Purchasing health care is a part of life you just can’t escape. You have to be prepared to make a good choice. There could be health implications if you just go cheap. Kaiser Permanente wants to help make this big decision an easy one. You can bookmark this page as your reference on health care coverage — it’s everything you didn’t care to know, that you now need to care about … starting with the 3 most important things …
Watch for a quick overview of what a health care plan is, some key terms to know, and what to consider when choosing your plan.
How does health insurance work?
Almost everyone gets sick, hurt, or needs some kind of medical help. Health care is the service provided by a licensed medical professional to diagnose, fix, or prevent a medical issue, and includes:
Health insurance is a contract between an insurer and you, the insured. This contract is known as health care coverage or a health care policy, which stipulates:
You pay a monthly premium to your insurer or health plan to provide you with coverage for health care.
Your insurer or health plan helps you pay for care (such as doctor visits, hospital care, and medications) when you need it.
A network of hospitals, doctors, and other health care providers that agree to coordinate care within a network in return for a certain payment rate for their services.
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. Unlike HMOs, PPOs do cover some care outside of the network.
Lower monthly premiums and lower out-of-pocket costs for services (generally) and prescriptions.
Premiums will generally be higher in a PPO plan, and you’ll usually be responsible for paying the full cost of the medical services you use until you meet the plan’s deductible, at which point your health insurer will then start paying.
You pay a monthly premium, and the doctor earns a salary rather than being paid by the procedure.
A fee is charged for each service.
You select a primary care physician who coordinates and manages your care in the network.
You are responsible for managing and coordinating your care yourself, which will often include transporting test results and data from doctor to doctor.
You see only contracted network providers, except for emergency situations.
PPO plans offer the flexibility to see a provider not in the PPO network and still be covered — though coverage will be lower staying in the PPO in-network.
A referral from your primary care physician may be required to see a specialist.
No referrals are required to see a specialist.
What's the difference between HMOs and PPOs?
A network of hospitals, doctors, and other health care providers that agree to coordinate care within a network in return for a certain payment rate for their services.
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. Unlike HMOs, PPOs do cover some care outside of the network.
Lower monthly premiums and lower out-of-pocket costs for services (generally) and prescriptions.
Premiums will generally be higher in a PPO plan, and you’ll usually be responsible for paying the full cost of the medical services you use until you meet the plan’s deductible, at which point your health insurer will then start paying.
You pay a monthly premium, and the doctor earns a salary rather than being paid by the procedure.
A fee is charged for each service.
You select a primary care physician who coordinates and manages your care in the network.
You are responsible for managing and coordinating your care yourself, which will often include transporting test results and data from doctor to doctor.
You see only contracted network providers, except for emergency situations.
PPO plans offer the flexibility to see a provider not in the PPO network and still be covered—though coverage will be lower staying in the PPO in-network.
A referral from your primary care physician may be required to see a specialist.
No referrals are required to see a specialist.
Worried you’ll choose the wrong plan? You’re not alone.
80% of consumers don’t choose the best available plan.1
What should you pay?
Your monthly plan cost. This is the cost of your coverage and doesn’t include the out-of-pocket cost for each service you receive — you’ll always pay at least this amount each month, regardless of how much or how little care you receive.
How much you have to spend for covered health care services before your health plan starts to pay for anything beyond no-cost preventive care. After you reach your deductible, you’ll typically just pay a copay or coinsurance.
A flat fee you pay for specific services covered under your health care plan. Copays may apply whether or not you’ve met your deductible.
A percentage of the cost that you’re responsible for paying when you receive a specific service. Coinsurance may apply whether or not you’ve met your deductible. People often confuse coinsurance with copays, but they’re different. Your plan may have copays or coinsurance — or it may have both.
The maximum amount of money you’ll have to spend out of pocket for most covered services within a year. After you reach this amount, your health plan pays 100% for most covered services. You’re only responsible for paying your monthly premium and, depending on your plan, copays, coinsurance, or both.
