Buyers Guide to California Health Insurance


California is known for sandy beaches and sunny weather, but the state also has some of the best health insurance options in the country. The state’s marketplace, Covered California, offers subsidized coverage to residents based on their income level. Choosing the right plan type will affect your premiums. Silver plans balance monthly rates and out-of-pocket costs, while Gold and Platinum plans have lower deductibles and out-of-pocket maximums, so benefits start sooner.

Open Enrollment

If you have health coverage through work or another source, the annual open enrollment period is a great time to consider your options. It’s also a good time to check out Covered California, the state exchange for the Affordable Care Act, or Medi-Cal. The number of uninsured people in California has continued to drop since the law known as Obamacare took effect. Remember that you may qualify for a tax credit to help pay your premium. It’s quick and easy. You’ll need basic details like your income, a photo I.D. and social security numbers. If you choose a plan that does not meet minimum essential coverage requirements, you could be subject to a penalty from the IRS. Be sure to check out a plan’s network to ensure that it includes the doctors, specialists, hospitals and pharmacies you prefer. You’ll also want to understand the difference between a Group and an Individual/Family policy.

The California health insurance marketplace, Covered California, is the Golden State’s official resource for individuals and families seeking affordable, high-quality health coverage. Californians may browse health plans and apply for financial aid like Medi-Cal through Covered California, the state’s health insurance marketplace. Medi-Cal benefits provide low-cost or free health insurance to California’s qualified citizens with a restricted income. Currently, Medi-Cal offers a standard set of healthcare services, such as doctor visits, hospital treatment, vaccinations, maternity services, and nursing home care. The Essential Health Benefits (EHB) is a set of coverage provisions mandated by the Affordable Care Act (ACA) for all Medi-Cal health plans. Medi-Cal and Medicare cover most of the roughly 4 in 10 Californians with public insurance. But many also have private insurance, making distinguishing between public and private health care in our state difficult.


Many people that qualify for financial help through Covered California will automatically be enrolled in the lowest-cost Silver plan. It means they will pay as little as $0 monthly for their health insurance. Health insurance companies must provide preventive care for free to all their enrollees. It includes things like mammograms and cholesterol screenings. These benefits are called essential benefits. Your health insurance provider may balance bill you if you go to a doctor or hospital that isn’t in your network. A balance bill is when a provider charges you for the difference between their usual charge and what your health insurance company allows them to bill you. Your health insurance policy should state your network and how you can find a provider. It is also known as a provider search or finding. In most cases, you can find a provider by searching online. Some websites have a list of available providers.


In California, Gold plans have higher monthly premiums than Bronze or Silver health insurance plans, but they offer lower costs when medical care is needed. They also have a lower deductible each year than the other metal-tier options. Individuals not offered health insurance coverage through an employer can find affordable health coverage by shopping on the California state exchange, Covered California. The website helps determine if individuals and families qualify for subsidies toward the cost of private health insurance coverage. Small businesses can find many employee plan options through Covered California. Businesses can purchase group plans offered by multiple companies through the year-round open enrollment period. COBRA insurance allows individuals to continue their previous employer’s health insurance plan for up to 185 days after they leave a job. However, COBRA is typically more expensive than buying a new policy on the health exchange.


The California health insurance marketplace offers private plans to those not covered by a work-based plan or public programs like Medicare or Medicaid. Individual and family coverage and small business plans are available through the exchange. The Affordable Care Act created four metal-tier categories for personal and small group health plans, with benefits becoming more robust as you move up the tiers. Platinum plans offer the highest actuarial value, which estimates how much a plan will pay for medical expenses. They also tend to have the highest monthly premiums. A bronze plan is typically more affordable if you are healthy and don’t expect to incur high costs for the year. However, if you’re planning on using your health plan often or have a high deductible, consider choosing a silver plan with lower out-of-pocket maximums. Remember that rates for each plan tier may vary based on your specific circumstances, including income and age. It is important to get a personal quote from an individual health insurance agent before selecting a plan.

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