Everyone wants the best, but how do you define best, and which one is it? We’ll answer those questions.
What’s The Right San Diego Health Insurance For You?
I love the “what is the best...” type of question. These questions are loaded with multiple answers. I’ll talk about what I mean by that in just a bit. In the meantime, you’re probably just wanting to know what the best health insurance in San Diego is?
Well, the answer depends on what “best” means to you.
Is it the lowest priced plan? Is it the best value plan, meaning the best cost for the benefits you get? Or is it the plan with the most doctors and/or hospitals to choose from? Is it the plan with the best benefits? Or is it the lowest cost plan that your doctor accepts?
All of these are possibilities.
What I’m going to do is grade the health insurance plans on criteria that I think are most important when picking the top plans:
- Network of Doctors & Hospitals
- Customer Service
Once I’ve done that I can show you which plans are the best in San Diego County.
The Network of Providers & Hospitals
Not all networks are created equal. This couldn’t be more true with health insurance networks. Big networks typically mean a higher price. Small networks mean your doctor might not be in the network or the choice of a specialist may be limited.
One of the biggest items with networks is the type of network. In San Diego County we have various network types: HMO; PPO; HSP; EPO. The last 3 (PPO, HSP, EPO) are all variations on a PPO network.
PPO Versus HMO Networks
Most people are familiar with PPO networks. A PPO network allows you to set up an appointment to go see any doctor in the network whenever you want to.
With an HMO network, you have a Primary Care Physician (PCP) who acts as the quarterback of your healthcare. If something new happens, you go see your PCP first. If the PCP can not treat you, the PCP will refer you to a specialist in the same medical group.
Because of HMO referrals, you'll want your PCP to be in a medical group with plenty of specialists.
For a PPO network, the only thing that matters is that your doctors are in the network and that there are plenty of specialists to choose from.
Overall, you want a network that provides access to many doctors, hospitals, and urgent care centers. Ideally, near where you live. I'll go over the major medical groups, the health insurance provider networks, and the hospitals, so you have the information you need to make a good decision.
Medical Groups In San Diego County
The table below shows the sizes of many medical groups in San Diego County.
The table above does not show every medical group that is in San Diego. We only show the medical groups that participate in HMO networks. Some of the data is from insurance company provider search tools.
One of my recommendations to everyone is to select your primary doctor from one of the 3 major medical groups: Scripps, UCSD, or Sharp. If you do this, then getting access to specialists and having all your doctors share the same medical records is easy.
As mentioned above, another important network factor is the size of the network for your health insurance plan. Typically, the PPO networks will be larger than HMO networks.
San Diego Health Insurance Networks
The table below shows the health insurance networks that are available within San Diego County.
The numbers in the above table give you an idea about the size of each network, however, they do not tell the full story about the networks.
For example, the Molina network is not even close to 2916 doctors. The Molina provider search tool counts doctors multiple times. Once for each clinic the doctor works at. The Molina tool also includes non-physicians in the totals. If your doctor is in one of the large San Diego medical groups, you probably won't find them in the Molina network.
The Health Net PureCare networks are primarily composed of stand-alone physicians. Doctors within large medical groups will not likely be in-network.
The Health Net CommunityCare network has the two large Scripps medical groups (Scripps Clinic and Scripps Coastal Medical Group), and Arch Health Partners, and a large number of community clinic physicians.
The Blue Shield HMO Trio network includes four of the Scripps medical groups: Scripps Clinic; Scripps Coastal Medical Group; Scripps Physicians Medical Group; Mercy Physicians Medical Group. The Blue Shield PPO network gives you complete access to all Scripps and UCSD doctors.
Last, but certainly not least, the Health Net PPO network is the only way to get access to Scripps, UCSD, and Sharp doctors in a single health plan. This network flexibility comes at a cost however, as this is always the most expensive plan at every benefit level.
Which Hospitals Are In The Health Insurance Networks?
The last key piece of the health insurance networks is which hospitals are available in each of the insurance company networks in San Diego.
Ideally, you want the hospital closest to where you live to be in your health insurance network.
It not, it’s okay, because you will be able to go to any hospital during a true emergency, and your treatment will be covered at in-network rates.
In San Diego County, there are many hospitals to choose from. The image above shows 32 hospitals, including all the major hospitals and many of the mental health hospitals as well.
Always check with your health insurance company to verify that the hospital in in-network.
Customer Service Rating Of Insurance Companies
One thing I find fascinating about health insurance companies is that they are almost universally hated based on customer ratings. If you look at any of the big rating websites like Yelp or Google, you’ll see that the insurance companies get 1 or 2 stars. Except for Kaiser.
Here is how I think this happens.
Everybody expects health insurance to work and cover their medical expenses, so when something turns out the way you expect, we don’t see that as something that should be put into a review.
