The unique part of Kaiser Permanente health insurance plans is that Kaiser has its own network of physicians and hospitals. Therefore, most people that have non-Kaiser physicians don’t select Kaiser plans because they would have to change doctors. Depending upon where you live, Kaiser may not offer plans in your area of the state.
In this Kaiser health insurance plan review we will summarize the benefits of each family of plans, describe who the plans are appropriate for, and compare the plans to the competition.
Deductible Plans
These are Kaiser’s PPO plans. They each provide free preventive care, unlimited office visits with a simple copay, and generic and brand name prescription coverage. The Deductible family has deductibles of 500, 1000, 1500, 2000, and 3000.
Click here to get more details about the Deductible plan benefits.
The Deductible plans are fairly high in benefits, so they will tend to be a better fit for individuals that need more regular doctor visits or brand name prescription coverage. Families with small children will also find these plans useful.
From a price versus benefit standpoint, the Kaiser Deductible family is competitive with Cigna’s Open Access plans, the Anthem Blue Cross Premier plans, and the Aetna Open Access Managed Choice plans. The Kaiser plans are slightly higher priced than the Cigna, Anthem, Aetna, and Blue Shield plans but they make up for that with a little better prescription benefits and lower Out-Of-Pocket maximums.
HSA Deductible Plans
The HSA Deductible plans are Kaiser’s Health Savings Account compatible offerings. As such they offer preventive care for free, and all other medical benefits are paid by Kaiser after you reach the deductible. The family of plans has deductibles of 0/1500, 0/2700, 30/2700, 40/4000, and 50/5000. With the 0/1500 and the 0/2700, Kaiser pays 100% for all medical benefits once you reach the deductible amount. For the other HSA plans, you begin sharing costs with Kaiser once you reach the deductible, with Kaiser paying 70% and you paying 30%.
Click here for a more detailed description of the plan benefits.
Like all Kaiser health insurance plans, the HSA Deductible plans offer free prenatal office visits. This can be a great cost savings since a normal pregnancy has 12-14 prenatal office visits. Over the last couple years, the 0/1500 HSA Deductible plan has been one of the top 2 maternity insurance plans in California. The remainder of the Kaiser HSA plans are not very competitive with the HSA plans offered by the other carriers so we don’t recommend them.
Kaiser Copayment Plans
The Kaiser Copayment plans are HMO plans with rich benefits. This family of HMOs offers free preventive care, unlimited office visits for a simple copay, and generic and brand name prescription coverage. As the name implies, these plans provide all benefits with just a copay. There is no coinsurance in these plans. The family has 3 separate copayment options. The $50 Copayment has $50 office visit copays and a $500/day hospital copay. The $40 Copayment plan has $40 office visit copays and a $350/day hospital copay. The $25 Copayment plans has $25 office visit copays and a $200/day hospital copay.
Click here for more details about the Copayment plan benefits.
The Copayment plans are a good option for someone that has an active injury prone lifestyle. These plans are the most benefit rich options available in the California marketplace. The other situation the Copayment plans are good for are women that are planning to get pregnant. The $50 copayment plan has been one of the top five maternity insurance plans in California for the last several years.
The Kaiser Copayment plans are the best HMO plans in California. They have richer benefits and lower monthly premiums than all but the Health Net HMO Value 50 plan. Comparing the Kaiser HMO plans to the Health Net HMO Value plan, the main difference is that the Kaiser inpatient and outpatient benefits are copays where the Health Net HMO plan has a 50% coinsurance cost. If a large medical event were to occur the Kaiser plans would give you better protection cost-wise.
Summary of Kaiser Permanente Review
Most people either love Kaiser or hate Kaiser. People that have recently moved to California tend to stay away from Kaiser once they learn that their choice of doctors and hospitals are limited to only Kaiser facilities. That being said, Kaiser Permanente health insurance plans are good values in the situations outlined above.
With Health Care Reform just around the corner, Kaiser Permanente is at the crossroad of being a major player or being left behind. The lack of facilities across the whole country may limit Kaiser’s ability to get a large enough customer base in order to compete with the larger competitors that do have a country wide footprint. If that occurs, then Kaiser could be limited to a lesser role in 2014 and beyond.
See the recent analysis for the other major insurance companies by clicking on these links:
Health Net Analysis
Blue Shield Analysis
Anthem Blue Cross Analysis
Cigna Analysis
Aetna Analysis
If you would like to discuss your specific needs with one of our advisors please call us. If you want to see what health insurance plans are offered where you live, and what the pricing looks like, “click here” to get a health insurance quote.