Need opinions on kaiser health insurance in retirement

[misty57]

DH is getting close to retirement. He will be offered retiree medical from his company, but it will still be pretty expensive AND it is not guaranteed. There is a disclaimer that they can discontinue it at any time. We both turn 55 this year so it will be 10 years before we will get Medicare (if at all).

We are considering breaking away from the company and going with Kaiser which is not a retiree medical benefit option. I called Kaiser Permanente today and they are sending me information about costs and benefits.

Here are my concerns:

What % increase have people experienced in premiums, deductibles, and co-pays over the last few years? Obviously the rates are going to increase; I'm just trying to get an idea of how bad our costs might get.

Also, how cooperative are they in allowing you to handle your own care? Does your primary care physician have to refer you to a Kaiser specialist if you want to see one (dermatology, gastrointerology, etc.) or are you allowed to just make an appointment when you want to see a specialist?

In addition, I am looking for any other feelings about the quality of care that RETIREES get from Kaiser, pro or con, who are not subsidized through a company retiree medical program or Medicare.

TIA

[clifp]

I've used Kaiser pretty much since retiring, so I joined in 2000 or maybe 2001 after my COBRA expired. I was a Kaiser member only a couple of years in the mainland.

In general, I have been pleased with service they have provided. Although frustrated by their antiquated (no electronic bill pay) accounting system. However, I have not had any medical problems other than the occasional flu, asthma flare-up, a couple of minor skin cancers spots burned off. Several friends in the mainland, have been less than happy with Kaiser when dealing with a major medical problem.

I believe I started pay $175 for the "silver plan" 25 copay and I am currently paying 285/month. There was big jump when I turned 50 a couple of years ago. Other than it has been the normal 5-10% increase in health care.

I should note that there are evidently pretty significant differences in customer satisfaction between Kaiser operations in various places, with Hawaii consistently being near the top among Kaiser facilities.

[misty57]

Quote:

Originally Posted by clifp I've used Kaiser pretty much since retiring, so I joined in 2000 or maybe 2001 after my COBRA expired. I was a Kaiser member only a couple of years in the mainland. In general, I have been pleased with service they have provided. Although frustrated by their antiquated (no electronic bill pay) accounting system. However, I have not had any medical problems other than the occasional flu, asthma flare-up, a couple of minor skin cancers spots burned off. Several friends in the mainland, have been less than happy with Kaiser when dealing with a major medical problem. I believe I started pay $175 for the "silver plan" 25 copay and I am currently paying 285/month. There was big jump when I turned 50 a couple of years ago. Other than it has been the normal 5-10% increase in health care. I should note that there are evidently pretty significant differences in customer satisfaction between Kaiser operations in various places, with Hawaii consistently being near the top among Kaiser facilities.

Okay. You can definitely answer one of my questions. When you had to have the skin cancer spots burned off, did your primary care physician do that or did you see a Kaiser dermatologist? If you saw a dermatologist, did you have to see your primary care physician first to get a "referral" or did you just make an appointment with a Kaiser dermatologist and go on your own?

[ziggy29]

Kaiser. People either love it or hate it. I had Kaiser for most of my life (until moving out of their service area in 2003) and I was generally pleased. Routine appointments tended to take a long time to schedule. But I liked the lack of an insurance bureaucracy -- if a Kaiser doctor considered something medically necessary, it was done; no claims process, little insurance bureaucracy.

Kaiser was one of the few plans which fully covered maxillofacial surgery, which my wife had in 2000. It probably would have been something like a $20,000 procedure and would have been likely challenged by a lot of insurance company beancounters, but again a Kaiser doctor considered it medically necessary, so it was all covered.

[M Paquette]

I'm a Kaiser customer in Northern California. This is one of their top rated regions (followed by Southern California) for customer satisfaction. I was initially a member while employed, and continued on COBRA with the same plan, paying the group rate for a typical lots-o-coverage corporate plan. I moved to individual coverage a year ago, on a high deductible plan (1500 ded, 3000 max out of pocket). Rate increases this year were about 10%, a bit less than other insurers in the region were getting.

Individual policies are currently using 1 year age bands, so the increase included both the bump from being a year older, plus the usual rise in medical expenses over the population. I have coverage through them for myself, the wife, and one daughter.

The level of care I've gotten is pretty good. Unfortunately I've had a lot of experience there the past several months. An annual physical turned up an anomaly, which had me referred to a specialist and under treatment within a few days. I was one of the unlucky few percent to get a side effect from treatment, which landed me in the ER overnight. Everything went well though, and the bills for my deductible showed up after a couple of months, and I'm receiving treatment that meets my expectations.

It works. The price is good compared to PPO insurers at the same coverage, and between their electronic record keeping and in-house specialists, they are way, way less hassle to deal with than the standard DIY find-a-specialist-and-beg-for-records drill I used to deal with. You do have to learn How Things Work to use their system effectively. (just showing up in a specialist department demanding care from some poor receptionist doesn't work, but it could get one a psychiatric hold... Yep, saw this while waiting for an appointment.)

Generally one starts off be seeing a primary physician, discussing the problem and figuring out what to do. The primary doc might bring in a specialist for consulting (electronic records, including photos or radiographs are really effective here). One can also call their advice line, which works great for minor problems. DD got a prescription for an annoying irritation over the phone, which we picked up a few hours later. I've gotten a specialist appointment directly from the advice nurse for something fairly obvious (basal cell cancer).

[misty57]

Quote:

Originally Posted by M Paquette I'm a Kaiser customer in Northern California. This is one of their top rated regions (followed by Southern California) for customer satisfaction. I was initially a member while employed, and continued on COBRA with the same plan, paying the group rate for a typical lots-o-coverage corporate plan. I moved to individual coverage a year ago, on a high deductible plan (1500 ded, 3000 max out of pocket). Rate increases this year were about 10%, a bit less than other insurers in the region were getting. Individual policies are currently using 1 year age bands, so the increase included both the bump from being a year older, plus the usual rise in medical expenses over the population. I have coverage through them for myself, the wife, and one daughter. The level of care I've gotten is pretty good. Unfortunately I've had a lot of experience there the past several months. An annual physical turned up an anomaly, which had me referred to a specialist and under treatment within a few days. I was one of the unlucky few percent to get a side effect from treatment, which landed me in the ER overnight. Everything went well though, and the bills for my deductible showed up after a couple of months, and I'm receiving treatment that meets my expectations. It works. The price is good compared to PPO insurers at the same coverage, and between their electronic record keeping and in-house specialists, they are way, way less hassle to deal with than the standard DIY find-a-specialist-and-beg-for-records drill I used to deal with. You do have to learn How Things Work to use their system effectively. (just showing up in a specialist department demanding care from some poor receptionist doesn't work, but it could get one a psychiatric hold... Yep, saw this while waiting for an appointment.) Generally one starts off be seeing a primary physician, discussing the problem and figuring out what to do. The primary doc might bring in a specialist for consulting (electronic records, including photos or radiographs are really effective here). One can also call their advice line, which works great for minor problems. DD got a prescription for an annoying irritation over the phone, which we picked up a few hours later. I've gotten a specialist appointment directly from the advice nurse for something fairly obvious (basal cell cancer).

We are also in Northern CA, so I appreciate the input. So I am assuming that the Cobra premiums for Kaiser were cheaper than the individual premiums, yes?

I called Kaiser this morning and they quoted $332/mo. per person. We would each have an individual plan with a $3K ded and $6000 out of pocket max., but I'm thinking we're older than you.

As your premiums increased, did your deductibles stay the same?

[Peter]

I'm also with Kaiser Northern CA, and have also been completely satisfied. The electronic records system works really well; setting up appointments, refilling prescriptions, etc.

To answer dancingmama's question, I did have to see my primary care physician first to get a referral to a dermatologist. But my appointment was set up via the electronic system, while I was with the primary. And then when I saw the dermatologist, she had immediate access to all my records. Much better than making phone calls and then having to fill out 'new patient forms' etc.

The other thing I like about Kaiser is that the physicians don't have any incentive to order unnecessary tests; they are paid a decent salary and can concentrate on patient care.

[M Paquette]

Quote:

Originally Posted by dancinmama We are also in Northern CA, so I appreciate the input. So I am assuming that the Cobra premiums for Kaiser were cheaper than the individual premiums, yes? ... As your premiums increased, did your deductibles stay the same?

The COBRA premiums were slightly cheaper, for a plan with a very low copayment and deductible. Individual coverage for folks on the high side of the mean population age costs more (surprise, surprise...). Our first year on a high deductible plan was slightly cheaper than the Gold COBRA plan, and our second year will be a bit more than COBRA.

The deductibles and copays are fixed by the plan, and won't change unless we move to a new plan.

[misty57]

Quote:

Originally Posted by M Paquette The COBRA premiums were slightly cheaper, for a plan with a very low copayment and deductible. Individual coverage for folks on the high side of the mean population age costs more (surprise, surprise...). Our first year on a high deductible plan was slightly cheaper than the Gold COBRA plan, and our second year will be a bit more than COBRA. The deductibles and copays are fixed by the plan, and won't change unless we move to a new plan.

Good to know, thanks. I just did some calculations and if premiums increase by 10% a year, we'll pay almost $140K in PREMIUMS ONLY over the next 10 years. We have it, but YIKES!!

[MasterBlaster]

You'll really know how good your (Kaiser or other) healthplan is when and if you have major medical problems.

When you are least capable of changing providers, and when you need them most, that's when you find out if they are any good (or not).

The experience from someone with routine care may be of casual interest for convieneience sake. But the healtplans's behavior when faced with major expenses (on you) is where they prove or disprove themselves.

[M Paquette]

Quote:

Originally Posted by dancinmama Good to know, thanks. I just did some calculations and if premiums increase by 10% a year, we'll pay almost $140K in PREMIUMS ONLY over the next 10 years. We have it, but YIKES!!

Yup. I actually budgeted for a 12% per year rate increase from retirement at 54 until I hit Medicare. Individual insurance buying and pricing is... interesting.

[skipro3]

My father, who lives in northern California, has Kaiser. He's 80 and has had several major health care issues; both carotid arteries had stints placed, A baseball sized tumor in his body just below his rib cage removed (benign). Angioplasty, cataract surgery, some sort of nasal surgury and a few others. I've always been very impressed with the way they treated him, both as physicians and him as a person. I've spoken to his surgeons before every procedure and found them to be articulate, patient and very professional. The facilities are always top quality and the wait to see the doctor from a scheduled appointment has never been more than I would expect; maybe 20 minutes tops. Scheduled surgeries were long waits. Cataract surgery was at least 6 month wait for example.
My mother, while alive, was also treated at Kaiser and they took very good care of her. When she was rushed to their emergency room after a fall (that she did not survive) they were very kind, respectful and patient with my father as well as the rest of the family. If I didn't live so far from their facilities I'd be a Kaiser member myself and I have PPO with a premium of only $35 a month.

[Brat]

Before I moved out of Kaiser's service area (NW) I had them for about 30 years. They provided me and my family excellent care. I have had occasion to talk to their HR and learned that they are able to attract and keep top notch health care professionals as their environment permits them to focus on patient care and still have a good family life.

[clifp]

Quote:

Originally Posted by dancinmama Okay. You can definitely answer one of my questions. When you had to have the skin cancer spots burned off, did your primary care physician do that or did you see a Kaiser dermatologist? If you saw a dermatologist, did you have to see your primary care physician first to get a "referral" or did you just make an appointment with a Kaiser dermatologist and go on your own?

I asked about the spot while seeing my PCP. They quickly scheduled a dermatology examine. The second examine was schedule directly with the dermatology dept. Interestingly enough the dermatologist actually went over my blood test results, which my PCP had ordered but I didn't get around to taking the test for a while.

[misty57]

I appreciate the time everyone took to respond and welcome more.

It appears as though we don't have to worry about the quality of care, which is one thing I am concerned about. If you have Kaiser, going "out of network" would be "out of pocket" and this is going to be expensive enough as it is.

On a side note, I am really disgusted that DH's company's retiree medical might be "worthless" after having worked for them for over 32 years. The portion of the premium that they pay is on a sliding scale and does not get any better after you've worked for them for 30 years. They only offer one plan that is a PPO and our portion of the premiums are higher than if we get Kaiser, although the total annual deductible IS less.

The other thing about his retiree medical that bothers me more than anything else is that the company can drop it at any time. Thus, if we go with that and one of us has a major medical problem and then the company decides to drop it, you're screwed in terms of getting decent premiums somewhere else.

[Brat]

Kaiser does refer out of network if they don't have staff to address your issue. It is their goal to get you fixed so if, say, you need a heart transplant they will refer you to the team that in their judgement will do the job best. Burn patients go to the burn center.

They are a member of the emergency network (call 911 and if you are directed to a non-Kaiser emergency room it is covered). The emergency network system matches patients to facility capabilities real time. If you have a stroke you will go to an emergency room with an available neurologist where ever. IMHO this is particularly important in the Bay Area where some emergency rooms have been closed in the last few years for financial reasons. [Tempted to get on soap box but will pass.]

If you are out of their service area and you need urgent care call their 'Advice Nurse' who can authorize treatment or if you can't do that as a practical matter you can file paperwork and plead your case.