Is your health provider good? Pros/cons of a popular health care provider + reviews

leading health care providers

health provider good

With over 12.5 million  members, Kaiser Permanente is currently recognized by Americans as one of the leading health care providers and not-for-profit health plans.

The thing with Kaiser Permanente is that it’s not just a health insurance company. It’s a managed care organization. Consumers can purchase a health insurance policy and receive medical care from one of the Kaiser Foundation Hospitals and medical centers.

But does its popularity make Kaiser Permanente inherently better than other health care providers in the market? Let’s consider 3 pros and 3 cons of Kaiser Permanente, including some reviews of real KP member experiences:

  • Pro 1: Easy to View Plan Options

  • Pro 2: Variety of Health Insurance Plans

  • Pro 3: Unique Provider Network Approach

  • Con 1: Negative Customer Reviews

  • Con 2: Service Areas
  • Con 3: Limited to Kaiser Permanente Hospitals and Medical Centers

3 REASONS KAISER PERMANENTE IS GOOD

Easy To View Plan Options

The plan selection at Kaiser Permanente is quite admirable. Kaiser Permanente won’t require you to give out personal information like your DOB or parts of your medical history to get even the most basic information about its insurance policy options in your area. You’ll be able to see health insurance options in your area after providing the following information:

  • Whether you are turning 65 during the year

  • If you get insurance through an employer

  • If you’re looking for an individual plan or for a group

  • Your zip code

Getting the cost information for a plan will require further research because the monthly premium depends on several factors, like age. But the initial questionnaire will give you access to brief descriptions of the types of plans available and the overall coverage you can expect.

Variety Of Health Insurance Plans

Kaiser Permanente offers individual, family, and employer-provided health insurance plans. It also offers Medicaid, Medicare, and charitable health insurance to individuals who qualify along with catastrophic plans.

One Oregon KP member wrote:

Kaiser Permanente is the best supplemental insurance provider. I pay $5 copay to see my primary care doctor, $10 to see a specialist, and $25 for urgent care. I only paid a copayment of $125 for a $20,000 surgery. My prescriptions are only $5 for a month’s supply, and $10 for a three month supply.

Employers interested in adding vision and dental insurance to their employee health benefits can offer dental and vision insurance through Kaiser Permanente, too.

Unique Provider Network Approach

One KP member based in West Covina wrote: “Able to communicate with Dr through e-mails and texts. […] Kaiser is like Mini mart, everything you need is available at all facilities.”

As you consider Kaiser Permanente medical insurance plans, keep in mind that it does not offer typical network structures, like Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans.

Instead, Kaiser Permanente has its own facilities and providers for patient care. However, this could be a pro. As one member states: “It is very convenient to have a pharmacy, lab, and x-rays onsite.”

Care received elsewhere is not covered by the insurance provider. We’ll talk more about this in the following section, which focuses on some cons associated with the company that might make you consider other health insurance providers.

3 CONS OF KAISER PERMANENTE

Customer Service/Negative Customer Reviews

Though Kaiser Permanente has received a lot of praise for their customer service, they’ll also received a high percentage of negative reviews on various review platforms.

Most reviewers who left 1-star reviews shared difficulties with claims payments and dissatisfaction with care received from Kaiser Permanente providers. For example:

Long phone wait times, inability to access doctors’ offices to leave message, extraordinarily long wait times to talk to appointment schedulers, same thing for pharmacy inquiries. — Bellflower KP Member

Prepare to stay on the line for 45-minutes only to make a phone appointment 5-days later where they can then make an appointment for you. Seattle, WA KP member

A high proportion of negative reviews is not uncommon for health insurers. However, consider issues found in reviews as you decide whether or not to buy a health plan from Kaiser Permanente.

Service Areas

One major limitation of Kaiser Permanente is the span of states that Kaiser Permanente can work with — or should we say, the lack of span of states.

