When it comes to health insurance, Kaiser and Premera are two big names in the Pacific Northwest. But how do these providers compare when looking at costs, networks, plan options and more?
This comprehensive guide examines the key differences between Kaiser and Premera to help you determine which may be a better fit for your healthcare needs and budget.
A Brief Comparison Table
| Category | Kaiser | Premera |
| Type of Insurer | National non-profit | Regional non-profit |
| States Served | WA, OR, CA and others | WA, OR, AK |
| Plan Types Offered | HMO | HMO, PPO, HDHP |
| Provider Network | Integrated system of Kaiser hospitals, clinics, doctors | Broad networks of independent doctors, hospitals, facilities |
| Provider Choice | Limited to Kaiser facilities and doctors only | Flexibility to use in-network or out-of-network providers |
| Referrals Required | Yes, for specialists | Varies by plan type |
| Monthly Premiums | Typically lower | Varies by plan, PPOs often higher |
| Out-of-Pocket Costs | Copays tend to be higher, no deductible on most plans | Deductibles and coinsurance common on PPOs and HDHPs |
| Prescription Drugs | Must use Kaiser pharmacies | Can use any in-network retail pharmacy |
| Customer Service | Direct access to integrated care team and online tools | Call centers, online tools, nurse hotlines |
Overview Of Kaiser And Premera
Kaiser is a national not-for-profit health insurance company that operates in 8 states and Washington D.C. In the Northwest, Kaiser provides coverage in Washington and Oregon through its Kaiser Foundation Health Plans.
Premera is a regional not-for-profit health insurer based in Mountlake Terrace, WA. Premera offers plans in Washington, Oregon and Alaska through two brands – Premera Blue Cross and LifeWise Health Plan.
Both Kaiser and Premera offer group and individual health plans. They contract with doctors, hospitals and other providers to create provider networks.
Some key differences:
- Integrated system: Kaiser combines insurance and healthcare services. Its plans utilize Kaiser’s own hospitals, clinics and medical groups.
- PPO/HMO options: Premera offers both PPO and HMO plans. Kaiser plans are a type of HMO requiring members to use in-network Kaiser facilities and doctors.
- Service area: Kaiser has a smaller regional footprint while Premera has a larger coverage network spanning multiple states.
Also Read: Is Kaiser Permanente Better Than CareFirst?
Cost Of Coverage
On average, Kaiser plans tend to have lower premiums than Premera plans.
However, Premera can be more affordable for those needing broader provider choice through PPOs. Premera also frequently offers HSA-qualified high deductible health plans, which have lower monthly premiums.
With Kaiser plans, copays and out-of-pocket costs may be higher for some services since you can only use Kaiser facilities and doctors. Premera’s larger provider network gives more options to help control costs.
When comparing plans, be sure to look at the full picture – monthly premiums, deductibles, copays, coinsurance, out-of-pocket maximums and covered services. Getting quotes for your specific situation is the best way to determine potential costs.
Provider Network And Choice
Kaiser plans offer access to Kaiser’s integrated system of hospitals, clinics and healthcare providers. This can be very convenient for members but choice is limited.
Premera has an extensive network of doctors, specialists, hospitals and facilities. PPO plans allow out-of-network benefits as well. This provides more flexibility and options for finding providers.
With Kaiser you must use in-network providers and facilities except for emergency care. Using out-of-network providers means paying full cost. Premera PPOs provide out-of-network coverage but costs are higher.
Consider provider access for your home, work and frequent locations. Look at specialist availability as well in case you need specialty care.
Plan Options
Kaiser primarily offers HMO plans through Kaiser Permanente. Key features:
- Set copays for office visits, prescriptions and hospital care
- No deductible generally, except on some high deductible plans
- Referrals required to see specialists
- No out-of-network coverage except emergencies
Premera Blue Cross offers PPO, HMO and HDHP options:
- PPOs have deductibles and coinsurance that allow using in-network or out-of-network providers
- HMOs have lower deductibles and set copays like Kaiser but are limited to in-network providers
- HDHPs have lower monthly premiums but higher deductibles you pay before coverage kicks in
LifeWise Health Plans focus on HMO and HSA-qualified HDHP options.
When choosing a plan, make sure it fits your budget and covers the types of services and providers you need. HMOs offer more predictability while PPOs provide flexibility. Consider how health needs and utilization could impact overall costs.
