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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