FirstMedicare Direct  
FirstMedicare Direct HMO plans are rated 4 out of 5 Stars for calendar year 2020 by Centers for Medicare and Medicaid Services (CMS).
FirstMedicare Direct PPO plans are rated 3 ½ out of 5 Stars for calendar year 2020 by Centers of Medicare and Medicaid Services (CMS).
Click HERE for 2020 Stars information.
Click HERE for 2019 Stars information.


Transition Prescription Fill Process

FirstMedicare Direct has a process in place to allow transition members to receive a supply of Part D drugs that may have coverage restrictions or are not on the FirstMedicare Direct covered drug list (formulary). The transition process allows a member to receive a temporary supply of drugs and sufficient time for members to work with their health care providers to select an appropriate formulary alternative, or to request a formulary exception based on medical necessity. 

The policy may apply to:

  • new members in our plan at the start of a contract year;
  • newly eligible Medicare beneficiaries enrolling from other coverage;
  • members who switch from one plan to another plan after the start of a contract year;
  • current members affected by negative formulary changes across contract years, or
  • members residing in long-term care facilities

For a complete description of the transition process, please click here Adobe PDF for 2019. Click here Adobe PDF for 2020.

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FirstCarolinaCare Insurance Company’s FirstMedicare Direct plans are HMO and PPO plans with a Medicare contract. Enrollment in a FirstMedicare Direct plan depends on contract renewal.This is a required statement by CMS. FirstCarolinaCare has filed and been approved to offer an HMO and a PPO Medicare Advantage Prescription Drug plan for 2020.


Page Last Updated:
Friday, October 02, 2020 11:13:16 AM