Kaiser Permanente health care is both affordable and popular in Ohio. Plans are flexible to meet individual and family needs and participating doctors and hospitals provide superior treatment. However, policies are limited to coverage in the nine counties of Northeast Ohio. Ranked as one of the best 100 plans in the state, it’s a highly respected resource in the Canton and Akron areas. Kaiser is also recognized nationally for their Medicare plan options.
With more than 100,000 policyholders, it’s not a “small company. There are four HMO policy options including a qualified high-deductible (HSA) plan. The four policies are part of the “Signature” portfolio. The HSA policy has a $5,000 deductible while the traditional comprehensive contracts offer $3,000, $2,000 and $1,500 choices. Additional HSA Ohio rate information from other carriers is also available. Conversion plans are also offered for employees that will no longer have their coverage at work. However, the benefits and cost will not be the same as your group policy.
Copays on the comprehensive plans are either $35 or $25 for visits to your primary physician. Specialist visits are $10 higher. As mandated by The Affordable Care Act legislation, all preventive services do not have to meet a deductible or copay. This includes annual physicals for both males and females, child well-visits and many other expenses.
Prescription benefits are provided with a $25 copay (Generic) after a $250 deductible must be met. Brand RX must meet a $45 copay (plus the deductible). Like many other plans, non-formulary drugs must be paid by the policyholder. Mail order options are available although they don’t appear to reduce costs.
Since these plans are not PPOs (they are HMOs), you must establish a PCP (Primary Care Physician) to coordinate your care and treatment. If you live in the area, there are many reliable and experienced physicians that will be available. If you’re out of the designated network area, emergency treatment would be covered as if you were being treated locally. This would, of course, include an ER admission.
Three Comprehensive Policy Options
The three comprehensive copay plans fully cover pre and postnatal visits to the doctor. Labor and hospital bill charges are also an included benefit but are paid after the deductible has been met and are subject to coinsurance (either 20% or 30%, depending on the policy). Currently mental health, chiropractic and substance abuse are excluded.
However, when State Exchanges are created, those benefits should be included on all policies with any of the participating carriers, including Kaiser. Also, federal financial aid in the form of an instant tax credit will be available. The amount of your assistance will be calculated by determining your Federal Poverty Level (FPL) ratio.
OK. So how affordable are Kaiser’s health insurance rates in Ohio? There are many scenarios that could be created, but we illustrated a non-smoking 35 year-old male that lives in Canton. Listed below are the monthly rates for the four plan options:
$115 – Signature $5,000 (HSA)
$121 – Signature $3,000
$135 – Signature $2,000
$154 – Signature $1,500
Typically, if you’re considering an HSA, the higher deductible options will be more cost-effective since the premise behind the coverage is to pay as little as possible and deposit the rest into a separate tax-deferred account. However, you must maintain a qualified HDHP policy, or you will forego all tax-advantages when paying medical, dental, or vision expenses.
Over Age 65 Options
The Center for Medicare and Medicare Services (CMS) awarded Kaiser their highest available designation for their Medicare Supplement contract. The designation is very-highly respected and takes into account many factors. Currently three MedSup options are available. They are:
Plus I $144 per month. There is no deductible and the annual out-of-pocket maximum is $2,500. $5 and $20 copays to primary care physician and specialist. 100% preventive benefits and $65 copay for ER.
Plus II $29 per month. No deductible with $3,400 out-of-pocket maximum. $10 and $25 copays to primary care physician and specialist. Same preventive and ER coverage as Plus I plan. However, the copay for the first five days of inpatient hospital care is $200 (The Plus I plan is only $100).
Plus III $0 per month (Really!) No deductible with $3,400 out of pocket maximum. $15 and $40 copays compared to Part II plan but $250 per day for first five days of inpatient hospital care, which is the highest of all three options.
Dental, vision and hearing benefits can often be added as supplemental riders. Typically, the cost is not expensive. Also, prices and benefits can change each year. Additional requirements and mandates may be required due to Department of Health and Human Services reviews.
Although Kaiser offers very competitive rates, they may not necessarily be the lowest priced option in your area. We will show you the best healthcare options in Ohio so you can easily compare policies and also apply for coverage.
NOTE: Kaiser no longer offers individual plans in the Buckeye State.