Kaiser HMO or Aetna PPO

[NoVA_Lurker]

We live in Reston also, and we have both in our house. My baby and I are on my insurance with Aetna, and his dad is on insurance through his employer and has had Kaiser for several years. We like both for different reasons.

He doesn't go to the doctor often and finds it very easy to have a "one stop shopping" kind of facility. The facility is nice, there is a pharmacy right in the building so you can pick up prescriptions immediately without another stop at the drug store, and he has not had any issues or concerns about the doctors who have treated him there. Mostly it's been minor stuff, but he's also had to see a few specialists (some of which are at other KP facilities in the area - Fairfax, Falls Church, etc). Also, if I recall correctly from looking at my own plans, I believe Kaiser generally pays 100% of most things when you use their network. There are facilities in other states, but not everywhere.

On the other hand, I found a few doctors for myself and selected our pediatrician based on recommendations. They all accept Aetna but are not part of the Kaiser network. I haven't had any real issues related to insurance. I do think that it is sometimes stressful to find new doctors and do that research and figure out how to select the "right" one, so for that reason, Kaiser is kind of nice since they can help you choose a primary physician from their local network and work with you from there.

The only thing I will say is that it did cost me several thousand dollars to have my baby earlier this year, and I think that would have been fully covered with Kaiser. HOWEVER, for this one year, I've had an Aetna plan that included an HSA and was not part of the traditional PPO, so I think that is why it was so much more expensive than I anticipated. For 2012, I switched back to the traditional Aetna PPO. (Mostly because I had some issues with the HSA funding from my company and I just haven't taken the time to fully understand how it works and how to use the account and all that. In general, though, I know that the HSAs are being promoted as a good long-term option.)

So, I would say that we've been happy with both.

[RusUs]

edamron,
please check this relatively recent thread, where Kaiser was discussed-
https://www.city-data.com/forum/north...ente-nova.html

I will repeat that my family and I have been using Kaiser for a few years. We still like it :-) It may take a few changes to find the doctor (PCP- Primary Care Physician) that you like, but you are not limited who you see. We never had a problem asking for a referral. I like their web site where I can access and see all our test results, email my doctor, order Rx, etc. Kaiser also has been adding new facilities. We started using the one in Fair Oaks area and we still go there. But they also have clinics in Falls Church, Reston, Ashburn and new one is coming soon in Tysons. Good luck!

[oneasterisk]

Originally Posted by gammann

If you can afford it, I would max out the HSA. Usually once you get a certain amount in the HSA you can invest it. This can basically be another retirement vehicle for you, albiet only for medical expenses.

Thanks for the tip. I've been funding it with an extra $100 a month. Apparently at the 2k mark, I can start using it to build another portfolio. I'd like to contribute more, but with maxing out a TSP and also contributing to a ROTH IRA it's hard to find the money to do all the things I want.

[edamron]

Thank you all for your wonderful information!! We will probably go with Aetna, and maybe Aetna HMO. At least for now. We will see how we like it. Seems hard to get used to a new insurance; we had BCBS for over 15 years and LOVED it.

Thank you again,
-e

[nancy707]

My family has had Kasier for 16 years and have had no complaints, and we have used every benefit offered. I have had 3 defibrillators in 10 years, my husband 2 stents and my daughters multiple medical issues . We have never been denied referals to any specialist in or out of the plan. I take very expensive medications which are always covered.
The 24 hr advice nurse is without one of the best features and you can be seen and treated 365 days a year

[tgbwc]

We have had Kaiser for 19 years and have never once had a problem. Like nancy707, we have used many of their services over that time period and it has always been easy to see a specialist. Once, when out of the area during Christmas, I had to call the 24 hr advice nurse because I was so congested I was having trouble breathing. It was late and she did not hesitate to tell me to go to the local hospital's emergency room. I only paid $50 for that visit. They were excellent when my wife developed issues while pregnant with my son and when he was born prematurely.

I prefer the "smaller" centers like Burke and Woodbridge over ones like Springfield, but sometimes have to go to the larger one for the specialist.

[san312]

Can anybody tell me what is premium with kaiser, I checked online and its giving me in the range of $1000 to $2200 for family of 4 which is way too much.

[Shuk]

Can I use Aetna in Kaiser?? If same one know

[BunniesOpinion]

Keiser has alot of rules with their plan. If you were in MD they have more locations but in VA...Also getting an authorization from them is a major headache if you go out of network.