This company limits itself to just several states out of the 50 in the U.S., which means its health plans aren’t even an option for you if you live outside of these states.

If Kaiser Permanente’s plans are not available in your area, your only choice is to consider another insurance company that does service your area.

Limited to Kaiser Permanente Hospitals and Medical Centers

Unlike most health plans that allow enrollees to choose the provider network structure (PPO or HMO), Kaiser Permanente plans only offer coverage for its hospitals and medical centers.

RELATED READINGS:

Best Company: Is Kaiser Permanente Good?

ConsumerAffairs: Top 1,990 Kaiser Insurance Reviews

The Balance: Kaiser Permanente Health Insurance Company Review

Starting in the health insurance industry: 6 Tips to be successful

health insurance industry

Overview: In order to be successful in the health insurance industry, pay attention to these 6 pieces of advice.

health insurance industry

What makes a successful health insurance agent successful in the competitive zeitgeist of the 21st century? It’s more than what you’re saying or selling.

To be successful as a health insurance agent, you need to have strong sales, marketing, and customer service skills. You’ll be required to locate and attract potential customers. You don’t necessarily have to be born with these skills, but developing them is crucial to your success.

Essential tips for success as a health insurance agent:

Prioritize Good Customer Service

This is a three-part tip. You need to 1) put the needs of the client before your own interests 2) be attentive and available to answer client questions or concerns and 3) have emotional intelligence. All of these tie into prioritizing good customer service. Here’s why:

  • Putting a client into a product that pays a lower commission because it better fits their needs will likely help you retain customers.

  • Customers want to be able to get in contact with their agents. Timely responses to inquiries and phone calls is a must. You almost must be able to do what you say you will do, when you say you will do it, or at least have a good reason as to why you can’t.

  • Listen and empathize with clients on a deeper level in order to discern what they really want and need. A good agent is tactful and knows how to help a client see financial reality clearly, even when the client is dead set against it.

Bonus: Do not prioritize earning a commission! You likely won’t last long in the business. Agents who listen carefully to what their clients and prospects say will be able to earn their trust — which is the hardest part of their job.

Related article(s): 8 Qualities That Make a Good Insurance Agent

Focus On Good Salesmanship (Record/Listen To Yourself)

We all know that health insurance agents (like all types of insurance agents) are salespeople by nature. Sales is namely all about confidence first, knowledge second, and everything else after. One way to develop your sales skills is to record your voice on the phone while talking to some clients.

  • Do you sound smart?

  • Do you sound confident?

  • Do you sound like a little kid who picked up the phone?

You need to acquire strong sales skills and learn the process of acquiring, nurturing, and maintaining quality customers. This might require attending seminars or undergoing a professional training program in sales.

Related article(s): 21 Insurance Sales Tips For Young or Inexperienced Insurance Agents

Develop a Strong Work Ethic

The insurance industry is competitive and you may be working independently for a good portion of the day. You need to develop a strong work ethic to be proactive when seeking out new customers, closing sales, and developing relationships with clients and industry professionals. Prioritizing your time and maintaining a strong work ethic will get you far throughout your career.

Study the Market

You need a plan to target the right prospects and seek out new customers in the right markets. Take the time to study the market and develop a strategy so you are making the best use of your time. Whether you are out on a sales call or conducting a presentation to potential customers, you need a deep understanding of what your customers want and who is the market to buy insurance — ideally, from you.

Learn From the Pros

Every successful agent needs a mentor, coach, or someone to guide them throughout their career. Make the time to connect with someone who is currently working your dream position or someone who is willing to mentor you as you grow in your career. This will provide you with valuable insights about the industry, tips for overcoming challenges you are dealing with, and an opportunity to learn from someone who has been in your position at some point in his or her career.

