Other than an average rate increase of 9% throughout California, Kaiser Permanente individual and family health insurance plans are very similar to 2018. They are still offering three off-exchange plans in addition to their Covered California standard benefit health insurance plans. Kaiser remains the lower price option in most of Northern California where they are usually the least expensive health insurance option.
Kaiser Permanente has seen their market share increase with the Affordable Care Act. Their percentage of Covered California enrollments has steadily increased from 24% in 2015 to 33% in 2018.They have also been very stable in their plan offerings on and off exchange. Kaiser rates increased 3% – 7% in Northern California and 6% – 10% in Southern California in 2018. In 2019, the average rate increase will be 9% throughout California.
Kaiser Direct Health Plans
In addition to the standard benefit design metal tier health plans, Kaiser will continue offer a non-standard benefit Bronze HDHP, Silver HDHP, and Silver plans.
- Bronze 60 5500/40% HDHP Health Savings Account compatible has a minor $150 increase to the maximum out of pocket amount for an individual up to $6,650 for 2019.
- Silver 70 HDHP 3000/15% Health Savings Account compatible increase the individual deductible by $300 up to $3,000 for 2019, but the maximum out of pocket amount remained the same at $6,500.
- Silver 70 2150/45 plan increased the individual deductible $150 to $2,150, but the maximum out of pocket amount jumped from $7,000 to $7,550 per individual for 2019. The pharmacy deductible increased $50 to $300, but the prescription drug copayments remained the same as 2018.
Gold Copayment vs. Coinsurance
Kaiser offers two different Gold plans; one is based on coinsurance and the other on copayment. The difference is that certain health care services are subject to either a member coinsurance percentage or a set copayment. Under the standard Gold plan an inpatient hospital stay is subject to $600 copayment up to 5 days, the same for maternity. With the lower cost Gold Coinsurance plan, both those health care services are subject to 20% coinsurance from the member. On average, most members with the coinsurance Gold plan who have a hospital inpatient stay will pay more cost sharing than the copayment plan. Both have a maximum out of pocket amount of $7,200, which when met, all health care covered by the plan are paid 100% by Kaiser.
Kaiser is offering an adult dental plan to their off-exchange members. The plan is $29.57 per month per individual. The dental plan administration is through Delta Dental and uses their PPO network. Similar to Health Net, the dental coverage has a fee schedule as opposed to coinsurance percentages for dental services. The Kaiser dental plan is about $20 less expensive per month than other Delta Dental PPO plan for the same $1,000 maximum benefit level. However, if you engage in the regular cleanings, x-rays, exams, and have one cavity filled, because of the fee schedule, there may be little savings.
Kaiser Plans Still Less Expensive Than PPO Plans
Many consumers have opted for a Kaiser health care plan because of their lower cost compared to other health plans. For example, in Region 16 of Los Angeles County a 50 year old individual rate for an off-exchange Silver plan is $557.58. Blue Shield’s Silver PPO off-exchange plan is $686.63. That’s over $1,500 per year in premium savings. Some people are taking that savings and visiting some of their other doctors who are not in the Kaiser network. There is a $137 difference between the Kaiser and Blue Shield PPO Bronze HDHP for a 50 year old in Region 16. Again, the lower rates, especially for people who rarely use health care services is attractive considering the emergency services will be covered as in-network anywhere in the United States.
It’s interesting that even though Kaiser Permanente’s market share has steadily increase over the years that their 2019 rate increases were higher than in previous years. They are certainly getting consumers who are looking for lower rates, especially since Anthem Blue Cross left most of California. Perhaps Kaiser is picking more people with health challenges which is pushing up the rates or they need to expand services to accommodate their growth in membership.
- Member Agreements
- Rates Plans Region
- Summary of Benefits
- 2019 Kaiser California Plans
- Dental Coverage Kaiser 2019
- Application Kaiser 2019
- Glossary Insurance Terms
- Grandfathered Account Change Form Kaiser 2019
- Plan_Account Change Form OE NonGrandfathered Kaiser 2019
- SEP Proof of Qualifying Life Event Form Kaiser 2019
- Special Enrollment Period Guide Kaiser 2019
- ZIP Code Rate Finder Kaiser 2019