Health Insurance...Kaiser or HMSA

[Garland]

Aloha,

Which coverage is better living in Kailua-Kona?

Mahalo?

[Miulang]

Kaiser has only 3 clinics on the Big Island, one in Hilo, Kona and Waimea. HMSA you can see just about any doc you want. Given the limited choice of locations for Kaiser, your better bet would probably be HMSA since there are more docs under that plan. Can't vouch for the quality of care of either Kaiser or HMSA on the Big Island, though.

Miulang

[1stwahine]

I've been a Kaiser member going on 30 years. They've grown and then some. As far as I know if you need specialty care or need to have tests that aren't available there your coverage covers plane, pick-up which is usually is a Kaiser Van that regularly goes to the airport. Yes, Kaiser is top-notched. You still have the choice of whom to choose as your physician within their system which are all excellent. Personally, I feel the care and professional aspect of Kaiser Permanente is unbeatable. I know first hand! Go with Kaiser!

[kamapuaa]

Did you guys know that Kaiser is a non-profit organization?

[Miulang]

I've been a Kaiser member going on 30 years. They've grown and then some. As far as I know if you need specialty care or need to have tests that aren't available there your coverage covers plane, pick-up which is usually is a Kaiser Van that regularly goes to the airport. Yes, Kaiser is top-notched. You still have the choice of whom to choose as your physician within their system which are all excellent. Personally, I feel the care and professional aspect of Kaiser Permanente is unbeatable. I know first hand! Go with Kaiser!
I'm an HMO member up here in Seattle, too, and my HMO allows me to get treated at a Kaiser facility if a Group Health facility isn't available, so if I got sick in Hawai'i, if I could get an appointment, Kaiser would treat me, too. But if there's only one clinic serving 10-15,000 people in one area (and remember the Big Island has only 3 Kaiser clinics), then chances are that you aren't going to have as much flexibility with docs or treatment as you would with a more open plan like HMSA in Hawai'i.

Miulang

P.S. Kaiser is a not-for-profit organization, just like my HMO is. We can make money (and have this year, unlike Kaiser), but we don't have shareholders to pay dividends to, and we get certain tax breaks, but any "profit" is kept in the organization for those rainy days when income doesn't meet expectations, which happens about every 3 years or so.

[kamapuaa]

I'm an HMO member up here in Seattle, too, and my HMO allows me to get treated at a Kaiser facility if a Group Health facility isn't available, so if I got sick in Hawai'i, if I could get an appointment, Kaiser would treat me, too. But if there's only one clinic serving 10-15,000 people in one area (and remember the Big Island has only 3 Kaiser clinics), then chances are that you aren't going to have as much flexibility with docs or treatment as you would with a more open plan like HMSA in Hawai'i.


I don't go to the doctor unless there is something wrong with me (sick, broke something, etc.), so the Kaiser model seems to work well for me. It's got kind of an "urgent care" feel. One lame thing though - it took me like 2 months to get an apointment with a dermatologist. :(

[Linkmeister]

Aloha,

Which coverage is better living in Kailua-Kona?

Mahalo?

Do you have an employer who's giving you the choice? If you're self-employed there are several hurdles you have to jump over to get coverage from either organization, and I can tell you the Kaiser plan for us self-employed is a 50% co-pay for labs, radiology, etc.

[Miulang]

Do you have an employer who's giving you the choice? If you're self-employed there are several hurdles you have to jump over to get coverage from either organization, and I can tell you the Kaiser plan for us self-employed is a 50% co-pay for labs, radiology, etc.

Yeah, health insurance really sucks if you're self-employed, doesn't it? :mad:

Miulang

[1stwahine]

There's an Added Coverage Plan (they can choose to go to outside) for Select Groups that is available through purchase from Companies for their employees. Participants pays 20%. Non participants pays 20% to Kaiser and 20% to the outside Medical Facility or Office they choose. per Holly at Kaiser Permanente's Honolulu Customer Office.

[Linkmeister]

Yeah, health insurance really sucks if you're self-employed, doesn't it? :mad:

Miulang

In a word, yes. It would be useful if there were groups actively seeking members to enlarge the health insurance pool the same way Credit Unions look for new members (your third cousin twice removed qualifies for c/u membership! Make a deposit now!)