Related article(s): How to Succeed as an Insurance Broker or Insurance Agent

Stay on Top of Market Trends

Because life insurance policies changes, it’s essential that you stay on top of trends to achieve the success you want. As a result, you’ll not only have a better chance of selling what the client needs but also what they believe they want. With a vast knowledge of life insurance and by remaining enthusiastic yet professional, you can carefully guide an individual toward the best coverage, whether trendy or not.

Related article(s): 5 Pro Tips – How to Be a Successful Insurance Agent in 2021

FINDING A MEDICARE DOCTOR NEAR YOU

MEDICARE DOCTOR

MEDICARE DOCTOR

If you’re looking to find a doctor that accepts Medicare near you, you’re not alone. One of the most significant challenges for anyone seeking healthcare is finding a great doctor who is within the confinements of Medicare.

Some great resources exist that might help in this endeavor. If you’re looking for quality advice for your particular health circumstances, Bernardini and Donovan can show you the tools to find the right doctor and the right insurance plan. We offer insurance services in the Inland Empire, including information on Medicare coverage in the Inland Empire.

Today, the B&D team will clarify the differences between Medicare and Medicaid. We’ll also highlight some questions to consider as a precursor to finding the ideal Medicare doctors that suit your needs along with additional resources that might help.

Medicare vs. Medicaid

Medicare is a program aimed to help adults over the age of 65 to receive Medicare Health Insurance. It also provides health insurance for disabled adults under 65 and anyone who has been diagnosed with End-Stage Renal Disease (permanent kidney failure). Medicare is a federal taxpayer-funded program run by the Centers for Medicare and Medicaid Services, a federal government agency, and generally remains the same across the US states.

Medicaid is an assistance program for low-income people of every age. With this program, patients typically do not pay any amount for their covered medical expenses. In some cases, a small copayment is required. This, unlike Medicare, is a federal-state program and varies across the US states as state and local governments run it within federal guidelines.

What Doctor Accepts Medicare

When you hear someone say a provider is a “Medicare doctor,” or that doctor “accepts Medicare,” that generally means that there’s a Medicare-approved doctor available who can agree to accept Medicare Assignment. The doctor (or another provider) agrees to accept what Medicare pays for that service and won’t charge you more than the standard Medicare deductible or coinsurance/copayment. The Medicare doctor also can’t charge you for sending a claim to Medicare.

Many people have health and medical questions and might feel overwhelmed because these are complex topics. Sometimes, you might not even know what questions to ask. At Bernardini and Donovan, we specialize in health and medical insurance services.

If you have questions about Medicare coverage, or you want to know if there’s a doctor who accepts Medicare near you, our team can help! Let’s start by addressing a few things that can hopefully ease the process of finding suitable Medicare coverage near you.

Do All Doctors Accept Medicare

Before jumping into finding a suitable doctor, it’s important to know the following information in advance:

  • Is the doctor “in-network”?

If you have Original Medicare, you can visit any doctor that accepts Medicare assignments. However, if you have Medicare Advantage (such as an HMO or PPO), you may be required to see in-network doctors in order to be covered.

Out-of-network or non-contracted clinicians are under no obligation to treat Medicare members, except in emergency situations. This means that Medicare coverage near you might be limited. You also may pay more for doctors who are out-of-network, or you might not be covered at all. Also, the costs that you experience for out-of-network doctors may not count towards your out-of-pocket maximum.

  • Do you have medical conditions you need the doctor to be familiar with?

If you have a rare or life-threatening condition, you may want a doctor who is familiar with it. For example, if you think you may need hospice care in the near future, a doctor with training in hospice care might be a good fit for you.

  • What plan do you have/How much are you willing to spend?

This is a matter of what you want vs. what you have or can afford. Do you have basic Medicare, Medicare Supplement together with basic Medicare, or a Medicare Advantage plan?

If you don’t know what all of these options mean to you, our Medicare page can help explain these options in more detail.

Finding Suitable Medicare Coverage

Your satisfaction with Medicare may depend upon finding a plan that will help you access convenient and capable doctors. Many of you will also hope to choose coverage that will allow you to keep the primary care doctor that you may already know and trust. Below are some brief rundowns of what each plan consists of.