Also Read: Is Aetna Better Than Premera?
Covered Services
Kaiser and Premera plans must offer the comprehensive essential health benefits required under the Affordable Care Act. This includes:
- Preventive and wellness services
- Prescription drug coverage
- Hospitalization
- Emergency care
- Maternity and newborn care
- Mental health and substance abuse treatment
- Rehabilitative services
- Lab work and imaging
- Chronic disease management
- Pediatric services including dental and vision
Always verify full coverage details in plan documents. Kaiser and Premera plans can vary in specific services covered, exclusions, limits and cost-sharing amounts. Plans frequently offer added benefits like acupuncture, vision hardware and fitness programs too.
Customer Satisfaction
Kaiser often scores well in member satisfaction surveys for integrated care, preventive health focus and customer service. Premera also has good ratings as a regional nonprofit insurer.
Consider talking to friends, family and neighbors to get first-hand feedback. Online reviews can provide pros and cons from real members’ experiences with each insurer.
Strong customer service resources like 24/7 nurse hotlines, online self-service tools and mobile apps add convenience as well. Test these out to see how each insurer’s support matches your needs and preferences.
Also watch this about Kaiser!
Frequently Asked Questions (FAQ)
There is no definitively “better” option between Blue Cross and Kaiser health insurance. It depends on your specific needs and priorities:
Kaiser HMO plans offer more integrated care and lower premiums on average. But choice is limited to Kaiser facilities and providers.
Blue Cross PPO plans allow for more provider choice and flexibility to use out-of-network providers. But monthly premiums may be higher.
Blue Cross has broader national and regional networks while Kaiser coverage is focused in select states.
Both not-for-profits have strong reputations for quality care and customer service.
Look at the full scope of costs, provider access, covered services and plan flexibility to determine what is better for your situation.
Premera can be a good insurance option, especially for those who value provider choice and plan flexibility. Key strengths of Premera health insurance include:
Large provider networks with access to many doctors, specialists and hospitals
PPO plans that allow out-of-network benefits and do not require referrals
Range of HMO, PPO and HDHP options to fit different needs and budgets
Strong focus on preventive care and wellness programs
Good customer service reputation as a regional nonprofit insurer
Downsides may include potentially higher premiums for PPOs compared to HMOs. Make sure to review plan details and costs thoroughly when considering Premera.
Potential downsides of Kaiser Permanente health insurance to consider include:
Limited provider choice since you can only use Kaiser doctors and facilities
Need referrals for specialists which can delay care
Restricted to Kaiser pharmacies for prescriptions
Copays may be higher than deductibles and coinsurance models
Out-of-network care is not covered except emergencies
Availability limited to states where Kaiser operates
Can face long wait times for some specialist appointments
However, Kaiser plans are typically affordable, offer integrated care, and earn high marks for quality and preventive health services. It’s about evaluating tradeoffs based on your healthcare priorities.
Some top alternatives to Kaiser Permanente to consider are:
Premera Blue Cross: Regional nonprofit with broad provider networks and a range of PPO, HMO and HDHP options.
Providence Health Plans: Faith-based regional insurer with affordability programs and focus on whole person care.
Cigna: National insurer with tailored plans, wellness incentives and access to large provider network.
Aetna: National insurer with PPOs, HMOs and HDHP options, as well as programs to control costs.
UnitedHealthcare: Nationwide coverage and large provider networks. Wide range of health plans.
Look for nonprofits or established national insurers with robust provider access, strong coverage for your needs, and excellent customer service. Shop and compare plans to make sure you get optimal healthcare access, affordability and experience.
Also Read: Choose Between Regence And Kaiser.
The Verdict
Here are key questions to help determine if Kaiser or Premera is a better choice:
- Providers: Do my doctors participate? What about specialists I see regularly?
- Locations: Which has better access and availability near where I live, work and visit frequently?
- Cost: Which offers more affordable premiums, deductibles and overall out-of-pocket costs?
- Plan type: Do I want an HMO, PPO or HDHP? Which gives the right balance of costs, choice and coverage?
- Services: Does the plan cover all health services I want and utilize regularly?
- Reviews: What do current members say about the insurer’s customer service, providers and care quality?
Take time to understand these key differences between Kaiser and Premera. Comparing plan details side by side along with getting quotes tailored to your situation makes it easier to determine the right health insurance provider for your needs.