CALIFORNIA HEALTH INSURANCE: FIND AFFORDABLE PLANS
Residents of California have many options for health insurance coverage. While group coverage through an employer is common, you can purchase California health plans from Covered California, enroll in Medicare or Medi-Cal, or purchase a plan directly from an insurance company. This guide provides detailed information about your options as a California resident.
What to know about insurance in California
Marketplace plans: California has a state-sponsored health insurance exchange, but you’re not required to use it if you don’t qualify for a subsidy or don’t want to utilize your If this applies to your situation, you can purchase health coverage through an agent or broker or directly from an insurance company.
Open Enrollment: California has an expanded open enrollment period compared to most states. You can enroll between November 1 and January 31 each year. However, in 2021 California enacted a further expansion to its enrollment period to ensure everyone living in California could purchase health coverage during the COVID-19 pandemic. You can apply for coverage through August 15, even without a life qualifying event.
Special Enrollment: Once the COVID-19 enrollment period ends, you may be able to enroll in a new health plan if you have a qualifying life event. Qualifying events usually result in a loss of coverage or a change in eligibility for your previous plan. For example, you may qualify for a special enrollment period if you give birth, lose your job, or move to California from another state.
Covered California: State and federal officials closely regulate insurance prices. If you decide not to use Covered California, you won’t pay any more for your insurance plan than you would if you purchased a plan from the exchange.
Coverage types: In California, 48% of insured residents have group health coverage. Another 25.3% have Medicaid, 11.4% are enrolled in Medicare, 6.6% have non-group coverage, and military insurance plans cover 0.9%. Just under 8% of California’s population is uninsured.
How do I enroll in California's Health Insurance Marketplace?
If you want to check your eligibility for a tax subsidy that helps reduce the cost of health insurance, you’ll need to use Covered California to shop for coverage. To start the process, visit CoveredCalifornia.com. If you’re ready to fill out an application, click the Apply button; otherwise, click Get My Estimate for a health insurance quote. The Get My Estimate option allows you to enter the number of people in your household, your total household income, age, and ZIP code to determine how much you can expect to pay each month for a health plan. It also uses your income to determine if you might be eligible for a tax subsidy to defray your out-of-pocket costs. If you click Apply, you’ll be prompted to create an account or log in to your existing Covered California account. To create a new account, enter your name, date of birth, Social Security number, and desired username and password as prompted. You’ll also need to create a four-digit PIN to help keep your account secure. Make sure you have the following documents available before you start the application:
Recent pay stubs
Financial documents for other sources of income
When you compare plans, you’ll be able to see the monthly premium, how much you can expect to pay for a primary care visit, and the annual deductible. Click on Details for more information about each plan, such as the copay required for lab tests or the amount of coinsurance you can expect to pay if you’re admitted to the hospital. The following health insurance companies offer insurance plans in California:
A. Care Health Plan
How do I enroll in California individual and families insurance?
Whether you’re shopping for individual or family coverage, there are a number of things that need to be taken into consideration, such as:
Preferred plan type
Individual vs. family deductibles
Insurance for individuals in California
If you have a limited budget and use health care services infrequently, look for a low-cost plan with a high deductible. You’ll have coverage for medical emergencies, but you won’t have to pay a high premium every month. If you have a chronic health condition and need regular medical care, you may benefit from choosing a plan with a higher premium and lower out-of-pocket costs. As an example, assume you need to visit a doctor six times per year. If you purchased a plan with a $300 premium and a $50 copay for each visit, your total cost for the year would be $600, assuming you didn’t have any other out-of-pocket expenses and the copay covers the full visit. The type of plan you choose is also an important consideration.
Health Maintenance Organization (HMO) plans typically cost less than other health coverage types and have some restrictions that can affect your ability to access care. For example, you may have to ask for a referral to see a specialist, and your network is local.
Preferred Provider Organizations (PPOs) don’t require referrals and usually offer nationwide coverage but tend to cost more than HMO plans. Most PPOs also have out-of-network benefits.
Point-of-Service (POS) plans combine the features of an HMO with the features of a PPO. You have to ask for a referral to see a specialist, but you can get care from out-of-network providers if you’re willing to pay a larger percentage of the cost.
Insurance for families in California
If you’re shopping for coverage for multiple household members, you must apply the same considerations to each person who needs health insurance. In some cases, it makes sense to purchase a low-cost plan and use it only if one of your family members has a serious illness or injury. In other cases, paying a higher monthly premium can help you save money on doctor visits, emergency care, lab tests, and other medical services. For example, if your child has a chronic heart condition, a plan with a high deductible and high out-of-pocket maximum may cost you more than a plan with a higher premium and lower out-of-pocket costs. You may also want to choose a plan based on the size of the network to ensure your family members can continue seeing their preferred providers.
How much does health insurance cost in California?
The cost of health insurance varies based on where you live, how old you are, and the level of coverage offered by each insurer. Insurance companies typically set a base rate for each plan and adjust the premium based on your age and tobacco use. As you age, your premiums will go up as your risk for health conditions increases. When you shop for health coverage via Covered California, you’ll notice that each plan is labeled bronze, silver, or gold. This tier system indicates how much you can expect to pay for your health insurance.