[Miulang]

In a word, yes. It would be useful if there were groups actively seeking members to enlarge the health insurance pool the same way Credit Unions look for new members (your third cousin twice removed qualifies for c/u membership! Make a deposit now!)
There may be some "affinity groups" that exist within Kaiser and HMSA already for self-employed business people who have professional organizations, like real estate brokers, for instance. I don't know how you'd find out about those though, unless you belong to a professional organization and then I guess you can ask if they have a group policy already. Most insurance companies will insure a group as small as 10 individuals, so if you have 10 friends who work in the same industry, my guess is you could probably buy a group policy that way. It won't be that much cheaper than an individual policy (the big money savings comes in groups larger than about 50 "employees", but any money saved is money saved, right?)

Miulang

[Garland]

Mahalos for the replys. Here's a post from another board that I frequent.

HMSA is better. I know for a fact, it cost your employer more money for you to sign up under HMSA than Kaiser.

Kaiser supposed to be better in terms of costs. Recently Kaiser posted increases in their health plan costs, which goes straight to consumers, which means you pay more. Now Kaiser and HMSA consumer out-of-pocket expenses are the same, which gives Kaiser a big disadvantage.

Under HMSA, you have two choices, HMO or PPO. PPO is more expensive for your employer. HMO requires you to have one primary care physician, which will end up costing you more. If you have a sports injury, you will have to see your regular doctor for a referral. If you are under PPO, you can just go see the sports doctor right away, with no referral.

I know under PPO, for prescription meds, you pay $5/mo for generic, or $20/mo for name brand. I believe Kaiser was $10/generic and $25/mo for name brand.

Kaiser has one advantage, in which you don't have to travel anywhere outside of the Kaiser facility if you have any problem. Sports injury, same building, having a baby, same building. HMSA, you gotta go to a specialist for different types of ailments.

In that sense, Kaiser sucks that there are limited number of locations to serve you. And Long's Drugstore only takes HMSA for prescription meds. There is only one Longs in the entire state that takes Kaiser, it's Long's Ewa Beach. There are no other drugstore that takes Kaiser in that area of the island, so Ewa Beach Longs agreed to take Kaiser.

So as you can see, I'm still unsure. A little more research is needed for sure!

[Miulang]

So as you can see, I'm still unsure. A little more research is needed for sure!

I agree with you. The most important considerations (besides the cost) should be convenience (how far away is that doctor's office), the ratio of patients/provider (in an HMO situation, it's typical for one doc to have a panel of 2-3,000 patients), availability of things like same-day appointments (essential if you have kids), after hours consulting (usually a nurse hotline), affiliation with a hospital. I think in the case of the Big Island, Kaiser probably contracts with Hilo General and the other local hospitals for beds because it would be cost prohibitive for Kaiser to build its own hospital, so the hospital affiliation isn't crucial there.

If you decide to go with HMSA and have a choice, pick the PPO option. That will give you most of the benefits that an HMO will give you but allow for more choices outside of your general HMO system. Your copays will be slightly higher, but if you need to see a doc outside the system, at least you get a discount over paying the normal rates for seeing a doc outside the system.

Take a look at your drug bennies, too. HMOs generally have lower copays for drugs (in my healthcare system, we don't have the option of paying more if we want a brand name v. a generic drug, so everybody pays the same for their drugs, depending on their contract, and because they buy in bulk, the costs are less). I think Kaiser has a mail order pharmacy (like my HMO does) which means you can get your drugs online and mailed to you rather than have to deal with ANY line.

HMOs are good for young people with growing families (the one stop for everything feature is one that parents like) and for older people with medical problems (their costs tend to be less, especially for the drug benefit, although it costs more for the systems to have older patients). I have a prescription for a drug that would cost me over $400 for a 3 month supply that I pay $30 for.

If you're young, healthy and have no kids, then HMSA will be cheaper for you because you're not going to be seeing the doctor very often (except probably for emergencies).

It really depends on what your priorities are. And I'm glad you're taking your time deciding. Most people spend more time trying to figure out what their next car will be than what kind of health care they want...until it's too late. :eek:

Malama pono,
Miulang

[Miulang]

Just found out that your State Legislature last year passed a law which allowed "trade associations" the ability to negotiate group contracts with HMSA and Kaiser. So if you're currently an individual member of either health plan because you own your own business and belong to an organization like the Chamber of Commerce, more than likely you can join a group plan for either Kaiser or HMSA.

