Blue Cross Blue Shield vs. Kaiser Permanente Insurance

Compared to Kaiser Permanente, Blue Cross Blue Shield may be the better health insurance option. Learn how each compares in network size, availability and more.

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SmartFinancial found that Blue Cross Blue Shield (BCBS) outperforms Kaiser Permanente (Kaiser) in provider network size, customer experience and coverage options. The BCBS provider network features 1.7 million providers nationwide, whereas Kaiser has hundreds of medical facilities and at least 88,000 healthcare providers in eight states. Additionally, BCBS offers a full array of coverage options compared to Kaiser’s basic three options. Kaiser does, however, have better mobile app ratings than BCBS.

Read below to get an in-depth view of how these two healthcare providers stack up.

Blue Cross Blue Shield vs. Kaiser Permanente: Quick Glance

Comparison

BCBS

Kaiser

Coverage Options

HMO, PPO, CDHP, EPO, FSA, HMO-POS, Indemnity, HSA, Medicaid, Medicare, POS

HMO, Medicare, Medicaid

Availability

50 states for individual/family plans; 47 states for MA plans

Available in eight states and the District of Columbia

Coverage Limit

Varies

Varies

Deductible

Varies

Varies

Maximum Annual Benefit

Varies

Varies

Waiting Period

Varies

Varies

Providers In-Network

1.7 million

Includes 39 hospitals, 737 medical offices, 23,656 physicians and 65,005 nurses.

Covers Telehealth

Yes

Yes

Policy Management

Mobile app, online account, phone

Mobile app, online account, phone

Blue Cross Blue Shield Pros and Cons

Pros

Cons

Available in all 50 states

Medicare Advantage plans not available in all 50 states

Larger network than Kaiser

 

More coverage options than Kaiser

 

>> Check out our full Blue Cross Blue Shield review here.

Kaiser Permanente Pros and Cons

Pros

Cons

One-stop shop for doctor, lab and pharmacy services

Available in only eight states

Insurance and medical care handled by the

same company

Fewer providers and coverage options than BCBS

>> Check out our full Kaiser Permanente review here.

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Blue Cross Blue Shield Vs Kaiser Permanente: Plan Structures

It’s an even match between BCBS and Kaiser regarding plan structures. However, BCBS does offer more coverage options than Kaiser (see above table).

Plan

BCBS

Kaiser

Dental

✓ 

Family

Individual

Medicaid

Medicare

  ✓

Vision

Group

Blue Cross Blue Shield Vs Kaiser Permanente: Plan Availability

When it comes to individual and family health insurance plans, BCBS eclipses Kaiser in nationwide presence. BCBS plans are available in all 50 states and Medicare plans are sold in 47 states.

Kaiser Permanente sells plans in the following eight states plus the District of Columbia:

  • California
  • Colorado
  • Georgia
  • Hawaii
  • Maryland
  • Oregon
  • Virginia
  • Washington

Blue Cross Blue Shield Vs Kaiser Permanente: In-Network Providers

BCBS takes the gold with an extensive health insurance provider network of 1.7 million. Kaiser’s network includes 39 hospitals, 737 medical offices, 23,656 physicians and 65,005 nurses. While Kaiser’s network is still large, it pales next to BCBS’ massive network.

Blue Cross Blue Shield Vs Kaiser Permanente: Cost

BCBS and Kaiser healthcare plans will vary in cost due to:

  • Age
  • Deductible
  • Health history
  • Health plan
  • State

Plan categories from both BCBS and Kaiser are available in bronze, silver, gold and platinum. The tiers dictate the cost of your coverage (not the quality of your care):

  • Bronze tier: Lower monthly premium but higher out-of-pocket costs
  • Silver tier: Average monthly payments. Lower out-of-pocket costs compared to bronze but higher than gold
  • Gold tier: Higher monthly payments but lower out-of-pocket costs
  • Platinum tier: Highest monthly payments with the lowest out-of-pocket costs.

BCBS and Kaiser also sell Medicare Advantage (Part C) plans, which combine Medicare Part A (hospital insurance), Part B (medical insurance), and sometimes Part D (prescription drugs). You will still be paying your premiums for Medicare parts A and B on top of your MA plan premium — however, Part A is typically free if you’ve paid Medicare taxes for at least 10 years. The average cost of an MA plan is $19 per month in 2022.

Blue Cross Blue Shield Vs Kaiser Permanente: Coverage Limits

Healthcare policy limits will vary between plans since different people have different needs, budgets and health concerns. Like any other health insurance company, BCBS and Kaiser are prohibited from setting a dollar limit on essential health benefits, which can include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization (surgery and overnight stays)
  • Laboratory services
  • Mental health and substance use disorder services
  • Pediatric services
  • Pregnancy, maternity, and newborn care
  • Prescription drugs
  • Preventive and wellness services/chronic disease management
  • Rehabilitative and habilitative services and devices

Blue Cross Blue Shield Vs Kaiser Permanente: Policy Management

BCBS and Kaiser members can access their health care plans through an online portal, by speaking to a representative or through a mobile app. Both online portals and mobile apps allow customers to:

  • Compare costs
  • Compare prescription drug costs
  • Find an in-network healthcare provider
  • Check coverage
  • Pay bills
  • Track spending
  • File claims
  • View claims and EOBs
  • Get an ID card

Kaiser’s app comes out on top of BCBS’, offering a better user experience.

