CareFirst

What CareFirst does

CareFirst BlueCross BlueShield is a not-for-profit healthcare organization and independent licensee of the Blue Cross Blue Shield Association, serving 3.5 million+ members across Maryland, Washington D.C., and Northern Virginia. Its core product portfolio spans ACA-compliant individual and family medical plans, Medicaid (CareFirst CHPMD), Medicare Advantage (CareFirst Advantage, including PPO and DSNP variants), prescription drug, dental, and vision coverage, distributed through direct consumer enrollment, the Maryland Health Benefit Exchange, employer group sales, broker partnerships, and two physical Engagement Centers in Baltimore.

CareFirst operates a vertically integrated payer-provider model through wholly owned subsidiaries including CloseKnit (virtual-first advanced primary care with 24/7 access to primary, urgent, and therapy services), Atlas Health, Comprehensive Primary Care and Associates, and CKNMG, giving members access to more than one million doctors, hospitals, and health facilities in the region. Its technology stack includes the Sapphire Digital care tools and CareFirst Mobile App, both recognized with gold medals in the 2026 Corporate Insight Health Plan Monitor Awards, plus a developer portal supporting the CARIN Implementation Guide for healthcare data interoperability.

Revenue is generated primarily through recurring health insurance premiums across individual, family, employer group, Medicaid, and Medicare Advantage segments, with additional employer-side solutions such as Max Performance Plus funding arrangements. Strategic priorities under incoming President and CEO Kurt Small (effective May 4, 2026) include strengthening affordability and access, expanding behavioral health and community health investments, adopting the CMS ACCESS model for chronic-condition care, and serving as an anchor in the Techstars AI Health Baltimore accelerator alongside the region's largest health systems and academic institutions.

Name

CareFirst

Legal name

CareFirst of Maryland, Inc.

Website

https://individual.carefirst.com

Company type

Private

Founded year

2014

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

CareFirst BlueCross BlueShield is a not-for-profit regional health insurer serving 3.5 million+ members across Maryland, Washington D.C., and Northern Virginia with medical, dental, vision, Medicare, and Medicaid plans, supported by a vertically integrated virtual and in-person care delivery network.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Health and Welfare Funds (525120), Health Care and Social Assistance (62)

SIC

Services-Health Services (8000)

akta.pro primary industry

Primary Care & General Medicine Virtual Care (Employer-Sponsored) (HLALADAA)

akta.pro secondary industries

Virtual Specialty Care Programs (Payer-Sponsored) (HLALACAD), Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH), Primary Care & General Medicine Virtual Care (HLALAAAA)

Keywords

• Health insurance plans
• Medicare Advantage coverage
• Medicaid managed care
• Dental and vision insurance
• Employer group benefits

Headquarters

HQ city

Baltimore

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales, Others

Revenue model

1. Health Insurance Premiums: Collection of recurring premiums from individual, family, employer group, Medicaid, and Medicare Advantage members for medical, dental, and vision coverage

Pricing tiers

Go-to-market motion2 records

Distribution channels6 records

Marketing channels5 records

Core offering

CareFirst BlueCross BlueShield sells ACA-compliant medical, dental, vision, and prescription drug health insurance plans to individuals, families, employers, Medicaid recipients, and Medicare beneficiaries across Maryland, Washington D.C., and Northern Virginia. It also operates CloseKnit, a virtual-first advanced primary care practice delivering 24/7 access to primary, urgent, and therapy services. The company generates revenue from recurring health insurance premiums and provides members access to a network of more than one million doctors, hospitals, and health facilities.

Product overview

CareFirst BlueCross BlueShield is a not-for-profit healthcare organization serving over 3.5 million members across Maryland, Washington D.C., and Northern Virginia. The company's product portfolio centers on core health insurance offerings including Individual & Family Medical Plans, Medicaid (CareFirst CHPMD), Medicare Plans, Prescription Drug Plans, Dental Insurance, and Vision Insurance. Beyond traditional insurance, CareFirst operates CloseKnit as a virtual-first advanced primary care practice providing 24/7 access to primary and urgent care plus therapy services. The company also offers employer solutions including Max Performance Plus for predictable cost management, Sapphire Digital tools for member experience, and various community health initiatives including the CareFirst Arena community space. The service area covers Maryland, the District of Columbia, and portions of Virginia, with access to over one million doctors, hospitals and health facilities.

