Cigna vs. Kaiser Permanente Insurance

Cigna and Kaiser Permanente are both well-known health care insurance providers, but how do they compare with each other, and which one is better suited for your healthcare needs? While both companies are close in overall rating, cost, customer experience, network size and quality, you may be more interested in Kaiser’s preventive approach or Cigna’s coverage.

Cigna History (Brief rundown)

Established in 1982, Cigna is one of the oldest insurers in the United States and boasts a global business with almost 95 million policyholders. In the United States, Cigna only offers private plans in 13 states and Medicare Advantage plans in 477 counties. Cigna offers PPO plans and HMO plans. Cigna does not own its own hospitals or employ its own physicians.

Click to read our full Cigna review.

Kaiser Permanente History (Brief rundown)

Kaiser Permanente is a nonprofit, group-practice health plan in California that practices a high level of integrated health care.  Founded in 1945, Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit health plans. They currently serve 12.6 million members in 8 states and the District of Columbia.

The main difference between Cigna and Kaiser Permanente is that Kaiser Medicare plans are HMO-focused, which tends to focus on preventive patient care with a multidisciplinary, team-oriented approach. HMO plans center around a PCP (primary care physician) to monitor and maintain healthcare and appointments. If a specialized test is needed, your PCP will coordinate with specialists to get you the care that you need. Kaiser Permanente combines insurance and health care by employing its own physicians and owning its healthcare facilities.

Kaiser Permanente only offers Medicare Advantage plans in 109 counties.

Click to read our full Kaiser Permanente review.

Cigna Vs Kaiser Permanente: A Quick Glance

Insurance company	Cigna	Kaiser Permanente
Policy Type	Medicare, PPO, HMO, FSA, EPO, HMO-POS, HSA, POS, CDHP, Medicaid	HMO plan with a Medicare contract
Availability	Available in 12 states	Available in eight states and Washington, D.C.
Coverage Limit	Varies	$8,550 Individual / $17,100 Family
Deductible	Varies	Varies
Max Annual Benefit	Unlimited per individual	Varies
Waiting Period	Varies	Varies
Providers In-Network	1.5 million	The company’s network includes 39 hospitals, 734 medical offices, 23,656 physicians, and 65,005 nurses.
Telehealth	Yes	Yes
Policy Management	Mobile app, website, phone	Mobile app, website, phone

Cigna Pros and Cons

Pros	Cons
Network of 1.5 million providers	Below average customer satisfaction rating in 2022 J.D. Power study
Affordable dental coverage with plans starting at $19	Medicare Advantage Plans unavailable in some states
Cigna received a perfect 5-star overall rating in 2021	Limited availability

Kaiser Permanente Pros and Cons

Pros	Cons
Network of 1.2 million providers	Limited provider network
Received standout rankings in the 2021 J.D. Power study	Only offers HMO plans, so policyholders must work with their network of medical providers.
The doctor’s office, laboratory and pharmacy are all under one roof

*Kaiser Permanente offers a patient-focused approach to care, but with fewer products available in fewer markets. Cigna has a more diverse portfolio of policies and a larger coverage area.

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Cigna Vs Kaiser Permanente: Plan Structures

The main takeaway between Cigna and Kaiser Permanente is that Cigna offers private health insurance through the Marketplace along with Medicare Advantage and Medicare Supplement Plans. Cigna also offers HMOs, PPOs, EPOs and Special Needs Plans (SNPs), which include:

• Chronic Special Needs Plans (C-SNP) for policyholders with heart disease and diabetes
• Dual-eligible Special Needs Plans (D-SNPs) for people with both Medicaid and Medicare
• Institutional Special Needs Plans (I-SNPs) for people who live in a nursing home or long-term facilities

Kaiser offers Medicare Advantage (Medicare Part C) coverage, including Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans. Both companies offer vision and dental insurance, individual and family plans, Medicare Advantage and Medicare Part D plans.

