Kaiser Permanente Health Insurance Review for 2022

Why Health Care Insurance Is important

Everybody needs health insurance because the cost of health care is so high that a serious illness or accident can cripple you financially. Even minor surgery, dental care, or general health care is not cheap these days.

The Need for Private Health Care Insurance

Public health cover is available through the government which offers programs such as Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Each of these programs has rules for being able to join and have limited health care coverage.

Private health insurance comes in a variety of cover options with additional benefits such as gym memberships, preventative care programs, and prescription drug cover. 

With private insurance, there are no barriers to entry such as age or income; you are covered as long as you can afford it and you pay your premiums regularly.

Medicare Explained

The federal government’s Medicare program consists of four parts: 

• Part A (Hospital Insurance). 

• Part B (Medical Insurance).

• Part C (Medicare Advantage). 

• Part D (Prescription Drug Insurance).

Parts A and B are available from the government, while Parts C and D are offered by private health insurers.

Original Medicare (Parts A and B)

Medicare Part A and Part B make up what is called Original Medicare or Obamacare, and is aimed at citizens over 65.

Younger people with certain disabilities, end-stage renal disease (ESRD), or ALS (also called Lou Gehrig’s disease) can also join the program.

Original Medicare covers medical treatment and services provided by doctors and other health care providers at public hospitals or other approved medical facilities when medically necessary. It covers some skilled nursing care, has limited home health care and end-of-life hospice care. Eye tests, most dental care options, and prescription drug cover are excluded.

As far as prescription drug cover is concerned, you can take out a stand-alone Prescription Drug (Part D) Plan with a private insurer while on Original Medicare, but at an additional cost.

It is important to understand that the Original Medicare cover is not comprehensive. If you can’t afford to pay for services outside of the Original Medicare framework, you may have to do without the care or rely on family for financial assistance.

Another drawback is that there is no limit to how much you may have to spend on the out-of-pocket expenses. 

If you want to limit your out-of-pocket costs, you can take out a Medigap insurance policy from a private insurer, but again, it will be an additional cost.

Visit the Medicare.gov website to read more about the differences between Original Medicare & Medicare Advantage plans.

You can only join Medicare, with a few exceptions, during fixed enrollment periods in each year. Visit the Kaiser Permanente website for more details on When To Enroll for Medicare.

Medicare Advantage (Part C) Plans 

An alternative to Original Medicare is Medicare Advantage Plans. These plans provide the same cover as Original Medicare but include cover for prescription drugs, eye care, as well as dental and hearing services in a single plan.

The extent of the cover and cost will vary depending on the Medicare Advantage Plan you choose.

Medicare Prescription Drug (Part D) Plans

These plans cover take-home prescription medication and most of the commonly prescribed outpatient drugs. If you choose Medicare Advantage Plan (Part C), Prescription Drug (Part D) cover is generally included.

Costs Involved With Health Care Insurance

Apart from the monthly premium, there are several other out-of-pocket costs that you need to take into account. These apply whether you choose Original Medicare or private health insurance:

• Deductible is a set amount—either in dollars or a percentage—that you pay before the insurer starts paying toward your medical expenses. This means you pay 100% for all medical services until you reach the deductible amount. Then your coinsurance will kick in. 

• Coinsurance is your share of the cost of any medical service or product covered on your plan. For example, if you choose a plan with 20% coinsurance, you carry 20% and the insurer 80%. Bear in mind that this percentage split will apply only after you’ve reached the deductible amount specified on your plan.

• Co-payment, or co-pay is the first portion of every medical bill for which you are responsible. It is usually paid at the point of service—for example, at the doctor’s office—and it is usually a fixed amount. It may differ according to the health care service. The co-pay for a doctor’s visit may be different to the co-pay that applies for a hospital visit.

• Out-of-pocket limit is the maximum you can be expected to carry in a year. Once you reach the specified maximum collectively on deductibles, co-pays, and coinsurance, your insurer will pay 100% of the cost of all medical services you use until the end of the year.

What Private Health Care Insurance Costs

The premium for private health insurance varies between plans, and insurers. 

The premium is based on factors such as your age, extent of cover, whether coverage is provided for an individual or family, where you live, and whether you are a smoker. 

Each plan also has its own levels for deductibles, coinsurances, co-pays, and out-of-pocket limits.

Kaiser Permanente: The Company

Kaiser Permanente officially opened to the public in July 1945, but it had its roots during the Great Depression.

Today, Kaiser Permanente operates as a collaboration between three entities: the nonprofit Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals, and the Permanente Medical Groups, which incorporate regional physician networks.

