Kaiser Permanente is an American integrated care consortium based in Oakland, California, United States. Henry J. Kaiser and Sidney Garfield were responsible for founding it in 1945.
Kaiser Permanente almost operates around 39 hospitals and around 700 medical offices. Talking about the organization, consists of over 300,000 personnel. There are around 87k physicians and nurses.
Blue Cross Blue Shield Association (BCBS, BCBSA) is a United States-based federation with around 34 independent companies. It provides health insurance in the USA for more than 115 million people.
It communicates with members and other operation policies that need licenses and trademarks. It operates in designated areas where it claims reimbursement programs to different sectors.
Brief about Kaiser and Blue Cross Shield Plans
Kaiser Permanente provides Medicare Advantage Plans. It has eight dedicated states around Washington, DC. They use one integrated care model where everyone can combine work without any miscommunication happening. They can be connected all the time.
Considering Blue Cross Shield, it is a group of 33 companies. Each company of Blue Cross provides different services according to the local needs that are tailored to local members.
Let’s get into detail about the advantages of the plans for Kaiser Permanente vs. Blue Cross Blue Shield.
General Kaiser Permanente Medicare Advantage
- Kaiser Permanente plans are rated below average because they are limited to selling only in eight Washington, D.C.
- J.D. Power has found that it earns above-average satisfaction in California Medicare markets.
- Most of the plans have drug coverage, which helps drug addicts stop drug consumption.
- Among the 10 people, there are 8 members with highly-rated plans.
- It is 5th largest Medicare Advantage provider plan
Medicare Plan Advantage Options
The medicare plan advantage options depend on the region that you live in. You can leverage different plans according to the region and go through what suits you the best. Let’s get into each plan’s benefits.
Kaiser HMO Plans
Kaiser’s HMO (Health Maintenance Organization) plans are for those who have in-network physicians. When a patient gets ill, the provider will be right there as a prevention source and for the medical attention that is needed as per the requirement. Not only that, but even special care is provided if the condition is critical, and they can also refer to their in-network specialist.
Apart from these basic services, they provide a few additional services and different membership programs, such as SilverSneakers. They provide memberships to use the gym facilities and other fitness and wellness programs you need.
Kaiser’s PPO Plan
Kaiser’s PPO (Preferred Provider Organization) plan often separates the cost of seeing providers into two tiers. There are two models: one is a “participating provider,” which has lower and more affordable costs, and the second is a “non-participating provider,” which you can access as a licensed provider only.
When compared, the PPO plan is different from the HMO plan, as you will need a referral to see its specialty. Talking about Kaiser’s plan, you will need pre-certification before you avail of a few of the surgeries, radiology, or any complex lab reports or work.
Kaiser Part D Plans
Most of the Kaiser Medicare Advantage plans include drug program coverage but there is also a separate plan available by Kaiser. The prescription of Kaiser plan D is available in three tiers, categorized in different price ranges.
Low- or generic-tier plan: It is the least expensive and most affordable plan, while premium plans include expensive drugs and some high-level treatments. If you are looking for a cost-saving hack, then it is always suggested that you join the affiliated Kaiser’s mail-order pharmacy programs.
Talking about special healthcare needs and treatments includes a few of the diseases and conditions that include:
- Chronic conditions
- Institutional special needs
- Dual-eligible SNPs for Medicare and medical coverage programs
States that are eligible for the Kaiser’s Medicare Advantage Plans:
- California
- Colorado
- Georgia
- Hawaii
- Maryland
- Oregon
- Virginia
- Washington DC
Kaiser’s Medicare Plan Coverage
There are different plan coverage and advantages that patients can leverage according to the region they live in. However, some plans can be included.
- You can leverage all the benefits of the Kaiser Medicare Advantage plan.
- The preventive care services include free or low-cost check-ups like normal reports checking blood pressure, cholesterol, or cancer screenings up to a limited age.
- Kaiser provides hearing and vision services that include an examination every year to check the well-being of the routine. However, other related exams for hearing and eyesight come under the Advantage Plus plan.
A brief introduction to Blue Cross Shield Medicare
Health insurance plans in the United States adopted the name “Blue Cross.” Justin Ford Kimball created it in 1929.
Employees in lumber and mining camps developed Blue Shield of the Pacific Northwest. It provided medical care with nominal monthly charges. Later, nine medical plans were associated with medical care plans and were renamed the National Association Of Blue Shield Plans.
Blue Shield Plans and its Advantages
HMOs and PPOs are two of the cost-saving options, along with the original Medicare benefits.
Advantages of HMO Medicare Plans (Blue Cross)
- There is a lower-cost premium or absolutely no monthly premium charge
- There is one primary care provider who will know your medical history. It helps a lot while treating the patients and providing accurate medication accordingly.
- No referral is required from a primary care physician before visiting.
- The Blue Shield HMO plans may or may not cover drug prescriptions.
Advantages of PPO Blue Cross Medicare
- It has higher monthly premium plans
- The patient does not need a PCP plan selection
- Patients can take advantage of doctors, healthcare, and hospitals outside of the network but need to pay the coinsurance.
- If patients do not want to pay for coinsurance, they can opt for doctors and healthcare providers within the network that are included in the plan under Blue Shield Medicare Plans.
Blue Cross Medicare Advantage plan is for one full year. If the plan is carried forward for the following year, determination will be carried forward. The patient will not lose Medicare coverage if the medicare plan is not available next year.
How to Find the Right Medicare Advantage Plan?
When you are planning to avail of any Medicare Advantage plans, it is important to research the basic requirements we have gathered some of the commonly asked questions before knowing or availing of any Medicare plans.
- What are Medicare Plans’ costs?
- Is the doctor included in the network of the medical plan?
- Know if there is any dental coverage included
- Ask if there are any extra services included with benefits for you as patients.
Choose The Appropriate Medicare Plan For Your Need
When you choose between Kaiser Permanente vs. Blue Cross Blue Shield, you must know your needs as both offer different Medicare advantages. Kaiser offers all the medicated care with the providers connected whereas BCBS has flexible plans that can be customized according to the local needs and that include both, in and out-network care.
When you tend to choose one of the plans, it also becomes important to know the basic advantages that you as a patient can get out of it.
Consider your location, health requirements, and preferred treatments when needed, this classification will help you to decide to choose one of the plans.
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Frequently Asked Questions
1. Which is the best health insurance provider?
Kaiser Permanente is the finest overall health insurer due to its affordable and high-rated policies. If Kaiser is unavailable, Blue Cross Blue Shield is a good health insurance carrier with more coverage options
2. How many hospitals does Kaiser have in the United States?
Kaiser Permanente is a significant nonprofit health plan in America. More than 24,605 Permanente Medical Group physicians, 73,618 nurses, and 75,000 allied health workers in 40 hospitals and 618 medical institutions are paid for by our health plan.
3. Which California health insurers are the largest?
Kaiser, Anthem Blue Cross, Blue Shield of California, Health Net, Aetna, United (group), and AARP (Senior) are California’s leading carriers, depending on the market sector.
