Blue cross blue shield family health plan

Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. Group Hospitalization and Medical Services, Inc., and First Care, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst BlueCross BlueShield, CareFirst MedPlus, and CareFirst Diversified Benefits are the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). The aforementioned legal entities (excepting First Care, Inc. of Maryland), CareFirst BlueChoice, Inc., and The Dental Network, Inc., are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. CareFirst of Maryland, Inc. CareFirst Community Partners, Inc. and The Dental Network, Inc. underwrite products in Maryland only.

“World’s Most Ethical Companies” and “Ethisphere” names and marks are registered trademarks of Ethisphere LLC.

Health Plans for Individuals and Families

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Benefits of buying a Blue Cross and Blue Shield of North Carolina (Blue Cross NC) health plan include:

DID YOU KNOW?

More than half of our members with a subsidy paid $0 per month in 2021!  

Source: Internal Blue Cross NC data, 2021.

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ACA 101: How It All Works

How to Shop for a Health Plan

When you’re shopping for a health plan, here are some things to think about:

Subsidies

To help make health insurance more affordable, the federal government offers financial help, also called subsidies, to individuals and families who qualify based on their income and household size. There are two types of subsidies available: Advanced Premium Tax Credit (APTC) and Cost Sharing Reductions (CSRs).

To qualify for a subsidy under health care reform, you must:

• Have income above 100% Federal Poverty Level (FPL)
• Not be eligible for public coverage, such as Medicaid, the Children’s Health Insurance Program (CHIP), Medicare or coverage through the Armed Services
• Not have affordable access to insurance through an employer (“affordable” is defined yearly by the federal Marketplace based on the percentage of premium an employee is responsible for)

Use this online calculator to estimate the subsidy amount you could potentially qualify for from the federal government.

Subsidy Calculator

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ACA 101: Subsidies and Cost Sharing Reductions

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Network

Each Blue Cross NC health plan has its own network of covered health care providers. The larger the network, the more in-network options you have for doctors, hospitals and other facilities. But plans with a larger network typically have a higher monthly premium. Plans with a health system-specific network are often less expensive and help you get coordinated care, but usually only the doctors and facilities of one major health system are in-network.

So, it’s important to weigh access versus cost when choosing your plan. While we also offer out-of-network coverage, you can save the most money by only seeing providers that are in your plan’s network.

In the next section, you’ll see the health plans available in your county. Use the Find an In-Network Doctor button to look up providers and hospitals that are covered by that plan’s network. 

Health Plan Options

We have new lower-cost plans for 2022. Enter your county to see which health plans are available in your area:

Prescription Coverage

Our Affordable Care Act (ACA) plans use the same formulary (a list of covered medications) and pharmacy network.

Use the Find a Drug button to see which medicines are covered and which tier they fall into. Tier 1 is often the least expensive, while Tiers 5 and 6 are the highest-cost.

Use the Find a Pharmacy button to search for in-network pharmacies.

ACA 101: Plans and Benefits

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Copayments, Deductibles and Coinsurance

When shopping for your health plan, you’ll choose between two types: Copayment plans and deductible/coinsurance plans. The type you select affects how you’ll pay for care at the doctor, pharmacy or hospital.

Copayments

A copayment is a fixed dollar amount you pay for a covered service at the time you receive it.

For example, you may have a plan that charges a $20 copay for an in-network doctor visit. All you’ll need to pay is your $20 copay. Plans with copays tend to be more expensive. But, you’ll know the cost of the visit before you go.

Deductibles

A deductible is the amount you owe for covered health care before your health insurance company starts to pay.

For example, let’s say you have a $3,000 deductible and you’ve paid $2,000 toward it. You just had an MRI that costs $1,500. You’ll have to pay $1,000 to reach your deductible. After that, you’ll only pay part of the remaining $500 based on your coinsurance percentage.

If your plan has an integrated deductible that means your medical costs and pharmacy costs both apply toward the same deductible and out-of-pocket maximum.

Coinsurance

Coinsurance is your share of costs for health care expenses based on a percentage of those costs.

After you’ve met your deductible, you may be charged coinsurance for health care services. The cost of the service will be split between you and your insurance company.

So, if you get a $100 bill for a chest X-ray and you have a 30% coinsurance amount, you’ll need to pay $30, and your insurance company will pay the rest.

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ACA 101: Copayments, Deductibles and Coinsurance

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Metallic Levels

Our ACA health plans are available in three metallic levels: Bronze, Silver and Gold. These levels were created by the ACA to show the value of coverage within a plan. They vary by how much of your medical costs a plan will pay on average. This can help you easily compare plans.

Bronze plans pay 60% of medical costs on average, and you pay 40%.3

Good if you want protection from worst-case medical scenarios, like serious sickness or injury. While the monthly premium is lower, you’ll have to pay for most routine care yourself.

Silver plans pay 70% of medical costs on average, and you pay 30%.3

Good if you are willing to pay a higher monthly premium than Bronze to have more of your routine care covered.

Gold plans pay 80% of medical costs on average, and you pay 20%.3

Good if you use a lot of care and are willing to pay more in monthly premiums to have more costs covered when you get medical treatment.

Health and Well-Being

As a Blue Cross NC member, you’ll enjoy benefits and programs that can help you improve your health and feel your best.

Telehealth

24/7 telehealth care options for behavioral and physical health (available in English and Spanish).4

Blue365®

Grab discounts on products tied to fitness, personal care, healthy eating, wellness, financial health, lifestyle and more.5

Support

Get access to programs to help you control type 2 diabetes and quit smoking.6

ACA 101: Vision and Dental

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Catastrophic Health Plans

Are you under 30 or qualify for a hardship through the federal government? You may be eligible for catastrophic coverage.7  These plans have a high deductible, but your monthly payments will be lower than most other plans.

