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CareFirst BlueCross BlueShieldMedicare Advantage · Administrative · Provider News · MD, DCMedium impact

2026 CareFirst BlueCross BlueShield Medicare Advantage (MA) PPO Plan Updates

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jun 20, 2026

Summary

CareFirst BlueCross BlueShield is updating their Individual Medicare Advantage PPO plans effective January 1, 2026, with changes to plan offerings, premiums, copays, and ID card designs. The policy introduces three plan tiers (Essential at $0, Complete at $42, Salute at $0) and emphasizes using CareFirst Direct for eligibility verification and the Prior Authorization Lookup tool for service requirements.

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What to do

by Jan 1, 2026 · 3 steps
01Billing team must update patient records to reflect new CareFirst Medicare Advantage plan tiers (Essential, Complete, Salute) and corresponding premium amounts.
02Front desk staff should verify eligibility using CareFirst Direct portal and use the Prior Authorization Lookup (PAL) tool for service requirements.
03Update encounter forms to note $0 copay for colonoscopies across all CareFirst MA plans.

Original notice

2026 CareFirst BlueCross BlueShield Medicare Advantage (MA) PPO Plan Updates
provider.carefirst.com · Always check the source before changing claims.
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