Carefirst: Insurance Or Not?

CareFirst BlueCross BlueShield is a health insurance provider with a wide range of insurance products and administrative services. It serves 3.4-3.5 million individuals and groups in Maryland, Washington D.C., and Northern Virginia. As the largest not-for-profit health plan in the Mid-Atlantic region, CareFirst is dedicated to making healthcare affordable, easy to use, and accessible to everyone. The company offers a variety of plan types, including HMO, POS, and PPO, to meet the diverse needs of its customers. With a long history dating back to 1934, CareFirst has established itself as a trusted and ethical healthcare company, consistently recognized for its commitment to improving overall health and increasing the accessibility, affordability, safety, and quality of healthcare.

CareFirst BlueCross BlueShield is a non-profit organisation

CareFirst offers a range of health insurance products and administrative services to individuals and employers in Maryland, Washington, D.C., and Northern Virginia. Its health plans cover medical, dental, and vision insurance, with access to over one million doctors, hospitals, and health facilities.

The organisation has a strong focus on affordability, accessibility, and quality. In 2019, they invested $43 million to improve overall health and increase the accessibility, affordability, safety, and quality of healthcare in their market areas.

CareFirst also has a commitment to ethical practices and has been recognised as one of the World's Most Ethical Companies on multiple occasions. Their mission includes assisting and supporting public and private healthcare initiatives for individuals without health insurance and promoting an integrated healthcare system that meets the needs of all residents in the communities they serve.

With a long history dating back to 1934, CareFirst BlueCross BlueShield has evolved through various mergers and expansions to become the leading non-profit health insurer it is today, dedicated to providing valuable health benefit services to its customers.

CareFirst offers a range of insurance plans, including HMO, POS and PPO

CareFirst is a not-for-profit healthcare company that offers a comprehensive portfolio of health insurance products to 3.4 million individuals and employers in Maryland, the District of Columbia, and Northern Virginia. It is the largest health care insurer in the Mid-Atlantic region and has dual headquarters in Baltimore, Maryland, and Washington, D.C.

CareFirst offers a range of insurance plans, including HMO, POS, and PPO. These plans differ in terms of provider networks, flexibility of coverage, and payment assistance for in-network and out-of-network doctors. Here is a detailed look at each type of plan:

HMO (Health Maintenance Organization) Plans

HMO plans offer a network of over 44,000 participating providers in the BlueChoice network located in Washington, D.C., Maryland, and Northern Virginia. Using an in-network provider will result in the most savings for the patient. If you go outside the BlueChoice network, your medical services will not be covered except for emergency services. HMO plans usually have lower monthly payments and are ideal if your preferred doctors are already in the network or if you receive most of your care close to home. HMO plans may require you to select a primary care physician (PCP) who can refer you to specialists when needed.

POS (Point of Service) Plans

POS plans offer more flexibility by combining the benefits of an HMO with access to out-of-network providers. You can use the BlueChoice network for the most savings or the PPO network and pay slightly more while still being protected from balance billing. POS plans are generally more expensive than HMO plans but less expensive than PPO plans. Using your PCP to coordinate care will result in lower costs, and they will handle the paperwork. POS plans offer coverage for out-of-area services, but it is important to check the plan carefully to understand the specific costs.

PPO (Preferred Provider Organization) Plans

PPO plans from CareFirst offer the most choice of providers, with a network of over 55,000 providers locally and hundreds of thousands of providers nationally. You can also go out-of-network and pay slightly more. PPO plans typically require higher monthly payments but offer increased flexibility. With a PPO plan, you are not required to choose a PCP, and you can see a different doctor of your choice at any time, including specialists. PPO plans also offer more options for laboratory service providers.

CareFirst has 3.5 million members and 9,500 employees

CareFirst BlueCross BlueShield is a not-for-profit, independent licensee of the Blue Cross Blue Shield Association. It is the largest healthcare insurer in the Mid-Atlantic region, serving 3.5 million members.

The company has been in operation for 83 years, with its history traced back to 1934 when a hospital association in Washington, D.C. formed Group Hospitalization, Inc. In 1998, the Maryland and District of Columbia companies merged to form CareFirst BlueCross BlueShield. Today, CareFirst has dual headquarters in Baltimore, Maryland, and Washington, D.C., and it serves Maryland and the Washington metropolitan area.

