CareFirst Medicare Advantage Plans Review

Available CareFirst Medicare Advantage Plans

With Medicare Advantage, you can expect benefits that go beyond Original Medicare. For example, most insurance carriers (including CareFirst) have plans that include Medicare Part D. Part D can greatly reduce your out-of-pocket cost for prescription drugs.

You may also find plans that offer things like routine dental, vision, and hearing coverage. Unlike Original Medicare, which provides the same general benefits to most beneficiaries, Medicare Advantage has unique features that come with each plan. This means that you can theoretically tailor your Medicare coverage to fit your specific needs when you choose from among the popular Medicare Advantage plans in your area.

CareFirst BlueCross BlueShield Advantage Core (HMO)

CareFirst has two Medicare Advantage plans to choose from: Core and Enhanced. The Core HMO plan covers all of the same benefits as Original Medicare (Part A and Part B), plus Part D prescription drug coverage, dental, vision, and hearing. Beneficiaries can also get a few extra benefits, including a fitness membership through SilverSneakers, a 24/7 nurse advice line, a diabetes management program, a telehealth video service, and an annual in-home assessment.

Since CareFirst’s plans don’t have any deductibles, you could start saving on your health care costs sooner than you would with Original Medicare. However, you may still have to pay copays for most types of medical services, and these copays vary based on the type of care you’re receiving. It’s also important to remember that, since it is an HMO plan, you will get the best rates only by using in-network health care providers. Going out of network may mean spending far more (potentially the full cost) out of pocket. This applies whether you choose the Core or the Enhanced plan through CareFirst, since they are both HMOs.

The Core plan has a lot of added benefits while still offering low premiums and no deductibles. This plan often works well for Medicare beneficiaries who want to stick to a budget and don’t anticipate frequent visits to the doctor, as the Core plan’s copays are higher than the Enhanced plan’s copays. If you don’t plan to travel far from your network of providers and you want lower deductibles and premiums, CareFirst’s Core plan could be the right choice for you.

CareFirst BlueCross BlueShield Advantage Enhanced

As the name implies, the CareFirst Enhanced plan is a more robust version of the Core plan. With CareFirst BlueCross BlueShield Advantage Enhanced, your coverage includes everything in the Core plan, plus routine chiropractic, acupuncture, and podiatry care. You’ll also enjoy the same $0 deductibles. And while the monthly premium may be higher, you could potentially end up saving on the cost of health care, as the Enhanced plan comes with a lower out-of-pocket maximum, more discounts on generic medications, and less expensive copays.

However, the Enhanced plan still has the same limitations as the Core plan, insofar as they are both HMOs and apply coverage to only a specific network of health care providers in Central Maryland. While this is fine if you live in Maryland and plan to stay there for life, it could put substantial limitations on your ability to travel or make a move out of state without changing your insurance carrier.

Some larger insurance companies we've reviewed, like Humana, offer Medicare Advantage in all 50 states and Washington, D.C., making it easier to enroll from virtually anywhere in the country. Nonetheless, if you live in Central Maryland and you are willing to pay a higher monthly premium for more covered treatments and lower copays, the CareFirst BlueCross BlueShield Advantage Enhanced is likely a good option for you.

Extra Perks and Benefits

Most of the perks and benefits are the same with both the Core and Enhanced plans. Here is a more in-depth look:

• SilverSneakers fitness: With SilverSneakers, you can access a free gym membership, fitness classes, and on-demand classes to work out from the comfort of your home.
• 24/7 nurse advice line: CareFirst Medicare Advantage plans cover calls to a designated line where you can discuss your symptoms and get recommendations for care from a registered nurse. This line is available with $0 copays and no out-of-pocket costs to you.
• CareFirst Video Visits: This feature makes it easier to connect with a doctor at any time. Whether you have an urgent medical issue or want to speak with a therapist or psychiatrist for behavioral health support, CareFirst Video Visits make it possible to do from your computer or mobile device. The cost per visit is generally the same as your urgent care copay or the copay for a Medicare-covered mental health session.
• Onduo diabetes management program: CareFirst partners with Onduo to provide daily diabetes support through a personalized management program. Eligible members can access continuous glucose monitors (CGMs), health and lifestyle support, and diabetic supplies like test strips and lancets. As a bonus, you can easily access the service and customize your experience via the Onduo mobile app.
• In-home assessment: In addition to the annual wellness exam covered by all Medicare plans, CareFirst Medicare Advantage plans offer an annual in-home assessment. This allows eligible members to schedule a yearly physical that is conducted at home.

How Much Do CareFirst Medicare Advantage Plans Cost?

According to the National Council on Aging, the average Medicare Advantage plan has a monthly premium of $18.50.1 This means that the CareFirst Core plan is on par with the national average, while the Enhanced plan offers more comprehensive coverage for a higher monthly cost. While they are competitive, these are not the most affordable premiums on the market. In fact, insurance companies like Aetna have plans with a $0 premium. Check out our Aetna Medicare Advantage review to learn more. Just remember that premiums are not the only factor you’ll want to consider when evaluating the cost of Medicare Advantage.

