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Carefirst individual

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Member Experience. Plan Administration. The ratings are being displayed for health plans for the plan year. Learn more about these ratings. View Small Business Plans. Show Filter. Ratings are between 1 to 5 stars 5 being the highest rating. These ratings are based on member experience, access to medical care, and health plan administration.

View Rating Details. Kaiser Permanente-HMO This star rating represents the quality rating for each health insurance company, not each health plan available. Metal Level. Catastrophic plans are NOT designed for day-to-day medical expenses such as doctor visits, prescription medicines or even emergency room visits.

Catastrophic plans are designed to cover excessive medical bills that occur above the limit you would be able to cover financially. Network Coverage. Nationwide In-Network. DC Metro In-Network. Clear Filters. You can use dental providers outside of the network without a referral for an additional cost.

Rahul: How did you support the regulatory approval process while balancing the onboarding of members and associates into the broader CareFirst organization? Vickie: It was different depending on the segment, but let's start with the DC plan. That was a small, privately owned plan. We have a significant presence in the Mid-Atlantic region, so we had broad connections to the community in the District before this acquisition. So, it was about ensuring that even though we had this acquisition in place, that local presence would continue to be front and center.

When you look at the Maryland acquisition, CareFirst has been in Maryland for a long time. So, there were strong relationships with our regulators, which gave us credibility when working with them in this new area. At that point, we needed to ensure there would not be disruption to our new members or the provider network. It was very important for them to understand things were going to continue seamlessly from a member and provider standpoint. Cindy: Echoing everything Vickie said, one other regulatory piece is the difference between government programs and commercial plans.

We needed to establish a framework for the oversight of first-tier downstream and related entities FDRs for Medicare and delegated entities for Medicaid. Also, it is not just about having services available, but also about getting services to people.

For example, in DC, we have brick-and-mortar wellness centers in the community for our Medicaid members. Although these onsite services have been impacted by the pandemic, having those services available, where our members live, is critical.

We're also now partnering with Cityblock to provide personalized care for members with complex health issues. Their unique model brings care to Medicaid members in their neighborhood settings. The two Medicaid plans were inherently different compared to the CareFirst organization.

One was a provider-sponsored plan while the other was a private equity-owned start-up. Now, it seems like all functional areas are getting comfortable with how these pieces come together within CareFirst.

Vickie: Our culture is still evolving. You also have to look at what the other organization brings to the table and understand how and why it is different from what you do today. Ultimately, we have to build on the best from each world. I also will be evaluating how to leverage synergies between these acquisitions. We're now moving forward with those opportunities and are working to begin or continue that process. I know one thing we're seeing in the industry is the link between the exchange population and the Medicaid population.

Now that you have both, are there plans for CareFirst to link them together? Vickie: Now that we participate in Medicaid in Maryland and the District, our next step is to see how we can effectively manage this movement and ensure things are seamless.

We're not there yet. That's something we're going to have to evaluate, to be perfectly honest. This is something, however, we will be evaluating over the next year or so to see where we can get the effectiveness as people are transitioning between ACA plans and Medicaid. So, good to hear that it's on your radar. One last question what key takeaways do you have for leaders interested in a similar path?

Vickie: At the end of the day, it's a lot of work. It's not for the faint of heart.

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