CareFirst BlueChoice Health Insurance in Great Falls, Virginia
- CareFirst BlueChoice is one of six carriers offering health insurance plans in Great Falls for the 2026 plan year.
- Marketplace Virginia (HealthCare.gov) offers HMO, PPO, and EPO plan types, with PPOs confirmed to be available on-exchange.
- Individuals and families with incomes between 100% and 400% of the Federal Poverty Level (FPL) may qualify for significant premium subsidies.
- Virginia Medicaid (FAMIS Plus) covers adults up to 138% FPL, pregnant women up to 200% FPL, and children up to 200% FPL.
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What Health Insurance Plans Does CareFirst BlueChoice Offer in Great Falls?
CareFirst BlueChoice offers a variety of health insurance plans through Marketplace Virginia (HealthCare.gov) in Rating Area 1, which includes Great Falls. Virginia's marketplace supports a diverse range of plan structures, including Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans. Unlike some states, PPO plans are available on-exchange in Virginia, meaning you can potentially receive subsidies for a PPO plan offered by CareFirst BlueChoice or other participating carriers. These plans are categorized into metal tiers—Bronze, Silver, Gold, and Platinum—each providing different levels of coverage and cost-sharing.Understanding Metal Tiers and Cost Sharing
When considering CareFirst BlueChoice plans, the metal tiers indicate how much the plan pays versus how much you pay out-of-pocket for medical care.
- Bronze plans: Typically have the lowest monthly premiums but the highest deductibles and out-of-pocket costs when you use medical services. They are designed for people who expect to use medical care infrequently or who want protection against catastrophic costs.
- Silver plans: Offer a balance between monthly premiums and out-of-pocket costs. They are particularly valuable for individuals and families who qualify for Cost-Sharing Reductions (CSRs), which can significantly lower deductibles, copayments, and maximum out-of-pocket limits.
- Gold plans: Feature higher monthly premiums than Silver plans but lower deductibles and out-of-pocket costs when you need care. These are suitable for those who anticipate more frequent medical needs.
- Platinum plans: Have the highest monthly premiums but the lowest out-of-pocket costs when you receive care, covering approximately 90% of medical expenses.
Eligibility and Financial Assistance for CareFirst BlueChoice Plans
Many Great Falls residents may qualify for financial assistance to make their CareFirst BlueChoice plan more affordable. The Affordable Care Act (ACA) provides subsidies in the form of premium tax credits and cost-sharing reductions, depending on your household income.Premium Tax Credits (Subsidies)
If your household income falls between 100% and 400% of the Federal Poverty Level (FPL), you may be eligible for premium tax credits. These credits can be applied directly to your monthly premium, reducing your out-of-pocket cost. The exact amount of your subsidy depends on your income, household size, and the cost of the benchmark Silver plan in your area. For example, the median income in Great Falls is $250,001 per U.S. Census Bureau ACS 2024 5-year estimates, but many individuals and families will have incomes that qualify them for assistance.
Virginia Medicaid (FAMIS Plus)
Virginia expanded its Medicaid program in 2019 (Virginia Medicaid Expansion / FAMIS Plus). Adults with household incomes up to 138% of the FPL may qualify for comprehensive Medicaid coverage. Unlike states without expansion, Virginia residents in this income range will not fall into a "coverage gap" and instead have access to robust, low-cost or no-cost health insurance. Applications for Virginia Medicaid can be submitted through commonhelp.virginia.gov.
Additionally, Virginia Medicaid (FAMIS Moms) covers pregnant women with incomes up to 200% FPL, providing extensive prenatal, delivery, and 12 months of postpartum care. The Family Access to Medical Insurance Security (FAMIS) program also covers uninsured children in households up to 200% FPL, with FAMIS Select offering low-cost coverage for children between 200% and 400% FPL.
Health Insurance Carriers in Great Falls
In 2026, 6 carriers offer marketplace plans in Rating Area 1, which covers Alexandria, Arlington, Clarke, Culpeper, Fairfax, Falls Church, Fauquier, Frederick, Fredericksburg, Loudoun, Madison, Manassas, Manassas Park, Orange, Prince William, Rappahannock, Warren counties. Great Falls is part of Fairfax County, which is included in this rating area. The confirmed carriers for this rating area are:- CareFirst BlueChoice
- Cigna
- HealthKeepers
- Oscar Health
- Sentara Health Plans
- United Healthcare
When comparing plans, consider each carrier's network of doctors and hospitals. Fairfax County is served by 5 hospitals, including Fort Belvoir Community Hospital in Fort Belvoir, Inova Fairfax Hospital in Falls Church, Inova Fair Oaks Hospital in Fairfax, Reston Hospital Center in Reston, and Inova Mount Vernon Hospital in Alexandria. CareFirst BlueChoice plans typically have established networks that include many of these local facilities and providers.
Making Your Health Insurance Decision in Great Falls
Choosing the right health insurance plan, whether from CareFirst BlueChoice or another carrier, requires careful consideration of your healthcare needs, budget, and eligibility for financial assistance.Great Falls, with a population of 15,228 and an uninsured rate of 2.3% per U.S. Census Bureau ACS 2024 5-year estimates, benefits from Virginia's expanded Medicaid and robust marketplace options. For those residents, comparing plans on Marketplace Virginia (HealthCare.gov) is the first step.
Here’s a general guide to help you decide:
- If your household income is below 138% FPL: You likely qualify for Virginia Medicaid (FAMIS Plus). This program offers comprehensive coverage with very low or no out-of-pocket costs.
- If your household income is between 100% and 250% FPL: You may qualify for significant premium tax credits and Cost-Sharing Reductions (CSRs). Consider a Silver plan, as CSRs are only applied to Silver-tier plans, making them a very strong value.
- If your household income is between 250% and 400% FPL: You may still qualify for premium tax credits, reducing your monthly payments. Compare Bronze, Silver, and Gold plans based on your expected healthcare usage.
- If your household income is above 400% FPL: While you won't qualify for subsidies, you can still purchase a plan through Marketplace Virginia or directly from a carrier. Focus on deductibles, copayments, and network access.
A licensed health insurance producer can provide personalized advice, help you compare CareFirst BlueChoice plans with other options, and guide you through the enrollment process at no additional cost.