California health insurance - Kaiser versus Sharp health plans
The Ultimate Showdown: Kaiser vs. Sharp - Which Carrier Reigns Supreme in Southern California?
This is our regional battle in Southern California.
The carrier that created the HMO model versus the regional powerhouse.
It's a question of doctors and hospitals that you want access to the greater San Diego area.
There are strengths and weaknesses both ways.
We'll look at a quick overview of the two carriers and then dive into the three markets:
- Individual and Family (including Covered California)
- Small Business
- Senior Medicare eligible
As for us, our reviews are here after 25+ years of comparing Kaiser and Sharp for thousands of Californians:
Let's first compare the very different structures of the two carriers.
Kaiser HMO model versus the Sharp HMO model
Interestingly, Sharp's HMO is a smaller, regional version of Kaiser's model.
Many carriers offer HMO plans but they contract out with independent hospitals and medical groups.
Kaiser and Sharp went the other way.
They actually provide the medical care (hospitals and doctor services) and provide the health insurance as a way to pay for this care.
Kaiser was really the first to roll out this very capital intensive model (hospitals are expensive).
Sharp's version of this model is just more focused on a specific region...San Diego county.
These regional HMO's survived the 90's and perceived die-off of HMO's by having really good providers and well-managed health plans.
Sharp is right there! Maybe best of the bunch.
Let's quickly look at each specifically and then jump to the 3 different markets.
Pre-Fight Stats - Kaiser's model
Kaiser is one of the big 3 carriers in California with a strong presence in San Diego.
Kaiser is a unique version of the HMO model.
They own the facilities and employ the doctors.
This combined with the insurance function accomplishes a one-stop shop for healthcare delivery.
For more guidance on how HMO is different from PPO (it's main rival).
There are some important aspects to look at when considering Kaiser in Sharp's backyard.
Locations of Kaiser Facilities in San Diego
With HMOs like Kaiser, you have to use their facilities.
This begs the questions...how close are their facilities to where you live and work and do you like them?
These are the main Kaiser locations in the greater San Diego county area:
- Carslbad
- Vista
- Escondido
- Marcos
- Rancho Barnardo
- Carmel Valley
- La Mesa
- San Diego
San Diego is one of the best represented areas for Kaiser coverage in the State and nation.
It's really important to have convenient access since you will have to stay within the Kaiser network for services.
Sharp Health Plan Pre-Fight Stats
Sharp is generally sought after because of their providers.
Usually, HMO's become a decision of cost versus doctor quality.
Not true with Sharp.
People generally choose Sharp BECAUSE of their doctors.
The fact that they are well-priced or an HMO is secondary or non-influential in their decision making.
This is a great trait to have.
Again, Sharp is an HMO so we need to stay in the network.
Here are the primary Sharp locations:
- Poway
- Sharp Rees Stealy
- Carmel Valley
- Genetic Center
- Mira Mesa
- Coronado
- San Diego
Let's jump into the three markets since that's where the real comparison matters.
- Individual and Family
- Small Business
- Medicare eligible
First, on to individual and family!
Individual and Family Comparison of Kaiser and Sharp
This is the real battlefield for these two carriers.
Both carriers have fully embraced Covered California.
Since 2014, that's the litmus test for wanting to be in the California individual/family market.
They passed.
It's probably helped Sharp more than Kaiser since it leveled the playing field against a much larger carrier (Kaiser).
You can always quote Sharp and Kaiser side by side here:
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Let's break it down into the main categories:
- Price
- Customer Service
- Network
- Online Services
- RX
We'll jump into Pricing...which is on everyone's mind!
Price comparison for Kaiser and Sharp individual family plans
Kaiser is used to being the low cost leader in the market.
They usually beat the major carriers.
Not so fast!
Sharp health can be priced even better for comparable coverage.
Keep in mind that the individual plans are standardized.
This means that a Silver plan with Kaiser will be the same as a Silver plan with Sharp health plans.
That makes it easier to compare.
Especially in terms of pricing.
Run your quote here to see both but generally, Sharp is priced better than Kaiser but only slightly.
Price is really the strong suit for both carriers and for the HMO model itself.
Customer Service Comparison for Sharp and Kaiser
Both carriers are pretty strong here.
In fact, they definitely lead the California carriers in this category.
- Kaiser does it with tremendous integration and investment in their systems (primarily computer).
