Health insurance is a crucial part of overall healthcare and financial planning. With rising medical costs, selecting the right health insurance provider can make a major difference in your budget and access to care.
Two popular options on the East Coast are CareFirst and UnitedHealthcare. But how do you choose between them?
This comprehensive guide examines the key factors to weigh when deciding between CareFirst and UnitedHealthcare. We’ll compare networks, costs, plan options, ratings, and more.
Read on for an in-depth analysis of the pros and cons of CareFirst versus UnitedHealthcare.
A Brief Comparison Table
| Factor | CareFirst | UnitedHealthcare |
| Coverage Area | Maryland, Washington D.C., Northern Virginia | National |
| Plan Types | HMO, PPO, POS | HMO, PPO, POS |
| Provider Network | 50,000+ providers including Johns Hopkins, MedStar | 1.2 million+ providers nationwide |
| Premiums | $200 – $600 per month (individual) | $150 – $700 per month (individual) |
| Deductibles | $0 – $4,800 | $0 – $5,000+ |
| Max Out-of-Pocket | $2,000 – $8,700 | $2,000 – $8,700 |
| Member Satisfaction | Higher ratings than UnitedHealthcare | Lower ratings than CareFirst |
| Financial Ratings | A (Excellent) from AM Best | A (Excellent) from AM Best |
| Recommended If | You want localized care and provider choice | You need broader national coverage |
CareFirst Overview
CareFirst BlueCross BlueShield is a not-for-profit health insurance company operating in Maryland, Washington D.C., and Northern Virginia. CareFirst offers HMO, PPO, and POS plans for individuals, families, and employers. It provides coverage to over 3.4 million members.
Some key facts about CareFirst:
- Headquarters in Baltimore, MD
- Founded in 1940
- Non-profit health insurance provider
- 3.4 million+ members
- HMO, PPO, and POS plans
- Medicare Advantage plans
- Products for individuals, families, employers
CareFirst plans utilize the BlueCross BlueShield network of doctors, hospitals, and healthcare providers. This gives members access to a wide range of in-network providers across the region and nationwide.
UnitedHealthcare Overview
UnitedHealthcare is the largest private health insurer in the U.S. It provides health plans for individuals, employers, Medicare, and Medicaid. UnitedHealthcare offers HMO, PPO, and POS plans with access to its broad network of healthcare providers.
Some quick facts on UnitedHealthcare:
- Headquarters in Minnetonka, MN
- Founded in 1977
- For-profit health insurance company
- Serves 49 million+ members
- HMO, PPO, and POS plans
- Large nationwide network
- Products for individuals, employers, Medicare, Medicaid
Unlike CareFirst’s regional focus, UnitedHealthcare has a national presence and network. This gives members more flexibility when seeking care outside of the mid-Atlantic region.
Comparing Provider Networks
One of the most important factors in choosing a health insurance provider is the network. The larger the network, the more choice you have in selecting healthcare providers.
CareFirst offers access to over 50,000 providers through the BlueCross BlueShield network in Maryland, D.C., and Northern Virginia. This includes major hospital systems like Johns Hopkins, MedStar, and Inova.
UnitedHealthcare has an expansive nationwide network with over 1.2 million providers. So while CareFirst may have more options locally, UnitedHealthcare gives you more flexibility when seeking care outside the mid-Atlantic area.
Both networks include top-tier hospitals and medical centers, so individuals and families should have access to quality care. But CareFirst may be a better choice for those who don’t plan to get care outside of the region frequently.
Comparing Costs And Plan Options
Along with the network, costs and plan choices are key considerations. Premiums, deductibles, copays, coinsurance, and out-of-pocket maximums all impact your bottom line.
CareFirst offers a range of HMO, PPO, and POS plans for individuals and families. Most plans have deductibles ranging from $0 to $4,800, with maximum out-of-pocket costs between $2,000 to $8,700. Monthly premiums for an individual can range from $200 to over $600 depending on the plan.
UnitedHealthcare also provides HMO, PPO and POS plans. Deductibles run from $0 to over $5,000 with maximum out-of-pocket costs between $2,000 to $8,700. Monthly premiums typically span from $150 to $700 for an individual.
Both insurers offer precious metal tiers – platinum, gold, silver, and bronze. In general, the higher metal tiers have higher premiums but lower deductibles and out-of-pocket costs. Lower metal tiers have lower premiums but you pay more when getting care.
When comparing costs, be sure to look at the full picture – premiums, deductibles, copays, coinsurance, and maximum out-of-pocket. And consider whether paying more upfront for lower care costs makes sense for your budget and health needs.
Also Read: Choose Between Kaiser Permanente And CareFirst.
