California Medicare Options - Health Net versus Blue Shield comparison and guide

Health Net versus Blue Shield in California

Both Health Net and Blue Shield are in the top 5 carriers in California now.

They have both experienced significant changes in how they operate over the past decade.

More importantly, both can be priced really well in the three different California markets:

Individual and Family (including Covered California)
Small Business (1-100 employees)
Medicare supplements and Advantage plans

We'll go through how they compare at each level specifically since these are distinct markets with differences across the carriers.

First, let's look at each carrier stats and our take on them.

One note...as licensed health insurance agents and Certified Covered California agents, we are unbiased in our approach.

First...some credentials Please!....

We deal with both carriers equally and there is no benefit to us for a client to go with either carrier.

We do deal with both carriers daily and have enrolled 1000's of Californians with each over a 20 year window.

We know them both well and hope to bring that knowledge to your use.

Let's get on with the comparison.

Health Net of California

Health Net was originally an HMO dominant carrier. In fact, the Department of Insurance required Blue Cross of California to "spin off" its HMO business in order to become a publicly held company.

Health Net was born!

They operated a strong HMO business during the advent and heyday of that model which started to show real problems in the late 90's.

At that point, Health Net pivoted and started to aggressively add PPO's to their portfolio.

They now are present in all key Californian markets:

Individual Family - HMO's, PPO's, HSA's and PPO's
Small Business - HMO, PPO, HSA's, EPO"s, HRA's
Medicare - Supplemental plans, Advantage plans
Dental, vision, life
Covered California inclusion for both Individual/Family and Small Group

Health Net of California's Strengths

Health Net has aggressively gone after all three markets based on price.

It's not unusual for their plans to be best priced in a given area.

Keep in mind that health insurance rates are dictated by the four factors:

Area
Age (each family member is priced separtely now)
Tax credit if available (Based on income)
Plan level (Bronze, Silver, Gold, Platinum, etc)

If you're eligible for a tax credit, that amount will apply the same towards any of the available carriers in Covered Ca including Health Net and Blue Shield.

You can quickly quote both carriers by market here:

In many situations, Health Net is leading the market in terms of pricing.

Also, keep in mind that the plan benefits are now standardized for most of the market including Individual/Family (including Covered Ca), Small Group, and Medicare supplements.

A silver plan has to match a certain level of benefits +/- 2%.
A Medicare F plan is the same regardless of carrier.

So what gives with Health Net versus Blue Shield?

Health Net's network of providers can be smaller than most carriers including Blue Shield.

It really comes down to flexibility in terms of doctor choice versus month cost.

A good example of this contrast is in LA county.

Health Net has very good pricing for HMO plans in the county but their network is about 2/3rds the size of Blue Shield on the individual family market.

Let's look at Blue Shield before we compare the two.

Blue Shield of California

Blue Shield of California has been a stable player in the California market for decades now.

There was a time when Blue Shield was not as efficiently run but that has really changed over the past 10 years!

They are now one of the most progressive and forward thinking carriers on the market.

This is true across all three market places (Individual/Family, Group, and Senior).

Blue Shield was always the competitive counter-weight to Anthem Blue Cross and Kaiser in the market.

They are now a dominant force especially with their success within Covered California.

Blue Shield competes in all major markets:

Individual and Family (strong in Covered Ca)
Small Business health plans (1 - 100 employees)
Senior - both Medicare supplements and Advantage plans
Dental, vision, life and more
Adopted Covered Ca early in both individual/family and Small Business

Blue Shield of California Strengths

Blue Shield of California has been very aggressive in terms of pricing over the past 5 years and this continues with the new ACA health plans.

In both Senior and Small Business, Blue Shield is consistently priced better than most carriers.

In terms of Blue Shield versus Health Net, we usually find a slight advantage with Blue Shield of California in the Small Business market and almost neck in neck for Senior. Advantage plans probably go to Health Net depending on the area.

For Individual/family (including Covered Ca), Health Net will usually have an HMO priced better (typically the lowest) than Blue Shield.

Blue Shield tends to focus more on PPO type plans.

Their pricing and network is then compared against Anthem Blue Cross (the other dominant EPO/PPO carrier).

That really fluctuates by area so it's important to put together a list of providers/hospitals you want access to.

The decision between Health net and Blue Shield in the Covered Ca market really comes down to HMO versus PPO.

Health net is strong in HMO. Blue Shield is strong in PPO.

Of course, you will pay more for PPO in most cases (but not all).

Blue Shield has stronger networks than Health Net in most cases.

Again, it's a question of price versus selection of doctors.

Since the market segment affects options so much, let's breakdown each one separately.

Individual and Family (including Covered Ca) - Health Net versus Blue Shield

First, run your free comparison quote of Health Net and Blue Shield here:

You can quote off-Exchange and/or Covered Ca.

Both Blue Shield and Health Net participate in Covered Ca for most counties.

Keep in mind that the benefits are standardized so a Silver plan is a Silver plan (+/- 2%).

That makes it easier to compare the two but it's not everything.

We now have to decide on HMO versus PPO.