- Sharp does it by remaining local, smaller, and well-run.
That seems to be the only way to win at the health insurance game these days.
Kaiser really has focused on providing a one-stop shop for it's members.
Electronic records follow a patient around and every doctor can access and share.
Sharp doesn't have this level of integration but it's close and they make up for it with a tighter ship.
People seam to love Sharp which is really an outlier for health insurance!
There are always issues with an HMO in terms of getting services approved, pre-approved, or fought for but that's true for all HMOs.
In general, both carriers make the process easier.
Let's look at probably the deciding factor...network!
Network comparison between Kaiser and Sharp
This is a big deal.
Since pricing is so good for both and the benefits are standardized, it comes down to whom you want to see when you need care!
- With Kaiser, you have to use Kaiser facilities and doctors.
- With Sharp, you have to use Sharp facilities and doctors.
We listed the main locations above but if you're investigating Sharp versus Kaiser, you're probably in the general San Diego county area and have both providers close to you.
They are in direct competition across the South with many locations close by each other.
There are certain locations that are incredibly convenient such as Sharp health in Coronado if you live there.
That can be the deciding factor.
What about quality of facilities and doctors?
Kaiser is good where they have a strong footprint.
They have a strong footprint in San Diego.
You tend to have their premier facilities and doctors in that situation.
Sharp went the other way.
They started with a really strong group of providers and built health insurance around access to that group.
Put it this way...they were able to create a health plan due to the popularity of their doctors and facilities.
You can't go wrong either way.
It may come down to your location (there's a Kaiser facility 5 minutes away) or your experience.
Some people have been in Kaiser...literally since birth!
They were born in a Kaiser hospital.
Kaiser has their information. Their history. Their medications. Etc.
Some people have doctors in Sharp from prior health plans.
Either way, this is probably the deciding factor since pricing is so comparable.
Let's look at Online Services
Online Service comparison for Sharp and Kaiser
Kaiser has the edge here.
They aggressively invested in all things online.
Billing. Claims history. Everything is pretty much available to you as the end user.
Since they are both the insurer and provider of care, it's a seamless integration.
Appointments can even be made online!
Sharp is close behind since they also have an integrated approach of providing both the health care itself and the health plan to pay for it.
You'll be able to access most of the key information for your account.
Both are leading the front in this category with Kaiser having the slight lead.
RX for Kaiser and Sharp
Sharp has the slight lead here.
For one reason.
Kaiser really manages it's RX list aggressively.
You may have a medication switched mid year as Kaiser negotiates a bulk contract for a given generic over another one.
This is more a function of being an HMO than being Kaiser.
HMO's manage health care much more.
Sharp is also an HMO but there is more control over meds than with Kaiser.
It's slight.
Both will aggressively manage the medication lists and that directly translates into your monthly premium.
RX costs are killing the cost of health insurance nationwide.
Almost single-handedly.
The carrier that can best negotiate the balance between member requirements and cost constraints will actually survive this period.
The rest won't!
Kaiser and Sharp are both in the "Survive" mode.
You can get access to the rates, benefits, provider directories, and RX
info through the quote here:
We're happy to help with any questions comparing Kaiser and Sharp.
Our services are 100% free to you as Certified Covered Ca agents.
Call 800-320-6269 or email us with any questions.
Small Business Comparison for Kaiser and Sharp
Many of the same considerations pop up with Small Group health plans when comparing the two carriers.
There is one main difference.
Sharp is a regional carrier.
It works really well if your employees are all in the greater San Diego county area.
If you have employees in other States or other parts of the State where Sharp doesn't have a network, it's not as good.
Kaiser has a much larger Statewide network and even stretches into other States.
It may be able to better address situations where employees are in LA county or the Bay Area.
Both are HMO's however.
You have to stay within their service areas to get care in a non-emergency situation.
We'll look at this in more detail within the Network section.
Otherwise, both carriers offer very competitive pricing and providers.
The plans are standardized at the small group level so a given metallic level plan can only differ by +/- 2% from another similar level.
I.e. Silver plan to Silver plan.
Let's compare the two group health plans offerings along the following guidelines:
- Price
- Customer Service
- Network
- Online Services
- RX
We'll start with both of their strengths...Price!
Employer health plan comparison for Sharp and Kaiser
This is where both Kaiser and Sharp lead.