Company

Google Play Store

Apple App Store

Blue Cross Blue Shield

3.17/5 stars 

3.12/5 stars

Kaiser Permanente

4/5 stars

4.3/5 stars

Note: With BCBS, you will need to download the mobile app specific to your state. We took the average of BCBS apps in 10 states to provide the overall average rating above.

Blue Cross Blue Shield Vs Kaiser Permanente: Medical Loss Ratio

Medical loss ratio (MLR) is the revenue from member premiums received versus how much of it is used for medical care improvement. Insurance companies must spend at least 80% (individual plans) or 85% (group plans) of premium dollars on improvements. If the MLR falls below the requirement, the difference is refunded in the form of a rebate for policyholders.

In 2022, BCBS will issue MLR in several states, including Massachusetts, Texas, Minnesota and North Carolina. It is unknown whether Kaiser will be issuing rebates this year. The Kaiser Family Foundation does note that all insurance companies will be paying a total of $1 billion in rebates.

Blue Cross Blue Shield Vs Kaiser Permanente: Enrollment Process

Open enrollment for buying a BCBS or Kaiser health plan through your state’s health insurance marketplace will run from November 1, 2022, to January 15, 2023 in most states. Health insurance coverage is still purchasable outside of the enrollment period but only if you experience a qualifying event, such as:

  • Becoming a U.S. citizen
  • Changing jobs
  • Getting married or divorced
  • Giving birth to a child or adopting a child
  • Household income falling below the federal poverty level
  • Losing health coverage (spouse or domestic partner loses their job or dies)
  • Moving to a new residence

General Medicare enrollment runs from October 15 to December 7. Medicare Advantage open enrollment is from January 1 to March 31.

Medicaid enrollment lasts year-round for qualified applicants and you can apply by contacting your state’s Medicaid department or enrolling through your state’s health insurance marketplace. Eligibility will vary by state but typically considers the following:

  • Age
  • Income level
  • Number of people in your family
  • If you are pregnant or have a disability

Blue Cross Blue Shield Vs Kaiser Permanente: Policyholder Experience

BCBS comes out ahead of Kaiser in terms of customer experience based on ratings pulled from several online sources.

Company

BCBS

Kaiser Permanente

Consumer Affairs

2.6/5 stars

3.4/5 stars

Best Company

3.7/5 stars

2.7/5 stars

Benzinga

4.5/5 stars

3.5/5 stars

Better Business Bureau

1.1/5 stars

1.08/5 stars

BCBS was also ranked among the highest scores for overall customer satisfaction in 19 out of 22 regions in a 2022 J.D. Power study of U.S. commercial health plans.

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How To File Claims With Blue Cross Blue Shield and Kaiser Permanente

In-network care does not require a claim to be filed by the insured for either company. Instead, doctors and medical facilities file claims with the insurance company on your behalf. However, medical services acquired out-of-network will require you to file a claim yourself.

BCBS members can submit claims electronically or by mail. Customers can use the Real-Time Claims web tool for electronic claims submissions or by signing up for the Electronic Data Interchange (EDI).

Kaiser Permanente members can submit claims by mail or by enrolling in the Electronic Data Interchange (EDI).

History of Blue Cross Blue Shield

Blue Cross was formed in 1929 as a partnership between Baylor University Hospital and its patients who were struggling financially. The administrators of the hospital wanted to make healthcare more affordable for some patients, many of whom were Dallas public school educators on restricted budgets. The initial payment plan set up by Baylor University Hospital consisted of a 50-cent prepay each month for up to 21 days of hospitalization per year. The success of the program leads to enrollment by employees in other professions across Dallas.

History of Kaiser Permanente

After World War II ended the shipyard workforce fell from 90,000 to 13,000. Only 12 of 75 medical group providers remained. On July 21, 1945, the Permanente Health Plan opened to the public to continue the health care delivery set up by Kaiser and Garfield. In 10 years, more than 300,000 people enrolled in Northern California with the support of two unions, the International Longshoremen’s and Warehousemen’s Union and the Retail Clerks Union.

In 1953, the name of the health plan and the hospitals were changed from Permanente to Kaiser Permanente. Even today, there are ties between the nonprofit Kaiser Foundation Health Plan and Hospitals and the Permanente Medical Groups.

FAQs

Does Blue Cross cover Lasik?

You can receive up to 25% off laser vision surgery if you have a Blue Cross Blue Shield vision plan. You can also use a flexible spending account (FSA) or health savings account (HSA) to pay for the vision correction procedure.

What pharmacies accept Kaiser Permanente’s health insurance?

If your health plan benefits include a prepaid prescription drug plan, you must use a Kaiser pharmacy to obtain drugs at plan prices. You can fill your initial prescription at many MedImpact pharmacies, which include Walgreens, CVS, Rite Aid, Kroger, Safeway, and Costco, but you’ll need to order refills through a Kaiser Permanente pharmacy or a mail-order refill service through Kaiser.

What is a flexible spending account by Blue Cross?

A Blue Cross flexible spending account allows you to designate money for medical, dental and vision expenses or dependent care. You accumulate money in your account through pre-tax deductions from your paycheck.

Key Takeaways

  • Blue Cross Blue Shield is available in more states than Kaiser Permanente.
  • Kaiser Permanente has a smaller provider network than Blue Cross Blue Shield.
  • Blue Cross Blue Shield has higher customer satisfaction ratings than Kaiser Permanente.
  • Kaiser Permanente’s mobile app is rated better than Blue Cross Blues Shield’s app.

To help find the best health insurance plan, use SmartFinancial to make sure you’re getting the plan you want for the price you want. Enter your zip code below or call 855.214.2291 to receive your free health insurance quotes.

Sources

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