Differentiator

Problem solved

Functional benefit

Brands

• CloseKnit: Virtual-first advanced primary care practice providing 24/7 access to primary and urgent care, therapy, and more through desktop or mobile device. A team-based approach for prevention, diagnosis, treatment, and management of various health conditions.
• Sapphire Digital
• Blue365

Products and services

• Individual & Family Medical Plans
• CareFirst CHPMD Medicaid Plan Medicaid managed care coverage for low-income families, children, pregnant women, parents, elderly, and individuals with disabilities in Maryland, providing access to over 15,000 healthcare providers plus benefits and programs.
• Medicare Advantage Plans Medicare Advantage plans covering Medicare-eligible individuals in the service area, offered through CareFirst Advantage, CareFirst Advantage PPO, and CareFirst Advantage DSNP entities, with supplemental benefits and Part D coverage.
• Prescription Drug Plans Prescription drug coverage integrated with medical plans, including drug search tools and formulary access for members across all product lines.
• Dental Insurance Plans Dental insurance plans providing coverage for preventive, basic, and major dental services through a network of participating dentists.
• Vision Insurance Plans Vision insurance plans covering eye exams, eyewear, and vision care services through a provider network.
• CloseKnit Virtual Primary Care Virtual-first advanced primary care practice offering 24/7 access to primary care, urgent care, and therapy through desktop or mobile device, with a team-based approach to prevention, diagnosis, treatment, and management of health conditions.
• Max Performance Plus (MPP) Fully insured funding arrangement for employer groups with 51+ eligible employees in D.C., Maryland, and Northern Virginia, offering stable monthly premiums with potential surplus when healthcare costs come in lower than expected; integrates with all CareFirst medical and pharmacy plans.
• CareFirst Mobile App Mobile application enabling members to manage claims, access digital ID cards, find providers, and use health trackers, recognized for mobile claims functionality by Corporate Insight's Health Plan Monitor Awards.

Quantifiable outcome

• 3.5 million+ members served
• +3 more outcomes

Named customers14 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature4 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• Techstars AI Health BaltimorecoreStrategic or Co-development Partner · 25 February 2026CareFirst joined as anchor collaborator alongside University of Maryland Medical System, Johns Hopkins, MedStar Health, and University of Maryland Baltimore to support early-stage startups developing AI-driven healthcare solutions. This accelerator provides access to clinical settings, operational structures, and commercialization pathways with a cohort beginning March 2026 and Demo Day at M&T Bank Stadium in June.
• CAQHminorStrategic or Co-development Partner · 6 January 2026CAQH is a healthcare data organization maintaining records on over 4.8 million providers and 75% of U.S. covered lives. CareFirst is now a co-owner alongside other leading health plans including UnitedHealth Group, Centene, CVS Health, Elevance Health, Cigna, Humana, and Blue Cross Blue Shield affiliates.
• CloseKnit HealthcoreTechnology or IntegrationCloseKnit provides virtual-first advanced primary care practice offering 24/7 access to primary care, urgent care, and therapy through desktop or mobile device. CloseKnit is the shared business name of Atlas Health LLC, Comprehensive Primary Care and Associates LLC, and CKNMG LLC - corporate affiliates within the CareFirst umbrella.
• Centers for Medicare and Medicaid Services (CMS)coreStrategic or Co-development PartnerCareFirst signed pledge to adopt the CMS ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model promoting technology-supported care for Medicare beneficiaries with chronic conditions including obesity, diabetes, musculoskeletal pain, and depression.
• Blue Cross Blue Shield Entities (ACCESS Model)coreStrategic or Co-development PartnerMultiple Blue Cross Blue Shield entities signed pledge to adopt CMS ACCESS model for technology-supported chronic condition care with a 10-year performance period beginning July 2026.
• 19 Community-Based Behavioral Health OrganizationscoreStrategic or Co-development PartnerThree-year nearly $8 million investment supporting Arlington Free Clinic, Association for Public Defender of Maryland, Centro Hispano de Frederick, Chase Brexton Health Care, Enoch Pratt Free Library, Identity Montgomery, St. Ignatius Loyola Academy, Luminis Health, Pathway Homes, Pathways to Housing DC, Pride Center of Maryland, Sasha Bruce Youthwork, SMYAL, West Cecil Health Center, Whitman-Walker Health, Worcester Youth & Family Counseling Services.
• 30 Community Organizations (Place-Based Grants)coreStrategic or Co-development Partner$7.1 million investment across D.C., Maryland, and Northern Virginia targeting Healthy Food Priority Areas to combat diabetes and diet-related chronic conditions through local food systems, food-is-medicine programs, and nutrition education.