They are generally the best priced option in greater San Diego.
Kaiser is used to this distinction in other parts of the State but Sharp gives them a run for the money in San Diego.
You can quote the two carriers side by side here:
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We will quote the best priced Silver plan across the market for you including Sharp and Kaiser.
This gives you a good view of the rates from a level playing group vantage point.
Expect to see Sharp and Kaiser as #1 and 2 in pricing.
They're that competitive.
Since the plans are standardized and they all have to cover the 10 essential health benefits, this makes pricing king.
As if it weren't already.
Read below in the network section for a way we can actually offer Kaiser and Sharp side by side to your employees.
This is probably best approach going.
Let's look at customer service.
Customer Service Comparison for Kaiser and Sharp employer plans
Both carriers are pretty good to work with but have different approaches.
Kaiser is gigantic!
They have invested heavily in all their systems for maximum integration.
It's the direction all health care needs to go.
They're leading the way.
If a component can be automated, integrated, or made automatic with Kaiser...it will be.
They're able to do this since they both provide the insurance and the care itself.
This makes the day to day management of healthcare for both the employer and employee much easier.
Kaiser does it with its size.
Sharp does it with its nimbleness.
Sharp is a small, regional carrier and healthcare provider.
They also administer both healthcare delivery and the corresponding insurance.
Due to their smaller size, they are more responsive in customer service needs.
Both have high satisfaction rates with the employers and employees.
So how do we pick (and do we even need to)?
Good question.
Network Comparison for Sharp and Kaiser Group Health Plans
Pricing is already pretty similar for the two carriers.
They both offer good customer service.
It comes down to what doctors and hospitals you want access to.
They are HMO plans so you must use their networks.
For many employees, this generally comes down to history and experience.
Many people have been in Kaiser or Sharp networks their entire lives.
Many were even born in a Kaiser or Sharp facility!
We're talking long histories.
Here's the tough part for employers...
You're likely to have some employees that are die-hard Kaiser members and others that are die-hard Sharp members.
No problem!
Enter the Kaiser Wrap (no, you don't eat it!)
Employer Kaiser Wrap with Sharp Health
With the Kaiser Wrap, we can offer the two carriers side by side to each employee.
We create a worksheet for you here by employee which shows their costs after your employer contribution (flat amount or % of a given plan).
They can pick from either carrier!
This is really the best approach for employers in the San Diego county area that want the significant savings of the two carriers but have employees spread across both networks.
Get your Kaiser Wrap quote below and make sure to note your two carrier preference:
The great part of the Kaiser Wrap is that we can specify the employer's contribution exactly.
For example, we can have an employer contribution of 70% towards the Silver Plan with Kaiser for Employee only.
The worksheet will then take that specific amount and deduct it from ALL the plans...both Kaiser and Sharp.
The employee can then pay the difference with pre-tax money (if POP 125 is setup which is a must!)
Everyone's happy.
- Employer has cost control.
- Employee has choice.
We can help bundle the whole program for you!
Out of State and out of Service Area for Kaiser Employee Members
For Employees that are out of State, Kaiser does offer a PPO with a specific network.
This may be a crucial factor if you have employees out of the area.
Again...the Kaiser Wrap addresses this as well.
Online Services for Sharp and Kaiser Group health plans
This figures into the investment Kaiser has made in all their systems.
The Online Services at Kaiser are probably top of the market.
And we have a competitive State for carriers!
Both employers and employees have access to a wide array of information and capabilities online with Kaiser.
As license Sharp and Kaiser agents, we can help with any day to day needs.
Most of our employers just send over the requests to us and we handle it for them.
There's no cost for our services as licensed group health agents with over 30 years experience.
Sharp's online services are definitely strong...just not up to Kaiser's for employer plans.
The members have good access to information but there is less control for the employer.
Again, this shouldn't make a difference since we can help with any of the employer side issues.
Slight advantage to Kaiser on this front.
RX List for Sharp and Kaiser with Employer health plans
Both carriers are HMO's.
This means they are going to manage the medication lists more aggressively.
That's just a function of HMO as it tries to contain costs.
Kaiser "manages" the RX more than Sharp only because they have are so large, they can negotiate directly on medications in bulk for their members.
You may see one medication subbed out for another one mid-year.
Medication cost is singlehandedly driving the cost of health insurance so the HMO's are going to manage this more and more.
