How To Find Your Best Health Insurance Coverage In California
The best health insurance coverage for you will depend on the availability of plans in your county, as well as your medical and financial situation. For example, California has approved expanded Medicaid coverage under the Affordable Care Act . Therefore, anyone with a household income equal to or below 138% of the federal poverty level would likely be better served by Medicaid.
When evaluating plans and your needs, you should carefully review the premiums and deductibles for private health insurance to determine what’s affordable. Typically, if you expect moderate to high medical costs, choosing a higher metal tier plan with more expensive premiums but better cost-sharing benefits would make more financial sense.
Gold and Platinum: Best if you expect high medical costs
Platinum and Gold are the highest tiers offered by the Covered California exchange, with health plans covering about 80% to 90% of your health care costs. These policies have the highest monthly premiums but come with the best benefits, including lower deductibles and out-of-pocket maximums. Because of this, Gold and Platinum plans can be the most cost-effective for those with higher medical bills, as you would reach the deductible quickly and then have access to coinsurance through your provider.
Silver: Best for people with low incomes or average medical costs
We recommend a Silver plan for most people because these plans balance cost-sharing benefits with affordable monthly costs.
Check The Doctor Networks
Have your agent check the doctor networks. Seriously, take the time to do that. Narrow networks are the biggest downside to buying individual health insurance today. Is your doctor in the network for the insurance company youre thinking about buying? If not, youll likely want to find another company or get used to the fact that you wont be seeing your doctor any longer.
Another problem arises when you have multiple doctors. One may be in the network while others are not. What do you do then? The answer, unfortunately, is compromise. Youll have to go with the company that has your most important doctors and then find new ones to replace the others.
If you cant find a plan that has your doctor, you still may be able to see her if you choose a PPO. But youll have to see your doctor on at out of network basis at a much higher out of pocket cost.
Make Your First Payment
A health insurance company will not issue your policy until youve made your first payment, often called a binder payment. The best way to make the binder payment is online at the time of your application. You can make it later by calling the insurance company or even mailing a check but you will run the risk of missing the payment deadline and voiding your application.
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More Financial Help Has Arrived
The American Rescue Plan is making health insurance even more affordable, and Covered California is the only place to get these savings.
Most likely, yes! Many people with higher incomes now qualify for financial help, and people who make less will get even more savings than before.
Use our nifty financial help calculator to see how much youll save. See what counts as household income.
These savings will only last through 2022, so dont wait to sign up.
Discover the programs and benefits available to you.
See if you qualify for special enrollment. Select the plan that’s right for you.
Coverage At Ucla Through The Health Insurance Exchange For 2022
- Blue Shield Exclusive PPO Network
- Call Blue Shield at for more information about these plans
For more information, visit the Covered California Health Plans website
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Types Of Individual Health Plans
Individual health insurance plans dont differ in terms of benefits. However, plans vary on costs, how theyre structured, which doctors accept them and which prescription drugs they cover.
Health plans in the ACA marketplace are divided into four metal tiers to make comparing them easier. The tiers are based on the percentage of medical costs the plans pay and the portion you pay out of pocket. Out-of-pocket costs include deductibles, copayments and coinsurance. Find out more about copays and coinsurance.
The percentages are estimates based on the amount of medical care an average person would use in a year.
- Bronze — Plan pays 60% of your health care costs. You’re responsible for 40%.
- Silver — Plan pays 70% of your health care costs. You responsible for 30%.
- Gold — Plan pays 80% of your health care costs. You responsible for 20%.
- Platinum — Plan pays 90% of your health care costs. You responsible for 10%.
New Law Will Allow Some California Residents To Add Parents To Their Health Plan As Dependents
California A.B.570, enacted in October 2021, makes California the first state in the country to provide a pathway for some policyholders to add their parents to their health plan as dependents.
The legislation only applies to individual/family health plans , and it will take effect in 2023. Under the new law, a California resident with individual/family health coverage will be able to cover parents as dependents, as long as the parents rely on the policyholder for at least 50% of their living expenses.
An earlier version of the bill would have applied to employer-sponsored health plans as well, but was opposed by business groups that worried about the cost. With the modification to make the legislation apply only to individual/family plans, the state expects that only about 15,000 people will use the option to add parents to their health plan.
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Health Maintenance Organizations And Managed Care Plans
This kind of health coverage is different from traditional insurance policies and is governed by a different set of laws in California. See our Types of Health Coverages page for more detail about HMOs and managed care plans and how they differ from health insurance policies.