When a primary care doctor accepts Medicare Assignment, that means he or she agrees to bill Medicare-approved amounts for various healthcare services. You can keep your costs as low as possible by seeking out a primary care doctor who accepts Medicare Assignment. Medicare offers a handy search tool that you can use to find nearby doctors who agree to accept Medicare Assignment and bill Medicare for their share of the bill.

If you’d rather not have to limit your choice of doctors to those who will agree to charge only what Medicare allows, you can consider buying Medicare Plan F or Plan G to supplement Original Medicare. These two supplements will typically cover excess charges, or bills in excess of Medicare’s limits. This benefit can help broaden your choice of caregivers. It doesn’t just apply to first-line primary care doctors but also to specialists. Still have questions regarding different Medicare plans? Our health and medical insurance services in the Inland Empire are designed to help Inland Empire residents clarify health and medical questions so you’re not in this alone.

Finding A Medicare Doctor Near You

Like most people, you probably want to find a likable, qualified, and conveniently-located doctor. This doctor might be the one you see most often, so the best strategy for finding your doctor will depend upon the kind of Medicare insurance you have. We’ve already touched base on the different Medicare plans available, so make sure to take that into consideration, as that might affect your choices.

If you are enrolled in a Medicare Advantage plan, your plan will also provide a directory of Medicare doctors in its provider network, if applicable. If you aren’t sure, call your Medicare doctor’s office and ask whether your plan is accepted before you make an appointment.

If you have Original Medicare, you don’t need to use doctors in a plan network. You can see any doctor you choose. But you can typically save money if you find a Medicare doctor who accepts Medicare payment terms (assignment). You may want to ask the doctor before you make an appointment.

Finding a suitable Medicare doctor is as simple as asking for referrals from friends, relatives, coworkers, and/or neighbors. You can also check with your insurance plan, medical societies, hospitals, and accreditation organizations. Just keep in mind that these resources cannot ensure that a particular doctor is the best one for you, but they do provide information on a doctor’s knowledge and skills.

Medicare Coverage in the Inland Empir

You might still find yourself having questions or concerns regarding your healthcare needs. Understanding Medicare and how to get the best care possible can pose a significant challenge. That’s why we at Bernardini and Donovan strive to help you understand the process, answer your questions, and help you find medicare doctors in your area!

At Bernardini & Donovan, we provide health and medical insurance services in the Inland Empire, so residents in or around the area who have questions can reach out to us for more information!

Don’t hesitate to contact us. There is no additional cost to you, so make sure to utilize our resource of expertise!

3 Questions For Your Doctor

medical insurance
Health insurance is a vital aspect of our health and well-being. And the exponentially rising cost of healthcare is insurmountable without some level of insurance. So, it is crucial that we are covered in the case of an unforeseeable ailment or injury. However, health insurance is a complicated web of pure confusion. It takes an expert, someone who has devoted their entire career to the subject, to fully understand its ins and outs. And while you do not need to comprehend every aspect of insurance or even your own coverage completely, there are some things you’ll want to be sure are made clear.
If you’ve recently moved or required specialized medical attention, you may be seeking a new primary physician. And in this process, you’ll need to consider a few questions. To help you better understand your insurance, your doctor, and choose the best avenue of care for your needs, know what questions to ask your physician’s office. These will help you know what is covered by your insurance plan and what to expect in costs before you even book an appointment. Take out the guesswork and surprises, and take hold of your health care!
Health Insurance Concept - Doctor in hospital with health insurance related icon graphic interface showing healthcare people, money planning, risk management, medical treatment and coverage benefit.

