WESTERN HEALTH ADVANTAGE VERSUS KAISER
In certain areas, Kaiser and Western Health Advantage are the two dominant carriers…for HMO at least.
The entire Sacramento area falls in this category.
How do we compare Kaiser and Western Health and more importantly…
Great questions and increasingly important as rates keep going higher for health insurance.
You can always jump right to the rates below for Kaiser and WHA but there’s a real difference between the two carriers.
Let’s get started!
What Do Kaiser And Western Health Advantage Have In Common?
They’re both HMO’s!
You can read detailed info in how HMO’s work versus PPO’s (its major market alternative) but here are the key take-aways and then we’ll look at how Kaiser and WHA differ.
First, what is an HMO?
Here’s the a quick refresher.
The HMO or Health Maintenance Organization specifies a way of accessing care and from whom you can access that care.
They came about in the 80’s to contain health care cost (that’s monthly premium to you) and they were popular due to their lower costs.
There are a few important points to focus on:
- You choose a primary care physician and/or medical group through which your care is managed
- The providers are within a certain distance from your residence
- Care is more managed than with PPO or EPO type plans.
Okay…let’s look at how these work in the real world with Western Health and Kaiser!
The WHA Way Of Doing HMO’s!
Western Health actually contracts out with independent doctors, hospitals, and medical groups.
These providers are responsible for providing your healthcare.
You generally have to remain in this group of providers and there are specialists available for referrals.
The Providers that an HMO contracts with are KEY!
This is really the big deal today (even for PPOs) since the networks are smaller.
This is also why Western Health Advantage is so….advantageous!
WHA has contracted with some great providers!
Here’s a small sampling but if you live in the vicinity of these providers, you’re in good hands.
Traditionally, the available list of doctors has been the issue with HMO’s.
WHA aggressively went after better medical groups such as those tied to UC Davis to neutralize this concern.
Again, the chosen medical group needs to be within a given radius of where you live but WHA has made provider contracting their primary concern (and strength).
That’s one down. (actually two with the vicinity question).
So that’s WHA’s version of the HMO. What about Kaiser?
Kaiser’s HMO Model
Kaiser’s model of the HMO stands alone in California and even the U.S.
Kaiser went a completely different way.
Instead of contracting with independent doctors, hospitals, and medical groups, Kaiser owns the facilities and employs the doctors.
With Kaiser, you need to stay within its network of providers…essentially Kaiser facilities. You can use Kaiser in other areas if they have facilities and doctors there.
It’s generally not easy to see providers outside of Kaiser’s network.
Since the insurance carrier owns the facilities and employs the doctors, there’s a built-in cost containment that takes place.
This is the ultimate goal of an HMO with either Kaiser or Western Health Advantage.
So…those are the two models. How do they compare?
The other consideration with HMO’s like Kaiser and Western Health
Two words up above may have slipped by. We need to address them in more detail.
Innocuous sounding enough but we need to understand it.
One major difference between HMO’s and PPO’s is that the carrier will “manage” health care more.
This sounds worse than it probably is but that depends on the health care shopper.
Basically, there will be more scrutiny of health care decisions.
With PPO’s, your contracted doctor decides on course of action and the carrier (generally) pays accordingly.
With HMO’s, you may have to get pre-authorizations for certain courses of treatment.
A course of treatment could even be denied before something else is tried first.
Keep in mind that PPO’s are also seeing more pre-authorizations needed now as carriers scramble to contain costs.
More “managed” care.
There are many times when what is financially prudent and what is medically prudent align and this is actually the best course of action.
We’ve gone the other direction where surgeries are consistently rattled off as first option (think prostate) when that may not be the best advice.
We won’t point fingers at doctors but…
People usually have a good sense of their feelings on this matter.
The response we hear generally is “I love Kaiser” for example…or “I hate HMO’s”.
HMO may be the direction that everything’s going anyway. PPO’s are becoming EPO’s which is somewhere in between PPO and HMO.
We’re scrambling to keep costs down or the system blows up.
With Western Health and Kaiser, you’re likely to see comparable levels of “management” so that doesn’t figure into our comparison as much.
So…how do we compare them?
Comparing Kaiser And Western Health Advantage
First, let’s address the big question.
On average, Kaiser and Western Health Advantage are the two best priced plans in a given area.
We typically see Western Health be the cheaper option at a given benefit level but they’re both significantly lower than other carriers.
You can quickly run your quote below to see how they stack up.
If price is comparable, what’s the second biggest concern?
Choice Of Providers With Kaiser And WHA
It really comes down to which providers or facilities you want access to.
If you want to see a specific doctor or use UC Davis, WHA is going to be your best option.
If you want to use your local Kaiser facility, well…then it’s Kaiser.
It’s that simple because you will not be able to access the other on a given plan.
That decision generally dictates which way to go since the premium is usually comparable.
We recommend checking the providers available to you through the quote above for WHA to see what they offer.
Basically, if you want to join or remain part of the above medical groups listed with WHA, you will want Western Health.
If you want to use your local Kaiser facility, it’s Kaiser.
Of course, if you want the lowest priced option and have some flexibility on provider, run your quote to see who is priced best for you.
For Small Employers, there’s a way to have your cake and eat it to! Read below.
Kaiser’s One Stop Shop Versus Western Health’s Medical Group Model
One interesting difference between the two carriers has to do with how information is maintained.
Some people really like Kaiser because “everything’s under one roof”.
It’s one big facility and they go there for all their needs.
That is an advantage of Kaiser and one that other medical groups are scrambling to mimic.
It’s convenient for say your OBGyn to see the recent labs from your Cardiologist.
It’s also very helpful in actually delivering health care!
Western Health Advantage can’t match this total integration but it does come close!
Since WHA contracts with Medical Groups, your records and care will be administered within that group.
They have the ability to share records and discuss patient needs and care across the group.
There is generally a primary care doctor who coordinates care across the different specialties to make sure you everyone is on the same page.
That’s an inherent benefit of HMO’s and you’ll have it with Kaiser or WHA although Kaiser’s is pretty seamless.
Small Employers Can Offer WHA And Kaiser To Employees
That’s right. A small employer (1-100 employees) can offer both Western Health and Kaiser to employees.
We can even base the employer’s contribution on a given plan (say the Kaiser Silver 2000) and have that amount apply evenly to either Western Health or Kaiser plans.
Very cool and very popular!
With a certain number of employees, you’ll have some that have existing doctors they want to stay with (WHA) while others have been with Kaiser for decades.
There’s no additional cost for this approach and you can quote your company here:
We can do this two ways. One is via a “Kaiser wrap”. Essentially, Kaiser will wrap around the WHA group policy.
We can also run a CalChoice quote which may be the best approach. Why?
There are situations where CalChoice’s Kaiser plans can be cheaper than Kaiser direct!
If you have Kaiser alone, let us run the quote to see if we can get it cheaper.
We’ll create a worksheet for each employee with both carrier options available!
Our services are 100% free to you as licensed California agents and Certified Covered California agents.
We have helped 10’s of 1000’s of Californians across the State make this same comparison.
We’re getting pretty good at it!
New to WHA? Get more info on Western Health Advantage here.
Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!