Plan	Cigna	Kaiser Permanente
Individual & Family	✓	✓
Medicare Advantage	✓	✓
Medicare Part D	✓	✓
Dental	✓	✓
Vision	✓	✓
Coverage through Employer	✓	✓
Small Businesses	✓	✓
Short-Term Health Insurance		✓

Cigna Vs Kaiser Permanente: Plan Availability

Cigna is offered nationwide, but offers Medicare Advantage plans in 18 states, including:

• Alabama
• Arizona
• Arkansas
• Delaware
• Colorado
• Georgia
• Florida
• Kansas
• Illinois
• Missouri
• Maryland
• Mississippi
• New Jersey
• North Carolina
• Pennsylvania
• South Carolina
• Tennessee
• Texas
• The District of Columbia

 Kaiser Permanente only sells plans in the following states:

• California
• Colorado
• Georgia
• Hawaii
• Maryland
• Oregon
• Virginia
• Washington
• Washington, D.C

Cigna Vs Kaiser Permanente: In-Network Providers

While both companies have a large network of healthcare providers, Kaiser uses in-network healthcare providers, which means policyholders will have to go to doctors and hospitals recommended by Kaiser. Cigna allows policyholders to seek care from doctors and hospitals that are not in their network. Both companies will charge more if you seek care outside of their networks.

Cigna maintains around 1.5 million health care professionals in its global network and represents over 99% of all pharmacies in the United States — over 67,000 pharmacies. Cigna offers Medicare plans throughout the United States and Cigna Medicare Advantage plans are accepted by a large network of doctors, hospitals, clinics, pharmacies and more. In 2022, Cigna had Medicare Advantage plans in 477 counties, while  Kaiser Permanente offered Medicare Advantage plans in 109 counties.

Cigna Vs Kaiser Permanente: Cost

Health insurance premiums are tailored to each individual. The following factors can all impact the cost of health insurance:

1. Location
2. Tobacco use
3. Age
4. Whether you have dependents
5. The type of plan itself
6. Lifestyle factors
7. Your deductible

Both Cigna and Kaiser Permanente offer Medicare Advantage (Part C) and Medicare Part D (prescription drug coverage). Medicare Advantage combines Medicare Part A (hospital insurance), Part B (medical insurance), and usually Part D (Medicine). The monthly premium for Medicare Advantage is $19. Policyholders must pay any premiums for Parts A and B along with the Medicare Advantage premium before they can receive Medicare Advantage.

Cigna also offers Medicare Supplement (Medigap) which fills in the gaps in your Original Medicare plan. The average cost for Medigap was $150 monthly in 2020 and it will not cover medicine. Just like with Medicare Advantage, members must pay any premiums associated with Parts A and B along with the Medigap premium before they can receive Medicare Supplement.

Cigna’s monthly premiums by tier are on average:

• Bronze – $268-$730
• Expanded Bronze – $286-$775
• Silver – $342-$929
• Gold – $357-$968

Cigna Vs Kaiser Permanente: Coverage Limits

Whether you choose health insurance from Cigna or Kaiser Permanente, coverage limits will vary per policy. Each plan has different out-of-pocket maximums, physician limits, hospital stays and more. Insurance plans that meet the Affordable Care Act (ACA) cannot enforce limits on essential benefits, which include:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Laboratory services
• Mental health and substance use disorder services
• Pediatric services
• Pregnancy, maternity, and newborn care
• Prescription drugs
• Preventive and wellness services
• Rehabilitative and habilitative services and devices

Insurers can no longer set a dollar limit on essential services. Most health insurance plans, including individual and small-group health plans, are offered in four tiers of coverage, including:

• Bronze
• Silver
• Gold
• Platinum

 As the tier increases so does the limit of medical expenses that an insurer will cover compared with what you would expect to pay in deductibles and co-pays.

Cigna Vs Kaiser Permanente: Policy Management

Cigna and Kaiser members can access their health care plans through both Apple and Android  mobile apps, an online portal, or by speaking with a representative. Both online portals and mobile apps make managing your plan easy by allowing you 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

Both insurers offer a live online chat where members can talk with an agent alongside phone and email support. Kaiser Permanente is only available by phone from 8 a.m. to 8 p.m, while Cigna offers phone support 24/7.

Cigna Vs Kaiser Permanente: Medical Loss Ratio

The Affordable Care Act (ACA), enacted Medical Loss Ratio in 2010, which requires insurers who cover individuals and small businesses to spend at least 80% to 85% of their premium income on health care claims and quality medical improvements. If they fall short of 80%, they must pay annual rebates to their customers.

