Plan Options & Coverage Types

HMO, PPO, POS, EPO Differences

• Centene offers primarily HMO plans across its subsidiaries, including plans from WellCare, Ambetter, and Health Net. PPO and EPO offerings are limited and typically available only through certain brands like Health Net in specific states.

• Kaiser Permanente exclusively offers HMO plans, operating on a unique integrated care model where members receive care within the Kaiser health system.

Individual Plans vs. Employer-Sponsored Plans

• Centene focuses on individual and family plans via the ACA Marketplace and Medicaid. Employer-sponsored plans are minimal or non-core.

• Kaiser provides individual, family, and employer-sponsored plans, including large-group and small-business coverage in states where it operates.

Medicare Advantage vs. Medicare Supplement

• Centene, primarily through WellCare, offers Medicare Advantage plans and D-SNPs (for dual-eligibles).

• Kaiser Permanente also offers highly rated Medicare Advantage plans, but does not offer Medigap (Supplement) plans.

Medicaid and ACA Marketplace Options

• Centene is a leading Medicaid provider and has a strong presence in the ACA Marketplace under brands like Ambetter.

• Kaiser participates in Medicaid and ACA exchanges, but only in the states where it owns healthcare facilities (8 states + D.C.).

Cost & Affordability

Monthly Premiums Comparison

• Centene’s ACA plans (Ambetter) are known for low monthly premiums, often among the most affordable on the Marketplace.

• Kaiser’s HMO plans are also competitively priced, especially in Medicare Advantage and ACA tiers, offering strong value for coordinated care.

Deductibles and Copayments

• Centene offers tiered options with Bronze, Silver, and Gold plans, balancing higher deductibles with lower premiums.

• Kaiser often features predictable copays and lower deductibles, especially in Medicare Advantage and employer plans.

Out-of-Pocket Maximums

• Both carriers offer compliant OOP maximums under ACA standards, with Kaiser’s caps often being lower due to the cost-control of in-house care delivery.

Pricing Transparency

• Centene provides online estimators via Ambetter and WellCare platforms.

• Kaiser integrates cost estimates into its member portal and mobile app, improving transparency with in-network costs.

Network Size & Provider Accessibility

Size and Geographic Reach of Provider Networks

• Centene has a broad national footprint, with a presence in over 30 states through its subsidiaries, using contracted third-party providers.

• Kaiser only operates in 8 states (CA, CO, GA, HI, MD, OR, VA, WA) and Washington D.C., with members restricted to Kaiser-owned providers.

Specialist Access and Referrals

• Both carriers require PCP referrals for specialists under HMO plans.

• Kaiser’s referral system is internal and streamlined due to their integrated model, while Centene’s referrals go through a broader network.

Availability of In-Network Hospitals and Doctors

• Centene’s network varies widely by region and brand; access is often broader than Kaiser’s, depending on location.

• Kaiser limits access to its own hospitals and doctors, ensuring consistency but reduced choice.

Out-of-Network Coverage and Reimbursement

• Centene’s HMO plans offer limited or no out-of-network coverage, except for emergencies.

• Kaiser also restricts out-of-network care, keeping services within their system unless urgent or emergent care is needed.

Member Benefits & Perks

Wellness Incentives

• Centene brands offer rewards for preventive screenings, health assessments, and immunizations.

• Kaiser includes comprehensive preventive care, lifestyle coaching, and wellness classes—often built into their HMO model.

Chronic Disease Management Programs

• Both carriers offer programs for diabetes, hypertension, asthma, and more. Kaiser’s model integrates these services directly with providers.

• Centene’s programs vary by subsidiary and are often contracted with third-party vendors.

Telehealth and Virtual Care

• Centene’s Ambetter and WellCare plans include virtual visits via Teladoc or similar platforms.

• Kaiser excels in virtual care with its own in-house doctors, accessible via mobile app, including video, phone, and email consults.

Mental Health Services

• Both provide mental health services, though Kaiser offers a more integrated experience through its own therapists and behavioral health clinicians.

Customer Service & Member Experience

Customer Satisfaction (J.D. Power, NCQA)

• Kaiser Permanente consistently ranks at the top of J.D. Power and NCQA ratings, especially in Medicare Advantage satisfaction.

• Centene’s satisfaction ratings vary by brand and state, with average scores and some negative feedback on administrative complexity.

Ease of Claims and Disputes

• Kaiser has a simple claims process due to its all-in-one structure.

• Centene’s claims process can be more complex, especially for services requiring prior authorization.

Online Portals and Apps

• Both insurers offer member portals and apps. Kaiser’s app is user-friendly, allowing appointment booking, messaging, prescriptions, and records.

• Centene’s digital experience varies by brand and state, with Ambetter and WellCare providing basic online tools.

Customer Support Responsiveness

• Kaiser offers coordinated support through care teams and 24/7 nurse lines.

• Centene has standard call centers and multilingual services, but experiences may vary regionally.

Reputation & Financial Stability

Financial Ratings

• Centene holds stable ratings: A- (A.M. Best), BBB+ (S&P).

• Kaiser has stronger financial ratings: A (A.M. Best), AA- (Fitch), reflecting its stable, member-owned model.

Company History

• Centene is a publicly traded company and a leading player in managed care, especially for government-sponsored programs.

• Kaiser is a non-profit integrated health system known for its clinical innovation and preventive care approach.

Regulatory or Complaint Issues

• Centene has faced some scrutiny in recent years over pharmacy benefit practices and billing issues.

• Kaiser maintains a strong reputation, though some concerns exist about access to mental health services.

Medicare-Specific Criteria

Medicare Star Ratings

• Kaiser Medicare Advantage plans often receive 4.5 to 5 stars, ranking among the best nationally.

• Centene’s WellCare MA plans typically rate 3.5 to 4 stars, with strong performance in some regions.

Additional Medicare Benefits

• Both providers include dental, vision, hearing, OTC allowances, and fitness memberships in many MA plans.

Medigap Availability

• Centene does not offer Medigap plans.

• Kaiser also does not offer Medigap, focusing entirely on Medicare Advantage.

Cost-Sharing for Medicare

• Kaiser usually has low, predictable copays in their Advantage plans.

• Centene offers D-SNP plans with $0 cost-sharing for eligible members, focused on affordability.

Employer & Small-Business Focus

Small Business Plan Options

• Centene does not focus on employer-sponsored plans.

• Kaiser offers group plans for businesses in their operating areas, with wellness and digital services included.

Fully Insured vs. Self-Funded Options

• Kaiser offers both fully insured and self-funded options to employer groups.

• Centene does not offer self-funded business health plans.

Wellness Initiatives and Employee Support

• Kaiser includes fitness, mental health, and chronic disease support in its employer plans.

• Centene lacks similar initiatives due to its focus on individual and government programs.