We belonged to Kaiser for about 30 years and MISS IT since moving out of their coverage area. When with Kaiser we had several times where we had emergencies - including once in Australia and once in South Africa - for which we were reimbursed promptly and without hassle. The pluses of Kaiser are having all your medical needs taken care of in one facility and little if any paperwork. By contrast, we now run all over town to get x-rays, MRIs, mammograms, blood tests, and other things not provided by the doctor's office. There also are huge amounts of paperwork. When I had an accident in Oregon, we had to keep track of every invoice and payment to make sure the providers got paid. One of them didn't get paid for a year because they mistakenly sent it to the wrong BC/BS region and that delayed it for months with me making phone calls every month to get it straightened out. The pile of paperwork for that one event was about two inches thick.
After moving from Kaiser territory we went on Blue Cross/Blue Shield and it became our secondary insurance when we became of Medicare age. We have since changed to AARP Health Options plus Medicare. We were not pleased with the way BC/BS was cutting costs. It eventually got to the point where every single one of our doctors dropped out of BC/BS because they increased patient rates and then decreased doctor rates to the point that it was ridiculous. When our doctors dropped them, so did we. I was especially disappointed in BC/BS because I worked for them many years ago when they were a quality insurer. On the other side and to be fair, they did pay our medical needs. It's just that they fight everything and, as mentioned previously, they did not treat our physicians fairly. If a specialist charged $100, they'd be lucky to get $50 and it would be whittled down wherever possible.
I would advise against any HMO other than Kaiser. At Kaiser the
doctors make the treatment decisions, but I've heard many complaints about other HMOs where the
bean counters make treatment decisions. Go with some other prepaid health plan, but consider carefully. As the saying goes, let the buyer beware. You may not be old enough for Medicare, but you are old enough for the AARP health plan. We've been happy with it so far. Talk with the people in your doctors' offices and find out from them which insurers seem fair. It varies by state and what might affect me might not affect you.
When you get to Medicare age (soon!), the general rule is that if Medicare will not pay for something, then neither will the secondary insurer. Medicare will be your primary insurer and will pay a specified portion, with your secondary insurer picking up the remainder of whatever Medicare allows. In other words, if your medical provider charge is $100 and Medicare approves $80 it then may pay $70 with the other $10 being picked up by the secondary. In this example, the medical provider "eats" the other $20. Now you know why our health care costs so much!
ArdraF