HMO Vs. PPO Vs. POS Plans
When choosing a health plan, you’ll also decide between HMO, PPO or POS options. Here’s a quick rundown:
- HMO – Must have a primary care physician who coordinates care. Out-of-network care is not covered except emergencies. Lower premiums but less flexibility.
- PPO – See any in-network doctor without referrals. Out-of-network care is partially covered but costs more. Higher premiums but more flexibility.
- POS – Combines features of HMO and PPO plans. See in-network providers without referrals or go out-of-network for partial coverage. Moderate premiums and flexibility.
In general, HMO plans have the lowest premiums, PPOs have the highest, and POS plans fall somewhere in between. Make sure to consider your preference for flexibility versus upfront costs when selecting a plan type.
Covered Services
The services covered by your health insurance have a major impact on your costs and care access. Both CareFirst and UnitedHealthcare offer comprehensive medical care coverage, including:
- Doctor visits and specialist care
- Hospitalization
- Emergency services
- Lab tests and imaging
- Mental health and substance use treatment
- Rehabilitative services
- Pediatric care including vision and dental
- Prescription drug coverage
- Preventive services like immunizations and cancer screenings
However, details like prior authorization requirements, included prescription formularies, and cost-sharing amounts can vary. It’s important to review full plan details. Those with specific healthcare needs like ongoing therapies or specialty medications should pay close attention to each plan’s covered service specifics.
Member Satisfaction And Ratings
Member satisfaction and third-party ratings provide useful insight into a health insurance provider. Here’s how CareFirst and UnitedHealthcare compare on key ratings:
- J.D. Power 2021 Member Satisfaction: CareFirst scored 743 out of 1,000 points. UnitedHealthcare scored 724 out of 1,000 points.
- NCQA Health Insurance Plan Ratings 2022-23: CareFirst received a 4 out of 5 rating. UnitedHealthcare received a 3.5 out of 5 rating.
- AM Best Financial Strength Rating 2022: CareFirst and UnitedHealthcare both received A (Excellent) ratings.
While scores can vary year-to-year, CareFirst tends to rate higher than UnitedHealthcare for member satisfaction. However, both deliver solid financial stability.
Beyond top-line ratings, it’s also helpful to compare consumer complaints. CareFirst and UnitedHealthcare have similar complaint index rates on ConsumerAffairs.com. Common complaints involve claims denials or delays, billing issues, and poor customer service.
Also Read: Is Horizon Better Than UnitedHealthcare?
Frequently Asked Questions (FAQ)
The main competitors for CareFirst are other BlueCross BlueShield providers like Anthem and regional competitors such as Kaiser Permanente. Nationally, leading insurance companies like UnitedHealthcare, Aetna, Cigna, and Humana compete for membership as well.
CareFirst HMO plans require you to select a primary care physician to coordinate care while PPO plans allow you to see any in-network doctor without a referral. HMO premiums are lower but you have less flexibility. PPO premiums are higher but you have more freedom in choosing providers.
No, Johns Hopkins has signed a multi-year contract extension with CareFirst after almost severing ties in 2018. This new contract keeps Johns Hopkins hospitals and physicians in-network for CareFirst members through at least 2025.
Yes, BCBS of Maryland and CareFirst are essentially the same entity. CareFirst operates the BlueCross BlueShield plans in Maryland, Washington D.C. and Northern Virginia. The BCBS of Maryland plans are now rebranded under the CareFirst name.
Also Read: Comparison Among Aetna, Delta, Guardian And Metlife.
The Verdict
When choosing between CareFirst and UnitedHealthcare, there are a few key questions to ask yourself:
- What is more important – low upfront premiums or lower care costs? CareFirst tends to have lower deductibles and out-of-pocket costs while UnitedHealthcare has lower monthly premiums.
- Do you need broader out-of-state coverage? UnitedHealthcare has the national network while CareFirst focuses on the mid-Atlantic region.
- How much care coordination do you want? CareFirst’s HMO plans provide close coordination with a primary doctor. UnitedHealthcare has more PPO options.
- What benefits or programs are valuable to you? Compare wellness initiatives, digital tools, and any other plan perks.
- How do prices, specific coverage details, and ratings compare for your situation? Look beyond the overview to see how costs and coverage align with your health needs.
There’s no one-size-fits-all answer – choosing between CareFirst and UnitedHealthcare depends on your priorities, healthcare needs, budget, and preferences. CareFirst is a leading choice locally while UnitedHealthcare offers more resources at a national level.
Making the choice between health insurance providers requires thorough research and an understanding of your specific needs. Use this guide to compare CareFirst and UnitedHealthcare plans across networks, costs, benefits, and other key factors. Weigh the pros and cons to select the right health insurance for your situation. Good luck!
