Choosing the right health insurance plan can be a challenge. If you live in one of Kaiser Permanente’s service areas, it’s definitely worth a look. Read on to learn more in this thorough Kaiser Permanente insurance review.
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Kaiser Permanente Insurance Products
Some insurance companies offer multiple lines of insurance. Kaiser Permanente focuses exclusively on offering affordable health insurance. Kaiser Permanente has health insurance plans in the following areas:
- Northern California: Kaiser has health care providers in many areas, including Fresno, San Francisco, Sacramento, San Jose, Santa Clara and Santa Cruz.
- Southern California: You can find Kaiser health providers in Kern County, the greater Los Angeles area, Orange County, San Diego County and more.
- Washington state: Kaiser has providers throughout the state.
- Colorado: You can find Kaiser providers and plans in most of Colorado’s major cities, including Denver, Boulder, Colorado Springs and Eagle.
- Georgia: Kaiser is available in Atlanta and Athens.
- Hawaii: You can find Kaiser providers and plans on the Island of Hawaii and in Kauai, Maui and Oahu.
- Mid-Atlantic Regions: Kaiser is available in Baltimore, Washington D.C. and its Maryland suburbs and Northern Virginia.
- Oregon: You can join Kaiser plans in Portland, Eugene and Salem.
Available Discounts and Tips on Getting the Best Rates
The process of how to get health insurance can be confusing. Plans have various enrollment periods. You can buy health insurance through your state marketplace during open enrollment, which starts in November and lasts for about 1 month. If you missed open enrollment, you might still be able to enroll in a plan if you experienced a significant life event. These include:
- Losing other health insurance
- Getting married
- Having a baby
Kaiser Permanente, like most health insurance plans, doesn’t offer discounts. To get the best rate on a plan, consider applying through your state’s health insurance marketplace. Why? When you apply for health insurance through your state, you answer questions about your household size and income. This helps your state determine whether you qualify for any premium tax credits or cost-sharing reductions.
The Premium Tax Credit
To qualify for a premium tax credit, your household income must be 100% to 400% of the federal poverty level for your family size. If your income is below 100% of the federal poverty level, you may qualify for your state’s Medicaid program. In 2019, the federal poverty line for all states except Alaska and Hawaii was $25,000 in annual income for a family of 4. In Alaska, it was $31,380 and in Hawaii, it was $28,870.
The premium tax credit lowers your monthly premiums for Kaiser Permanente plans and other plans sold through the marketplace. The IRS can send your tax credit to your insurance company. Depending on your income, you may also qualify for cost-sharing reductions. These reductions lower your deductible and copay. This means you pay less out-of-pocket when you receive health care services.
Kaiser Permanente Insurance Coverage Selections
Kaiser Permanente offers a range of health care plans to meet different needs. These include:
- Individual and family plans: These plans can be purchased directly from Kaiser or through your state’s health insurance marketplace.
- Medicare plans: Kaiser offers Medicare Advantage plans. These plans work with Medicare to provide your health care. These plans cover doctor visits, hospital services and prescriptions. Medicare has rated Kaiser’s Medicare plans 5 out of 5 stars.
- Medicaid plans: Depending on your state, you may be able to receive your Medicaid services through a Kaiser Permanente health plan.
- Employer-sponsored coverage: Many people receive their health insurance through their employers. If you live in a Kaiser service area, check with your employer to see if Kaiser is an option for you.
Pricing and Value
Kaiser Permanente prices its plans based on several factors. All health insurance plans consider these factors. They include:
- Age: Older people are more likely to use health care services. Health insurance companies charge higher premiums for older people than younger ones.
- Location: Each plan location is different. Every area has different insurance providers and competition. This impacts Kaiser’s premiums.
- Tobacco: Health insurance plans may charge more for users who use tobacco products.
- The number of plan members: An individual plan costs less than a family plan.
Exact plans that Kaiser offers vary by location and have the same components as other health insurance plans. Kaiser Permanente’s health insurance plans are available at different price points. The best health insurance plan depends on your budget and how often you use health care. As you review Kaiser Permanente’s plans, consider:
- The deductible: Kaiser’s lowest-priced plans have the highest deductibles. This is the amount you pay for covered services before your plan starts coverage. In Southern California, Kaiser Permanente’s HSA Bronze plan has a $6,900 deductible per person ($13,800 per family). Its Deductible Bronze plan has a $6,300 deductible ($12,600 per family). You can see your primary care provider for a $65 copay before you meet the deductible.
- The copays: A copay is a flat fee that you pay for a specific service. Prescriptions also usually have a copay. You may have to meet your deductible before the copays apply, but it varies by plan.
- The coinsurance: Some of Kaiser Permanente’s plans have coinsurance. Coinsurance is the percentage of the cost of a covered service that you’re responsible for. Instead of a $40 copay to see a primary care provider, for example, you might pay for 40% of the cost of the visit. Coinsurance typically starts after you meet your deductible.
- Out-of-pocket maximum: Kaiser’s plans also have an out-of-pocket maximum. This is the most you will pay out-of-pocket for covered services. It includes your deductible, copays and coinsurance. A lower out-of-pocket maximum means a higher monthly premium.
The best value plan for you depends on your health care needs and preferences. If you like more predictable costs, you might want a plan with a higher premium and a lower deductible. If you want to minimize your monthly premium, choose a plan with a higher deductible.
Kaiser Permanente has a reputation for good customer service, but it also depends on which region you live in. Its Mid-Atlantic state plans have a 3.5 out of 5 consumer satisfaction rating from NCQA, which is a health insurance rating organization. Its Washington plans have a 1.5 out of 5 consumer satisfaction rating.
Kaiser Permanente offers extensive resources on its website. You can find doctors, refill prescriptions and schedule appointments. You can also email your doctor via the website. Each service area also has a dedicated member services number. In most areas, you can reach member services during business hours Monday through Friday. In California, you can reach member services 24/7.
One of the perks of getting health insurance through Kaiser Permanente is the claims process. With most health care plans, you’re trying to get your doctor to bill your health insurance. With Kaiser, your health insurance and your health care are both coming from Kaiser Permanente. That doesn’t mean things will always go smoothly, but it does increase your chances. If you need assistance with a bill or claim, you would reach out to member services. It’s essentially one-stop healthcare shopping.
Is Kaiser Permanente Right for You?
Kaiser Permanente is unique in how it combines health insurance with health care. In many areas, you can get care in a Kaiser facility. A Kaiser facility has several different providers and many have an in-house pharmacy. This allows you to get all of your health care needs taken care of in one spot.
Kaiser typically expects its members to see network providers. If you have a doctor you’re attached to who isn’t in the Kaiser network, you’ll need to either switch providers or choose a different plan. Kaiser is more flexible when it comes to emergencies, but in general, it expects you to see doctors and go to hospitals within the Kaiser network.
To decide if Kaiser Permanente is right for you, look at a variety of plans. Go online and look at your plan options in your area. Research Kaiser’s reputation in your area. Consider which type of plan you’re most comfortable with and how important it is to choose your providers. If you’re flexible and you like the convenience of getting all your healthcare under one roof, Kaiser might be a good fit.