The flipside is that we have much lower premiums with these HMO's such as Kaiser and Sharp.
It's a trade-off but one we may not be able to afford much longer!
Review for Sharp and Kaiser Comparison for Group health plans
The net net...
It comes down to doctors and hospitals you want access to.
- Both carriers have very aggressive pricing.
- Both carriers are easy to deal with from a customer service point of view at the employer and employee level.
It's the doctors. The hospitals.
Offer both of them side by side.
This has been the most popular approach in San Diego county.
We're lucky to have two solid carriers with such different profiles.
Of course, we're happy to help with any questions at 800-320-6269 or by email.
Medicare Advantage Comparison for Sharp and Kaiser
Since Kaiser and Sharp are primarily HMO carriers, it's clear where their focus will be for Seniors.
Advantage Plans!
More detail on the difference between Advantage plans and Supplements here.
Here are the key concerns between the two:
- Price
- Customer Service
- Network
- Online Services
- RX
Price comparison for Sharp and Kaiser Advantage Plans
Both Kaiser and Sharp are very aggressive on pricing but that's not the whole picture with Advantage plans.
We have to look at the benefits as well since these plans are not completely standardized.
Advantage plans are generally low or no cost with different benefits on the backend.
The Sharp Advantage plan reviews are just ridiculous:
It's important to run your quote below so you can compare the two:
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Take a look at few key items:
- Max out of pocket - how plan treats the really big bill
- Deductible for larger services
- Copays for smaller services such as office visits and RX
We have Advantage plan specialists who can help you analyze this.
They even know specific plans that work in a given situation.
This assistance is 100% free to you.
Again, the pricing for Sharp and Kaiser will generally beat any other carriers in the area.
Customer Service for Advantage Plans with Kaiser and Sharp
Both carriers are able to offer pretty simplified service to their members.
This is because they both provide the health care itself AND the Advantage plan to pay for it.
It's very seamless...for senior health insurance.
As with the other markets, they accomplish this in different ways.
Kaiser is a very large company that has invested significantly in their systems.
It's shows!
Sharp is at the other end of the spectrum.
They are a smaller and very specialized regional carrier and health care provider.
This allows them to be more responsive as they're closer to their members.
No phone banks in another country to address calls!
Network Difference for Sharp and Kaiser Advantage Plans
Network is important with Advantage plans since they are essentially HMO's.
You have to stay within the network.
This is expected with Sharp and Kaiser and really drives the decision.
Here's the question...
Do you want to stay with Kaiser or Sharp doctors and hospitals?
It's that easy (or hard as the case may be).
They both have significant networks in the greater San Diego county area.
It usually comes down to which one you have accessed in the past.
They will have your records and doctors ready to continue with the Advantage plan.
Online Services for Sharp and Kaiser Advantage Plans
Kaiser has the upper hand here only because they've invested so heavily in their online systems.
They really want to integrate the full process from appointment setting to payment.
Sharp is close behind since they also provide care and insurance simultaneously.
Keep in mind that there are limits set by the government on what can be done online once you get into the Medicare world.
Especially for Advantage plans!
Lots and lots of rules and restrictions for protecting seniors.
We get that. It's a good thing if occasionally difficult.
RX List for Sharp and Kaiser Advantage Plans
Medication can be included in Advantage plans so we need to look at the lists between the two.
They are pretty comparable for HMO's (less than PPO's) with Sharp having a slight lead when we've check for people.
If you have medications now, our Advantage specialist can check both carriers to see where they stand.
This is really important to do upfront.
The RX list can and does change...especially with Kaiser and HMO's in general.
Run your quote below and email us with any RX questions:
Kaiser versus Sharp Final Review
We have some good HMO choices in San Diego county.
That's not true for everywhere in California so we're lucky.
- Kaiser is Golaith.
- Sharp is small, regional contender.
Pricing will be good for both. Customer Service will be good for both.
It really comes down to which doctors and hospitals you want access to.
They are HMO's so we have to stay in the network.
If you have a beautiful Kaiser facility right down the street, that's probably the deciding factor.
Same for Sharp (such as Coronado).
Getting back to basics, the doctors will be the deciding factor between these two well run companies.
Call us at 800-320-6269 or email us with any questions.
Our assistance is 100% free to you...even for Covered California plans!
Sharp health plan under Covered California review, rates, and plans