part A or B.
- Medicare Advantage, also referred to as Medicare Part C, consolidates your hospital (Part A), doctor (Part B), and drug coverage (Part D) into a single plan.
- These Medicare Advantage plans adhere to Medicare guidelines, providing all the benefits of Original Medicare. They are offered by private insurance companies such as CareFirst and Kaiser Permanente. Additionally, under a Medicare Advantage Plan, CareFirst and Kaiser Permanente can offer extra supplemental benefits like access to a nurse line, fitness programs, telehealth services, and in-home assessments, which are not covered by Medicare Part A or B.
CareFirst Medicare Advantage PPO Plan:
As a participant in the Medicare Advantage plan, you have access to the following additional supplemental Benefits:
- The Silver Sneakers program provides access to live or on-demand at-home classes and workshops, as well as the opportunity to enroll in gyms and fitness locations.
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You are entitled to routine eye exams, diabetic eye exams, and preventive glaucoma screenings annually, along with allowances for purchasing frames or elective contact lenses.
Kaiser Permanente Medicare Advantage HMO Plan:
When you enroll in a Kaiser Permanente Medicare Advantage plan, you not only receive medical and prescription drug coverage under one plan, but also gain access to additional features designed to care for your overall well-being, all at no extra cost.
You will receive the rates prior to the beginning of Open Enrollment.
Your Benefits
You will be transferred from a Medicare Supplement plan to a Medicare Advantage plan.
*CareFirst Blue Cross Blue Shield Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in CareFirst Blue Cross Blue Shield Medicare Advantage is under the business name of CareFirst Advantage PPO, Inc., an independent licensee of the Blue Cross and Blue Shield Association. The registered service marks BLUE CROSS® and BLUE SHIELD® and the Cross and Shield Symbols are owned by the Blue Cross and Blue Shield Association, which is an association of independent Blue Cross and Blue Shield Plans.
- With the Medicare Advantage plan, your medical and drug coverage are bundled together, simplifying the process by requiring only one ID card when you seek care. Remember to present your ID card to both your doctors and pharmacist.
- Your Medicare Advantage ID card is essential for ensuring that your providers can accurately file claims and access your benefits. Please remember to have your ID card on hand during appointments to facilitate smooth processing and accurate coverage.
- Keep your Original Medicare card safe, but remember you won’t need to present it to your doctors.
No, there is no Part A or Part B deductible.
Yes, there are copays based on the services you receive. Additionally, some benefits may have coinsurance. For specific details, please refer to your Evidence of Coverage.
Your Network of Providers
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.
Yes, we encourage you to visit network providers; however, you have the flexibility to seek care from 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.
If your provider is within the CareFirst Medicare Advantage PPO network (visit www.carefirst.com/findadocmappo), you can continue seeing them. If they are not in the network but accept Medicare and are willing to bill CareFirst, you can still see them. If you don’t find your provider in the directory, please contact them to confirm their willingness to bill CareFirst before your visit.
With a Medicare Advantage PPO Plan, you’ll have access to a national provider network through the Blue Cross and Blue Shield Association. If your doctor is not in the network but accepts Medicare and is willing to bill CareFirst for their services, your medically necessary services will still be covered. Your out-of-pocket expense or copay will be consistent whether you see doctors in or out of network.
If your provider refuses to accept the plan, please contact CareFirst Medicare Advantage Member Services at 1-888-320-2664 (TTY:711). They will then reach out to your provider on your behalf to clarify how the plan operates.
No, this plan does not require referrals.
Some services may require pre-certification or prior authorizations. Your Evidence of Coverage, which is your member contract, will outline the services that require pre-certification or prior authorizations.
Your Prescription Drug
No, there is no prescription deductible.
Yes, this plan offers full donut hole coverage, ensuring that during the initial coverage phase you’ll maintain the same copay.
Yes, this plan includes catastrophic coverage, ensuring that during the initial coverage phase, you’ll only pay copays and nothing more.
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.
Your mail-order prescriptions will transfer automatically, but it’s important to inform the pharmacy about your new coverage.
If you have active prescriptions with refills at either the retail pharmacy or mail order, you do not need new prescriptions. However, please inform the pharmacy of your new coverage and present your new ID card.
The CareFirst plan provides coverage for basic Medicare Part D medications as well as certain Medicare Part D excluded medications, such as those for weight loss, erectile dysfunction, and vitamins. You can visit www.carefirst.com/madrugsearch to search for your prescription drugs on the formulary. Alternatively, you can call CareFirst Member Services at 1-888-320-2662 (TTY:711) for assistance in looking up your medications, checking for any restrictions, and finding out your copay price.
If you receive prescriptions from the VA, you can continue doing so. This benefit operates independently and may involve distinct 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
If the member was hired before January 2010, they are eligible for retiree health benefits. Additionally, any applicable dependents already on the plan will also be covered.
If the member was hired before January 2010, they are eligible for retiree health benefits. Additionally, any applicable dependents already on the plan will also be covered.
If the widow or widower was covered on the member’s plan before the member passed away, they will continue to be covered on their plan. If the spouse is over 65 years old, they will be covered for an additional two years. If the spouse is under 65 years old, their coverage will continue until the end of the month in which they turn 65.
- 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.
- 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.
The percentage is negotiated by the Local 689 Bargaining Agreement and WMATA.