Kaiser Permanente medical loss ratio in 2020 was 80%. With Kaiser, you're covered for certain specialty care, including care for ongoing health conditions, at any of their facilities in:

• California
• Colorado
• Georgia
• Maryland
• Oregon
• Virginia
• Washington state
• Washington, D.C.

Cigna’s MLR was 70.5% in 2020, down from 81.6% a year ago, which has a lot to do with the onset of the pandemic which caused healthcare in the United States to plummet as hospitals canceled elective procedures and patients elected telehealth options. Since then, healthcare use levels have been restabilized. Cigna returned $13,127,296 in rebate checks, an average of $103 per member.

Cigna Vs Kaiser Permanente: Enrollment Process

Open Enrollment Season under the ACA for an individual or family will begin November 1st of this year and ends January 15th in most states.  You can shop coverage for Cigna and Kaiser Permanente directly through the insurer or the health insurance marketplace. You may also be able to get Cigna or Kaiser Permanente through your workplace.

You can get coverage outside of the enrollment period if there has been a qualifying event, such as:

• Becoming a U.S. citizen
• Getting married or divorced
• Changing jobs
• Household income falling below the federal poverty level
• Giving birth to a child or adopting a child
• Moving homes
• Losing health coverage

Cigna and Kaiser are available through the health insurance marketplace. You can begin by visiting https://www.healthcare.gov.

Cigna Vs Kaiser Permanente: Policyholder Experience

Company	Cigna	Kaiser Permanente
Consumer Affairs	3.8/5 stars	1.4/5 stars
Trusted Choice	2.5/5 stars	2.7/5 stars
BestCompany	2.7/5 stars	2.7/5 stars
Affordable Health Insurance	4.2/5 stars	4.5/5 stars
BBB	1.24/5 stars	1.11/5 stars

Every year, Medicare evaluates plans on a 5-star rating system. The Centers for Medicare and Medicaid Services rates Medicare Part D and Medicare Advantage plans annually using the 5-star quality scale. In 2021, Cigna earned a perfect 5 stars rating, the highest possible rating, and is highly rated by the BBB and AM Best. Cigna received below-average ratings with the 2022 JD Power and Associates Commercial Member Health Plan Study.

Members are happy with Kaiser Permanente; it earned 846 points out of 1,000 in J.D. Power’s latest U.S. Medicare Advantage Study, placing it high for customer satisfaction. The National Committee for Quality Assurance (NCQA) Health Plan Ratings report named Kaiser Permanente among the highest-rated commercial and Medicare health plans in the nation. In comparison with over 1,000 health systems, Kaiser Permanente is the only one to achieve a rating of 5 out of 5 stars in recognition of its high-quality patient care, preventive services, treatment, and patient experience.

All in all, both companies received high ratings and are excellent for policyholders who want highly-rated customer service and coverage. Although Cigna and Kaiser Permanente differ in coverage options and locations served, they both have strong quality and financial ratings along with dedicated customer service and ease of use. If you live in a location serviced by Kaiser and prefer its managed care process, it may be the right choice for you. If you like to have options for coverage and health care providers, Cigna might be a perfect fit.

How To File Claims With Cigna and Kaiser Permanente

Since Kaiser has its own network of doctors and hospitals there are virtually no claim forms to file. If you choose to get out-of-network care, you will have to file a claim for reimbursement. Members are responsible for paying out-of-pocket for any amounts that are greater than the maximum allowable charge.

To file a claim with Cigna Health Insurance, download and print the form you need. You can send your completed form with itemized bills to the Cigna HealthCare Claims Office, which is printed on your Cigna HealthCare ID card. For questions, you may call 1 (800) 997-1654. You should be covered outside of copay. For reimbursement for Part D prescriptions, you can fill out a drug claim form and mail it in.

When using an in-network doctor or hospital, your claims will be submitted to the insurance company by that provider. If you see an out-of-network provider, then you will need to submit a claim form yourself. Also, be sure to review your policy details for state-specific steps required when filing a claim.

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Find Out Which Insurance Is Right for You

Both Cigna and Kaiser Permanente provide health benefits for individuals and families, dental insurance, Medicare, Medicare Supplement plans and more. You can shop around to find an insurance carrier that fits your lifestyle and budget needs. SmartFinancial can help. Just enter your zip code below and fill out a brief form to receive free health insurance quotes in minutes.