Kaiser vs. Blue Cross: Is Kaiser Better than Blue Cross?

Updated: September 19, 2023
is kaiser better than blue cross

When it comes to choosing the right health insurance provider, you want to ensure you’re making an informed decision. Two prominent names that often come up in this conversation are Kaiser Permanente and Blue Cross Blue Shield. In this article, we will not only address the question, “Is Kaiser better than Blue Cross?” but also explore additional keyphrases like “Is Kaiser good insurance?” and “Kaiser Permanente vs. Blue Cross Blue Shield.” Let’s dive into the details to help you make the best choice for your healthcare needs.

Pros & Cons of Blue Cross Blue Shield

Pros

  • Found in all fifty states
  • Superior network size to Kaiser
  • More insurance options than Kaiser

Cons

  • Not all 50 states offer Medicare Advantage plans.

Pros and Cons of Kaiser Permanente

Pros

  • Services from a doctor, lab, and pharmacy all in one place
  • The same organization handles both insurance and medical treatment

Cons

  • Accessible only in eight states
  • Fewer options for doctors and coverage than BCBS

Kaiser Permanente vs. Blue Cross Blue Shield: Plans Available

The availability of individual and family health insurance coverage across the nation is where BCBS outperforms Kaiser. While Medicare policies are only offered in 47 states, BCBS insurance is accessible in all 50.

In addition to the District of Columbia, Kaiser Permanente provides insurance coverage in the following eight states:

  • Hawaii
  • Georgia
  • Maryland
  • Virginia
  • Oregon
  • DC, Washington
  • Washington
  • Colorado

Kaiser Permanente vs. Blue Shield: In-Network Providers

With a vast network of 1.7 million health insurance providers, BCBS wins the prize. The Kaiser network comprises 65,005 nurses, 23,656 doctors, 737 medical offices, and 39 hospitals. Kaiser’s network is still sizable, but BCBS’ enormous network dwarfs it.

Kaiser Permanente vs. Blue Cross Blue Shield: Cost

The cost of BCBS and Kaiser healthcare insurance varies depending on age, health history, deductible, and health plan.

State

There are four plan category levels offered by BCBS and Kaiser: bronze, silver, gold, and platinum. Your insurance’s cost is determined by the tiers, not by the caliber of your care:

  • Bronze: Higher out-of-pocket expenses but a lower monthly premium
  • Silver: It has regular monthly payments with smaller out-of-pocket costs than bronze but is more costly than the gold plan.
  • Gold: The monthly payments for this plan are pretty expensive, but the out-of-pocket costs are lower.
  • Platinum: The monthly premiums are the highest, while deductibles and copayments are the lowest.

Both companies provide Medicare Supplement (Part D) insurance and Original Medicare (Parts A and B). If you pay for Medicare for around ten years, you may qualify for free Part A, but the MA plan will cost you. In 2022, the median monthly cost for an MA plan is $19.

Kaiser Permanente vs. Blue Cross Blue Shield: The Limits for Coverage

Since diverse people have varied requirements, resources, and health concerns, healthcare policy constraints will range between plans. BCBS and Kaiser, like all other health insurance providers, are banned from imposing financial limits on critical medical care, which can include:

  • Emergency assistance
  • Laboratory service and hospitalization
  • Services for substance use disorders and mental health
  • Children’s services
  • Prescription medications
  • Maternity and infant care
  • Chronic disease prevention and management services
  • Rehabilitative and habilitative services and equipment.

Kaiser Permanente vs. Blue Cross Blue Shield: The Policy Management

Members of both companies can contact their health insurance plans via a mobile app, a real-person agent, or a website. Customers can:

  • Check coverage.
  • Compare prices for prescription drugs.
  • Locate in-network healthcare providers.
  • Paying the bills.
  • Keep track of every activity.
  • Obtain an ID card using both mobile apps and internet portals.

Blue Cross Blue Shield BCBS vs Kaiser Permanente: The Medical Loss Ratio (MLR) of both Companies

The MLR calculates how much member premiums are used to improve medical care. Insurance companies must put at least 80% (for personal policies) or 85% (for business plans) of premium money toward improvements. Policyholders will be reimbursed for the difference if the MLR is less than needed.

