Kaiser Permanente Vs CareFirst | Which is Best-2021?

Kaiser Permanente is a US-based integrated managed care company located in Oakland, California. It was founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield. Kaiser comprises three separate but autonomous groups: the Kaiser Foundation Health Plan, Inc. (KFHP) and its regional subsidiaries – Kaiser Foundation Hospitals and the regional Permanente Medical Groups. It operates 39 hospitals and over 700 medical offices.

CareFirst Blue Cross Blue Shield, simply known as CareFirst, is one of the leading health insurance providers in the United States. Founded in 1934, CareFirst has dual headquarters in Baltimore, Maryland, and Washington, D.C. It is a non-profit organization and an autonomous entity of the Blue Cross Blue Shield Association. Kaiser serves more than 626,000 members in the Federal Employees Health Benefits Program.

Kaiser Permanente

Kaiser Permanente is the largest managed care organization in the United States. It operates more than 700 medical offices with over 80,000 physicians and nurses. Currently, Kaiser has over 12.2 million health plan members that produce a net income of $79.7 billion.

Types of Plans

Kaiser Permanente offers a wide range of health insurance plans to its customers. It operates in eight states – Hawaii, Washington, Oregon, California, Colorado, Maryland, Virginia, Georgia, and in the District of Columbia.   The following plans are available at Kaiser Permanente:

Individual and Family plans

Kaiser Permanente offers a variety of health care plans to individuals and families. The following table shows an example of the types of plans available at Kaiser (California plans):

Types of Plans Name of Plans Annual Medical Deductible Max Out-of-Pocket Primary Care Office Visit
Deductible Bronze Bronze 60 HMO 8200/0% $8,200 / $16,400 $8,200 / $16,400 No charge after deductible
HSA Bronze Bronze 60 HDHP HMO $7,000 / $14,000 $7,000 / $14,000 No charge after deductible
Deductible Bronze Bronze 60 HMO $6,300 / $12,600 $8,200 / $16,400 First 3 office visits $65. * Additional visits $65 after deductible.
Deductible Silver Silver 70 HMO Off Exchange $4,000 / $8,000 $8,200 / $16,400 $40
Deductible Silver Silver 70 HMO $4,000 / $8,000 $8,200 / $16,400 $40
HSA Silver Silver 70 HDHP HMO 3250/20% $3,250 / $6,500 $7,000 / $14,000 20% after deductible
Deductible Silver Silver 70 HMO 2500/45 $2,500 / $5,000 $8,200 / $16,400 $45
Copayment Gold Gold 80 HMO None $8,200 / $16,400 $35
Copayment Gold Gold 80 HMO Coinsurance None $8,200 / $16,400 $35
Copayment Platinum Platinum 90 HMO None $4,500 / $9,000 $15
Deductible Catastrophic Minimum Coverage HMO†† $8,550 / $17,100 $8,550 / $17,100 First 3 office visits no charge.‡‡ Additional visits no charge after deductible.

Medi-Cal/Medicaid plans

Medicaid is a state health coverage program offered by the USA’s government to people of low incomes and limited resources. You can qualify for a Medicaid program if –

  • Your income is less than 100% to 200% of the Federal Poverty Level (FPL)
  • Pregnant
  • Elderly
  • Disabled
  • A parent/caretaker of a child

Kaiser Permanente offers Medicaid program in the following states:

  • California
  • Colorado
  • District of Columbia
  • Georgia
  • Hawaii
  • Maryland
  • Oregon
  • Virginia
  • Washington

Medicare plans

Medicare is another federal health coverage program offered by the government. These plans are provided to older citizens of 65 years or older than that. Kaiser Permanente offers the following Medicare plans to its members:

  • Kaiser Permanente Senior Advantage Basic Sacramento, Sonoma (HMO)
  • Kaiser Permanente Senior Advantage Enhanced Sacramento, Sonoma (HMO)

Small Business plans

Kaiser Permanente offers plans for small businesses so that employers can provide coverage for their employee’s health. The following chart will give you an idea about their plans:

Services Offered

KP Bronze 60 HSA HMO

(Your Cost)

KP Silver 70 HMO 1500/40

(Your Cost)

KP Gold 80 HMO Co-insurance

(Your Cost)

KP Platinum 90 HMO

(Your Cost)

Preventive Care None None None None
Primary Care 40% after deductible $40 $35 $20
Inpatient Hospital Care 40% after deductible 30% after deductible 20% $290 a day up to 5 days
Outpatient Surgery 40% after deductible 30% after deductible 20% $290
Prenatal and Postnatal None None None None
Delivery and Inpatient Well-Baby Care (Maternity) 40% after deductible 30% after deductible 20% $290 a day up to 5 days
Lab Tests 40% after deductible $35 after deductible $35 $20
X-rays 40% after deductible 40% after deductible $50 $40
Urgent Care 40% after deductible $40 $35 $20
Ambulance Services 40% after deductible $250 after deductible $250 $150
Generic Drugs 40% after deductible $20 $15 $5
Specialty Drugs 40% after deductible 30% after $250 brand deductible 20% up to $250 per prescription 10% up to $250 per prescription
Emergency Department Visit 40% after deductible $250 after deductible $250 $150
Mental Health Visit 40% after deductible $40 $35 $20
MRI, CT, PET 40% after deductible $250 after deductible 20% $150

CareFirst

CareFirst is an independent licensee of the Blue Cross Blue Shield Association. It has been serving the people, Maryland residents, the District of Columbia, and Northern Virginia for over 83 years now. In 2019, CareFirst invested 43 million dollars in improving the quality of their healthcare services and increasing the accessibility of people.

