Kaiser Permanente Health Insurance Review (2026)

In my analysis, Kaiser earns its 4.7 MoneyGeek score because HMO premiums average $586 a month, $91 below the national average, and its HMO claim denial rate of 8 in 100 is the lowest when compared to other insurers on the ACA Marketplace.   

Kaiser covers seven states and Washington, D.C., with no ACA option outside those markets. Any doctors you currently see outside Kaiser's employed network won't be covered for routine care, so check whether your current providers are in Kaiser's network before enrolling.

Kaiser's HMO plans average $586 a month, $91 below the national HMO average. Over a year, the $91 monthly difference amounts to $1,092 in savings. Kaiser achieves this through its closed network, which limits care to Kaiser's own doctors and facilities and removes outside provider costs from members' premiums.

EPO plans average $575 a month, $159 below the national EPO average. Oregon residents have access to EPO plans only, so the $575 figure is the only relevant comparison for that state.

Take a closer look at Kaiser Permanente’s typical premiums, deductibles and out-of-pocket maximums, broken down by plan type and metal tier:

Kaiser sells HMO plans in all six metal tiers, from Catastrophic through Platinum. EPO plans are available only in Expanded Bronze, Silver and Gold, which means EPO members have no access to Catastrophic or Platinum coverage. Oregon residents have EPO plans only.

The tier you choose determines how costs split between you and Kaiser. Lower tiers set a smaller monthly premium against a higher deductible. Higher tiers reverse that trade-off. A higher monthly premium means lower out-of-pocket costs when you use care. HMO plans require care from Kaiser's own doctors and facilities. A specialist visit also requires a referral from your primary care physician. EPO plans limit care to Kaiser's network as well, though some states allow direct specialist access without a referral.

Kaiser sells individual plans in seven states and Washington, D.C. Colorado has the largest selection at 27 HMO plans, Oregon has EPO plans only, and Washington is the one state where Kaiser sells both plan types.

Members outside these markets have no Kaiser option. Within Kaiser's coverage states, your state determines which plan type is available. California, Colorado, Hawaii, Maryland, Virginia and Washington, D.C. have HMO plans only.

Kaiser's integrated system connects insurance, medical care, prescriptions and lab work in one organization. Members access these benefits through Kaiser's network.

• Integrated Care Network: Kaiser Permanente members get primary care, specialist visits, lab work, imaging and pharmacy services at the same facilities. One system for all providers means test results, referrals and records move without handoffs between separate organizations.
• Telehealth: Scheduled phone and video visits are available through Kaiser Permanente providers for primary care, urgent care and mental health appointments. Most routine appointments qualify for telehealth.
• Mental Health Coverage: Plans cover outpatient therapy, psychiatric care and intensive outpatient programs. Members also have access to digital mental health tools for stress management, sleep and mood tracking at no additional cost.
• Mail-Order Pharmacy: Fill maintenance prescriptions through Kaiser Permanente's mail-order pharmacy, which delivers to home addresses in most service areas. This can lower per-refill costs compared to retail pharmacy pickup.
• Preventive Care: Routine screenings, annual wellness visits and immunizations are covered with no cost-sharing on most plans.
• 24/7 Nurse Advice Line: Call a registered nurse anytime, day or night, for guidance on symptoms, medications and whether to seek in-person care.

Kaiser's quality scores leads most other top insurers on the ACA Marketplace, according to the CMS Quality Rating System. HMO plans score 94.66 out of 100 and EPO plans score 94.39. For HMO members who see doctors regularly, the medical care sub-score is the most relevant figure at 96.3 out of 100.

HMO plans deny 8 in 100 claims and EPO plans deny 9 in 100. The ACA marketplace average is 19 in 100, according to CMS Quality Rating System data. EPO plans also score higher on plan administration, at 95.74 out of 100 versus 90.55 for HMO, an advantage that reflects faster billing and enrollment processing.

Kaiser Permanente is a not-for-profit health system that combines health insurance, medical groups and hospitals into one organization. Members in California, Colorado, Hawaii, Maryland, Oregon, Virginia, Washington and Washington, D.C. can buy ACA plans directly from Kaiser.

Kaiser employs its own physicians and operates its own hospitals, labs and pharmacies. This structure separates it from traditional health insurers, which pay external providers for care. When one organization controls both the insurance and the care delivery, it manages costs and quality more directly than an insurer buying services from outside providers.

Kaiser leads on price and claim approvals among the four insurers in this review. HMO plans average $586 a month, $23 below BCBS and $188 below UnitedHealthcare at the same plan type.

Kaiser's main limitation is reach. BCBS sells in 35 states, UnitedHealthcare covers 26 and Cigna covers 11. Kaiser covers seven. For members outside Kaiser's seven states, BCBS is the closest alternative on HMO pricing.

Kaiser Permanente plans vary by state, tier and age. Filter by those factors to compare monthly premiums, deductibles and maximum out-of-pocket limits across available options.

We rate the best health insurance providers based on premiums, out-of-pocket expenses, customer experience, claims denial rates and plan selection.

MoneyGeek health insurance provider scores use these weights:

• Affordability (60%): When scoring providers on affordability, we considered monthly premiums, deductibles and maximum out-of-pocket (MOOP) costs. Within the affordability score, the weights are: monthly premiums (66.67%), deductible (16.67%), MOOP (16.67%).
• Customer Experience (30%): Centers for Medicare & Medicaid Services (CMS)’s Quality Rating System (QRS) overall rating for health-insurance plans. This is a 5-star rating system used to help consumers compare health plans on the Health Insurance Marketplace. Ratings are calculated based on three main categories: Medical Care, Member Experience and Plan Administration. Providers with the highest overall rating get the highest score.
• Denial Rate (10%): Denial rate is the percentage of submitted claims or applications that are rejected instead of approved. Providers with the lowest denial rate get the highest score.

Data sources

Health insurance plan and provider data was updated with the Centers for Medicare & Medicaid Services (CMS) exchange data released in October for the 2026 enrollment period as well as manual collection of health plan data from state insurance marketplaces for 22 states.

Sample consumer profile

We collected data on all available health plans for consumers ages 18, 26, 40, 50 and 60. Monthly premiums are based on a 40-year-old buyer unless otherwise noted, such as the category for seniors. We analyzed plans for each cited metal tier, which include Catastrophic, Bronze, Expanded Bronze, Silver, Gold and Platinum.