As with health insurance policies, health plans can be purchased either as “group” or “Individual/Family” plans.
HMOs and Managed Care Plans are regulated by the California Department of Managed Health Care . For a complete list of Managed Care Plans in California, please visit the DMHC web site.
NOTE: Medicare Advantage/HMO plans are not directly regulated by the Department of Managed Health Care. These plans are regulated by the federal government through the Centers for Medicare and Medicaid Services . For more information about Medicare Advantage/HMO plans, visit their Medicare Advantage Plan web page or call them directly at 1-800-633-4227.
Covered California Premium Changes In Previous Years
For perspective, heres a look at how overall average premiums have changed in Californias marketplace over the last several years:
2015: Increase of 4.2 percent.
2016: Increase of 4 percent. The exchange noted that consumers who shopped around during open enrollment would have the opportunity to lower their premiums by an average of 4.5 percent, and as much as ten percent in some areas of the state.
2017: Increase of 13.2 percent. This was more than triple the average rate increases in 2015 and 2016, but it was also considerably lower than the average rate increases that were implemented in many other states for 2017.
2019: Increase of 8.7 percent. The weighted average rate increase for 2019 was 8.7 percent, but the exchange noted that it would only have been about 5 percent without the elimination of the individual mandate penalty at the end of 2018 .
2020: Increase of 0.9 percent: Insurers in Californias individual market finalized a weighted average rate increase of 0.9 percent, which was the lowest the state has seen since ACA-compliant plans became available in 2014 .
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How To Get Cobra
Group health plans must give covered employees and their families a notice explaining their COBRA rights. Plans must have rules for how COBRA coverage is offered, how beneficiaries may choose to get it and when they can stop coverage. For more COBRA information, see COBRA Premium Subsidy. The page links to information about COBRA including:
Health Coverage For People With Disabilities
If you have a disability, you have three options for health coverage through the government.
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Medicaid provides free or low-cost medical benefits to people with disabilities. Learn about eligibility and how to apply.
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Medicare provides medical health insurance to people under 65 with certain disabilities and any age with end-stage renal disease . Learn about eligibility, how to apply and coverage.
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Affordable Care Act Marketplace offers options to people who have a disability, dont qualify for disability benefits, and need health coverage. Learn about the .
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Due To Covid And The American Rescue Plans New Subsidies Covered California Enrollment Is Open Through The End Of 2021 For Uninsured Or Unsubsidized Californians
In response to the ongoing COVID pandemic and the Biden administrations decision to open a special enrollment period on HealthCare.gov, Covered California announced a COVID-related special enrollment period for uninsured residents from February 1, 2021 through May 15, 2021. The state estimated that 1.2 million uninsured residents are eligible for premium subsidies through Covered California or Medi-Cal.
Soon thereafter, the federal government enacted the American Rescue Plan, which provides additional premium subsidies to marketplace enrollees, making health coverage much more affordable in 2021 and 2022. To give California residents ample opportunity to take advantage of these new subsidies, Covered California announced another special enrollment period, running from April 12 through December 31, 2021, for uninsured residents as well as residents who were enrolled off-exchange . This window gives these individuals an opportunity to switch to an on-exchange plan in order to take advantage of the new premium subsidies, since there is no longer a subsidy cliff in 2021 or 2022.
For uninsured and unsubsidized residents, there is no need for a qualifying event during this special enrollment period. Covered California is spending between $20 million and $30 million on advertising this year to ensure that residents across the state are aware of the opportunity to enroll in low-cost health coverage through the marketplace during the special enrollment period in 2021.
Do I Have To Use The Health Insurance Marketplace In California
Unlike most states, California has a dedicated health insurance exchange: Covered California. You dont 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.
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Will California Be The First State To Implement Single
No U.S. states have single-payer health care systems, although some have tried to implement single-payer. Vermont was working towards single-payer under a 1332 waiver, but pulled the plug at the end of 2014, amid concerns that the costs would be higher than expected. In Colorado, single-payer advocates pushed for reform in 2016, but voters defeated Amendment 69 by a wide margin.
Will California eventually succeed where others have failed? Perhaps, but it wont be in the immediate future.
On February 17, 2017, State Senators Ricardo Lara and Toni G. Atkins introduced S.B.562, the Californians for a Healthy California Act.
S.B.562 was sponsored by the California Nurses Association, and would have transitioned California to a single-payer system at a not-yet-determined future date . The program, which would be overseen by a nine-member board of directors, would not have deductibles, copays, or coinsurance, and would cover all medical care determined to be medically appropriate by the members health care provider on a fee-for-service basis.
