Comparing Seattle Marketplace Health Plans
April 18, 2019 11:36 AM Subscribe
Trying to decide between:
• AMbetter (coordinated care)
• Kaiser permanente
• Molina
• Premera blue cross
I'm moving to Seattle and need to enroll in a health plan through the marketplace. These are the four options I'm seeing. Does anyone have any experience with these companies? I'm someone who visits the doctor relatively frequently, so I'll be choosing a Silver plan.
I'm moving to Seattle and need to enroll in a health plan through the marketplace. These are the four options I'm seeing. Does anyone have any experience with these companies? I'm someone who visits the doctor relatively frequently, so I'll be choosing a Silver plan.
This is not in Seattle! But my partner has Ambetter (in St Louis metro area) and it was really hard for her to find a doctor. Once she did, she's had great service. But their website may not be accurate as to what doctors take the plan, as we found out when we called doctors.
posted by possibilityleft at 12:20 PM on April 18, 2019
posted by possibilityleft at 12:20 PM on April 18, 2019
In my Seattle experience, Kaiser and Premara are what most people I know have.
posted by k8t at 1:01 PM on April 18, 2019
posted by k8t at 1:01 PM on April 18, 2019
Kaiser users here, mrsfreedomboy and I find having the actual services, pharmacy and the billing and coverage all in "one house" to be excellent, referrals out to surgeons, the consults, all of it = first class, great service for labs/tests [e-mail of lab results etc], delivery of meds in the mail to our rural WA island retreat, on-line tools are also excellent, e-mail to doctors, follow ups etc. Worth a look for sure depending on your needs and costs, FYI our coverage is Medicare and Kaiser's supplemental.
posted by Freedomboy at 1:10 PM on April 18, 2019 [2 favorites]
posted by Freedomboy at 1:10 PM on April 18, 2019 [2 favorites]
I have AmBetter in Indianapolis. It’s...ok. At least here, their online “find a doctor” tool leaves a lot to be desired. Often, it comes up with doctors or facilities 200 miles away. And, there are dumb oddities like the gastro doc I was seeing is in-network downtown at the hospital where he does serious surgery, but he’s not in-network at his office up near me, where he would examine patients. Wha???
Their prescription formulary can be a bit restrictive, depending on what meds you need. And, they seem to require prior authorization for pretty much anything that isn’t a regular office visit or an emergency. And anything requiring authorization is gonna be an out-of-pocket expense for you.
That said, they pay what they say they’ll pay on things they say they’ll pay for.
posted by Thorzdad at 1:51 PM on April 18, 2019
Their prescription formulary can be a bit restrictive, depending on what meds you need. And, they seem to require prior authorization for pretty much anything that isn’t a regular office visit or an emergency. And anything requiring authorization is gonna be an out-of-pocket expense for you.
That said, they pay what they say they’ll pay on things they say they’ll pay for.
posted by Thorzdad at 1:51 PM on April 18, 2019
I live in the South Puget Sound and here are some thoughts and my experience:
If I were on Washington Apple Health (Medicaid) I might consider Molina, otherwise no.
Depending on exactly where you live here, there is a shortage of providers for many types of health care and getting a primary care provider or appointments with specialists can take extraordinarily long times. Molina works mostly with Medicaid and Medicare patients and their provider network reflects that with its attendant problems. I have also seen that providers tend not to stay very long in these networks, making for poor continuity of care.
Regarding Ambetter, this is what the website, Best Company, says: “Ambetter Insurance is a very unpopular health insurance company. Most customers do not recommend Ambetter. The primary issue for most people seems to be finding doctors/clinics reasonably nearby that accept Ambetter.
More from the Best Company website: “Ambetter should be somewhat of a last resort when choosing an affordable health insurance company. While its plans all have decent coverage for preventative care and some vision and dental benefits, they make it difficult to access full details of their various plans. Data points such as the annual maximum out-of-pocket limit and co-pays are difficult to find on their website.” Nope not for me.
As an employee of a small company, I hade Lifewise (Premera) for a while. It was expensive and only okay. There formulary wasn’t ideal for my needs. Meh.
When I went to individual marketplace insurance, we researched all these options. We chose the Visits Plus Silver HD plan for its combination of benefits and that worked out well.
Last year I chose the Flex Gold plan because the cost was only slightly higher than the Silver with a lower deductible and better overall benefits. Turned out to be a good choice because I spent seven days in the hospital and had gall bladder surgery. My total share was less than $5k, so I was glad to have that gold plan.
