I’ve had Kaiser for years. It’s a closed network for routine visits. But it absolutely covers you when you are out of network. As someone who’s traveled with kids who don’t pick opportune times to get sick I learned the system… You call them and they tell you what clinic or urgent care to go to… And it’s covered in full. ER out of network is also covered.
Like any hmo your care is as good as your primary care physician. If you don’t like your primary it’s easy to switch. Our pediatrician is totally awesome.[quote=bearishgurl][quote=no_such_reality][quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).
It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.
I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]
Any reason you’re not looking the Anthem/Blue Cross EPO or HSA/EPO that is cheaper than the Kaiser one? Kaiser has 7 million members in California. Basically, 1 in 5 Californians is covered by Kaiser. Your service level will be largely dependent on your ability deal with the system. There’s horror stories, but horror stories are common place across any group that is that large.
As for OOPM, yes and no. The kicker is they’ll cover the bills that are medically necessary. So no optional treatments once you hit the limit, but if you get hit by a bus, you’re covered.[/quote]
nsr, there is a good reason why the plans you are suggesting (above) are “cheaper.” My research on them indicated that they have virtually zero out-of-network coverage. I’m not sure how that applies to emergency coverage but as a road traveler, I’m concerned that these carriers wouldn’t cover my bills at all, even if I was moved from an EMT to a regional hospital from a rural area where I sustained a medical incident or injury.
If one spends 46+ weeks per year in a large metropolitan area because they are a “worker bee” (ex: SD County) and takes “staycations,” drives to nearby cities in populous counties or only flies to other large metropolitan areas within the CONUS, these plans can work for them.
But they don’t work for campers, hikers, off-roaders, skiers, road travelers and/or those with friends/relatives residing in rural areas of the country for whom they regularly visit.[/quote]