As of 2024, the deductibles for Original Medicare are $1,632 per benefit period (Part A) and $240 annually (Part B) for most beneficiaries.2 By comparison, either of the CareFirst Medicare Advantage plans could help you save on the cost of health care by offering $0 deductibles. As soon as your coverage period starts, you can begin to benefit from your plan without having to meet a deductible. So, rather than spending $1,632 per benefit period on medical care that falls under Part A and $240 per year on medical care that falls under Part B, you could start enjoying coverage for medical services right from the start.

That said, prices can vary substantially from one plan to the next, and premiums and deductibles are not the only factors that matter. With that in mind, let’s take a closer look at the average costs you can expect with CareFirst Medicare Advantage.

Cost of CareFirst Core Plan

Keep in mind that these costs do not include the Part B premium, which you may need to pay in addition to your CareFirst premium. As of 2024, the Medicare Part B premium is $174.70 per month for most beneficiaries.

Below are some of the most important costs you can expect with the CareFirst Core plan:

• Premium: $18.50 or $33 per month (varies by county)
• Out-of-pocket maximum: $8,300 per year
• Prescription drug prices: Generic medications starting as low as $7
• Medical deductible: $0
• Drug deductible: $0

Some of the most common costs seniors and other Medicare beneficiaries incur are the copays required to access certain services. Here are the copays most beneficiaries can expect with the CareFirst Core plan:

• Primary care provider: $5
• Specialist: $50
• Urgent care: $30
• Emergency room visit: $95
• Medicare-covered preventive services: $0
• Lab services: $0
• Inpatient hospital visit (up to the first five days): $350
• Outpatient hospital services: $250

Cost of CareFirst Enhanced Plan

The CareFirst Enhanced Plan comes with a higher monthly premium than the Core plan, but it also comes with fewer and lower copays. Just remember, you may still need to pay your Medicare Part B premium along with the costs outlined below:

• Premium: $75 or $85 (varies by county)
• Out-of-pocket maximum: $7,300 per year
• Prescription drug prices: Generic medications starting as low as $5
• Medical deductible: $0
• Drug deductible: $0

And here are the copays you can expect with the CareFirst Enhanced plan:

• Primary care provider: $0
• Specialist: $40
• Urgent care: $20
• Emergency room visit: $90
• Medicare-covered preventive services: $0
• Lab services: $0
• Inpatient hospital visit (up to the first five days): $350
• Outpatient hospital services: $150

Enhanced plan members are eligible for $0 primary care provider copays, as well as lower copays for specialists, urgent care, and emergency room visits. While the copay for the first five days of inpatient care is the same with both plans, the outpatient copay can be far less expensive with the Enhanced plan.

Where Are CareFirst Medicare Advantage Plans Available?

CareFirst serves more than 3.4 million people throughout Maryland; Washington, D.C.; and northern Virginia.3 However, CareFirst Medicare Advantage is available only in Central Maryland. More specifically, eligible members may need to reside in one of the following counties to access lower premiums:

• Anne Arundel County
• Carroll County
• Frederick County
• Harford County
• Howard County

Residents in the following locations may also be eligible for CareFirst Part C coverage with higher premiums:

• Baltimore County
• Baltimore City
• Montgomery County
• Prince George's County

Reviews and Ratings

It’s important to do ample research before choosing a Medicare Advantage plan. Fortunately, many third-party agencies review and rate Medicare Advantage companies and even individual plans. We’ve provided a few ratings of CareFirst from some of the most reputable business and insurance rating agencies:

• AM Best: B++
• BBB: A-
• NCQA: 3.5 out of 5 stars
• CMS: 3.5 out of 5 stars

Each agency uses its own criteria to rate CareFirst as a business and a Medicare Advantage insurance carrier. CareFirst generally receives above-average ratings for its products and services. For instance, the National Committee for Quality Assurance (NCQA) gives CareFirst 4 out of 5 stars in the “Rating of Health Plan” category, but it uses dozens of other categories to assess patient experiences, access to preventive care, and the quality of treatments.4 It’s important to evaluate your needs and see exactly how CareFirst compares to other Medicare Advantage insurance carriers, especially in the areas that are most important to you.

Customer Service

CareFirst offers various resources to help you enroll, find a plan in your area, or simply learn more about your coverage. The customer service team is available to answer calls between 8 a.m. and 6 p.m., Monday through Friday, as well as from 8 a.m. to 12 p.m. on Saturdays.

Final Thoughts on CareFirst Medicare Advantage Plans

While CareFirst’s geographic limitations might preclude many people from signing up, CareFirst still offers competitive Medicare Advantage plans for seniors and other eligible beneficiaries in Central Maryland. The extensive benefits and $0 deductibles make CareFirst plans both affordable and comprehensive in their coverage. Plus, the inclusion of Part D, dental, vision, and hearing means that most plan holders will not need to purchase additional coverage. If you live in Central Maryland and are interested in Medicare Advantage, CareFirst is a high-quality option.