What You Need to Know
Founded in 1945, Kaiser Permanente is one of the country’s largest not-for-profit health plans.
More than 12 million Americans are members of Kaiser Permanente.
Policyholders must get their care through Kaiser healthcare providers and treatment centers, unless there’s an emergency.
What Is Kaiser Permanente?
Kaiser Permanente is one of the country’s largest not-for-profit health plans, with headquarters in Oakland, California. The company is a managed care organization where consumers can buy a health insurance policy and receive healthcare from one of the Kaiser Foundation Hospitals and medical groups.
The company is made up of three distinct entities:
- Kaiser Foundation Health Plan, Inc.
- Kaiser Foundation Hospitals and its subsidiaries
- The Permanente Medical Groups
Basics on Kaiser Permanente
Kaiser Permanente was founded in 1945 on the heels of the Great Depression and World War II; it began as a healthcare program for steel mill and shipyard workers.1
The company’s founders were industrialist Henry J. Kaiser and Sidney Garfield, a young surgeon. Garfield had built a hospital in the middle of the Mojave Desert to treat thousands of men building the Colorado River Aqueduct. When many men couldn’t pay, Garfield hatched a “prepayment” system by which insurance companies would pay him a fixed amount upfront per day, per covered worker.
Years later, Kaiser heard about Garfield and tapped him for two projects: providing healthcare to 6,500 workers and their families at the Grand Coulee Dam, the largest construction site in history, and later, providing healthcare for 30,000 workers at the Kaiser Shipyards in Richmond, Virginia. After World War II, Kaiser and Garfield made the model permanent. On July 21, 1945, the Permanente Health Plan opened to the public.2
Today, Kaiser Permanente has 12.4 million members, 23,371 physicians and 63,306 nurses and operates in3:
- Northern and southern California
- Washington, D.C.
What Health Insurance Does Kaiser Permanente Offer?
Kaiser Permanente offers a variety of healthcare plans that vary based on where you live.
Those who enroll in the HSA version have the option of pairing their plan with a health savings account (HSA). Plans generally include medical, prescription drugs and vision and dental coverage. Like other plans, Kaiser’s plans follow the metal tier model, with more benefits for those with a gold plan, fewer for those with a silver plan and the least for those with a bronze plan.
For example, someone living in Baltimore, Maryland, might choose Kaiser’s Deductible Bronze Plan which pays 40% once you’ve met your $7,500 annual deductible (combined medical and pharmacy). The monthly premium for this plan is $261.06.
The HSA Silver Plan, which pays 20% once you’ve met your $3,200 deductible (combined medical and pharmacy), has a $304.66 total premium.4
Kaiser Permanente’s Medicaid/Medi-Cal (the latter is just for California residents) plan extends free or low-cost coverage to people of low incomes and limited resources. If you qualify for Medicaid under your state program, you might be able to receive Medicaid through Kaiser Permanente.
Kaiser also offers highly-rated Medicare health plans for people over 65 or who otherwise qualify for Medicare. Kaiser covers plans covered by employers as well.
Kaiser’s plans typically include medical care, prescription drugs and vision and dental coverage.
What Are Member Benefits for Kaiser Permanente?
In addition to medical, pharmacy, dental and vision coverage, Kaiser also offers other benefits to its members. Depending on your plan and where you live, you may be eligible for:
- Silver&Fit: This program helps Kaiser Permanente members with a Medicare Advantage HMO plan stay active.
- ChooseHealthy: Members get discounts on fitness gear, gym memberships and some complementary therapies, including acupuncture or massage.
- Wellness coaching: Get phone support for losing weight and reducing stress.
- Smoking-cessation programs: The Quit for Life Program is an individual phone-based program with an online tool.
- Transportation to medical appointments: Members receive free rides to health appointments if enrolled in a Kaiser Medicare plan.5
How Do You Enroll in Coverage with Kaiser Permanente?
There are a variety of options for enrolling: On the company’s website, healthy.kaiserpermanente.org, you can explore all available plans after entering your ZIP code and birthday. You can also chat live with an agent on the website.
Enrolling via phone is also an option; call 1-800-488-3590; or 1-877-852-5081 for Medicare health plans. Finally, you can sign up through a licensed insurance agent.
How Do You File Claims with Kaiser Permanente?
To file a claim with Kaiser Permanente for a service you paid for out-of-pocket, fill out a Medical Reimbursement Claim Form. You’ll also need to get an itemized bill from your care provider outlining the charges and a payment receipt for services rendered. The form, bill and receipt should be sent to the appropriate address for your region.
Kaiser Permanente gets high marks from a variety of ratings organizations, including AM Best, Standard & Poor’s and the Better Business Bureau.
How is Kaiser Permanente Rated?
In 2019, Kaiser Permanente Insurance Company received eight complaints through the National Association of Insurance Commissioners (NAIC).6
Consumer Affairs gives Kaiser Permanente four out of five stars based on 1,500 ratings submitted last year.7
Trustpilot gives the company 2.3 stars out of five based on 26 reviews,8 and the Better Business Bureau gives it an A+ rating9, while WalletHub rates the company 2.5 stars out of five based on 1,933 reviews.10
What Are the Strengths of Kaiser Permanente?
Kaiser Permanente generally gets high ratings from consumers, and the enrollment process is simple, allowing you to both get a quote for a policy and apply on the company’s website.
Many customers also like the fact that their doctor’s offices, lab, pharmacy and any other providers they see are all under one umbrella.
What Are the Weaknesses of Kaiser Permanente?
Kaiser Permanente is restricted to certain parts of the U.S. For example, if you live in Texas, currently you can’t get coverage through the company.
Some people also feel limited by the fact that they must choose Kaiser providers and treatment centers unless there’s an emergency and not near a Kaiser facility.
Choosing a health insurance company can be complicated.
As you research your healthcare options to help you make the best decision, think about:
- your family’s medical needs
- how important it might be to you to use providers outside Kaiser’s network
- your budget
- the pros and cons of Kaiser compared to other insurance companies
The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.