Helping my DS choose a health plan for the San Jose / Santa Clara area. His choices are between Cigna and Kaiser. He could also stay on my health plan, which is anthem blue cross.
Seeking input on if one or the other has more coverage (number of doctors) in the area and/or perceived quality of the network.
I live in SoCal and Kaiser is very prevalent here, as is Anthem Blue Cross. Cigna seems less so.
It is really a matter of personal preference whether you want Kaiser or any other health plan. I do know people in the bay area who have and like Kaiser because everything is coordinated in the same system. There is no waiting for insurance approval, doctors just send you for a test and you get it, etc. Personally, I am not an HMO person and prefer to have more choice. It makes the biggest difference when something big happens to you. For example, for my cancer care I was able to choose between Stanford, UCSF, and Sutter. I’m glad I wasn’t locked into Kaiser.
In our experience most doctors in the bay area outside of Kaiser take all major health insurance plans. It has been seamless when we’ve had changes in employment and have had to switch plans. I doubt there is much difference in coverage between Cigna, Anthem, Aetna, etc.
Our local Facebook group is full of complaints about Kaiser (including from the people who actually work for Kaiser). We went with a PPO rather than Kaiser even though the latter was cheaper because of what sounds like a lot of inflexibility in the system. However, if your DS doesn’t really need much other than annual checkups it may be fine.
We are keeping our D on our plan till she ages out. It just seems easier for now and my husband has a really good rate from his work so it also works out cheaper all round than if she took one on her own.
The thing is that you never know whether someone will need more, even if they are young and healthy. When I was younger, my then-husband swerved to avoid a bike, wrapped the car around a light pole, and ended up in a coma in the hospital, followed by many months intensive rehabilitation for brain damage. He was in his early 20s and honestly, most of the other patients we saw during rehabilitation were also shockingly young with similar reasons for being there. Hope for the best, plan for the worst.
That’s a good point. Most of the complaints I saw about Kaiser involved when specialist treatment was required.
Most of the complaints I’ve heard about Kaiser are around mental health care and an inability to access it. Also may be a concern for many young people these days.
The major big multi specialty providers in the SF bay area are Kaiser and Sutter. There are also some university based ones like UCSF and Stanford. There are also some smaller providers, some of which are semi-concierge.
Sutter is the more expensive of the big two (they seem to be quicker to suggest expensive options), and insurance plans that have Sutter in-network tend to reflect Sutter’s higher price. Stanford may be even more expensive with fewer insurance plans having it in-network.
Kaiser plans have only Kaiser in-network, but it is very obvious what is or is not in-network for Kaiser, unlike with some other plans and providers.
Sutter is actually less expensive than Kaiser, at least in some cases. For example, in my case as my employer plan offers a choice between Sutter and Kaiser, and Sutter is quite a bit less expensive for me (and my dependents).
Interesting… In my employer plan options, the plans with Sutter in-network are about 35% more expensive than Kaiser plans with similar copay / deductible / OOPM and benefits.
Mine is just the opposite!
I think the OP’s son can probably see which plan is more expensive for him on a yearly basis (and likely the cheapest is to stay on parent’s Anthem family plan).
Our neighbor is a nurse who has worked at Kaiser, Stanford and other hospitals in the area. Kaiser is good for very simple primary care and routine conditions, because everything is covered. But specialist care is poor, typically the doctors are of more average ability and prefer a relatively easy life rather than being the super-competitive top of their class types that Stanford hires.
If you have something really complicated or are in a severe accident then Kaiser will send you to Stanford, but you need to hope that the Kaiser doctors recognize the seriousness of the problem before you die or suffer permanent consequences (which our neighbor says happens more often than it should).
Personally we have moved from Stanford to Sutter for everyday care, as we found Stanford was outrageously expensive, and kept being dropped by our plan (Blue Shield) while they renegotiated their rates.
But if I had some rare, life threatening condition I would certainly go to Stanford. They saved our D after she was born very prematurely and needed heart surgery that (given her size) could only have been performed at a handful of hospitals worldwide.
I hear you!
I was with Kaiser for a long time, but then one of my kids needed rare eye surgery and Kaiser had only one surgeon in all of SoCal who had any experience with it at all and none with infants (age of my kid) and refused to send us to UCLA where their surgeon had much more experience with this surgery in general as well as for infants. We ended up paying UCLA ourselves and it definitely left a bad taste in my mouth.
I switched out of Kaiser a few years after that so I could have a wider choice of specialists.
Thanks!
I hadn’t thought about Stanford health care being so close, but of course it is. Great resource to have nearby!
Personally I like the flexibility of a PPO and for myself I would not pick Kaiser. That said I know a number of people who have Kaiser and are quite happy. My daughter has Kaiser in Northern California and she loves the low cost. She gets Botox for migraines and her copay is very low. Her maternity care included the c section and hospital stay for just $200.00. Specialists are hard to get in to see as the primary Dr is the gatekeeper.
This is the type of complaint I have most often seen…they don’t have the specialists but don’t want to fund their members getting the treatment they need elsewhere.
But be careful about whether it is in-network for your insurance plan: Health Insurance Through Your Employer | Stanford Health Care . Note that for many plans, it is in-network for some services but not all services.
For those on Medicare, Stanford accepts traditional Medicare and supplement, but appears to be out-of-network for Medicare Advantage plans: Medicare | Stanford Health Care
Thanks for the heads up!
Another aspect to consider is whether any of the plans offered are an HDHP plans that would allow your son to open an HSA. Might be worth it, if he has relatively low health needs on average, to be able to access more tax advantage savings space.
HSAs are triple tax advantaged and a great way for young people to super charge their retirement savings.
That’s what he decided. He went to enroll in the HSA plan last night as primary and to keep my (very good) plan as secondary—only to find that you apparently can’t have a non-HSA plan as secondary if the primary is a high deductible HSA plan.
He’s probably going to decline the employee coverage and stay on my plan, at least until next t January. It’s completely free for him to be on mine as I already cover my spouse and other kid, so an additional “child” doesn’t cost any more.
The deadline is today, so please —if anyone sees a problem with this—I’d love to know.
Thanks