This year I went back to a silver plan because I will be transitioning to Medicare. I plan on selecting the Kaiser Medicare Advantage plan
Note: Kaiser bought Group Health in Washinton and several family members have had excellent care through Group Health and Kaiser.
posted by Altomentis at 2:13 PM on April 18, 2019
If I were on Washington Apple Health (Medicaid) I might consider Molina, otherwise no.
Depending on exactly where you live here, there is a shortage of providers for many types of health care and getting a primary care provider or appointments with specialists can take extraordinarily long times. Molina works mostly with Medicaid and Medicare patients and their provider network reflects that with its attendant problems. I have also seen that providers tend not to stay very long in these networks, making for poor continuity of care.
Regarding Ambetter, this is what the website, Best Company, says: “Ambetter Insurance is a very unpopular health insurance company. Most customers do not recommend Ambetter. The primary issue for most people seems to be finding doctors/clinics reasonably nearby that accept Ambetter.
More from the Best Company website: “Ambetter should be somewhat of a last resort when choosing an affordable health insurance company. While its plans all have decent coverage for preventative care and some vision and dental benefits, they make it difficult to access full details of their various plans. Data points such as the annual maximum out-of-pocket limit and co-pays are difficult to find on their website.” Nope not for me.
As an employee of a small company, I hade Lifewise (Premera) for a while. It was expensive and only okay. There formulary wasn’t ideal for my needs. Meh.
When I went to individual marketplace insurance, we researched all these options. We chose the Visits Plus Silver HD plan for its combination of benefits and that worked out well.
Last year I chose the Flex Gold plan because the cost was only slightly higher than the Silver with a lower deductible and better overall benefits. Turned out to be a good choice because I spent seven days in the hospital and had gall bladder surgery. My total share was less than $5k, so I was glad to have that gold plan.
This year I went back to a silver plan because I will be transitioning to Medicare. I plan on selecting the Kaiser Medicare Advantage plan
Note: Kaiser bought Group Health in Washinton and several family members have had excellent care through Group Health and Kaiser.
posted by Altomentis at 2:13 PM on April 18, 2019
On the west coast so many doctors are associated with Kaiser it's almost always the best option unless you have top tier Blue Cross. It's just easier to find a doctor and more things are covered if you need surgery or the like.
posted by fshgrl at 3:52 PM on April 18, 2019
posted by fshgrl at 3:52 PM on April 18, 2019
We're on Ambetter in Arizona, and ... same same from what a lot of folks have said. We found a nearby doctor who takes it, and is just okay. We've tried to find another doctor, but every time I get up the gumption to find someone, the same thing happens - we find a provider on their site, I research the provider, I contact them to make an appointment, and they tell me that they don't take Ambetter patients, and haven't for a couple of years.
(But at least I've found a great gastroenterologist who's covered, so that makes my guts happy.)
I'm hoping the marketplace plan options are better in 2020, so we can hopefully find a plan with more doctors to choose from, while still keeping the one specialist I like.
posted by themissy at 4:00 PM on April 18, 2019
(But at least I've found a great gastroenterologist who's covered, so that makes my guts happy.)
I'm hoping the marketplace plan options are better in 2020, so we can hopefully find a plan with more doctors to choose from, while still keeping the one specialist I like.
posted by themissy at 4:00 PM on April 18, 2019
Seattle isn’t a big Kaiser market like California is. Premera will give you more access (Swedish, UW, Virginia Mason,Polyclinic). It depends on your needs, but for any specialty requirements, I’d go BCBS in this location.
posted by OneSmartMonkey at 10:18 PM on April 18, 2019
posted by OneSmartMonkey at 10:18 PM on April 18, 2019
Me and my family have been on Kaiser (née Group Health) for years. We’ve found the experience really positive. We have a fair amount of specialist need — my husband needs a rheumatologist, my son a pediatric psychiatrist for med management — and it’s been really easy to find providers. The advantage of Kaiser is that once you have Kaiser, you can see *all* the Kaiser docs without trying to find someone in the speciality you need who accepts your insurance and is taking new patients. It’s just a whole layer of hassle that doesn’t apply.
posted by KathrynT at 11:39 PM on April 18, 2019 [1 favorite]
posted by KathrynT at 11:39 PM on April 18, 2019 [1 favorite]
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posted by humboldt32 at 11:52 AM on April 18, 2019