CareFirst's 3.5 million members include individuals and groups, with over 626,000 members in the Federal Employees Health Benefits Program (FEHBP). The company provides health insurance to Congressional Employees and their families, offering access to 96% of hospitals and 95% of doctors and specialists across the U.S.

To serve its 3.5 million members, CareFirst employs 9,500 employees and contractors across Maryland, Washington, D.C., Northern Virginia, and beyond. The company has been recognised as one of the "World's Most Ethical Companies" and strives to provide affordable and accessible health insurance to its members.

In addition to its large membership and workforce, CareFirst has a significant market presence. It holds a 75% market share in Maryland and is recognised for its financial performance, with revenues of $11.8 billion and medical care spending of $9.9 billion as of 2022.

CareFirst has contributed to COVID-19 relief and vaccination efforts

CareFirst BlueCross BlueShield is a not-for-profit health insurance provider that has contributed significantly to COVID-19 relief and vaccination efforts. During the pandemic, CareFirst contributed $8 million to organizations at the forefront of the pandemic, with an additional $2.2 million invested in COVID-19 relief and equitable vaccine efforts. These grants supported COVID-19 relief, recovery, and equitable vaccination for communities in the Mid-Atlantic region, including Maryland, Washington D.C., and Northern Virginia.

As part of their Better Together campaign, CareFirst released $1.2 million to three community organizations: CASA de Maryland, United Way of the National Capital Area, and West Virginia Health Right. These organizations work to address equitable vaccine distribution in underserved communities. With this funding, they served nearly 20,000 individuals through COVID-19 education and vaccination events.

In addition, CareFirst invested $200,000 in eight Federally Qualified Health Centers (FQHCs) in Washington, D.C., providing support for nearly 80,000 individuals and communities disproportionately impacted by the pandemic. The funding helped with vaccine administration, personal protective equipment (PPE), refrigeration units, and other vaccination demands.

CareFirst also provided care packages to its most vulnerable members, including Medicaid members, individuals over 65, those under 65 with underlying medical conditions, and student health plan members. They offered premium credits and payment deferrals to individuals and employers facing financial difficulties due to the pandemic. Furthermore, they covered all costs associated with FDA-authorized COVID-19 vaccines for their members and waived copays, coinsurance, and deductibles for COVID-19 testing and treatment through December 31, 2020.

The company also launched a public health campaign, "Better Together," encouraging people to get vaccinated. They mandated COVID-19 vaccinations for their workforce, Boards of Directors, and guests, aligning with their initiatives to achieve target vaccination rates.

CareFirst offers prescription drug plans

CareFirst is a health insurance provider serving 3.5 million individuals and groups in Maryland, the District of Columbia, and Northern Virginia. It is an independent licensee of the Blue Cross Blue Shield Association and is a not-for-profit healthcare company.

• Mail Service Pharmacy: This option allows members to refill their prescriptions conveniently through home delivery or delivery to their office or a CVS location.
• Coordinated medical and pharmacy programs: These programs help improve overall health and reduce costs by working with members to ensure they are taking the right medications and getting the best value.
• Personalized notices: Members receive phone calls and letters from the pharmacy benefit manager, detailing cost-saving opportunities, safety alerts, and drug education.
• Formulary (Drug List) Structure: An independent national committee of physicians, pharmacists, and other healthcare professionals review and approve the drugs on the formulary to ensure they are safe and clinically effective. The formulary includes brand-name drugs and generic drugs, which generally cost less.
• Tiered pricing: Depending on the plan, prescription drugs fall into one of five drug tiers, with varying prices. Members can log in to their accounts to access specific cost-share information and view their annual summary of benefits.
• Preventive drugs: Certain drugs, such as statins, aspirin, folic acid, fluoride, and smoking cessation products, are available at no additional cost if prescribed by a doctor. Oral chemotherapy drugs and diabetic supplies are also included at no extra charge.

CareFirst's prescription drug plans offer flexibility, convenience, and affordability for its members, ensuring they have access to the medications they need.

Frequently asked questions