Three questions to ask your doctor: 

1. Is this office covered by my current health insurance plan?

You can answer this inquiry in more than one way. You can simply call the office directly and ask. However, this might turn into quite a few phone calls to random doctors’ offices. Or you can check your health plan’s website for a provider directory. This may be a more direct and easily navigable solution. Also, check if your plan requires prior authorization before your visit. This will avoid charges that could otherwise be applied to your plan.

2. Does my health plan cover my healthcare requirements?

There are several essential health benefits covered by all private health care plans. These include prescription drugs, emergency visits, pregnancy, maternity, and newborn services. However, beyond these, each plan is a bit unique in its coverage. If you have questions about what particular services are covered, you can reach out to your plan for answers.

3. What will I be charged?

While you are free to visit an out-of-network provider, you’ll save the most money with someone who is in-network. This indicates that their office accepts your insurance, resulting in a smaller out-of-pocket fee. As discussed above, each plan is a bit different from the next. So avoid any unwelcome surprises and learn which services aren’t subject to your plan.
Insurance and finding a healthcare provider who is both in-network and compatible with your preferences and needs, can be a headache. That’s why we at Bernardini and Donovan are here for your insurance inquiries and navigation. Don’t go it alone- this is a complicated topic! So leave it to the experts. We’ll assist you in this process, finding the best options for your exact criteria.

Know Before You Go: Quick Tips to Take Before You Travel

Tips to Take Before You Travel

As you plan your summer vacation, the last thing that you plan for is to get sick. However, studies have shown that around 15% of travelers experience some medical need during their travels. It can range from accidents or injuries surrounding their exciting plans or could be that they fall sick from some foreign bug. Either way, travelers that experience these type of medical needs often have some questions about how their medical needs will be paid for. So before you go on vacation, here are a few tips to make sure that your health has a priority.

health insurance
  • Call Your Health Provider

    One of the easiest ways to find out if your health provider will pay for out of the country health benefits is to ask them! Some health policies will provide a certain amount of health coverage, but many will make you pay out of pocket and then submit for reimbursement. And if you have original Medicare, there is not international coverage. You will want to make sure that you are asking the following questions:

    • Will my policy cover me while I travel abroad?
    • Will I have to submit for a reimbursement
    • Will my coverage include preexisting conditions
    • Ask about injuries that are due to circumstances outside of your control, such as acts of war, natural disaster, or acts of terror?
    • Will preauthorization be needed for treatment in a hospital?
  • Get a Quote for Travel Medical Insurance

    This type of insurance is different than travel insurance because it focuses on your medical care or you need for evacuation instead of trip cancellation. If you should get injured or sick while on a trip, it helps to pay for your medical needs, and if you were to get injured in a remote area where you could not receive proper medical care, it would cover the cost of the evacuation to get to an appropriate hospital. Many types of travel insurance also include this aspect, so make sure that you are looking at precisely what is covered when you purchase it. It will usually cost you to 4-8% of what you have paid to go on your trip.

  • Don’t take unnecessary risks

    While we understand that for some, going on an adventure is part of their vacation, it is important that you are not signing up for an unsafe situation. Many times accidents that happen while on vacation are simply that, accidents. A person trips while walking on cobblestones or one may be involved in a car accident. These are all very normal if not unfortunate circumstances. But if you are signing up for an experience, make sure you are working with a reputable company that complies with basic safety standards.

    We hope that your summer vacations are full of fun and excitement and that sickness and injury stay far away. But if you should get ill, we hope that you’ve taken these tips to heart and covered yourself for any travel mishaps that you may encounter.

Out and About First-Aid

health insurance

Out and About First-Aid

Spring is in the air! Which means that we are coming to an end of a very wet winter for us in Southern California. But one of the many benefits to all of the rain is the Rolling Green Hills and Mountains. There is never a better time to go for a hike, a long walk or backpacking for a few days. But while you are out communing with nature, you will want to make sure that you are prepared for any possible injuries that could happen. Bring along some basic first aid that is set up for your type of excursion as well as for how many people will be going with you and you will be on the right track. Here are a few common problems that come up while taking part in outdoor activities.

