Compare The Major California
Health Insurance Carriers
Now that the core benefits are
standardized by the ACA law, it really comes
down to pricing and carrier.
For example, a Bronze plan is a Bronze
plan regardless of carrier so how do we then compare
the carriers?
Great question.
We'll give you the ground rules and
carrier basics here but we created an entire article
on what see day in and day out when dealing with the
carriers.
This is the type of information you
REALLY need.
You can find that full comparison
here but let's get the broad strokes so we know
what choices we have.
Carrier Options in California
Carriers Participating in Covered Ca for
Individuals and Family
- Anthem Blue Cross of California
- Blue Shield of California
- Kaiser
- Health Net of California
- (+9 smaller regional carriers)
Group Health Exchange (SHOP)
- Kaiser
- Blue Shield of California
- Health Net of California
- Chinese Community Health Plan
- Sharp Health Plan
- Western Health Advantage
You can quote the new Exchange and non-Exchange
plans for
Group Health or
Individual
Family
important considerations when comparing
carriers in the California health insurance
market.

1. Pricing drives decisions now.
In fact, as
medical costs have skyrocketed over the past
decade, cost is now the driving factor and it's
only going to get worse.
This has led to a
wholesale moves down the benefit scale to offset
rate increases and the carrier which dominates
this price point, will be our focus.
2. Large HMO and PPO networks of doctors and
hospitals.
The networks of the different major
California carriers are similar but not exact.
90% of the doctors and hospitals will be similar
from carrier to carrier but there will be
differences and ultimately, what really matters
is that your doctor and hospital participate.
It's hard to choose a carrier and plan for an
entire company up front but you can request
doctor/hospital choices from your family members
or company employees to check against the
provider online search for the plan that meets
item #1 above.
Again, most likely, any of the major carriers will address most of their
needs.
3. Plan and benefit flexibility.
We want it
all.
We want the option to choose from lots of
plans be it HMO, PPO, HSA, and we want to
be able to offer all these plans to our family
members and/or employees.
That's all we want!
The good news is
that we can have that now.
Most of the major
carriers offer an ability to do this now and
they have dozens of plans available from
catastrophic plans to very rich HMO and PPO
options with little cost sharing.
4. We want our interaction with a carrier to be
easy.
You're busy either running a family or a
company.
The last thing you need is chasing
around claims or membership issues.
As your
licensed broker, we can help you with these
issues but we can attest to the definite need to
deal with a California carrier who is easy to
deal with. From dealing with them all on a daily
basis, there are definitely differences on this
front.
5. Rate stability going forward.
Premiums on the
California health insurance market just keeps
climbing.
Although we can switch health
plans annually, it's never pleasant
so ideally, we want a carrier that is stable in
terms of pricing.
This is function of plan
design, financial strength, management, and of
course pricing strategy.
California Health Carrier
Comparison

Anthem Blue Cross
Anthem is one of the strongest, nationwide
carriers...probably in the top three.
1. Plan Pricing - their pricing is generally in
the top 1-2 carriers for the California health
market.
2. Network - Anthem has one of the largest PPO
networks in the State and the allow
participation in the Blue Card network for
family members or employees in other States.
3. Flexibility - They were the first to offer a
true cafeteria-like flexibility called Employee
Elect where you could offer all their plans (or
almost all) to each employee. They extended this
to their dental options as well. On the
individual side, they consistently bring out new
plans on the PPO and HSA side.
4. Ease of Use - Traditionally they have been
the easiest to deal with. They were the first to
bring out online applications, the ability to
email membership requests, and credit card for
initial month premiums. Online tools are
available on the Group side to streamline
changes, additions, and questions.
5. Pricing Stability - Their increases have been
low to middle depending on the market segment
with HMO's being less competitive than PPO and
HSA plans.