Bronze plans have the lowest prices for premiums, but these plans also offer the lowest level of coverage. You can expect to have a high deductible and a high out-of-pocket limit with this type of plan. Although the average cost of a bronze health plan increased between 2018 and 2021, the cost of the most affordable bronze plan only went up by $36 over four years, increasing from $287 to $323.
Silver plans offer a little more coverage than bronze plans, but these plans also tend to cost more. You typically have a lower deductible, lower copays, and a lower out-of-pocket maximum in exchange for a higher monthly premium. The monthly cost of the most affordable silver plan decreased from $404 to $400 between 2018 and 2021.
Gold plans offer some of the highest levels of coverage, but these plans also have high premiums. Some gold plans have $0 deductibles, meaning you don’t have to pay a large amount of money before your insurance starts to pay for covered services. Gold plans also tend to have the lowest prescription copays. The most affordable gold plan cost increased slightly between 2018 and 2021, rising from $427 to $444.
What kind of low-income health insurance is available in California?
California has coverage options for low-income residents who can’t afford the high cost of private health insurance. Medi-Cal, California’s Medicaid program, offers coverage for adults and children, even children who don’t qualify for traditional Medicaid.
Medicaid in California
The federal government disburses funds to each state for the Medicaid program, ensuring that low-income residents of the United States have access to preventive care and other health care services. The basic eligibility requirements include the following:
Reside in California
Senior citizen, legal alien, U.S. national, or permanent resident status
The income limit depends on household size. In 2021, the maximum income level for a single person is $17,131. For each household member, the maximum income limit goes up by $6,038 per person. For example, if your household includes 10 individuals, your income limit would be $71,474 per year. To apply for Medicaid coverage in California, apply online at the Covered California website. If you don’t have internet access (or prefer not to complete an online application), you can apply in person at your county’s social service office or fill out a paper application and mail it to the following address: Covered California P.O. Box 989725 West Sacramento, CA 95798-9725
Medi-Cal for Children
Medi-Cal coverage is available to children under the age of 19. In most cases, Medi-Cal coverage costs nothing. Even if the agency determines you have to share some of the costs, you’ll only pay $13 per child per month, up to a maximum of $39. Under this plan, you can get comprehensive coverage for multiple children for less than $40 per month. To apply for Medi-Cal for Children coverage, visit the Covered California website, a local enrollment center, or call the Service Center at 800-300-1506. Note: if you live in the Bay Area, your child may be enrolled in California CHIP (CCHIP) instead of Medi-Cal. The CCHIP program also offers comprehensive coverage for enrollees.
Are there short-term health insurance plan options in California?
No. In 2018, the California Legislature passed SB-910, prohibiting insurance companies from selling, renewing, or issuing short-term, limited-duration health insurance plans to California residents. The law went into effect in 2019, making it illegal for insurers to sell or issue health plans that expire less than 12 months from their effective dates. Therefore, no insurers offer short-term insurance options in California.
California Insurance FAQs
Does California require health insurance?
Yes. California has an individual mandate effective January 1, 2020, meaning you must have health insurance or pay the penalty when you file your state tax return. The penalty for not having coverage is at least $375 per child and $750 per adult.
Do I have to use the Health Insurance Marketplace in California?
Unlike most states, California has a dedicated health insurance exchange: Covered California. You don’t have to use HealthCare.gov, the federal Health Insurance Marketplace, to enroll in a health plan. If you need help paying your health premiums, you must shop for coverage via the Covered California website.
What types of alternative health insurance plans (like cost-sharing plans) are available in California?
California allows residents to participate in health care sharing ministries or groups of people with shared religious beliefs who cover each other’s medical expenses. You should know that HCSMs don’t qualify as “minimum essential coverage,” so unless you sign up with an organization that meets a narrow definition outlined in the Affordable Care Act, you have to pay a tax penalty if you don’t have health coverage. Moreover, as cost-sharing plans are not strictly health insurance, cost-sharing plans are not obligated to pay out health insurance claims.
Do I need health insurance if I have an HSA/FSA?
Although HSAs and FSAs help save money for medical expenses, it’s still good to have health insurance. A medical emergency can cost much more than what you have saved in an HSA or FSA. If you live in California, you also need health coverage to avoid paying a tax penalty.
Do I need short-term disability coverage in California if I have health insurance?
Health insurance and disability insurance have two different purposes. Health insurance covers the cost of medical services and equipment. In contrast, disability insurance replaces some of your lost income if you’re unable to work due to a serious illness or injury. Even if you have health insurance, it’s helpful to have short-term disability coverage so that you have some way to cover your lost wages if you’re too sick or injured to work.
Do I need long-term disability coverage in California if I have health insurance?
Suppose your illness or injury is so serious that you can’t work for more than six months. In that case, long-term disability coverage replaces a percentage of your lost wages so that you have money to pay your mortgage, utility bills, and other expenses. It’s good to have long-term disability insurance to ease the financial burden when you’re unable to work due to an illness or injury, even if you already have health insurance coverage.
What does Medi-Cal for Children cover?
Medi-Cal for Children covers a wide range of medical and dental services. Covered services include well-child visits, prescriptions, emergency care, dental cleanings, ambulance transportation, and mental health counseling.