Kaiser vs Aetna
It is that time of the year when we pick our health plans. We have used Aetna so far and most doctors accept it. We like it but it is way more expensive than Kaiser by ~$3k. We are a healthy family of 4. How is Kaiser compared to Aetna? Is the $ saving worth switching to Kaiser? What are Kaiser's downsides
Kaiser provides the insurance and controls the care too - leads to a very compromised service. They have some very shady practices (using older / cheaper drugs, delaying tests, etc.). It won’t hurt if you’re young and healthy, but if you need ongoing care, it can be a compromise. Of course, no surprise bills, everything under the same roof. Consider a high deductible plan if you’re mostly healthy- it can offset the cost. I had Kaiser for a few years, and my partner is a physician. We decided to change after a few frustrating experiences.
Been using Kaiser for 4 years, previously used a PPO (Aetna/blue shield/etc). The great thing about Kaiser: - Vertically integrated healthcare - so everything is in one place- doctor visits, labs, pharmacy, all done at the same place. So you get a lipid panel blood test, it’s done at the Kaiser lab, immediately processed and you get the lab results same day or next. Very efficient for things like this (scans/lab work/prescriptions). - good advice nurses on call 24/7- have had to use this a few times with sick kids late at night. They can get you to a pediatrician quickly at any hour. - because it’s vertical, you can do an e visit same day as symptoms, get a prescription filed, and picked it up all within a couple hours - so again super fast and efficient. The biggest issue with Kaiser is it is really bad for specialized care. It is excellent for general care and preventative services. So if you’re in a situation where a primary physician isn’t good enough and you need a specialist, it can take forever to get to the right person. Everything is run off of a standard protocol - so you have to jump through every hoop to finally get a referral to the right specialist. That person is also usually super busy so then it takes longer to actually get the tests you need. Going through this now with Kaiser cardiology and it took months to get from a primary physician to a face to face with a cardiologist. Then more time to get the cardiologist to be persuaded to do certain tests. With a ppo - you will have much faster and better service in the case where you need to see a specialized doctor.
All the vertical integration you talk about in Kaiser is also available in anthem and Aetna plans. I use Sutter health which has a vast network of hospitals, clinics and labs and everything is integrated in one app. Kaiser has limited coverage, you don't have a Kaiser hospital everywhere.
Thanks for the details. We use Sutter and they provider vertical health too. The specialized care part worries me. Do they have urgent cares? My PPO currently covers walk ins with Sutter and any of those newer urgent carss if needed. Would Kaiser limit that?
Always remember Insurance and being healthy should not be linked. You might be doing some activity and break your back. So go for what covers the best We have been using Kaiser insurance for more than 15 years.
Ditto. Kaiser for prob 25 years now and its worry free when you’re with Kaiser not to get a random bill for visits.
Is it a long wait for regular and/or specialist appointments? My kid has special ophthalmologist needs like pediatric optha and cornia specialists. Would that be too difficult? How does it work if I need to get referred out, if needed?