Available Plans

CareFirst offers robust health insurance plans for people of all ages and classes. Here is a list of healthcare plans available at CareFirst:

Individual and Family Health Insurance Plans

The individual and family health insurance plans of CareFirst are Affordable Care Act (ACA) compliant. They include core health benefits, such as prescription drugs, preventive care, immunizations, hospitalization, and emergency services. The health plans offer different benefits and pricing based on the location you enroll from.

Maryland Plans:

Bronze

Silver Gold

Catastrophic

BlueChoice HMO HSA Bronze ($6,150)

BlueChoice HMO Value Bronze ($6,000)

BlueChoice HMO Bronze ($8,250)

BluePreferred PPO Bronze ($8,250)

BlueChoice HMO Value Silver ($2,250)

BluePreferred PPO HSA Silver ($3,000)

BlueChoice HMO Value Gold ($1,000)

BlueChoice HMO Gold ($1,750)

BluePreferred PPO Gold ($1,750)

BlueChoice HMO Young Adult ($8,550)

Washington, D.C. Plans:

Bronze

Silver Gold Platinum

Catastrophic

BlueChoice HMO Standard Bronze ($7,500)

BluePreferred PPO Standard Bronze ($7,500)

BlueChoice HMO HSA Standard Bronze ($6,350)

BluePreferred PPO HSA Standard Bronze ($6,350)

BlueChoice HMO Standard Silver ($4,000)

BluePreferred PPO Standard Silver ($4,000)

BlueChoice HMO Standard Gold ($500)

BluePreferred PPO Standard Gold ($500)

BlueChoice HMO HSA Gold ($1,500)

Blue Preferred PPO HSA Gold ($1,500)

BlueChoice HMO Standard Platinum ($0)

BluePreferred PPO Standard Platinum ($0)

BlueChoice HMO Young Adult ($8,550)

Virginia Plans:

Silver

Gold

Catastrophic

BlueChoice HMO HSA Silver ($3,000)

BluePreferred PPO HSA Silver ($3,000)

BlueChoice HMO Gold ($1,750)

BluePreferred PPO Gold ($1,750)

BlueChoice HMO Young Adult ($8,550)

Medicaid Plans

Medicaid is a federal and state program aimed at helping certain people to afford health care. Individuals with a low income, children, pregnant women, parents, seniors, and the disabled can qualify for a Medicaid plan. Every state has its requirements and coverage programs. However, the state government offers the following coverage irrespective of the states:

  • Hospital services
  • Nursing home and home healthcare
  • X-rays and lab diagnostics
  • Transportation for medical care
  • Pediatrician visits

CareFirst offers Medicaid plans to residents of the District of Columbia and Maryland through CareFirst Community Health Plan.

Medicare Plans

Medicare plans are offered to people who are 65 years old or above. They can qualify for any Medicare plan if they are a permanent resident of the area or have certain disabilities or low income. CareFirst offers two types of Medicare plans –

Medicare Advantage Plans

CareFirst Medicare Advantage allows you to choose from two of their plans –

  • CareFirst BlueCross BlueShield Advantage Core (HMO)
  • CareFirst BlueCross BlueShield Advantage Enhanced (HMO)

Medicare Supplement Plans

A Medicare Supplement plan provides coverage to certain expenses that the Medicare Advantage plan does not cover. CareFirst offers MedPlus Medicare Supplement Plan that covers limited out-of-pocket doctor’s visits. Features of this plan include –

  • Freedom of choice
  • Nationwide coverage
  • No referral required
  • SilverSneakers fitness program
  • Optional dental and vision (added cost)
  • Exclusive member discounts

Prescription Drug Plans

  • CareFirst offers cost-effective prescription drug plans to its members that include –
  • More than 69,000 pharmacies nationwide
  • Access to thousands of covered prescriptions drugs
  • Fast mail service pharmacy
  • Affordable medical ad pharmacy programs to improve health

Here is a list of the CareFirst prescription drug plans:

Drug Tier

Costing

Tier 0 $0 Drugs
Tier 1 – Generic Drugs $
Tier 2 – Preferred Brand Drugs $$
Tier 3 – Non-Preferred Brand Drugs $$$
Tier 4 – Preferred Speciality Drugs $$$$
Tier 5 – Non-Preferred Speciality Drugs $$$$$

Besides these plans, CareFirst offers some other plans like student plans, dental plans, and vision plans.

Both Kaiser Permanente and CareFirst offer affordable health care plans to their customers. You can choose your desired plan depending on what you need the most. For more information, you can visit https://healthy.kaiserpermanente.org and https://individual.carefirst.com.

Frequently Asked Questions

  1. In which areas does Kaiser Permanente serve?
  • Kaiser Permanente offers its services in the following areas –
  • California
  • Colorado
  • District of Columbia
  • Georgia
  • Hawaii
  • Maryland
  • Oregon
  • Virginia
  • Washington
  1. What type of healthcare plans does CareFirst offer?
  • CareFirst offers three different types of healthcare plans. These are –
  • Home Maintenance Organization (HMO)
  • Point-of-Service (POS)
  • Preferred Provider Organization (PPO)

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