When it comes to choosing a health insurance plan, two major players in the Pacific Northwest are Regence and Kaiser Permanente. But which one is the better choice for you and your family?
In this comprehensive guide, we’ll compare and contrast Regence and Kaiser looking at plan options, provider networks, costs, and more.
A Brief Comparison Table
| Features | Regence | Kaiser Permanente |
| Type of Plans | PPO, HMO, POS | HMO |
| Provider Network | Broad nationwide network through BlueCard PPO | Integrated network of Kaiser facilities and doctors |
| Provider Choice | See any doctor without referrals (PPO) | Must stay within Kaiser network except emergencies |
| Coverage Areas | WA, OR, ID, UT with nationwide access | CA, CO, GA, HI, MD, OR, VA, WA |
| Costs | Higher premiums, lower out-of-pocket maximums | Lower deductibles and copays |
| Prescription Drugs | Copays or coinsurance | Fixed copays per prescription |
| Preventive Care | Free in-network | Free onsite services |
| Telehealth | Through Doctor on Demand | Through Kaiser online system |
| Pediatric Dental/Vision | Sold separately | Included with children’s plans |
| Customer Service | Member portal, app, offices | Member portal, app, medical centers |
Overview Of Regence And Kaiser
Regence is a regional not-for-profit health insurer offering plans in Washington, Oregon, Utah and Idaho. Regence has a nationwide network called BlueCard PPO which gives members access to in-network doctors across the country.
Kaiser Permanente is a national managed care organization with plans in 8 states and Washington DC. Unlike traditional health insurance, Kaiser provides both the health coverage and medical care through its network of hospitals and doctors. This integrated system can provide more coordinated care.
Both insurers offer group and individual health plans at the bronze, silver, gold and platinum levels to meet ACA requirements. Let’s take a closer look at how they compare.
Plan Options And Coverage
Regence offers a variety of PPO and HMO plans. The PPO plans allow you to see any doctor without a referral, while HMO plans require you to select a primary care physician (PCP) to coordinate care. Regence PPO plans typically have higher premiums but lower out-of-pocket costs compared to the HMO options.
Kaiser Permanente plans are a form of HMO with more limited provider choice than PPOs. You must get referrals to see specialists and use Kaiser facilities and doctors within their network, except for emergency care. Kaiser plans integrate coverage with healthcare services to streamline care.
Both insurers cover all the essential health benefits required by the ACA, including hospitalization, maternity care, mental health services, prescription drugs and more. Some key differences:
- Preventive care – Both plans cover in-network preventive services like checkups, cancer screenings and vaccines at no charge. Kaiser may have more on-site services.
- Lab work – Regence may use external labs for bloodwork and tests, while Kaiser has its own integrated labs.
- Mental health – Regence offers in-network therapy and psychiatric services. Kaiser has its own psychiatrists and counselors.
- Telehealth – Regence covers telemedicine through Doctor on Demand. Kaiser has its own online care system.
When comparing plans, look closely at out-of-pocket costs like copays, coinsurance and deductibles which can vary widely. Kaiser plans tend to have lower deductibles but fixed copays for services.
Provider Networks
A key factor when selecting insurance is the provider network.
Regence has broad PPO networks with many regional and national providers. Regence BlueCross BlueShield plans allow you to see any provider that accepts BCBS insurance without a referral. The BlueCard network gives access to over 96% of doctors and hospitals across the country.
Kaiser Permanente has its own integrated network of doctors and hospitals you must use for services, except emergencies. Their network is more limited than Regence but offers coordinated care through Kaiser facilities. Kaisers network includes over 23,000 doctors at 747 medical facilities. Availability may depend on your location.
Those who value a wide choice of providers may prefer Regence, while Kaiser offers care coordination but less flexibility. Check that your preferred doctors, specialists and hospitals are in-network before enrolling.
Also Read: Choose Between Kaiser And Premera.
Cost And Plan Premiums
While benefits are most important, cost inevitably plays a role in choosing coverage. Here’s how Regence and Kaiser stack up:
Premiums – Regence PPO premiums tend to be higher than HMO plans. Kaiser premiums vary but are competitive or lower than many PPOs on average.
Deductibles – Kaiser plans have relatively low deductibles, often $500 to $1000. Regence’s deductibles can range from $1000 to the federal maximum of $7000 depending on your plan selection. High deductible health plans (HDHP) are also available.
Copays and coinsurance – Regence has copays for office visits and services, while Kaiser uses fixed copays for most services like a $10 generic prescription. Regence may have coinsurance of 10-50% for major care until you reach your out-of-pocket max.
