Kaiser Permanente Vs CareFirst | Which is Best?

Kaiser Permanente Vs CareFirst Which is Best

Kaiser Permanente is a US-based integrated managed care company 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 Blue Cross Blue Shield Association entity. 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. Kaiser has over 12.2 million health plan members, producing 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 the District of Columbia.   The following plans are available at Kaiser Permanente:

Individual and Family plans

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

Types of PlansName of PlansAnnual Medical DeductibleMax Out-of-PocketPrimary Care Office Visit
Deductible BronzeBronze 60 HMO 8200/0%$8,200 / $16,400$8,200 / $16,400No charge after deductible
HSA BronzeBronze 60 HDHP HMO$7,000 / $14,000$7,000 / $14,000No charge after deductible
Deductible BronzeBronze 60 HMO$6,300 / $12,600$8,200 / $16,400First, 3 office visits are $65. * Additional visits $65 after deductible.
Deductible SilverSilver 70 HMO Off Exchange$4,000 / $8,000$8,200 / $16,400$40
Deductible SilverSilver 70 HMO$4,000 / $8,000$8,200 / $16,400$40
HSA SilverSilver 70 HDHP HMO 3250/20%$3,250 / $6,500$7,000 / $14,00020% after deductible
Deductible SilverSilver 70 HMO 2500/45$2,500 / $5,000$8,200 / $16,400$45
Copayment GoldGold 80 HMONone$8,200 / $16,400$35
Copayment GoldGold 80 HMO CoinsuranceNone$8,200 / $16,400$35
Copayment PlatinumPlatinum 90 HMONone$4,500 / $9,000$15
Deductible CatastrophicMinimum Coverage HMO††$8,550 / $17,100$8,550 / $17,100The First three office visits are no charge: ‡‡, Additional visits are no charge after the deductible.

Medi-Cal/Medicaid plans

Medicaid is a state health coverage program offered by the USA’s government to people with 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 a 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 65 years or older. Kaiser Permanente provides 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 small business plans so employers can provide coverage for their employee’s health. The following chart will give you an idea about their plans:

Services Offered

K.P. Bronze 60 HSA HMO

(Your Cost)

KP Silver 70 HMO 1500/40

(Your Cost)

K.P. Gold 80 HMO Co-insurance

(Your Cost)

K.P. Platinum 90 HMO

(Your Cost)

Preventive CareNoneNoneNoneNone
Primary Care40% after deductible$40$35$20
Inpatient Hospital Care40% after deductible30% after deductible20%$290 a day up to 5 days
Outpatient Surgery40% after deductible30% after deductible20%$290
Prenatal and PostnatalNoneNoneNoneNone
Delivery and Inpatient Well-Baby Care (Maternity)40% after deductible30% after deductible20%$290 a day up to 5 days
Lab Tests40% after deductible$35 after deductible$35$20
X-rays40% after deductible40% after deductible$50$40
Urgent Care40% after deductible$40$35$20
Ambulance Services40% after deductible$250 after deductible$250$150
Generic Drugs40% after deductible$20$15$5
Specialty Drugs40% after deductible30% after the $250 brand deductible20% up to $250 per prescription10% up to $250 per prescription
Emergency Department Visit40% after deductible$250 after deductible$250$150
Mental Health Visit40% after deductible$40$35$20
MRI, CT, PET40% after deductible$250 after deductible20%$150

CareFirst

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

Maryland Plans:

Bronze

SilverGold

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

SilverGoldPlatinum

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 conditions:

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

CareFirst offers Medicaid plans to the District of Columbia and Maryland residents 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 specific 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 for 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 other plans like student plans, dental plans, and vision plans.

Both Kaiser Permanente and CareFirst offer affordable healthcare 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)

You may also like:

Leave a Comment

Scroll to Top