More than 12.6 million members in 8 states and the District of Columbia benefit from Kaiser Permanente health insurance. 

Pros and Cons of Kaiser Permanente

Pros

✅ Established health insurer with consistently good ratings.

✅ Low deductibles on drug plans.

✅ Low-premium health savings account plans. 

✅ One of the best Medicare Advantage insurers

✅ High scores for quality of care given.

Cons

❌ No Medigap plans.

❌ No stand-alone drug coverage plans (Medicare Part D).

❌ Plans are not available in every state.

❌ Plans require that you use a provider network.

Health Care Cover from Kaiser Permanente

Kaiser Permanente has a range of health insurance policies available including individual and family plans, Medicare, Medicaid, and Employer Group Health plans. It doesn't offer Medigap or stand-alone Prescription Drug Plans. 

• Medicare Plans.

Kaiser Permanente is one of the best insurers for Medicare Advantage (Part C) Plans which are classified as either Bronze, Silver, Gold, or Platinum. 

These metal tiers determine the level of deductibles, co-pays, coinsurance, and deductibles of the plans. 

Bronze plans have the cheapest premiums but the highest out-of-pocket expenses, while Platinum plans cost the most in monthly premiums but have the lowest out-of-pocket expenses.

Where you live will determine whether you can get health insurance from Kaiser Permanente.

The insurer offers Medicare health maintenance organization (HMO) plans in California, Hawaii, and Washington. Both Medicare HMO and HMO-POS plans are available in Colorado, Oregon, Southwest Washington, Georgia, Maryland, Virginia, and the District of Columbia.

• Health Savings Account (HSA) Plans.

These are health plans that have a high deductible, very low premiums, and a health savings account from which to pay for health care services. 

The savings are not taxable as long as you use it for medical expenses, in which case you’ll qualify for a tax benefit. 

If you have Medicare coverage, you can’t take out a health savings account plan.

• Employer/Group Insurance Plans.

Kaiser Permanente has a range of plans for employers that provides cover to their employees.

• Low-Income Health Insurance.

A number of plans are available for low-income earners and indigents.

Kaiser Permanente is one of the providers of the government’s Medicaid insurance program, which offers health care cover to low-income individuals.

Its Charitable Health Coverage Program helps people who cannot get any form of health care insurance to access medical services.

Kaiser Permanente aids low income and vulnerable people through its Medical Financial Assistance Program which provides urgent and medically necessary care to these groups.

Additional Perks from Kaiser Permanente

A range of additional wellness services are available on some of the plans, which include:

• Virtual Health Care.

Virtual care is available to members 24 hours a day, 7 days a week.

• Preventative Health Care.

Most health plans include access to free vaccinations, screenings, and other preventative care measures. And members will receive automated reminders.

• Apps.

The Kaiser Permanente app allows you to manage your plan—for example, you can set up appointments, order repeat prescriptions, view your test results, and more. It also has wellness apps that aid sleep, help you to relax, enhance your mood, and build good emotional health. 

• Healthy Living Program.

The insurer offers incentives and support to encourage members to live healthy lives, such as discounted gym memberships, as well as reduced rates for acupuncture and chiropractic treatments.

Kaiser Permanente offers tailored online support for members who want to lose weight or quit smoking, as well as one-on-one consultations with a wellness coach.

Is Kaiser Permanente A Good Insurer?

ConsumerAffairs.com

ConsumerAffairs is a private company that provides useful information to consumers. It assesses companies based on reviews from real customers.

Of the 162 reviews from actual Kaiser Permanente members, the insurer was given an average score of 3.4 out of 5 stars. The reviews show that the experiences of the members vary widely. Some reviewers gave the insurer only 1 star and others gave it 5 stars.

Centers for Medicare & Medicaid Services (CMS)

CMS is a government agency in the Department of Health and Human Services (HHS) that runs the federal Medicare program.

Every year, CMS rates Medicare Advantage and Medicare Part D Prescription Drug Plans by awarding 1-5 stars to plans based on their performance. A 1-star rating means a plan performed poorly and 5 stars reflect an excellent performance.

The star ratings take into account member experiences, the efforts of insurers to ensure the health of members, chronic disease management, pharmacy services, and customer service levels.

Each health plan is rated separately, and five Kaiser plans were awarded 5 stars in the 2023 CMS Star Ratings. Kaiser Permanente Medicare health plans in California, Colorado, Georgia, Hawaii, and the mid-Atlantic states (Maryland, Virginia, and Washington, D.C.) all received the top score of 5 stars.

