Quick map of what I’ll cover:
- Kaiser Permanente HMO
- UnitedHealthcare PPO
- Aetna HDHP + HSA
- Blue Cross Blue Shield PPO (Anthem)
- Cigna EPO
- A few PA-specific tips from the trenches
I’m Kayla, a physician assistant. I’ve had five health plans over eight years, across two states. I picked them at work, paid the premiums, fought the denials, and yes—sat on hold. I’ll keep this simple and real. Numbers and all.
If you’d like the blow-by-blow narrative I originally published for ASQH, you can see that full PA perspective here.
Kaiser Permanente HMO — smooth inside the bubble
I had Kaiser when I worked in Oakland. My share of the premium was about $110 a month for just me. Copays were easy: $20 for primary care, $40 for a specialist, most generics were $10.
Here’s the thing. When you stay in the Kaiser system, it hums. One app. One chart. I booked a same-day visit for a bad sinus infection at 10 a.m. and picked up meds at 11:30. That speed felt amazing during flu season.
But once I needed to go outside, it got rough. I wanted a dermatology second opinion from a non-Kaiser doc. Out-of-network coverage was basically none, unless it was an emergency. I paid cash for that visit. It stung.
Pros I felt:
- Low premium for me
- One-stop system saved me time
- Fast urgent care access
Cons I hit:
- Very limited out-of-network help
- Referrals stayed inside
- Travel coverage felt thin
Would I keep it? Yes, if I lived near a big Kaiser hub and rarely traveled.
UnitedHealthcare PPO — wide net, but you’ll do the prior auth dance
I carried UHC in Colorado through a hospital job. My share was about $210 a month. Deductible was $1,500. Out-of-pocket max was $5,000. It covered me well in and out of state, which mattered since I fly to see family.
My real test came with my knee. I needed an MRI after a ski fall. Prior auth took two phone calls and a note from the ortho. It cleared in two days. I paid around $480 toward my deductible for the MRI, which was fair in my mind. Specialist visits ran $50.
UHC had a huge network. I saw a therapist on telehealth for $25 a session. Claims posted in about a week. Not bad.
Pros I felt:
- Big network, even when I traveled
- Prior auth wasn’t fast, but it worked
- Telehealth was easy and cheap
Cons I hit:
- Hold times ran 15 to 40 minutes
- The online portal felt clunky
- EOBs weren’t very clear
Would I keep it? Yes. It’s my current plan, and I’m fine with it.
Aetna HDHP + HSA — cheap now, pricey later (but the taxes help)
I tried an Aetna high-deductible plan at a private clinic job. Premium was low—about $65 a month for me. Deductible was $3,000. My employer put $1,000 into my HSA. Nice touch.
When I was healthy, it felt great. Preventive care was covered. Telehealth for simple stuff was $0. Then I tweaked the same knee. That high deductible came fast. One MRI, two PT evals, four follow-ups—I spent about $1,350 out of pocket in two months. The HSA helped, and the tax break was real. Still, you feel every bill.
One billing win: my annual physical got coded as a specialist visit and came out as $180 due. I called, asked them to recode as preventive (99395), and it dropped to $0. If you’re a PA, you know that game.
Pros I felt:
- Very low premium
- HSA funds rolled over and grew
- Preventive care was fully covered
Cons I hit:
- Big hit when something goes wrong
- You must track every bill
- Requires cash flow and patience
Would I keep it? Only if I had a solid emergency fund and no big health needs that year.
Speaking of newer players, I spent a year on the up-and-coming Taro Health plan—my unfiltered take lives here.
Blue Cross Blue Shield PPO (Anthem) — the safe bridge during job gaps
I used Anthem BCBS for two months on COBRA between jobs. It was pricey: $652 a month for me alone. But it kept my coverage clean. I had a weekend urgent care visit in Austin while traveling. Paid a $75 copay. Claim hit the portal in five days.
BCBS networks are wide. If you’re bouncing between employers, it’s a safe net. I wouldn’t pay COBRA long term unless I had to, but for a gap, it did the job.
Pros I felt:
- Very broad network
- Fast claims
- Easy to keep doctors while switching jobs
Cons I hit:
- COBRA cost was steep
- App felt dated
- Customer service was fine, not warm
Would I keep it? For a few months, yes. For years, only if the employer rate was good.
Cigna EPO — good prices, thin mental health access where I was
I had a Cigna EPO for one year. Premium was $175 a month. Deductible was $1,000. No out-of-network unless emergency. It looked solid on paper. Then I tried to book a therapist.
Ever try to call four names and find out two aren’t taking new patients and one moved? That was me. I ended up using Headway to find someone in network. It worked, but it took weeks. Once I got in, copay was $25, and it was steady.
Medical care was fine. Prescriptions were fair. But that search burned time I didn’t have.
Pros I felt:
- Low copays
- Simple structure
- Stable pricing on my meds
Cons I hit:
- Mental health network was thin near me
- No out-of-network cushion
- Took extra work to find care
Would I keep it? Only if my core doctors were in network and I didn’t need specialty mental health care.
A quick PA-specific aside: needle sticks and shots
I had one needle stick at work. That went through Occupational Health, not my health plan. Baseline labs, follow-up testing, and meds were covered by the employer. Good to know if you’re new on the floor.
Also, check coverage for Hep B titer, TB testing, and flu shots. Many plans cover them, but sometimes they must be coded as preventive. If the bill looks off, ask about codes. It matters.
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What I check each fall before I pick a plan
- My doctors and hospital in network? I search the exact names.
- Premium vs deductible. I do a rough math check on likely spend.
- Out-of-pocket max. That’s my worst-case number.
- Mental health panel. I call one or two offices to confirm they take the plan.
- Imaging costs. I ask what an MRI runs with the plan.
- Travel or out-of-area rules. I visit family, so this matters.
- Mail-order meds. Three-month fills can save money.
For a deeper, research-backed checklist that echoes these questions, the nonprofit ASQH has a free guide available here.
Need an even broader framework? This comprehensive guide on selecting health insurance plans walks through premiums, deductibles, networks, and real-world cost scenarios step by step.
Curious how a nonprofit alternative stacks up? I also road-tested one and wrote about the wins, bumps, and head-scratchers here. For another perspective, check out this in-depth review of nonprofit health insurance options that digs into mission-driven carriers, member experiences, and value for money.
One more thing. If a bill looks wrong, I compare the EOB to the visit notes. I’ve fixed three claims in the last two years that way. Kind, firm calls go a long way.
My bottom line, plain and simple
- Kaiser HMO: Best if you live near a big Kaiser site and stay inside the system. Smooth as butter then.
- UHC PPO: