In Los Angeles & Orange County, we have 6 different insurance carriers for the individual & family market. Many of our clients are deciding between Kaiser’s HMO & Oscar’s EPO as both offer great hospital systems in the region. We will go over some of the major differences between the two health insurance options.
Networks
Both Kaiser and Oscar offer great networks of doctor and hospital systems. Unlike Oscar, Kaiser is both a healthcare provider and a health insurance carrier. You must go to the Kaiser doctors and facilities for you to be covered by your Kaiser plan. Oscar is not a health care provider but has contracts with large hospital systems in the region such as Providence, USC, Torrance Memorial, Kindred, Children’s, and more in their Select EPO with their Circle EPO additionally having contracts with UCLA & Hoag.
PPO vs EPO vs HMO
Kaiser has always been an HMO or Health Maintenance Organization. This means that your primary care physician is the gatekeeper of your care. Under an HMO model, you must get a referral from your PCP to go and see a specialist. Under Oscar’s EPO model, you are offered more provider choices as EPO plans allow you to see any in-network specialist without a referral. For example, if you have chronic back pains with Oscar you can go straight to various in-network orthopedic specialists while at Kaiser you have to wait for the primary doctor to write you a referral, often he wants to first try different methods to relieve your back pain and only after these treatments did not help you will be referred to a specialist. Your PCP will want to refer within their own IPA or Independent Physician’s Association to keep the business within their practice. Since Kaiser is both a healthcare provider and insurer, maintaining an HMO model helps keep costs down and keeps your personal health data all in one system versus spread across different practices. Oscar as an EPO will only pay inside their network. Under a PPO system, you can see any in-network or out-of-network doctor; however, the individual and family PPO plans have high $5,000 + out-of-network medical deductibles before covering your out-of-network doctor at 50% coinsurance of the in-network negotiated rate.
Telemedicine
Both Oscar and Kaiser offer telemedicine services for free. Through Oscar’s mobile app, you have access to doctors who are available 24/7/365 to treat conditions such as colds and flu, ear and eye infections, skin conditions, mental health, and more. This can be a very valuable service that saves you time and money on your healthcare and is especially valuable during self-quarantine with the coronavirus. As a Kaiser member, you can contact doctors online through the member portal or you can call a doctor on call by calling 833-574-2273.
Urgent Care
Although both Kaiser & Oscar have some great urgent care facilities, they do lack in the number of in-network urgent care centers. Neither has an impressive urgent care network and Kaiser’s closest in-network hospital/urgent care for West LA is all the way in the east side of Culver City. Oscar’s closest urgent care center for West LA is Exer Urgent Care- Beverly Hills which is also not particularly close for people living on the west side of LA. Oscar does have a solid number or urgent care facilities in the South Bay (5 between El Segundo & Carson).
Customer Service
Kaiser and Oscar both have exceptional customer service and maintain high customer retention rates. One aspect where Oscar shines in is that they assign 4 care guides and a nurse to each of its members to provide personalized customer service to its members. Your care guides can help you navigate through your care and help you find the right care for your needs. Since Kaiser keeps all of your health data linked to your medical record number, having all of your health date a in one place.
Price
Both Kaiser and Oscar offer some of the most competitive prices. As an example, for a 40-year-old in 2020 in West LA, the Oscar Silver 70 Circle EPO is about 2% lower in price than Kaiser’s Silver 70 HMO while the Oscar Silver 70 Select EPO (without UCLA/Hoag in-network) is about 10.5% less than Kaiser’s Silver 70 HMO.
Overall, choosing the right insurance carrier depends on your personal medical needs and budget. Please contact us at Solid Health Insurance Agency or at info@solidhealthinsurance.com to go over your health insurance options, either through Covered California or directly to Kaiser, Oscar, or another insurance carrier. At Solid Health Insurance Services, we are always happy to assist you with all of your health, dental, vision, life, and long-term care needs.