Both Kaiser Permanente HMO and Cigna HSA offer comprehensive health coverage with distinct advantages. Kaiser Permanente HMO stands out for its integrated system and potentially lower costs, while Cigna HSA provides greater flexibility with network access and HSA management tools. The best choice depends on individual preferences regarding network restrictions, cost considerations, and the importance of HSA features.
| Attribute | Kaiser Permanente HMO | Cigna Health Savings Account (HSA) |
|---|---|---|
| Monthly Premium Cost | Kaiser Permanente HMO monthly premiums range from $395.53 to $642.94. The average monthly cost for an ACA marketplace plan is $501. Costs range from $386 for a 21-year-old to $1,049 for a 60-year-old. | Cigna has higher-than-average ACA health plan rates compared to competitors. The monthly premium cost can depend on factors such as age, state, plan type, and metal tier level. |
| Deductible Amount | Some Kaiser Permanente HMO plans have no annual deductible, while the lowest-tiered plans have deductibles equal to the annual out-of-pocket limit. A Kaiser Permanente Deductible HMO plan may have a $500 individual deductible. For a family, it could be $500 per member or $1,000 for the entire family. Other Kaiser Permanente HMO plans have a $0 deductible. A $1,000 individual / $2,000 family deductible is also possible. For 2025, HSA-eligible plans must have a deductible of at least $1,650 for self-only coverage and $3,300 for family coverage. For 2026, it is $1,700 for self-only and $3,400 for family coverage. | For plan year 2020-2021, one Cigna High Deductible Health Plan (HDHP) had an annual in-network deductible of $1,500 for an individual and $3,000 for a family. The out-of-network deductible was $3,000 for an individual and $6,000 for a family. For the Cigna Smart Plan with HSA, the individual deductible is $1,650 and the family deductible is $3,300. Out-of-network deductibles are $3,300 for individuals and $6,600 for families. For the Cigna OAP + HSA plan, the in-network deductible is $1,600 for an individual and $3,200 for a family. The out-of-network deductible is $3,500 for an individual and $7,000 for a family. Minimum deductibles can be $1,400 for single coverage and $2,800 for family coverage. |
| Out-of-Pocket Maximum | Examples include a $3,000 individual / $6,000 family out-of-pocket maximum. Other plans have a $3,500 individual / $7,000 family maximum. Another example is a $4,500 individual / $9,000 family out-of-pocket maximum. A lower out-of-pocket maximum of $1,500 individual / $3,000 family is also possible. For 2025, HSA-eligible plans must have an out-of-pocket maximum that does not exceed $8,300 for self-only coverage and $16,600 for family coverage. For 2026, it is $8,500 for self-only and $17,000 for family coverage. | For plan year 2020-2021, the in-network out-of-pocket maximum was $3,275 for an individual and $6,550 for a family. The out-of-network maximum was $6,550 for an individual and $13,100 for a family. The Cigna Smart Plan with HSA has an out-of-pocket maximum of $4,000 for an individual and $8,000 for a family. Out-of-network maximums are $6,000 for individuals and $12,000 for families. For the Cigna OAP + HSA plan, the in-network out-of-pocket limit is $4,000 for an individual and $8,000 for a family. The out-of-network limit is $6,000 for an individual and $12,000 for a family. For 2021, the annual out-of-pocket maximum cannot exceed $4,500 for single coverage and $9,000 for family coverage. One plan has an out-of-pocket maximum of $6,000 for individuals and $12,000 for families in-network, and $12,000 and $24,000 out-of-network. |
| Co-pay for Primary Care Visit | Some plans offer primary care visits for $20 per visit. Other plans have a $40 copay for most primary care visits. Some plans may have no charge for office visits. | With the Cigna Core Plan, the co-pay for primary care visits is $20. |
| Co-pay for Specialist Visit | Some Kaiser Permanente HMO plans have a $20 copay for specialist visits. Other plans may have a $50 copay for physician specialist visits. Some plans may have no charge for office visits. | With the Cigna Core Plan, the co-pay for specialist visits is $30. |
| Prescription Drug Coverage (Formulary) | Kaiser Permanente uses a formulary, which is a list of covered drugs. Generic drugs may have a $10 copay. Preferred brand drugs may have a $20 copay. Specialty drugs may have a $15 or $20 copay for up to a 30-day supply. | Prescription and behavioral health coverage are included in the HDHP. Cigna utilizes CVS Caremark for prescription drug coverage. Certain diabetes medications have a co-pay maximum of $25 for a 30-day supply or $75 for a 90-day supply. |