Blue Shield of California
Blue Shield of California a very strong carrier
in California which has become even more
aggressive on the market in the recent few
years. Blue Shield is one of the few non-profits
on the market and it has always been an advocate
of consumers in the market. Blue Shield offers a
good PPO comparison to Anthem and Health Net and
it is very competitive on the market currently.
1. Plan Pricing - they are consistently priced
in the top 1-3 for comparable plans.
2. Network - For PPO plans, they compare well
with Anthem in most counties. They do allow
access to the Blue Card network for employees or
dependents in other States. Their HMO is
comparable to Cross but neither is thought to be
the strongest carrier for HMO plans.
3. Flexibility - They offer plans in the HMO,
PPO, HSA, and HRA segments across individual and
group with multiple deductibles, copays, and
price points.
4. Ease of Use - This is where Blue Shield has
made so much progress. Over the last few years,
Blue Shield has made great gains in terms of how
easy they are to deal with on a day to day
basis. It's been a huge improvement.
5. Pricing Stability - Their pricing is
extremely competitive on the Small Group market.
On the individual side, their newer plans are
priced higher but are richer in benefits.

Health Net of California
Health Net of California was originally Blue
Cross' HMO many years ago.
Traditionally, they
were a strong HMO carrier but they have
aggressively moved into the PPO market as the
future of HMO's and its cost structure dimmed.
Health Net has become very strong on Small Group
market and they have come out with a very
aggressively priced individual family market.
1. Plan Pricing - Today, Health Net's individual
plans are probably the lowest priced on the
market. Their group plan pricing tends to be in
the top 1-3 on the market with a strong HMO
pricing model.
2. Network - Health Net has a strong HMO network
as that has been their bread and butter long
before the PPO came along for them. The PPO
network is solid although likely smaller than
Anthem or Shield with their focus on PPO.
3. Flexibility - Health Net allows a cafeteria
type Small Group offering where you can offer
many plans to carriers. On the indvidual market,
they have narrow range of plans but they are
priced very well.
4. Ease of Use - Health Net tends to be pretty
reasonable both in terms of enrollment
(underwriting) and membership. They have catched
up with Cross and Shield in terms of online
capabilities and systems.
5. Pricing Stability - The group pricing has
been relatively stable and we have new
individual plans that are the lowest on the
market.

Kaiser of California
Kaiser of California is likely the largest
carrier in the State. It's very different from
the other carriers in that the doctors/hospitals
belong to the carrier. You must stay within
their network in most cases.
1. Plan Pricing - Kaiser has always been hard to
beat in terms of pricing and that will likely
continue.
2. Network - This is what literally makes Kaiser
a separate model of health care altogether.
Kaiser employs the doctors and owns the
hospitals. You must stay within the Kaiser
network for most situations. The availability of
Kaiser really depends on where you live. On
average, they will have more facilities in
denser areas and less in rural area. There are
areas where there is no Kaiser network.
3. Flexibility - Kaiser has tried to expand their
plan options albeit within their facility network.
Kaiser offers some pro's in terms of flexibility
such as electronic records and facilitated
processing but poses other concerns such as greater
medical service management.
4. Ease of Use - This is another facet of the
Kaiser model which is very different. In
general, the day to day with Kaiser can be
pretty nice...kind of like a one stop shop.
Where we hear negatively from our clients is if
you have a more serious situation or want a
wider breadth (say a specialist) of providers.
Kaiser is pretty solid when it comes to
information technology and the general
administration with such things as electronic
records. Of course, there can be a significant
amount of "management" when it comes to medical
services but that's inherent in any HMO.
5. Pricing Stability - Pricing has always been
advantage with Kaiser and if pricing is your
only concern and HMO is fine...Kaiser will be
hard to beat.
We focused on Anthem Blue Cross, Blue Shield of
California, Health Net of California, and Kaiser
since they are some of the strongest California
health insurance carriers.
There are many other
options on the market, but from our experience,
they usually are not advisable against one of
the above mentioned four. Many large California
carriers have opted out of
the Exchange on the IFP market (Aetna, United,
and others).
Call 800-320-6269 to go over any questions you may have on the carriers in
the State.
Our newest and bestest head to head comparison is available through the link
below!
Some head to head comparisons:
United
Health versus Anthem Blue Cross Comparison
Health Net
versus Anthem Blue Cross Comparison
Blue
Shield of California versus United Health Comparison
Health Net versus LA
Care Comparison
Sharp versus
Kaiser Comparison and Review
Again, there is absolutely no
cost to you for our services. Call 800-320-6269 Today!