You see your doctor to get a routine check-up.
This visit costs $100.
Your insurance plan covers $80 of the doctor’s fee.
You pay the difference.
In this case: $20
BRONZE
Lowest monthly premium
Highest deductible
Highest out-of-pocket costs for care
A good choice for healthy people who rarely see the doctor and want a low-cost way to protect themselves in case they occasionally get injured or sick.
SILVER
Moderate monthly premium
Moderate deductible
Moderate out-of-pocket costs for care
A good choice for generally healthy people willing to pay a little more each month to have fewer out-of-pocket expenses before their health plan starts covering the cost of care.
GOLD
Higher monthly premium
Lower deductible
Lower out-of-pocket costs for care
A good choice for people with dependents and for those who use health care services regularly throughout the year.
PLATINUM
Highest monthly premium
Lowest deductible
Lowest out-of-pocket costs for care
A good choice for people with known health issues who have frequent specialty care needs, tests, and prescriptions.
People with the wrong plan pay an extra $2,000+ every year for health care1
Now that you understand health insurance a little better, we’d like to explain why we’re the right choice for you. Kaiser Permanente is an alliance between Kaiser Foundation Health Plans and their respective Permanente Medical Groups. This care and coverage partnership is the foundation of our integrated system of care, which operates far differently than traditional health insurance.
In the traditional PPO model, health insurance and health care are separate entities with competing agendas. Our HMO-based system puts care and coverage on the same team, with one common goal: your health.
You and your doctors make the treatment decisions, not the insurance company. This eliminates redundant and expensive tests, frees you from having to manage your care on your own, and most importantly, produces better health outcomes for you.
84%
of Kaiser Permanente members say our medical centers are conveniently located
80%
of Kaiser Permanente members say we are a brand they can trust
80%
of Kaiser Permanente members say they receive excellent medical care
79%
of Kaiser Permanente members say they have experienced excellent telehealth/virtual care
Convenient care access
Our innovative suite of care access options allow you to get treated how when, and where you need it.
Healthy lifestyle programs
We offer personalized, online programs to help you create an action plan to reach your health goals.
Fitness deals
Stay active and fit with a variety of reduced rates on studios, gyms, fitness gear, and online classes — just for Kaiser Permanente members.
Self-care apps
Our wellness apps can help you navigate life’s challenges, improving your sleep, mood, relationships, and more for total health.
Personal wellness coaching
Get one-on-one guidance and support from a dedicated wellness coach who can help you set goals, stick to them, and, most importantly, see results.
Kaiser Permanente is the region’s leading health system, with our quality of care and service recognized by many organizations.
In the survey Best Health Insurance Companies of 2024 by Insure.com, Kaiser Permanente as a national enterprise is rated #1 overall among 70+ competitors—for the fourth year in a row. In the NCQA Commercial Health Plan Ratings 2023, our commercial plan is rated 5 out of 5, the highest rating in the region. The 2022 Commission on Cancer, a program of the American College of Surgeons, granted Three-Year Accreditation with Commendation to the Kaiser Permanente cancer care program. The Mid-Atlantic Permanente Medical Group is the largest multispecialty medical group in the Washington, DC, and Baltimore areas and exclusively treats Kaiser Permanente members. Permanente doctors are recognized as Top Doctors in Northern Virginia Magazine (2024), Arlington Magazine (2023), Baltimore magazine (2023), Bethesda magazine (2023), and Washingtonian magazine (2023). According to NCQA’s Quality Compass® 2023, we’re rated 5 out of 5 in 31 care measures, including: controlling high blood pressure, glucose control and blood pressure control (140/90) for diabetes, breast cancer screening, colorectal cancer screening, childhood and adolescent immunizations, and postpartum care. Quality Compass is a registered trademark of the NCQA.
Make sure your employer offers Kaiser Permanente as
a health plan option, so you can join our community of
care.
Give us a call at 1-800-514-0985 to learn more.
