Kaiser Permanente vs. Blue Cross: The HMO Battle

If you are looking at plans in California, Georgia, or the Mid-Atlantic, you’ve seen the Kaiser model. It’s an HMO (Health Maintenance Organization)—they are the doctor, the hospital, and the insurance company all in one.

Compare that to Blue Cross (a PPO or EPO model), and you have two completely different ways of experiencing healthcare. Which one is right for you?

The Kaiser "One-Stop-Shop"

The pro of Kaiser is convenience. Your doctor, your lab, and your pharmacy are all in the same building. The communication is seamless. The con? You are in a "walled garden." If you want to see a world-renowned specialist who isn't a Kaiser employee, you are paying 100% out of pocket.

The Blue Cross Flexibility

Blue Cross gives you the "keys to the city." You can see almost any doctor in the country. The downside is the paperwork. You have to manage your own records, and your co-pays are often higher because you’re paying for that freedom.

The Prescription Reality

Kaiser is excellent at managing common medications, but they can be very restrictive with new, high-cost brand names. They prefer you use their "in-house" alternatives. Blue Cross has a wider formulary but often hits you with high co-insurance.

The Solution

We work with patients in both systems. If Kaiser says "No" to a drug your outside specialist recommended, or if Blue Cross wants a $400 co-pay, we bypass them. We use advocacy to get those meds for $40 a month directly from the maker.

Don't let your insurance model limit your care. Get meds for $40/mo.