When something goes wrong, then we feel neglected or mad so we want to lash out in some manner to hurt the insurance company. Leaving a scathing review is the result for many people.
Kaiser Permanente is the exception to this rule. Kaiser tends to get much higher ratings. I think this is partly because members are encouraged to leave reviews when they are pleased.
In general, my experience is that the customer service from each insurance company varies from one year to the next. It actually varies from one call to the next.
Sometimes I’ll get someone on the phone that sounds like they don’t really care and are just going through the motions. What I do in that situation is politely thank them for their help, hang up, and then call back and speak to someone else.
The second person is usually in a different frame of mind and is able to effectively help me.
California Health Insurance Plan Ratings 2019
Not all the insurance companies above are available in San Diego. Only Kaiser, Sharp, Blue Shield, and Health Net are offering individual and family (IFP) health plans here. The rest offer Group health insurance plans.
If I grade the insurance companies based on my experience as a broker, my rankings would be:
- Sharp Health Plan
- Blue Shield
- Health Net
- Blue Cross
Some people love Kaiser and others hate them. I am neutral and help my clients get the plan that is the best fit for them.
Price Of Health Plans
The last factor we use to determine the best health insurance plans is the price of the plan and the medical benefits each plan provides.
Bronze health insurance plans provide the lowest costs (usually), but also provide very little in medical benefits. You get preventive care for no cost, and 3 office visits and lab tests for co-pays. Otherwise, all other medical needs are your responsibility until you’ve spent $7,550 during the year. Bronze plans are the second most popular plans in California.
The most popular plans are Silver. Silver health plans give you zero cost preventive care, unlimited office visits for co-pays, and all lab tests, x-rays, MRIs, and other diagnostic procedure are a copay. Outpatient surgeries are a 20% cost. Silver plans do have $2,500 deductible, but it only comes into play if you are admitted to the hospital. Otherwise, medical expenses are co-pays or 20% coinsurance (you pay 20% and the insurance company pays the other 80%).
The table below shows how all the health insurance plans in San Diego compare to each other from a price standpoint. We use prices at age 30 and age 55.
From this table. we can see the Molina HMO or Health Net HMO plans are typically the lowest cost in each plan type.
If you compare the pricing of the Bronze plans versus the Silver plan, you will see that some Silver plans only cost $40/mo - $55/mo ($78 - $107 for a 55-year-old) more than a Bronze plan. At Blue Shield, the Silver HMO plan costs less than the Bronze plans.
Here are some common issues and questions about the best plans:
Because of the smaller price difference between the Silver and Bronze health plans, the Silver plans are the better value for most age groups.
Why didn’t Molina make it into the top plans? Because you won’t find your doctors in Molina’s more limited San Diego network.
Does it make sense to upgrade from Silver to Gold or Platinum? Only in special circumstances.
If you are going to have an in-hospital stay, then upgrading to Gold or Platinum could make sense. Upgrading would keep you from having to pay the Silver $2,500 deductible.
The List of Top Health Insurance Plans in San Diego!
Here’s the moment you’ve been waiting for. What are the top health insurance plans in San Diego County?
Drum roll …
Health Net Silver 70 CommunityCare HMO
This plan has the best combination of price, benefits, and network. The inclusion of the two Scripps medical groups makes this plan ideal for Scripps patients. This plan is usually lower cost than many of the Bronze options from other insurance companies.
Sharp Health Plan Silver 70 Premier HMO
If your doctors are in one of the two Sharp medical groups (Sharp Community Medical Group or Sharp Rees-Stealy Medical Group, then this is the best option for you. The customer service, price, and benefits are a great value.
Kaiser Permanente Bronze 60 HMO
This is the only Bronze plan to make the list. Kaiser gets the nod over Molina by virtue of their network size and customer service ratings. The Bronze plans had large rate increases in 2019 and Kaiser definitely gained many customers looking for catastrophic coverage like the Bronze plans.
Blue Shield Silver 70 HMO Trio
With Blue Shield's Silver 70 HMO plan you get access to more of the Scripps medical system, but at a higher cost than Health Net's top plan. For this reason the plan is fourth on the list. If your doctors are not within Scripps, then this plan will not be a good fit for you.
These plans all use HMO networks. The PPO networks simply cost too much to be considered great (or even good) medical plans.
If I had to pick one PPO plan I would pick a Silver PPO plan from Blue Shield.
The best health insurance plan for you is the plan that provides access to your doctors and hospitals and gives you the coverage you need. The list I’ve provided above is a good starting point for you.
Your next steps are to determine which networks your doctor is in. Then determine what benefits you need to have. Finally, you’ll need to run a set of quotes and determine which plan fits your needs and is affordable.
If you have any questions, feel free to call us at 858-613-3628 to get answers and help.