Compare Kaiser HMO vs Blueshield PPO- health insurance- what are advantages and dissadvantages - YouTube

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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