According to the Kaiser Permanente website, this is the 13th consecutive year that all Kaiser Permanente Medicare health plans were rated 4 stars or higher.

Visit the online Medicare Plan Finder Tool on Medicare.gov to compare the star ratings, and obtain information such as the cost and coverage of Medicare Advantage Plans, Prescription Drug Plans, and Medigap Plans.

National Committee for Quality Assurance (NCQA)

Another organization that researches health insurance plans is the National Committee for Quality Assurance, or NCQA.

Health insurers are assessed on the quality of care provided to clients, client satisfaction ratings, and the health plans' efforts to improve. Plans are given between 1 and 5 stars with 1 star being the worst, and 5 stars given to the best performers. 

Kaiser Permanente insurance companies in the various states score top marks in the NCQA Health Plan Report Cards with many companies being awarded 4 and 5 stars.

State of California Office of the Patient Advocate (OPA)

Kaiser Permanente has a very large number of customers in California, so it's worth having a look at how the quality of care they received was rated.

According to the OPA’s health report card for Kaiser Permanente was highly rated for the care it provided to patients.

Source: Kaiser Permanente - Northern California - HMO 2022-23 Edition

Financial Rating from Fitch

According to ratings agency Fitch, Kaiser Foundation Health Plan Inc. and its subsidiary health plan businesses have a very strong business profile. In May 2022, Fitch gave the insurer an AA- which is a very high rating for being financially strong. This means Kaiser Permanente can pay its bills and you have certainty that your cover will remain in place.

J.D. Power

Kaiser Permanente health plans also achieved excellent ratings in the J.D. Power 2022 U.S. Commercial Member Health Plan Study which assessed 147 health plans across 22 regions throughout the U.S.

The study measures how satisfied members were based on the following six factors: 

• Billing and payment.

• Cost. 

• Coverage and benefits. 

• Customer service. 

• Information and communication.

• Provider choice. 

J.D. Power awards points to each plan out of 1,000. The higher the number of points, the better the plan performed based on the six factors. Have a look at the table of top performers below to see how the various Kaiser Permanente plans performed.

Source: https://www.jdpower.com/business/press-releases/2022-us-commercial-member-health-plan-study

Summary: Why Choose Kaiser Permanente

When you choose a health insurance company, you should choose one that has a good reputation in the market, has a low level of complaints, and has a range of plans that will suit your needs and your budget.

Not only did Kaiser Permanente receive relatively few complaints compared with other insurers in 2021, it also, according to the National Association of Insurance Commissioners (NAIC), improved its service delivery between 2020 and 2021.

The 0.3 rating awarded to Kaiser Permanente 2021 in the NAIC’s National Complaints Index, means its level of complaints is well below the median (mid-range ranking) for insurers.  The median index level is 1. Insurers that receive a rating of above 1 have more complaints than the median and those below 1 have fewer complaints.

Although widely available in California, Kaiser Permanente plans elsewhere are limited to eight states and the District of Columbia, so if you live elsewhere, this insurer isn’t an option for you.

The insurer is scored highly in the J.D. Power 2022 U.S. Commercial Member Health Plan Study and has a good rating from Fitch for its financial strength.

Overall, Kaiser Permanente is a solid choice for its Medicare Advantage Plans, the good quality of care provided by its provider network, the low level of complaints, and top-rated plans as assessed by third parties.

The experience of members on Kaiser Permanente health plans varies widely based on the reviews of actual customers on ConsumerAffairs.com. Some members gave the insurer only 1 star reflecting a poor experience, while others gave it 5 stars reflecting their very positive experiences.

Need Further Information? Contact PolicyScout.

Call PolicyScout at 1-888-912-2132 or send an email to Help@PolicyScout.com to get assistance from one of our trained consultants about your health care options.

Frequently Asked Questions about Kaiser Permanente

Can Kaiser Permanente end my Medicare plan if I become ill?

No, you cannot be kicked off a health plan due to any health conditions. But, your plan will stop if you do not pay your monthly premium, move to an area which is not serviced by Kaiser Permanente, or if you do not stay on the Medicare program.

Are there disadvantages of an HMO plan as provided by Kaiser Permanente?

An HMO plan is based on a network of hospitals, doctors, and other health care providers that coordinate patient care at negotiated rates. 

This means lower monthly premiums and lower out-of-pocket costs for you. It is also simpler to manage your health care when all the services fall under one umbrella.

Disadvantages are that you have limited flexibility to choose your health care provider and if you need to see a specialist, your primary care doctor must refer you.