Dehydration

This is a tricky one because most people do not realize they are dehydrated until its too late. But the best way to combat dehydration is to take small sips of water throughout your outdoor activity. Make sure to carry enough water for the whole of your trip or know where you can refill your water bottle. If safe water is not available, sterilization tablets will be a must-have.

Cuts and bites

If you get a cut, you will want to ensure that you clean the area off with a disinfectant and make sure there is no debris in the wound. Then you need to stop the bleeding. Use a sterile piece of gauze to apply pressure and to stop the bleeding. Then use a bandaid to protect the wound. If you get stung by an insect make sure to remove the stinger as soon as possible and use pain relievers, a cold pack, and/or anti-itch creams to help.

Hopefully, these few tips will help you next time you go for a hike. And we have one final suggestion. Always be sure to carry a first aid kit with you. A basic first aid kit will include:

  • One elastic-roll bandage
  • Aspirin or ibuprofen
  • Adhesive tape
  • Alcohol Swabs
  • Antacid
  • Antihistamine
  • Antiseptic ointment
  • Adhesive bandages, assorted sizes
  • Bulb irrigating syringe
  • Butterfly bandages
  • Chemical heat and cold packs
  • Dry-wash pads or wipes
  • Diarrhea medicine
  • Gauze pads
  • Hydrocortisone cream (soothes allergic skin)
  • Insect repellent
  • Mirror, small and unbreakable
  • Moleskin, 1 or 2 packets
  • Cotton swab, sterile, packaged in pairs
  • Safety pins
  • Scissors (Swiss Army Pen Knife has scissors, small blade and nail file)
  • Sunscreen
  • Triangular bandage
  • Tweezers
First Aid box - bdhealthinsurance.

Value of Health Insurance

Value of Health Insurance

Value of Health Insurance

Having health insurance provides real tangible benefits. It also provides more abstract benefits. With any insurance that you are purchasing you are essentially investing in your peace of mind. There are always What-if’s that run through our minds. But insurance promises to be something that will help you if any of those scary what if’s come to pass. You get in a car accident – you have insurance for that. Your loved one passes away – you have insurance for that. You get sick – you have insurance for that.

 

Health insurance comes with mandated benefits as well. Every insurance plan that you can purchase will include:
Outpatient care
Emergency services
Hospitalization
Mental Healthcare
Prescription drugs
Rehabilitative services
Laboratory Services
Preventive Care
Pediatric Services.
Some plans that you purchase can have more services. But under the Affordable Care Act, which is still the law, though that may change soon, these benefits are all mandatory.

 

Without health insurance, there is a higher possibility of suffering from debilitating debt due to high medical costs. No one plans on breaking a bone or needing to stay in the hospital. If it were up to us, we would all be healthy at all times. But these things do happen, and the cost of fixing a broken leg can be up to $7,500.  A three-day stay in the hospital can be upwards of $30,000. These are astronomical numbers in comparison to what you pay in premiums and co-pays.

 

Another important aspect to look at with health care is the preventative care. Most of these services have no cost to you. Receiving shots or getting specific screening tests allows you to catch anything early or prevent illness from ever getting a foothold. Our health is one of our most valuable assets. And keeping our health as a priority through proper preventative care will save you in the long run. Speak to us today about which health insurance will be the best for you, your family or your business.

What to consider prior to buying health insurance for you and your family

As the time comes for open enrollment or to renew your health insurance, here are some helpful hints to look at before your purchase a plan.

Look before you renew
As the landscape for health insurance continues to change it is important that you make sure that your fully check out your options before opting to renew. Not only do the options available in your plan change from year to year but your personal circumstances change. You may have moved, found a new job, or had a child and all of these can change what you need from your provider. Also, if your plan is being replaced make sure you fully look over what it is being replaced with so you are not surprised later down the road and find that what you need is not covered.

