Supplement-65 Application - CareFirst BlueCross BlueShield 2026

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  1. Click ‘Get Form’ to open the Supplement-65 Application in the editor.
  2. Begin by filling out Section 1, Applicant Information. Provide your personal details such as name, address, and Social Security number. Ensure all information is printed clearly.
  3. In Section 1B, select the Supplement-65 Plan you wish to apply for by checking only one option. This is crucial for processing your application correctly.
  4. Proceed to Section 2 and enter your Medicare coverage information as it appears on your Medicare card. This includes your Health Insurance Claim Number and effective dates for both Part A and Part B.
  5. Complete Section 3 regarding eligibility by answering the questions truthfully. If applicable, provide documentation for guaranteed issue eligibility in Section 9.
  6. Review all sections carefully before signing on page 11. Make sure there are no errors or omissions that could delay processing.

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Medicare Supplement plans (or Medigap) can help cover the healthcare costs not covered by Original Medicare, including some copays, coinsurance, and deductibles. Medicare Supplement plans also provide the flexibility to choose any doctor that accepts Medicare and can include added benefits to complement your coverage.
Aetna, CareFirst and Cigna offer the best Medicare Supplement plans in Maryland, with savings of up to 20% on Plan G policies.
Medigap plans are sold by private insurance companies, like Blue Cross and Blue Shield (BCBS), and are designed to assist you with out-of-pocket costs (e.g., deductibles, copays and coinsurance) not covered by Parts A and B.
The gaps in Medicare could cost you thousands out of your own pocket each year. A serious illness or lengthy hospital stay could make a big dent in your savings. Protect yourself with a CareFirst MedPlus Medicare Supplement (Medigap) plan, which offers limited out-of-pocket costs for doctors visits.

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