Miulang

[Linkmeister]

Just found out that your State Legislature last year passed a law which allowed "trade associations" the ability to negotiate group contracts with HMSA and Kaiser. So if you're currently an individual member of either health plan because you own your own business and belong to an organization like the Chamber of Commerce, more than likely you can join a group plan for either Kaiser or HMSA.

Miulang

Now that's interesting. I have to find some time to look for trade associations. DPMA (Data Processing Mgmt Ass'n) is defunct, I think; that's one I used to belong to.

[1stwahine]

I have to hand it HMSA for getting to know if their memebrs are getting quality care. MAMA is 80 years old. About three months ago, she gets a survey from HMSA to fill out about her kidney doctor. Problem is her kidney doctor is deceased. She calls HMSA to inform them. :confused:

Last month, someone from HMSA calls her to talk to her about why she didn't send in the survey. Duh. The woman still asks and takes the information from MAMA. I laugh and went on with my usual activities.

This morning, I go and get MAMA'S mail. She yells at me cause HMSA sends another "survey" regarding the same doctor. Auwe! She's hoohoo with me cause I keep laughing. Eh, they just trying to find out if the long deceased doctor did his job...kinda like The Attorney General Office still saying my late husband alive! :eek:

Have a good day everyone. :D

[spoon]

Aloha,

What about individual coverage, not associated with any organization? I'm a recent grad and will be doing an unpaid internship for the next 3 months or so. I have to find my own coverage for that time period. Any additional advice, given this situation? I don't use any prescription drugs, so this is just in case of emergencies.

Any advice greatly appreciated,
spoon

[1stwahine]

Aloha! Anybody out there know of or have any knowledge of the "many" surveys being conducted by HAMSA 65+? For the past three weeks, MAMA has been giving personal information to "representatives" of HMSA. I finally caught two. One, yesterday who hung-up on me and another just now who said she representated HMSA 65+.

After repeated questions, she finally said she is from the "Wilkinson Company" and not "HMSA." She didn't want to give me a phone number nor connect me to a supervisor. I am afraid this is a scam that has been deducting my mother for questions, she has been giving willing and which has not helped her in any way.

I'll have to wait till tomarrow to call HMSA and find out.

Whacks, whacks! :rolleyes:

[Miulang]

Aloha! Anybody out there know of or have any knowledge of the "many" surveys being conducted by HAMSA 65+? For the past three weeks, MAMA has been giiving personal information to "representatives" of HMSA. I finally caught two. One, yesterday who hung-up on me and another just now who said she representated HMSA 65+.

After repeated questions, she finally said she is from the "Wilkinson Company" and not "HMSA." She didn't want to give me a phone number nor connect me to a supervisor. I am afraid this is a scam that has been deducting my mother for questions, she has been giving willing and which has not helped her in any way.

I'll have to wait till tomarrow to call HMSA and find out.

Whacks, whacks! :rolleyes:
Does Mama have HMSA coverage? If she does, it could be an independent survey company hired by HMSA to ask questions about Medicare services. When you call HMSA tomorrow, ask them if their marketing dept. is conducting any kind of survey for its Medicare program (you know, everybody's making a big deal about the new Medicare drug program, so maybe that's what it's about). If they say, no, they're not doing any kind of survey, tell Mama not to give out ANY personal information, especially not things like social security numbers or date of birth over the phone. Did you register your phone number on the National Do Not Call list? If you did, and if you still got the call, chances are the call was legitimate (companies can only call former or current customers).

Miulang

[1stwahine]

Does Mama have HMSA coverage? If she does, it could be an independent survey company hired by HMSA to ask questions about Medicare services. When you call HMSA tomorrow, ask them if their marketing dept. is conducting any kind of survey for its Medicare program (you know, everybody's making a big deal about the new Medicare drug program, so maybe that's what it's about). If they say, no, they're not doing any kind of survey, tell Mama not to give out ANY personal information, especially not things like social security numbers or date of birth over the phone. Did you register your phone number on the National Do Not Call list? If you did, and if you still got the call, chances are the call was legitimate (companies can only call former or current customers).

Miulang

Tita Miulang, Yes. MAMA has HMSA 65+. Yes, I've registered with the National Do Not Call list...heheheh. Doesn't everybody? I'm pisst cause we got three of these calls during dinner. Two which I caught that didn't sound legit so I'll call tomarrow. I've taken the cell away from her which she is mad at me. I just don't like the idea people asking "personal" medical questions about her. What next, financial? These days so much can't be trusted.

Lynn