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Kaiser Permanente Insurance is among the nation’s oldest managed care organizations, and it holds first place as the largest. Established in 1945 by industrialist Henry Kaiser and Dr. Sidney Garfield, it comprises three entities: Kaiser Foundation Health Plan, Kaiser Foundation Hospitals, and the Permanente Medical Groups.
There are just a little more than nine states in the country where you can buy into a Kaiser Permanente Insurance plan: California, Colorado, Ohio, Georgia, Hawaii, Maryland, Virginia, Oregon, Washington—plus Washington, D.C. The company got its start when Dr. Garfield graduated from medical school and was looking for patients; Kaiser had just formed an industrial indemnity to pay the medical costs of his injured laborers. The two of them ended up collaborating on a plan for workers’ compensation costs for construction crews working in the Mojave Desert.
This industrial health insurance plan evolved over the years into Kaiser’s three arms. The Foundation Hospitals and the Kaiser Permanente Insurance plan both operate as non-profit entities. The Permanente Medical Groups are profitable franchises owned by physicians, mostly to provide the doctors’ offices for patients to use outside of the hospitals.
If you’re exploring Kaiser Permanente Insurance, you’re really looking at the Foundation health plans. Kaiser offers employer-paid health insurance plans, plans for individual and family coverage, and plans to supplement Medicare. There are also Kaiser plans for those who qualify for HCTC (health credit tax credit) plans, including people who have lost their jobs because of trade with foreign countries.
Company-sponsored offerings include the following health insurance plans:
• Deductible plans, which operate like PPO plans. You must use physicians in the Kaiser Permanente Insurance network. You have a yearly deductible which you must satisfy before Kaiser begins to cover your medical costs. And you might also be responsible for a percentage, or co-pay, of your care. There is a limit on how high your out-of-pocket expenditures can run, but the money you pay toward your deductible does not count toward the out-of-pocket limit.
• HMO plans, which offer a wide selection of physicians and ancillary providers. You focus on preventative care and wellness programs and the healthier these efforts keep you; the more you save on healthcare expenditures. And these plans offer same-day appointments if you feel you need emergency care, but you’re not in a life-threatening situation.
• POS plans, which offer three tiers of coverage. In Tier One, you choose from a limited range of Kaiser Permanente Insurance health care providers. Tier Two is a health insurance plan in which you have a wider range of providers but you pay more of the costs. Tier Three means you can go to any doctor you like, but your costs are the highest. In Tier One, you must be referred to specialists by a primary care physician (PCP). In Tiers Two and Three, you can choose whatever specialists you prefer.
• Precertification is necessary for just about all of these plans. That means that you should not have any outpatient procedure or visit a specialist without checking with your insurance plan.
Individual plans come in a wide range of co-pay plans, deductible plans, and HSA plans:
• Co-pay plans cost the most of all Kaiser Insurance plans. You are responsible for co-pays with no deductibles to be met.
• Deductible plans are a lot more affordable. You can choose the amount of your yearly deductible and the level of your co-pays.
• HSA plans offer health insurance with a high deductible to be met, and very little expenditures on your part once that deductible is met. You can pay money into your health savings account to cover incidental medical costs and also enjoy several tax advantages.
Kaiser has been a leader in effective moderation of healthcare costs for decades. While its website questions whether health insurance costs will ever drop any lower, it does promote itself as one of the best options for your healthcare dollars.
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