Scale indicators9 records

Recent moves6 records

Expansion highlights5 records

Emerging players

• Oscar Health: Oscar Health is a technology-focused ACA marketplace insurer with strong digital member experience that competes directly with CareFirst in individual marketplace segments. While smaller, Oscar's tech-forward approach represents a competitive threat in markets where CareFirst participates.

Broad incumbents

• Cigna Group: Cigna is a global health services company with strong employer-sponsored health benefits and Evernorth care services. Competes with CareFirst on employer group business and shares CAQH co-ownership status.
• Humana: Humana is a leading Medicare Advantage-focused national payer with comparable MA product offerings to CareFirst Advantage. Competes directly in Medicare Advantage markets and shares the CAQH co-ownership relationship.
• Elevance Health: Elevance Health (formerly Anthem) is the largest BCBS affiliate and a publicly traded national health insurer with significant presence in CareFirst's mid-Atlantic footprint. It competes directly with CareFirst on employer group and Medicare Advantage, with substantially greater capital resources.
• UnitedHealth Group: UnitedHealth is the largest U.S. health insurer with vertically integrated Optum care delivery capabilities that closely parallel CareFirst's CloseKnit strategy but at vastly greater scale. Co-owner of CAQH with CareFirst and a direct competitor across all product lines.

Direct peers

• Highmark Health: Highmark is a major regional Blue Cross Blue Shield licensee serving Pennsylvania, West Virginia, Delaware, and New York with a comparable integrated payer-provider model and similar member scale (~3.5M+). Both organizations are large not-for-profit regional Blues with comparable employer, individual, and Medicare Advantage offerings.
• Independence Blue Cross: Independence Blue Cross is a Philadelphia-based BCBS licensee serving Southeastern Pennsylvania with similar individual, employer, and Medicare Advantage products. Both are mid-Atlantic/regional Blues operating in concentrated geographies with comparable regulatory environments.
• Kaiser Permanente: Kaiser Permanente is the largest integrated payer-provider in the U.S., combining insurance with owned provider networks. Its vertical integration model closely mirrors CareFirst's CloseKnit strategy of owning care delivery alongside insurance underwriting.
• Blue Cross Blue Shield of Michigan: BCBS Michigan is one of the largest not-for-profit BCBS licensees, serving ~4.5M members with a comparable diversified portfolio across individual, employer, Medicare, and Medicaid lines. The scale, not-for-profit structure, and BCBS affiliation make it a directly comparable peer.
• Horizon Blue Cross Blue Shield of New Jersey: Horizon BCBS NJ is a regional BCBS licensee serving the New Jersey market with comparable employer, individual, Medicare Advantage, and Medicaid offerings. Similar in geographic concentration, scale, and product mix to CareFirst.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/user/CareFirstSocial
• Facebookfacebook.com/CareFirst
• LinkedInlinkedin.com/company/carefirst-bluecross-blueshield
• Instagraminstagram.com/carefirstbcbs
• Xx.com/CareFirst

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Subsidiaries6 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments8 records

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about CareFirst