Employers often ask us what other companies offer when it comes to benefits programs.
While we may compare a benefits program to others in their industry or in our geography, we’ll instead provide a general overview of the trends we’re seeing for small businesses (less than 100 employees) in 2022.
HMO medical insurance
Medical insurance in North Bay is largely for health maintenance organizations, or HMOs. Kaiser Permanente has, by far, the largest HMO presence (we estimate around 70% of the business).
Some employers offer HMOs from other major carriers such as Blue Shield of California and Anthem Blue Cross, but these plans usually cost significantly more because they are not tied to a medical group. The most popular HMOs have lower premiums because they only work with one medical group.
Medical insurance here is largely HMO. Among HMO carriers, Kaiser beat its competitors as the most popular carrier in each “metal” level. Here are the most popular plans by level:
- Kaiser Bronze 60 HMO 6300/65
- Kaiser Silver 70 HMO 2250/55
- Kaiser Gold 80 HMO 250/35
- Kaiser Platinum 90 HMO 0/20
Looking at each level, Kaiser isn’t the cheapest option, nor do they have the best blueprint designs, but they are the most popular due to their ease of use. This has made it very attractive for employers to offer Kaiser as part of their benefits program.
PPO medical insurance
While HMOs are indeed a big part of the medical insurance option here in North Bay, Preferred Provider Organizations, or PPOs, still have a place with many employers.
Although generally more expensive, PPO plans offer members the flexibility to receive care from any provider – inside or outside your network. This means that you can visit any doctor or specialist or use any hospital.
Additionally, PPO plans do not require you to choose a primary care physician (PCP) and do not require referrals.
Blue Shield of California holds the most popular PPO plans across all metal tiers:
- Blue Shield Bronze Full PPO 6250/65
- Silver Blue Shield 70 PPO 2250/50
- Blue Shield Gold Full PPO 500/30
- Blue Shield Platinum 90 PPO 0/10
Looking at each metal level, again Blue Shield isn’t the cheapest option, but they have the best plan design (for the level).
Looking further, the cheaper plans of some of the other popular PPO carriers offer a small saving for a larger reduction in plan benefits, so the popularity of Blue Shield indicates that employers are willing to pay a little more to offer a plan that offers better benefits.
Andrew’s PPO Story
In short, the main differences between HMOs and PPOs are affordability and flexibility, but what will work best for you really depends on your current situation.
I have always opted for PPO plans because they allow me and my family the freedom to use any provider we choose without requiring a primary care physician to be the gatekeeper.
The difference in options became a reality for me while on an HMO plan. The insurance company didn’t have the right primary care physician for my daughter in their system.
When my daughter’s doctor attempted to refer her to a specialist, the request was denied because the referring doctor was not the PCP listed in the insurance company’s system.
The provider office my daughter was referred to refused to book her appointment because the HMO declined the referral. It was very stressful and interfered with the urgent care she needed. If we had been on a PPO at the time, that wouldn’t have been a problem.
Rosario’s HMO story
There’s a lot to say for convenience.
I was enrolled in both PPOs and HMOs. When my children were young, I wanted more streamlined solutions for my family, not only with specific providers, but also with plan design options.
The convenience of going to a place like Kaiser to see a doctor, then walking upstairs to do the lab work, then finally walking to the pharmacy for prescriptions was so worth it to me, especially when doing all of this with a sick child during winter or rainy months.
When my daughter went to college in Southern California, I wanted her to have easy access to care without adding to her new challenges in school and again, the Kaiser/HMO made sense.
Her medical records were in their system, and she knew how to navigate the medical system, which gave me peace of mind and gave her no excuses for saying she couldn’t go to the doctor. An HMO was a win-win for me.
2022 has just begun and the popularity of each of the carriers tells us that there is no single answer. Providing employees with a better plan design or more convenience options can give your business a competitive edge and keep you competitive.