Health Insurance Benefits from Kaiser Permanente


Choosing a health plan is like doing a cost-benefit analysis. What do I get for what I pay? When you purchase a Kaiser health insurance plan, you are purchasing a bundle of medical benefits. Certain services like doctors visits, medications and hospitalization are covered at a certain price. Once you are a health plan member with Kaiser Permanente, then you pay a certain copayment (fixed dollar amount) or a percentage for these services and the carrier pays the rest. These Kaiser Permanente benefits differ depending on which plan you choose.

One of the first questions you have to ask yourself when choosing the right Kaiser benefits package is: Am I wanting a lot of first-dollar benefits or am I mostly interested in benefits that will cover me if something catastrophic happens? Everyone needs some type of coverage should the unthinkable happen so you don’t get wiped out by huge medical bills. However, some people are willing to pay higher monthly premiums for more first dollar benefits. They want low copayments for primary and specialty care, prescription drugs, etc. These richer Kaiser benefits come with a cost, but some find peace of mind in knowing that they will only pay $30 for a doctor visit or $200 for an out-patient surgery. Regardless of which plan you sign up for, preventive care services, such as an annual physical, pap smear, colonoscopy, and immunizations, including flu vaccines, will be free or have a minimal cost.

In the new world of Health Care Reform, if you’re wanting these richer Kaiser Permanente benefits packages, you’ll want to choose a Silver, Gold or Platinum Plan. We recommend you start by looking at the Silver Plans. These plans offer middle of the road benefits packages. Based on your income, you may qualify for Cost Sharing Reduction (CSR), which gives you improved benefits at affordable Silver Plan prices. Silver Plans normally give you 70% coverage, but if you qualify for Cost Sharing Reduction, your Silver Plan might give you 73, 87 or 94 percent coverage. The Gold Plan gives you 80% coverage and the Platinum Plan gives you 90% coverage, so potentially CSR could give you better Kaiser benefits than a Gold or Platinum Plan at the Silver Plan price range. If you qualify, for Cost Sharing Reduction, especially if you qualify for the 87 or 94 CSR plans, then you would almost certainly want to enroll in a Silver Plan to get these improved benefits at the lower cost.

If you don’t qualify for Cost Sharing Reduction and you’re looking to save money, then you’ll want to go with the Silver or Bronze benefits packages. For many consumers, it comes down to deciding between the Bronze or the Silver, and that can be a tough decision to make because there’s quite a difference between these two plans with regard to price and benefits…so much so that many consumers are asking if there’s a plan between the two. Unfortunately, at this time there isn’t, so we usually recommend that if you’re young, healthy and don’t go to the doctor much, then go with the Bronze, but if you want more services covered right away (before you reach the deductible), then go with the Silver Plan. And, if you take expensive medications or you’re looking to have a baby, get an expensive surgery, etc. then you might want to go with a Gold Plan or a Platinum Plan.


Kaiser Health Benefits in the New World of Health Care Reform

Due to the implementation of the Affordable Care Act, otherwise known as Obamacare, Kaiser Permanente benefits packages have changed…a little. Kaiser Permanente, being a model health insurance carrier for Obamacare, didn’t have to make as many drastic changes as many of the other carriers. The plan names have all changed, but many of the benefits are the same. Deductibles and out-of-pocket maximum limits have gone up. Copayments for various benefits have gone up or down a little, but for the most part the Kaiser benefits have stayed pretty stable.