In many markets (especially more populous areas), Health Net focuses on HMO. Blue Shield focuses on PPO.

Check out our HMO versus PPO comparison for clarification. Otherwise, we get down to what really matters.

Pricing versus Network!

This is it.

In a given area, you'll find significant differences in the monthly premium and the doctors you have access to.

IMPORTANT: The individual/family networks are smaller than business networks...roughly 2/3rds the size.

By law, the rates, benefits, and networks have to be identical between Covered Ca and off-exchange for the same plans.

They're not always easy to use.

Through your online quote (we recommend on-Exchange), you will have access to provider directories.

We'll research this for you...for free! Our services as Certified Covered Ca agents are 100% free to you.

You can call us at 800-320-6269 or run your Health Net versus Blue Shield quote

Small Business - Health Net versus Blue Shield of California

What about the new (1 - 100 employee) Small Business market?

How do Blue Shield and Health Net stack up?

Let's first set the stage.

The ACA law mandates that there are specified Benefit levels that all plans must meet.

They are Bronze, Silver, Gold, and Platinum.
A given carrier's plan must meet one of these 4 standards by +/- 2%.
You'll see a little wiggle room (deductible goes up but copays are richer, etc) but 2% is a slim margin.

That means that a Health Net Silver plan will be very comparable to a Blue Shield Silver plan. +/- 2%.

The Blue Shield versus Health Net comparison is a very popular one right now.

Why???

Because they are both very aggressive in the Small Business market.
Their pricing is generally the best in a given area (aside from Kaiser).

This is especially true if you want a mix of HMO and PPO.

For example, if you want straight HMO and like Kaiser, that's going to be hard to beat.

If you want to offer employees an option of HMO, PPO, HSA, etc, you'll need to look at Health Net or Blue Shield.

Their pricing is really strong right now.

Health Net tends to have better pricing for HMO. Blue Shield tends to have better pricing for PPO.

It partially depends on which way you're leaning (HMO versus PPO).

Either way, we can set a fixed monthly contribution per employee or a fixed % towards a given plan to protect the employer's budget.

What about networks?

The group plan networks were not impacted by the ACA law.

These are the original strong networks with the most providers.

That's true for HMO and PPO although the HMO list is usually about 2/3rds the size of PPO.

Both carriers offer a full suite of dental, vision, life, etc to provider a comprehensive benefits package.

We're happy to run the numbers for both and see how your area and employee demographics match up.

You can request a quote for both Blue Shield of California and Health Net across PPO, HMO, HSA, HRA, and ancilliary benefits.

Senior Market - Health Net versus Blue Shield

This is probably the market where we've seen both Blue Shield and Health Net grow the most in the past few years.

Especially on the Medicare Supplement side.

There was a time when AARP and Anthem Blue Cross dominated this market.

First, Blue Shield started to aggressively price their core G plan for age 65 seniors.

Health Net followed suit.

It's been that way for a few years now and it's not uncommon to find them neck and neck in pricing but significantly cheaper than the other carriers.

Make sure to run your Senior quote for Health Net and Blue Shield since rates can differ by zip code and age.

Medicare supplements are interesting in that the benefits are standardized (a G plan is identical whether through Health Net or Blue Shield).

The networks for supplement plans are also identical (basically, providers that accept Medicare).

So we're really looking at pricing and price stability.

Medicare ultimately dictates what is covered and the Medicare supplement plan pays accordingly.

So back to pricing.

That's where both Blue Shield of California and Health Net are the strongest.

Blue Shield has been one of the most competitive for a few years now.

Health Net joined the party more recently.

Either way, run your Medicare supplement quote here and compare both among the California carriers.

We can't forget about Advantage plans. You can compare Supplements and Advantage plans here.

You can quote both types of plans here (we'll send link for doctor/RX and "opt-in" required by law to quote Advantage plans):

Now...for Advantage plans (and Part D for medication), that's a whole different ballgame.

After you enter your doctor/RX info and "opt in", we'll send a full quote of all the plans in your areas! Even ones we don't contract with.

The networks, benefits, and rates can all be different with Advantage plans so check out our How to Compare Advantage plans or our Insider's Guide to Advantage plans to learn more.

Health Net versus Blue Shield wrap up

Both carriers have really come into their own in the past 5-7 years.

Blue Shield is non-profit and Health net is a publicly traded company but ultimately, what matters is how they treat their members.

Apples and apples, Blue Shield is easier to deal with from a customer's point of view (we deal with membership daily for both).

You need to contrast that with Health Net's pricing strength on the HMO side where they are hard to beat.

On the Senior side, Shield for the supplement; probably Health Net for the Advantage plan.

We're happy to walk through your situation in regards to Blue Shield and Health Net.

Or feel free to run your quote here - Health Net versus Blue Shield :

Individual and Family coverage

Small Business (1 - 100 employees)

Medicare supplements

NEW! Our Carrier Comparison with Updated, Ready-to-Use information.

You can run your Health Net and Blue Shield of California Exchange Quote to view rates and plans side by side from the major carriers...Free.

Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!