Understanding plans
To better understand our plans, it helps to understand how the different plan types work and your related healthcare costs.
CareFirst offers a variety of plan types (HMO, POS, PPO). Plan types refer to how plans provide coverage and from which network of providers you receive care. Review the information below to learn more about each plan type. Plan names are found at the top of each benefit summary.
Congressional National plans have PPO or Advantage in the plan name. National plans are the best option if you or your family live or work outside Washington, D.C., Maryland or Northern Virginia.
Congressional Regional plans have Plus or HMO in the plan name. Regional plans are a good option if you and your family live or work in Washington, D.C., Maryland or Northern Virginia. They are not recommended if you live outside this area.
Cost sharing refers to the part of your healthcare costs that your plan doesn’t pay. Cost sharing is made up of three parts: deductibles, copayments and coinsurance. For a detailed definition of cost sharing, please refer to our Important Terms section.
Our HMO plans use the BlueChoice network which is located in Washington, D.C., Maryland and Northern Virginia. When you see one of our more than 50,000 participating providers, you'll save the most money. If you go outside the BlueChoice network, your medical services will not be covered (except for emergency services).
|
Type of Plan |
Advantages |
Other Considerations |
Available Plans |
|---|---|---|---|
| Health Maintenance Organization Requires use of in-network providers and selection of PCP. |
Usually the least expensive choice. Your PCP and providers handle the paperwork. Copayments are usually known in advance (deductibles and/or coinsurance may apply in some plans). |
With BlueChoice HMO, visits to a specialist usually require a referral from your PCP. Very limited coverage out of the HMO's service area. HMOs have a smaller network of providers than PPO or Traditional Indemnity plans. Seeing an out-of-network provider usually means you will pay the entire cost. |
BlueChoice (HMO) |
Our POS plans offer more flexibility. These plans combine the benefits of an HMO with access to out-of-network providers. You can see providers in the BlueChoice network for the most savings or use the PPO network and pay slightly more but still be protected from balance billing. You can also visit a provider outside of CareFirst's networks, but you'll likely pay charges that exceed CareFirst's allowed benefit.
|
Type of Plan |
Advantages |
Other Considerations |
Available Plans |
|---|---|---|---|
| Point of Service Combines the features of managed care with out-of-network benefits. |
Includes benefits of an HMO and access to out-of-network providers. When you use your PCP to coordinate care, you'll pay the lowest cost and they'll handle the paperwork. Copayments for in-network services are known in advance. (Deductibles may apply in some plans.) |
More expensive than an HMO (but usually less expensive than a PPO). Using out-of-network providers will cost you more. Coverage for out-of-area services will vary; check the plan carefully to understand costs. |
BlueChoice Advantage (POS) BlueChoice Plus (POS) |
Our Preferred Provider Organization (PPO) plans offer the most choice of providers. You can receive care from the PPO network of more than 55,000 providers locally and hundreds of thousands nationally. In addition, you can go out of network and pay slightly more.
|
Type of Plan |
Advantages |
Other Considerations |
Available Plans |
|---|---|---|---|
| Preferred Provider Organization Has negotiated rates with a network of providers. |
Flexible. Large choice of providers. No referrals required. You are not required to choose a PCP. Preferred Providers will usually handle paperwork for you. Coverage for out-of-area services is usually included; check the plan carefully to understand availability and costs. |
Usually more expensive than an HMO or POS plan. Many out-of-network services will require that you pay a deductible and coinsurance. Using out-of-network providers will cost you more. |
BluePreferred (PPO) |