Benefits include:

• 100% preventive care coverage1
• $35 copays for first three non-preventive primary care provider visits
• Essential health benefits covered after deductible is met
• Plans meet ACA Bronze-level requirements

• All Blue Cross NC individual ACA plans may be purchased through the Health Insurance Marketplace as a Qualified Health Plan (QHP) or through other sources, such as directly from Blue Cross NC. Advanced Premium Tax Credits (APTC) and Cost Sharing Reductions are only available when plans are purchased through the Health Insurance Marketplace. If you apply through Blue Cross NC, you’ll be able to go to the Health Insurance Marketplace to get any APTC or Cost Sharing Reductions you’re eligible for. The Health Insurance Marketplace displays all QHPs available for sale in a given state by all issuers and may contain more QHPs than displayed on this site. The Health Insurance Marketplace allows individuals to apply via its website, in person or by phone.

  This website is operated by Blue Cross and Blue Shield of North Carolina and is not the Health Insurance Marketplace website. This website does not display all QHPs available through the Health Insurance Marketplace website. To see all available QHP options, go to the Health Insurance Marketplace website at HealthCare.gov. All information discussed on this page pertains to Blue Cross NC individual-market, medical health insurance plans that are eligible for sale in 2022 and meet ACA guidelines. The information contained does not apply to plans that are transitional, group, dental-only or other plan types. All details regarding plan benefits and design contained herein are for informational purposes only. Please see the product benefit booklet for all terms and conditions that apply.

  Your coverage will automatically renew. Your coverage may be canceled by Blue Cross NC for fraud or intentional misrepresentation of material fact on your application or for nonpayment of premiums. Coverage for dependent children ends at the end of the month they become age 26. Members will be notified 30 days in advance of any change in coverage. To be eligible for a catastrophic health plan, you must be under 30 years of age when the plan begins or qualify for a hardship exemption through the federal government.

  The policy form number for Blue HomeSM with Novant Health and Blue HomeSM with UNC Health Alliance, Blue LocalSM with Atrium Health, Blue LocalSM with Wake Forest Baptist Health and Blue ValueSM is ACAPOS-I, 5/21. The policy form number for Blue Advantage® is NGFPPO-I, 5/21. All plans may not be available in all geographic areas. This webpage contains information only. It is not your insurance policy. Your policy and application are your contract. If there is any difference between this webpage and the policy, the provisions of the policy will control.

  Blue Cross NC has collaborated with Novant Health to bring you Blue Home with Novant Health. Blue Home with Novant Health is a health insurance plan offered by Blue Cross NC that provides access to a limited network of providers. Novant Health is an independent company that is solely responsible for the physicians and medical facilities it owns and operates. Novant Health does not offer Blue Cross or Blue Shield products or services.

  Blue Cross NC has collaborated with UNC Health to bring you Blue Home with UNC Health Alliance. Blue Home with UNC Health Alliance is a health insurance plan offered by Blue Cross NC that provides access to a limited network of providers. UNC Health is an independent company that is solely responsible for the physicians and medical facilities it owns and operates. UNC Health does not offer Blue Cross or Blue Shield products or services.

  Blue Cross NC has collaborated with Atrium Health to bring you Blue Local with Atrium Health. Blue Local with Atrium Health is a health insurance plan offered by Blue Cross NC that provides access to a limited network of providers. Atrium Health is an independent company that is solely responsible for the physicians and medical facilities it owns and operates. Atrium Health does not offer Blue Cross or Blue Shield products or services.

  Blue Cross NC offers several decision support tools, such as Find a Doctor, to aid members in making decisions around their health care experience. These tools are offered for member convenience and should be used only as reference tools. Members should consult their own legal counsel, tax advisor or personal physician as applicable throughout their health care experience.

  The federal government determines eligibility and subsidy amount for health insurance plans purchased on the federally facilitated Marketplace. Details can be found at HealthCare.gov.

• Prime Therapeutics is an independent company that is solely responsible for the services it provides. It does not offer Blue Cross or Blue Shield products or services.

• 1

  Preventive care services as defined by recent federal regulations are covered at no charge to you in-network. Federal and state-mandated preventive services are available out-of-network, for which members will pay deductible and coinsurance, plus charges over the allowed amount. Visit BlueCrossNC.com/Preventive for examples of preventive care services.

• 2

  Available on select plans in select counties.

• 3

• 4

  Telehealth benefits available to all plans either from Blue Cross NC or through the provider network. Blue Cross NC provides the telehealth program for your convenience and is not liable in any way for the goods or services received. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notice. Decisions regarding your care should be made with the advice of a doctor. Depending on your plan, selected programs may not be available to you at this time. Check with Blue Cross NC Customer Service to determine your eligibility. Blue Cross NC has contracted with a third-party vendor independent from Blue Cross NC to bring you telehealth benefits.

• 5

  Blue365 offers access to savings on items that members may purchase directly from independent vendors, which are different from items that are covered under the policies with Blue Cross NC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither Blue Cross NC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice. Visit www.blue365deals.com/terms-use for complete terms of use.

• 6

  Blue Cross NC provides tobacco cessation and diabetes reversal programs for your convenience. Blue Cross NC is not liable in any way for the goods or services received through the respective vendors. Blue Cross NC reserves the right to discontinue or change the program at any time without prior notification. Decisions regarding your care should be made with the advice of your doctor. Check with Blue Cross NC Customer Service to determine your eligibility. Blue Cross NC has contracted with a third-party vendor independent from Blue Cross NC to bring you these offerings.

• 7

  Final determination of hardship eligibility for catastrophic health plans can only be obtained through the Health Insurance Marketplace at HealthCare.gov.

• All other trade names are the property of their respective owners.

• U21561, 12/21

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