| In-network Coverage | Kaiser Permanente HMO plans typically only cover care from in-network providers. | The Cigna Choice Fund Open Access Plus plans offer access to a broad national provider network. After meeting the deductible, one plan pays 90% for in-network care. With the Cigna Smart Plan with HSA, the plan pays 80% after you meet the deductible. |
| Out-of-network Coverage | Out-of-network coverage is generally not offered, except for emergency services. Services from non-plan providers will be authorized only if not available from plan providers. | After meeting the deductible, one plan pays 50% for out-of-network services. With the Cigna Smart Plan with HSA, the plan pays 50% after you meet the deductible. |
| Preventive Care Coverage | Most Kaiser Permanente health plans cover preventive care services at no extra cost. This includes services like routine physical exams, flu shots, and certain screenings. | Cigna Choice Fund HSA covers preventive care at 100% when received from an in-network doctor. This includes routine check-ups, screenings, vaccinations, and wellness programs. |
| Emergency Care Coverage | Emergency care is generally covered, with a copay. The copay is sometimes waived if you are admitted to the hospital. | When you need emergency care, you have coverage. |
| Availability of Telehealth Services | Kaiser Permanente offers telehealth services, including virtual visits with doctors. Members report satisfaction with telehealth services. | $0 virtual care (telehealth) and preventive care visits. You can talk to a board-certified doctor 24 hours a day via smartphone, computer, or tablet. |
| HSA Contribution Limits (for HSA plans) | For 2025, the maximum contribution limits are $4,300 for individuals and $8,550 for families. For 2026, the limits are $4,400 for individuals and $8,750 for families. People age 55 and older can contribute an additional $1,000 each year. | The IRS sets annual contribution limits. For 2018, the maximum contribution was $3,450 for an individual and $6,900 for a family. For 2019, the calendar year maximum was $3,500 for an individual and $7,000 for a family. For employee-only coverage, the IRS annual contribution limit is $3,550, and for family coverage, it is $7,100. If you are age 55 or older, you may contribute an additional $1,000 catch-up contribution. For 2020, the limits were $3,550 for single coverage and $7,100 for family coverage. For 2021, the limits were $3,600 for single coverage and $7,200 for family coverage. For 2024, you can contribute up to $4,150 if you have individual coverage, or $8,300 if you have family coverage. The 2025 limits increase to $4,300 for individuals, and $8,550 for those with family coverage. |
| Range of in-network doctors and specialists | Not available | Cigna Choice Fund Open Access Plus plans offer access to a broad national provider network. |
| Ease of getting referrals to specialists | A referral is needed to see a specialist | No referral is needed to see a specialist. |
| Customer service experience | Not available | Cigna’s One Guide service offers personal assistance to help resolve health care issues, find providers, get cost estimates, and understand bills. |
| Coverage of prescription drug needs | Not available | Maricopa County bundles its prescription and behavioral health benefits along with its medical coverage. |
| Understanding plan benefits and coverage details | Not available | Cigna offers online tools and a mobile app to check coverage details, deductible expenses and claims information. |
| Effectiveness of mobile app or online portal | Redesigned member app and website to make them easier to use | myCigna.com or the myCigna mobile app allows you to access your account, view balance information, manage healthcare expenses, and link to HSA Bank Customer Website. |
| Handling of pre-existing conditions | Kaiser Permanente plans do not include a pre-existing condition clause | Since 2010, it is illegal for health insurance companies to deny you medical coverage or raise rates due to a pre-existing condition. |
| Ease of managing and using the Health Savings Account | Not available | HSAs offer a debit card to easily pay from your account at the time of service. You can access your account online to view information, set up your profile, designate a beneficiary, and manage expenses. The myCigna mobile app makes it easy to check if a doctor is in your plan's network. You can pay for IRS-qualified medical expenses with funds from your HSA by using your debit card. |