On April 26, the Senate Health Committee passed the measure, sending it on to the Senate Appropriations Committee. And on June 1, the legislation passed the full Senate, by a vote of 23-14.
On May 22, the California Senate Appropriations Committee :
California Created An Individual Mandate That Took Effect In 2020
California also enacted S.B.104 and S.B.78 in 2019, in order to create an individual mandate in California starting in 2020. The penalty for non-compliance will be based on the federal individual mandate penalty that applied in 2018 , but exemptions and maximum penalties will be California-specific. For example, the state notes that because Californias tax-filing threshold is higher than the IRS filing threshold, 115,000 fewer people will have to pay Californias individual mandate penalty, compared with the number of people who would have had to pay the federal penalty if it had remained in effect.
As a result of the state-based premium subsidies and individual mandate, California estimated that 229,000 additional people would obtain coverage in 2020. And the restored individual mandate penalty kept premiums 2 to 5 percent lower than they would otherwise have been, resulting in an overall average rate increase of less than 1 percent the smallest the state has seen since ACA-compliant policies debuted in 2014.
Covered Californias enrollment total for 2020 ended up at 1.54 million for 2020, as opposed to 1.51 million in 2019. And after open enrollment ended, Covered California opened a special enrollment period through April 30 for people who didnt know about the states new premium subsidies and/or the states new individual mandate.
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Whats The Current State Of Health In California
- Over 1.5 million Californians signed up for plans on the Affordable Care Act exchange in 2020. Only Florida had a larger enrollment.1
- In 2010, before the enactment of the ACA, Californias uninsured rate was 18.5%. In 2019, it dropped to 7.7%.2
- California had 3 million uninsured residents in 2019, the second-highest in the nation. Only Texas had more uninsured residents.3
- Approximately one-third of the states population is enrolled in a Medi-Cal plan, with over 13 million participants in 2020.4
President Expands Special Enrollment Period For Low
The ACA marketplaces open enrollment is usually from in most states, but starting in 2022, low-income Americans will have more chances to get a marketplace plan.
People with income up to 150% of federal poverty level will be eligible for a special enrollment period each month. The Centers for Medicare and Medicaid Services estimates that about one-third of marketplace plan members will qualify.
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How Do I Choose A Health Plan
It can be overwhelming to find the right health plan for you and your family. Starting in 2014, all health insurance newly sold to individuals and small businesses must be classified as one of the four levels of coverage: Bronze, Silver, Gold or Platinum. In addition, a minimum-coverage plan will be available to those who are under 30 years old or can provide a certification that they are without affordable coverage or are experiencing hardship.
This system will make it easier for you to compare plans.
- You can choose to pay a higher monthly premium for a Platinum or Gold plan so that when you need medical coverage you pay less.
- Or you can choose to pay a lower monthly premium for a Silver or Bronze plan, but when you need medical coverage, you pay more.
It’s up to you.
If you need help understanding the levels of coverage and making a choice that works for you and your family, visit Covered California online or contact them at .
What Is The Average Cost Of Health Insurance In California
The average cost of health insurance in California is $537 per month for a 40-year-old purchasing a Silver plan. However, rates may vary depending on your location, age and the plan’s metal tier. For example, a 40-year-old would pay 28% more than a 21-year-old, and a 40-year-old could save $98 by choosing a Bronze plan.
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Find Cheap Health Insurance Quotes In California
L.A. Care and Molina Healthcare have some of the cheapest rates, but their plans have limited availability. The Silver 70 HMO and the Silver 70 EPO are the most affordable Silver health insurance plans in California.
In California, you can also get cheap health insurance through Medicaid or the online state insurance exchange if your household income is at or below 138% of the federal poverty level.
Covered California: California’s Healthcare Marketplace
As part of the Affordable Care Act, California created a health insurance marketplace called Covered California. Through Covered California, individuals, families, and small businesses can purchase insurance products sold by private insurers. Covered California also helps individuals and families determine if they qualify for the Medi-Cal program and subsidies from the federal government toward purchase of a private insurance plan. Visit Covered California for more information about getting coverage.
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Types Of Health Insurance Plans
When purchasing health insurance, your choices typically fall into one of three categories:
- Traditional fee-for-service health insurance plans are usually the most expensive choice. They offer the most flexibility in choosing health care providers.
- Health maintenance organizations offer lower co-payments and cover the costs of more preventive care. Your choice of health care providers is limited to those who are part of the plan.
- Preferred provider organizations offer lower co-payments like HMOs but give you more options when selecting a provider.
