Compare Kaiser HMO vs Blueshield PPO- health insurance- what are advantages and dissadvantages


Let’s take a look at a comparison of Blue Shield of California and Kaiser health plans. Both are the most popular plans in California and in some zip codes these are the only plans available for consumers. I will mainly compare the Kaiser HMO plan with Blue Shield PPO plan make sure to watch this video until the end as I will share with you the advantages and disadvantages of both Kaiser and Blue Shield okay, so let’s start with the cost. Kaiser only offers HMO plans on the individual market and HMO plans are generally cheaper. Blue Shield offers HMO and PPO plans regarding the benefits itself I want to make clear that we are comparing apples to apples, and in most cases the coverage is the same for both plans For example if we are comparing standard benefits of bronze plans then the coverage will be the same obviously The cost of bronze plans will be different for Blue Shield and Kaiser Let’s move on flexibility and choice Network and out of in-network and out-of-network doctors With Kaiser you will only be able to see doctors that are in network With a Blue Shield PPO plan you will be able to see in network doctors and out-of-network doctors But obviously it makes sense to check if your doctor is in network as you pay less for the in-network care.

Since we’re talking about networks Let’s explore it in details; so, HMO usually has a limited network of doctors PPOs have a larger network of doctors let’s move on to the Referral with Kaiser plans you will need to select the primary care doctor and get a referral in order to see other specialists; with a Blue Shield PPO plan you can self-refer to the specialist without getting the authorization from your primary care doctor Let’s move on into the claims with HMOs.

You don’t have to file a claim yourself Since it only allow for in-network services and Kaiser does the payment of claims Internally; with a Blue Shield PPO plan you may have to pay for services directly and then file a claim to get reimbursed Although this is very, very rare this might happen if you get service from out of network providers Okay as I mentioned earlier Let’s also take a look at advantages and disadvantages of Kaiser and Blue Shield Let’s start with the advantages of Blue Shield PPO Their network of doctors grew recently; so there are plenty of doctors to choose from The fact that you don’t need a referral to see a specialist is a big advantage for Blue Shield a PPO plans Online accounts are good and went through a recent upgrade so that’s a very good plus Let’s take a look at the disadvantages of BlueShield Blue Shield had some billing issues in the past few years and Billing and membership were two separate systems and there were quite a few issues as a result lately Blue Shield upgraded their system So it is working great now and also The Blue Shield PPO plans are more expensive than Kaiser in their in many areas So that’s a disadvantage in a way a cost is a big deal.

Let’s take a look at Kaiser advantages now their integrated medical records and one shop a One-stop shop is a big advantage so basically you have all you need under one roof They have a strong online account services and access to records easily Also, they have a pretty streamlined billing and claims process so The claims are processed faster and easier Let’s take a look at Kaiser disadvantages- usually they have a slower process through medical care options and their services can be delayed or Denied; it is an HMO after all.

If you have a comment on this topic. I would like to add advantages or disadvantages – both Keyser and BlueShield, or in case you would like to add something, feel free to comment under the video.

If you would like a specific side by side comparison based on your zip code and age Please feel free to reach out directly and I will be glad to provide a no-obligation free quote and a side-by-side comparison If you qualify for plans through covered, California and have a specific question also Please feel free to reach out I am a certified insurance agent in the covered California as well.

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