TABLE OF CONTENTS
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.
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:
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:
Whether you’re shopping for individual or family coverage, there are a number of things that need to be taken into consideration, such as:
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.
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.
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.
|Average premiums in California||2018||2019||2020||2021|
|Most affordable bronze plan||$287||$301||$314||$323|
|Most affordable silver plan||$404||$416||$396||$400|
|Most affordable gold plan||$427||$449||$443||$444|
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.
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:
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 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.
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.
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.
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.
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.
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.
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.
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.
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.