I am already enrolled - AdvantageBlue PFFS

How do I use my plan?

AdvantageBlue PFFS is a Medicare-approved private fee-for-service plan offered to you by Medi-CareFirst BlueCross BlueShield (Medi-CareFirst).  AdvantageBlue PFFS offers benefits for all medically necessary services that are covered by Medicare Part A and B.  The plan also offers additional benefits that Medicare does not cover.

Finding Doctors

Your AdvantageBlue PFFS plan gives you the ability to choose your health care provider both at home and when you travel.

However, not all providers may accept this plan; even those that accept Medicare.  It is important that providers know before providing services to you that you have AdvantageBlue PFFS coverage in place of Medicare. 

Providers have the right to decide if they will accept AdvantageBlue PFFS each time they see you.  This is why you must show your AdvantageBlue PFFS ID card every time you visit a health care provider.

Your provider must accept AdvantageBlue PFFS' terms and conditions of payment.  If you need emergency care, it is covered whether the provider agrees to accept the plan's payment terms or not.

Scheduling Appointments

When scheduling your appointment, ask your doctor if he or she accepts Medicare and the AdvantageBlue PFFS terms and conditions BEFORE you make the appointment.

Make sure you show your AdvantageBlue PFFS card instead of your Medicare card to your doctor with each visit . 

If your doctor accepts the AdvantageBlue PFFS terms and conditions, then services will be provided and you will pay a copay, if applicable, at the doctor's office.  The claim will be handled by your doctor and paid directly by Medi-CareFirst.

Medical ID Card

Your member identification card provides you with health care protection nationwide.  Be sure to carry it with you at all times. 

You will need only this card when you visit your doctor.  You will not need your red, white and blue Medicare health insurance card; however keep your Medicare card in a safe place for future reference.

Prescription ID Card

You will receive a separate prescription drug identification card only if drug coverage was selected for your AdvantageBlue PFFS plan. 

When you go to the pharmacy to have a prescription filled, show your AdvantageBlue PFFS prescription ID card.  Your AdvantageBlue PFFS prescription ID card is different than your Original Medicare card or your AdvantageBlue PFFS member ID card. 

You should always take your AdvantageBlue PFFS prescription ID card with you when you go to the pharmacy.  This will ensure that you:

• Pay only your copay at the time your prescription is filled,
• Have no additional paperwork to complete or mail when you return home.

If you do not have your prescription ID card with you when you fill a prescription, you may have to pay the full cost of the prescription (rather than paying just your copay).  If this happens, you would then fill out a claim form when you get home and send it to the address on the form.

Evidence of Coverage

Refer to your Evidence of Coverage for detailed information regarding the administration of your plan.  Keep your Evidence of Coverage in a safe place for future reference.

Your Evidence of Coverage will provide you with the following information:

• Your covered benefits,
• Your costs for your AdvantageBlue PFFS plan,
• Your rights and responsibilities as a member,
• General exclusions,
• Filing an appeal or grievance,
• Ending your membership, and
• Legal notices.

Appeals and Grievances

Medicare Advantage private fee-for-service plans have many rules.  You can ask Medi-CareFirst to make exceptions to those rules.  You can also appeal our decision.  Click here to learn more.

Learn More

If you have more questions about using your plan see our Frequently Asked Questions section.

* Note:  A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plan’s terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies.  Providers can find the AdvantageBlue PFFS terms and conditions on our website at www.medi-carefirst.com/mcf/attachments/AdvantageBluePFFS_ TermsAndConditions_2008.pdf.