May 03, 2023
As of May 1, 2023, the CareFirst Medicare Advantage 2023 Pre-sales kits have been updated with a new Summary of Benefits. The new Summary of Benefits applies to both the Core and Enhanced plans for both Service Area 1 and Service Area 2 kits. Spanish versions will also include the new Summary of Benefits.
The following updates have been made to the Summary of Benefits.
Added Inpatient Mental Health Services
Inpatient individual therapy per visit:
- Member pays $330.00 copay for Days 1 to 5
- Member pays $250.00 copay for Days 1 to 5
Outpatient individual therapy per visit:
- Member pays a $40.00 copay for each outpatient individual therapy visit.
- Member pays a $20.00 copay for each outpatient individual therapy visit.
Outpatient group therapy per visit:
- Member pays pay a $20.00 copay for each outpatient group therapy visit.
- Member pays pay a $10.00 copay for each outpatient group therapy visit.
Changes Due to the Passing of the Inflation Reduction Act
A separate insert will be in the pre-sales kit reflecting the following information
| BENEFIT | ORIGINAL INFORMATION | CORRECTED INFOMRATION | WHAT DOES THIS MEAN FOR YOU |
|---|---|---|---|
| Medicare Part B Prescription Drugs | 20% coinsurance of the total cost for Medicare-covered Part B chemotherapy or other drugs | Beginning April 1, 2023, the MA enrollee cost sharing for a Part B rebatable drug must not exceed the coinsurance amount of the original Medicare adjusted beneficiary coinsurance for that Part B rebatable drug. | If applicable, a refund will be provided by the plan. |
| Durable Medical Equipment (DME) and Related Supplies | 20% coinsurance for Medicare-covered items | Insulin furnished under Part B on or after July 1, 2023, through an item of durable medical equipment (i.e., a medically necessary traditional insulin pump), is subject to a coinsurance cap for a month’s supply of such insulin (that does not exceed $35 and the Medicare Part B deductible does not apply). | Members will never pay more than $35 for insulin under Part B. |
Action Needed
Agents should destroy their supply of printed older versions of the Medicare Advantage pre-sales kits and replace with a supply of the new updated pre-sales kits. Any use of the older versions will be considered out of compliance.
If you need assistance on how to order a new supply of pre-sales kits, please contact our Medicare Agent Sales Support Team via e-mail at medicareagentsalessupport@carefirst.com or call 833-601-0461.
