California Health Insurance: Find Affordable Plans

Residents of California have many options for affordable 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.

• 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. For insurance coverage starting in 2022, you can enroll between November 1, 2021 through January 31, 2022.
• 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.

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
• Tax returns
• 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:

• AetnaCVSHealth
• Anthem BlueCross
• Blue California
• Chinese Community Health Plan
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Oscar
• Sharp Health Plan
• Valley Health Plan
• Western Health Advantage

Whether you’re shopping for individual or family coverage, there are a number of things that need to be taken into consideration, such as:

• Medical needs
• Preferred plan type
• Premium affordability
• 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.

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 2020 and 2023, the cost of the most affordable Bronze plan only went up by $28 over four years, increasing from $314 to $342.
• 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 increased from $396 to $411 between 2020 and 2023.
• 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 2020 and 2023, rising from $443 to $453.

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
• Limited income
• S. 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 $18,075. For each household member, the maximum income limit goes up by $6,277 per person. For example, if your household includes 8 individuals, your income limit would be $62,018 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.

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.

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.

Medicare is another option if you’re looking for affordable health insurance in California. When it’s time to enroll in Medicare, you have two options:

• Original Medicare is a basic plan that doesn’t include prescription coverage and doesn’t cover vision exams for glasses, routine dental care, or other services. Because Original Medicare is considered a no-frills plan with only hospital and medical insurance, you have the option of signing up for Medicare Part D and Medicare Supplement Insurance to make your Medicare costs more manageable. Medicare Part D covers your prescription medications, while Medicare Supplement Insurance fills some of the gaps in Original Medicare. For example, you can use Medicare Supplement Insurance to pay your Medicare deductible. The Medicare Part A deductible for inpatient hospital stays is $1,600 in 2023. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• Medicare Advantage Plans are all-in-one plans that give you more coverage. Offered by private insurance companies, these plans typically include prescription coverage and may even cover hearing aids and other extras that aren’t included in Original Medicare. Another benefit of Medicare Advantage is that multiple plan types are available, including HMO plans and PPO plans, giving you more flexibility when choosing doctors and medical facilities. As of 2023, there are 492 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.

Eligibility

Although many people on Medicare are 65 and older, Medicare coverage is also available if you’re younger and have a qualifying disability. If you want to enroll in Medicare before you turn 65, you typically need to receive 24 monthly disability payments before becoming eligible. However, this requirement is waived if you have amyotrophic lateral sclerosis or end-stage renal failure requiring a kidney transplant.

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

California has several free resources if you need help navigating your Medicare options. HICAP is a statewide program (staffed mainly by volunteers) that provides free, unbiased options counseling to help you understand your post-retirement health insurance options and can be contacted at 800-434-0222.

The CA Department of Insurance has a Senior Information Center that educates you about your health insurance options, changing laws that affect your coverage, and how to stay protected from common health insurance scams and can be reached at 800-927-4357.

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.

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