Making Sense of Health Insurance

Find answers to your questions, understand what costs are associated with healthcare, and learn how to use and choose a plan.

Over 65? Visit our Medicare Basics page to learn more.

How Health Insurance Works

What is health insurance?
Different plans and networks
Affordable Care Act (ACA) basics
Turning 26 and other life events

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What Health Insurance Covers

What benefits are covered?
Health plan information
Choosing a PCP
Member ID card(s)

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Health Insurance Costs

What impacts the cost of health insurance?
How to save on health insurance costs
Lower your prescription costs
Financial assistance

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Choosing a Health Insurance Plan

How do I get coverage?
Questions to consider when choosing a plan
Why CareFirst?

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Quick Links

Click the links below to quickly access and explore the topic you’re interested in.

How does health insurance work?

What is preventive care?

What core benefits must all plans cover?

What is a qualifying life event?

New to CareFirst?

Learn more about the largest not-for-profit insurer in the Mid-Atlantic region, serving 3.5 million members.

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Already a Member?

Whether you’re a first-time or long-time member of CareFirst, find answers to questions about your plan benefits and services.

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See what people are asking about health insurance.

Member FAQs

Question #1

What is a deductible?

Answer

Your deductible is the amount of money you pay each year before your insurance plan begins paying for all or part of your costs.

Question #2

What doctors are in my area?

Answer

Most insurance companies provide free online search tools or directories to help members find the care they need. At CareFirst, our Find a Doctor tool lets you search by city, state or zip.

Question #3

Should I get care at an urgent care center or visit my doctor?

Answer

Where you receive care is a personal choice. But your out-of-pocket costs will usually be less when you visit your doctor’s office.

Question #4

What does “provider” mean?

Answer

Depending on how it’s used, “provider” can refer to either a healthcare professional (doctor, specialist, dentist, eye doctor, etc.) or a healthcare facility (hospital, urgent care clinic, lab, pharmacy, etc.).

Question #5

What does “in-network” mean?

Answer

When a doctor, hospital or other provider accepts your health insurance, they are “in-network” because they have a contract with the insurance company. In-network providers are also called participating providers.

Gain more insight through real member stories.

Understanding Plan Types

CareFirst is pretty much a no-worry health insurance provider. I travel three to four times a year, and l like the peace of mind of being able to easily use it outside of my home area.

— Member, 18–44 years old

PPO plans offer the most flexibility to see providers (doctors, hospitals, specialists, etc.) locally and nationally.

Learn more about plan types.

Shopping for a Plan

I had to find a health plan that would give me the best coverage, at the best price, to cover the cost of facilities and services I needed for ongoing treatment.

— Member, 45–64 years old

Knowing what to ask before choosing a plan can help to ensure your health needs are met.

Learn more about shopping for a plan.

Taking Advantage of Other Benefits

CareFirst’s wellness program and rewards are a tremendous way to incentivize well-being and motivate someone to take part in their ongoing healthcare.

— Member, 45–64 years old

Explore all the benefits of a plan to see how they can help you achieve your health goals.

Learn why CareFirst may be a good fit.

Learn a few key terms to increase your understanding of health insurance.

Explore Glossary

Term #1

Copayment (copay)

A fixed dollar amount you pay when you visit a doctor or other provider for service.

Term #2

Coinsurance

The percentage of the cost you pay after you meet your deductible.

Term #3

EOB

EOB stands for Explanation of Benefits. An EOB is not a bill.

Term #4

PCP

PCP means primary care provider, or sometimes primary care physician.

Term #5

Out-of-Pocket Maximum

The most you will have to pay in deductibles, copays, coinsurance and prescription drugs in a calendar year.

Have more questions? We’re here to help.

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Open Enrollment begins November 1, 2022.

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