Doctors and prescriptions, oh my…
You will want to make sure that your preferred doctor accepts that coverage before you enroll. And going to a doctor outside of your coverage can cost you substantially more that going in your plan. Also, you will want to know what your prescription medication is going to cost you. Most companies will assign medications to a different level or tier so that between different companies the medication you need may be covered but it may be on a different tier and therefore would cost you much more.

Consult an insurance broker
When the Affordable Care Act come into effect its purpose was to let people comparison shop relatively easily for different health care options. However, the health care market is wide and varied and you can very easily not see a special savings or find out that what you need is not covered when it is too late. Health Insurance brokers are working hard to stay ahead of the changes in the law, know all the different nuances of plans being offered and want to help you find your best fit. Contact us at Bernardini & Donovan and let us help you look beyond the bare essentials to finding a package that fits you and your family perfectly.

What you need to know about Medicare Deadlines.

There are some people in the world that just know things. They are the mavens that can rattle off facts, dates and details that the rest of the population just never grasped. This blog post is not for them. This post is for those of us who don’t know the first thing about Medicare and the deadlines needed to sign up.

So first things first. You become eligible for Medicare when you turn 65. But the deadlines for signing up extend to the months that surround you birthday. However, there is an exception if you already are receiving Social Security benefits you are automatically enrolled in Medicare A and B. But if that is not the case then you need to sign up yourself. You have a window of enrollment that last seven months. The seven month window begins three months before your birthday month, goes through your birthday month and continues on for the next three months after your birthday. So if your birthday was in June you could sign up for Medicare starting March 1st and it would end September 30th. If you miss this deadline you can join during open enrollment from January 1 to March 31 each year.

The reason that you will want to make sure that you sign up during these seven months is so you will avoid any fees that come with signing up late. The monthly Part B premiums will be raised by 10% for each 12 month period you wait to sign up for Medicare. “The idea behind the penalty is to give people a financial incentive to enroll in insurance from the get-go as opposed to waiting until they have some kind of negative health event,” says Mark Duggan, an economics professor at Stanford University.

It is important to note that if you or your spouse are still working for an insurance providing company when you or your spouse turn 65 it is not mandatory to enroll at that time, you can stay with your current provider. However, once the household member that they insurance is provided through retires then you will need to enroll. You will have an 8 month period enrollment time. The 8 month time period starts the month after the employment ends or when your insurance coverage from that job ends.

We hope this information helps, but if you have more questions please feel free to contact us at Bernardini & Donovan

Taxpayers Covering Majority of California’s Health Care.

Most people assume that our healthcare systems are paid for through private funds. Those private funds coming from health insurance premiums or from employer based coverage. However, a recent study shows that in California, that is just not the case. In fact about 71% of all funds paying for California’s healthcare comes from public funds, meaning California’s taxpayers are paying for a majority of the state’s health coverage. In 2016 it is estimated that $367 billion will be spent on health care. With these numbers that means that roughly around $260 billion will come from taxpayer money.

But California seems to be a unique case. When looking at the country as a whole, it was estimated that only 45% of the $3 trillion spent on health care comes from public funds. So what has made California stand out so much from the national average? Well there are a few factors to look at. One is that the national average is estimated to be much lower than what is actually being used. The American Journal of Public Health estimates that a more accurate picture of national spending is around 65% of public funds are put towards health care. The second aspect is that California does have some unique cases. UCLA’s study on California’s expenditures states that “health spending through county public health expenditures, new Affordable Care Act subsidies and tax subsidies for employer-based health insurance drives the proportion of care paid for by the public well beyond the CMS estimate” California also has had a larger expansion of Medi-Cal coverage showing around ⅓ of the state’s population is covered through this low income program.

What does this mean for you? Researchers are now beginning to question what it would look like to have a single payer health care system because we are already leaning towards that end of the spectrum as it stands. But we will have to wait and see how things continue to change with our aging generations and shifting political systems.