Kaiser Permanente Insurance Review: Why Is It Top-Rated?
by Stephanie Guinan
Kaiser Permanente consistently earns top ratings for its individual insurance and Medicare plans, often ranking far ahead of any competitors. It has a unique model of having insurance and medical care as branches of the same company. This is great for those who want a streamlined experience between health insurance and health care, but these policies are not a good fit for those who want flexibility when choosing their health care providers.
Good for
- Those who want top-tier customer service and coverage.
- Those who want convenience of getting all medical care at Kaiser facilities.
- Healthy people who want strong preventive coverage.
Bad for
- Residents who live outside of coverage areas.
- Those who want the flexibility to see any doctor.
- Frequent travelers who want routine care anywhere.
Health insurance plan options
Kaiser Permanente offers multiple types of health insurance, including individual plans, family plans, Medicare, Medicaid and group health insurance.
Most Kaiser insurance plans are HMO (health maintenance organization) plans, and this type of health insurance only covers in-network care and generally has cheaper monthly costs. This means your medical benefits are limited to Kaiser's 700 medical offices and 39 hospitals. You're also required to select a primary care physician who can refer you to specialists as needed.
A key concern for those with ongoing health conditions is that this integration between insurance and health care limits your access to specialists who are not affiliated with Kaiser. Keep in mind that Kaiser may have similar providers.
The limited network can also be a problem for people who travel regularly. When you're away from home, only urgent care and emergency room services are covered at facilities that are not affiliated with Kaiser. The company also has a dedicated travel line to help you navigate circumstances, coverage or preapproval when you're traveling to another Kaiser service area or outside of the service area.
Individual and family plans
You can also buy Kaiser health insurance plans through the Health Insurance Marketplace set up by the Affordable Care Act (also called "Obamacare") or directly from the insurance company. However, buying insurance through the marketplace does give you access to healthinsurance tax credits, which can reduce how much you pay for insurance.
Kaiser Permanente plans include required standard coverages, such as access to free preventive care and screenings, as well as financial protections like an out-of-pocket maximum. Plans are divided into the metal tiers of Bronze, Silver, Gold and Platinum. Kaiser's plans are also classified into the three insurance categories below, so you can choose a Bronze Deductible plan, a Gold Copayment plan or another combination.
- Health savings account (HSA) plans: These high-deductible plans are the cheapest plans offered by Kaiser. They allow you to set up a health savings account so you can avoid paying taxes on the money you'll use to pay for doctor appointments and other health care services.
- Deductible plans: These plans function like traditional insurance where you'll pay for most health services out of pocket until your spending reaches the deductible amount. Then, you'll pay the coinsurance rate specified by your plan.
- Copayment plans: These Gold and Platinum tier plans have high monthly rates. However, they have no deductible. These policies can help you save money if you expect high medical costs because you'll only pay a copayment for covered services.
Medicare
Kaiser Permanente also offers Medicare plans, which you can buy either directly from the company or through Medicare.gov.
Plan options:
- Medicare Advantage (Medicare Part C) plans expand the coverage you get with Original Medicare, adding on more cost-saving benefits and prescription drug benefits. These bundled plans can streamline your health coverage, and Kaiser has been named one of our best Medicare Advantage providers.
- Medicare Advantage Plus plans are how Kaiser classifies its Part C plans that also include coverage for dental care, hearing aids and eyewear.
- Prescription coverage is only available as a part of a bundled Medicare Advantage plan. Stand-alone drug coverage plans (Medicare Part D) are not offered.
Kaiser does not offer Medicare Supplement (Medigap) plans, and those who are looking for these plans can choose from our best Medicare Supplement providers, which include UnitedHealthcare and Aetna.
Kaiser Permanente's health coverage stands out in two ways:
- Its integration of health insurance with health care makes it easier for you to track costs and manage claims.
- The strong preventive care program includes access to screenings, health resources, lifestyle programs and health classes.
Depending on your plan, Kaiser's member services may include:
- Women's health services
- Mental health
- Addiction and recovery
- Chiropractic care
- Wellness coaching
- Prescription delivery
- Dental care (add-on)
- Vision care (add-on)
The company's powerful suite of digital tools also stands out from the competition. Plans include:
- Telehealth over phone, video or email
- Online access to health records including test results, doctor's notes and vaccination records
- A cost lookup tool
- The ability to schedule or cancel appointments
- Health insurance management including tracking your deductible
Plus, there are fitness resources including discounted gym memberships, health calculators and discounted massage therapy.