Massachusetts, Texas, Minnesota, and North Carolina are just some states where BCBS will start providing MLR in 2022. Kaiser’s decision to offer rebates this year is still being determined. According to the Kaiser Permanente Family Foundation, all insurance companies will provide $1 billion in refunds.

Kaiser Permanente vs. Blue Cross Blue Shield: The Enrollment Process

From November 1st, 2022 – January 15th, 2023, most states’ health insurance marketplaces will be open for enrollment to purchase a BCBS or Kaiser Health plan. Your household’s income must be below the federal poverty threshold whenever an event occurs, such as becoming a citizen of the United States, changing jobs, getting married, divorcing, having a child, or adopting a child, which can qualify you. You can still get health insurance after enrollment if your health coverage is lost due to the death or job loss of a spouse or domestic partner.

Enrollment in Medicaid is available to anyone who meets the requirements all year. Contact the Medicaid office in your state or register on the insurance exchange website to apply. 

SHOULD I CHOOSE KAISER PERMANENTE OR BLUE CROSS BLUE SHIELD?

In conclusion, you should pick the health insurance company that suits your needs. Consider the following while comparing Blue Cross Blue Shield vs. Kaiser:

Where are you physically located?

This insurance company might be suitable if you reside in one of Kaiser’s eight covered states or near Washington, DC. If you need clarification and are thinking, “Is Blue Shield better than Kaiser?” Blue Cross Blue Shield is better if you live in a state that Kaiser does not cover.

What are your main concerns?

Kaiser’s wellness-focused incentives and “one-stop shop” approach to care may be the right fit if you’re searching for high-quality treatment and convenience. BCBS is a beautiful option for consumers who want more provider options and flexibility with their care.

How are you feeling?

Your out-of-pocket expenses will be cheaper no matter which provider you select if you are in generally good health. If you have a chronic disease, you should carefully evaluate the specifics of each health insurance plan to see where you can get the most coverage and the best prices. Think about any specialists you visit and other unique health requirements like mental and behavioral healthcare.

Your decision on the service provider will also be influenced by whether you have a spouse or dependents. To choose which business best meets your family’s healthcare needs, you must carefully analyze its benefits. This should also be considered if you intend to start a family.

Businesses have a more difficult challenge selecting health insurance for employees because each employee will have distinct demands. These specific elements that organizations must take into account are:

What is your benefits budget?

A budget balance is necessary for every firm. It’s crucial to have a strong idea of how much you can spend on benefits and pick a provider within that budget.

What is the makeup of your workforce?

Businesses with a high percentage of young, single personnel will have very different needs than a large firm with employees of all ages who might have dependent spouses and children. The plan you select should offer sufficient coverage for most of your employees.

Where are you located?

Are your staff dispersed across the nation or just in one state? You should ensure that all employees—not just those who work near your office or corporate headquarters—can use your benefits.

Do you want a more wholesome workforce?

Both insurers offer adaptable options and top-notch assistance for individual and employer-sponsored insurance. Blue Cross Blue Shield and Kaiser Permanente also provide consumer-directed health plans, enabling staff members to act as their advocates. These programs provide employees with power over their purchasing and health decisions. Long-term cost control for employers can also be achieved using these kinds of strategies.

Advice on Picking a Medical Plan

Think past the premium.

For the duration of the plan year, the monthly premium is predictable and will not change; however, the plan’s total cost to you will vary depending on a variety of variables. This is valid whether you’re considering the program with the lowest premium or even the one with the highest bonus. Consider how your plan will affect your ability to access doctors, the breadth of coverage, and the cost of the services you will receive.

Define your requirements.

Consider what matters to you.

  • Do you want to minimize the amount you pay for medical services?
  • Are you content with being limited to a particular set of physicians and having a primary care physician and a medical group refer and approve your services? Or are you prepared to pay a more excellent price to speak with specialists directly and without a pass?
  • Is there a specific physician you or a member of your family would like to see? If they do, do you know if the health insurance you’re considering covers them?
  • Do you want any particular treatments or services to be covered?
  • Do you or a family member frequently take prescription medications? If yes, are they on your insurance plan’s formulary or preferred prescription list?

Take personal expenses into account.

The sums you will require to pay for services covered by your plan are your “anticipated out-of-pocket charges.” While HMOs often demand predetermined copayments, PPOs typically contain annual deductibles and coinsurance requirements for most treatments. HMOs usually require predetermined copayments. Under an HMO, you could pay a coinsurance fee for some services (for example, infertility treatment on some plans). Certain preventative care services are now accessible thanks to health care reform legislation. To find out how much you will be responsible for paying for particular services, consult the schedule of benefits for the plan.