Out-of-pocket max – Regence plans have an annual limit on your costs for care ranging from $2000 to $7000 or more. Kaiser also caps out-of-pocket costs, typically around $1500 to $3000.
To find your total potential costs, look at monthly premiums plus deductibles, copays, and annual out-of-pocket maximums. Weigh costs against the plan’s coverage and network access. Those needing frequent medical care may save with lower Kaiser copays and deductibles.
Company Ratings And Reviews
Seeing what current members say can give helpful insight into a health plan.
Regence has an “A” (Excellent) financial stability rating from AM Best. Reviews praise Regence’s large provider network and benefits but some describe high premiums or claim denials. Many members rate Regence positively.
Kaiser Permanente also has top ratings for service and care from NCQA and J.D. Power. Most reviews praise Kaiser’s quality of care, coordination and low costs. Complaints include referrals to use Kaiser doctors. Overall, reviews indicate high member satisfaction.
For both providers, experiences can vary based on your particular location and plan. Checking reviews for your state can be useful.
Enrollment And Plan Administration
Regence health plans have open enrollment periods through the federal exchange or state marketplaces. You can also buy plans directly but won’t get subsidies if eligible. Group plans offered through an employer have annual open enrollment.
Kaiser is available to purchase directly, through exchanges, or from employers. You must live within a Kaiser coverage area to enroll, which spans several states. Switching providers means moving from Kaiser to a new plan.
For administration, Regence members can access benefits and claims through an online member account and app. Kaiser also has an online account system and app to handle medical appointments, prescription refills, test results and more.
Those wanting in-person help can visit local Regence offices or Kaiser medical center locations. Both also have customer service channels like live chat for assistance.
Also Read: Choose Between Ambetter And Florida Blue.
Which Is Better For You? Key Factors To Consider
When weighing Regence versus Kaiser for your health insurance needs, some key points to help decide:
- Provider choice – If you want more flexibility and options, Regence PPO plans allow you to see different doctors without referrals.
- Coordinated care – Kaiser’s integrated system can provide smoother care transitions, while Regence has less care coordination between providers.
- Costs – Kaiser tends to have lower deductibles and copays, while Regence has pricier premiums but lower out-of-pocket maximum costs on PPO plans.
- Add-ons – Regence offers dental and vision for adults. Kaiser incorporates dental and vision for kids but less routinely for adults.
- Locations – If you live outside Kaiser’s coverage area and want broad nationwide access, Regence is likely a better option.
Consider your expected healthcare usage, preferred doctors, costs and geographical needs as you compare. Those who travel frequently may prefer Regence for broader coverage. Families and those with chronic conditions may benefit more from Kaiser’s coordinated care approach.
Also watch the video about Kaiser!
Frequently Asked Questions (FAQ)
Blue Cross (Regence) tends to offer more flexibility with provider choice through PPO networks, while Kaiser requires you to use their facilities and doctors within their system for coordinated HMO-style plans. Blue Cross also covers more states nationwide. Ultimately, it depends on which factors matter most to you in selecting insurance.
Some top alternatives to Kaiser providing competitive HMO-type plans are Anthem Blue Cross, UnitedHealthcare, and Cigna Health. Like Kaiser, these feature set copays for services but offer wider coverage areas and provider networks to choose from. PPO plans from insurers like Aetna, Humana and Blue Shield also offer non-HMO options.
Potential downsides of Kaiser are needing referrals to see specialists and use Kaiser facilities/doctors within their network except for emergencies.
The integrated system can limit choice compared to PPO or POS plans. Kaiser physician availability may be limited in some regions. Some complaints include issues getting appointments and facility crowding.
The top 5 health insurance providers based on membership are:
UnitedHealthcare with over 50 million members
Anthem Blue Cross with 41 million members
Humana with 17 million members
Centene with 15 million members
Cigna Health with 15 million members
The largest insurers overall are UnitedHealthcare, Anthem, Humana, Cigna and Aetna. But exact rankings fluctuate annually and regionally. Top Medicaid and Medicare insurers include Centene, Molina Healthcare and Anthem.
Also Read: Choosing Between Aetna VAnd Premera.
The Bottom Line
When choosing between Regence and Kaiser Permanente for health coverage, consider your preferences for provider choice, coordinated care, costs and geographical availability. Weigh network access, out-of-pocket costs, convenience and healthcare needs.
Those wanting maximum provider flexibility may prefer Regence, while Kaiser offers tightly integrated care. Review plans details and research reviews to see which option best fits your situation. With side-by-side comparisons of these leading insurers, you can determine the right health insurance for your needs.