Annual maximum out-of-pocket limits are another feature of plans that should be remembered. The out-of-pocket maximum of a plan shields you from spending a limitless sum on services. Once you’ve paid the plan’s maximum deductible, the remainder of the calendar year is 100% for most medical procedures.

Identify the covered benefits and exclusions of the plan.

Considering your unique demands, carefully consider the range of benefits the plan offers and what is excluded. Some programs include extras like chiropractic and acupuncture treatment coverage. The coverage for infertility varies between UC plans.

Consider whether someone you are covering will reside somewhere else over the year.

Choose a plan that offers services outside of the area if you travel, work remotely, or have family members who reside elsewhere. Besides Kaiser’s Visiting Member Benefits, HMO plans only pay for urgently needed or emergency care when you are outside your plan’s service area. Coverage under the UC Health Savings Plan, UC Care, and CORE extends to you even while you’re out of state or country. While the UC Health Savings Plan only covers emergency care when traveling outside the US, UC Care and CORE offer the complete spectrum of plan benefits.

Ask yourself if you anticipate any changes in your life in the coming year.

You should think about what you need once your circumstances alter if you anticipate changes in your family, or if you intend to retire. If a family member becomes eligible for benefits after you enroll, UC lets you switch plans outside of Open Enrollment. The services you and your family will use from the project may alter, or your premiums may increase by adding a new family member.

Your plan benefits may be impacted by retirement and Medicare coordination. With a few exceptions, such as relocating out of your plan’s coverage region or switching to your plan’s Medicare plan, you often cannot change plans at retirement. You can alter your dreams at the following open enrollment after you retire. Knowing how your program will function in retirement, including with Medicare, if you are eligible, can be crucial if you retire mid-year.

Take into account prescription drug coverage.

Plans differ in terms of copays and coinsurance for prescription medicines. There are defined copay amounts for most eligible prescription drugs under UC plans. CORE and UC Health Savings plan members pay the total cost of prescription medicines until the annual deductible is satisfied. Most insurance plans have prescription formularies or preferred drug lists. Your copays or coinsurance for a drug on the plan’s form will be lower than those for a drug not on the model. To assist you in keeping your costs down, examine if your medications are listed on the plan’s formulary.

FAQs

Kaiser Permanente vs. Blue Shield of California: What’s the difference?

If you are confused about the question “Does Kaiser take blue shield?” then the wellness-focused incentives and “one-stop shop” type of care offered by Kaiser may be the best option if you’re searching for high-quality treatment and convenience. BCBS is a beautiful option for consumers who want more provider options and flexibility with their care.

What sets Kaiser apart from other insurance companies?

They care for their members using a distinctive business strategy that unites health insurance and medical treatment into a single, well-coordinated experience. They are a direct health care system that is membership-based, prepaid, and unlike a standard insurance company.

Who has the best rating among health insurance providers?

Blue Shield is our top choice on our list of the Best Health Insurance Companies of 2022. The insurance offers affordable prices, various coverage options, and high third-party ratings.

Is California’s Kaiser a reputable insurer?

According to the state report card, Kaiser Permanente in California achieved an average rating of 4.5 stars out of 5 for the standard of its medical care. This is substantially better than the state’s 3.1-star average health insurance plan rating.

Is Kaiser a California-only company?

California, in whole or in part, is included in the Kaiser Permanente service region.

  • Hawaii
  • Georgia
  • Maryland
  • Virginia
  • Oregon
  • DC, Washington
  • Washington
  • Colorado

As a Kaiser Permanente member, you have access to emergency and urgent care worldwide.

Is Blue Shield California the same as BCBS or Blue Cross Blue Shield?

In most states, BCBS can merge under the Association of Blue Cross Blue Shield umbrella. However, California is home to two distinct health insurance companies competing with one another and offering substantial network coverage: Anthem BCBS of California.

What is the Californian name for Blue Cross Blue Shield?

The BCBS of California has a new name in California, Anthem Blue Cross. Blue Cross Association has issued separate licenses to Anthem BC (Blue Cross) and Anthem Blue Cross Life & Health Insurance Company.

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