In addition to sandy beaches and sunny weather, California also has good health insurance options for residents. In a US News study, the Golden State was ranked as the eleventh best state regarding health care access, health care quality, and good public health.
Health care options in California
According to the California Department of Insurance, Californians can get coverage through many avenues:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Californians get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 47% | ||
| Individual or family | 7% | ||
| Medicaid | 26% | ||
| Medicare | 11% | ||
| Military | 1% | ||
| Uninsured | 7% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
California falls slightly below the norm of uninsured Americans. Nine percent of Americans are uninsured, versus eight percent of Californians. That's a good sign for resident policyholders because high rates of uninsured people can raise costs for insured people.
California health insurance costs and rate factors
Residents of the Golden State spend an average of $7,549 per year in health care expenditures, only a little below the national average. Costs vary based on individual habits, including these factors:
Health insurance plan type
The health insurance marketplace organizes plans into metal categories, including bronze, silver, gold, and platinum. The higher your plan in the metal tiers, the more it costs you.
So, how much does a Californian pay in health insurance? According to these stats, an average 40-year-old California resident can pay this much in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $314 | $396 | $443 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
The jump from a bronze plan to a gold plan will cost you about 41 percent more in premiums. Considering the steep increase in coverage though, a high price tag is often worth it. Gold plans cover 80 percent of medical costs, whereas bronze plans only cover about 60 percent.
You may qualify for a catastrophic plan, which is generally reserved for those under 30 or with certain exemptions. A catastrophic plan comes with an $8,150 deductible as of 2020. Though coverage from the metal tiers cost more in monthly premiums, you'll probably save money when you need to use your health insurance.
Body mass index
Insurance companies ask for your BMI before calculating your health insurance costs. Why? Because a high body mass increases the chances of serious health issues, which creates a high-risk policyholder. A high BMI means high premium rates.
California had a 26 percent obesity rate in 2018. Out of the many Californians who use QuoteWizard to compare health insurance plans, 20 percent have a BMI in the obese range.
Tobacco use
Due to the serious health effects caused by smoking, tobacco users have higher premiums than non-smokers. About 11 percent of Californians smoke, the second lowest rate in the country.
Age
As your age rises, so can your premiums. Older people tend to pay around three times more in health insurance premiums than younger ones. CA residents who use QuoteWizard to shop for health insurance are, on average, 39 years old.
Location
Your location greatly impacts the cost of your premiums. Every state has different rules, regulations, and health care providers, California is no exception.
According to the California Office of the Commissioner, the health of your neighbors can influence the cost of your premiums. This is because the more claims that are filed in your area, the more premiums can rise for policyholders.
According to America's Health Rankings, California is the seventeenth healthiest state in the US.
California health insurance companies
Health insurance companies are abundant and accessible in the Golden State. California also offers Covered California, a state-run health insurance exchange, which aids residents with applying for health coverage. These companies offer individual and family plans in California:
- Anthem Blue Cross of California
- Blue Shield of California
- Chinese Community Health Plan
- Health Net
- Kaiser Permanente
- L.A. Care Health Plan
- Molina Healthcare
- Oscar Health Plan of California
- Sharp Health Plan
- Valley Health Plan
- Western Health Advantage
Anthem BlueCross of California
Anthem BlueCross of CA offers free preventive care to members. The company has several plans, including individual and family. These include minimum coverage plans, Medicaid, and Covered CA. BlueCross also offers online tools. These include: a 24/7 nurse advice line, personalized coaching, a maternity program, chronic condition management, and more. Plans are offered at different price levels. The price of your plan depends on how often you plan on seeing a doctor and the level of coverage you need.
Anthem BlueCross' mission is “delivering better care to our members, providing greater value to our customers and helping improve the health of our communities.”
Blue Shield of California
Blue Shield of CA boasts several member benefits. These include a 24/7 nurse help line, care programs, gym discounts, wellness programs, and more. Most members (56 percent) purchase individual and family plans through Covered CA. Medical plans come in bronze, silver, gold, platinum, and minimum coverage. Depending on your plan, you’ll receive different benefits, deductibles, and out-of-pocket costs.
Blue Shield was founded in CA in 1938. Today, the company has 6,800 employees serving over four million members. Blue Shield prides itself on giving back to the community. In 2014, employees raised over $400,000 for local nonprofit organizations.
Chinese Community Health Plan
Chinese Community Health Plan uses metal tiers to organize plan types. The metal tiers include bronze, silver, gold, and platinum. Out-of-pocket limits range from $3,350 to $7,900 for individual plans and $6,700 to $15,800 for family plans. Benefits vary based on the plan you choose. Most plans include:
- Low copays on pediatric vision and dental
- Prescription drug coverage
- Emergency health coverage
- Outpatient services
- And more
CCHP also offers Medicare and employer plans.
CCHP is a San Francisco-based health plan that was founded in 1986. The company’s network includes over 1,700 doctors and it serves over 21,000 members.
Health Net
Health Net plans come with several benefits. These include a nurse advice line, health coaching program, disease management, and more. Health Net also offers free in-home health assessments. The price of your plan is a balance of the price of your monthly premium and how much you pay for care. For example, if you see a doctor less often, you may want higher deductibles but lower monthly premiums. Or, if you see a doctor more often, you may want higher monthly premiums and a lower deductible.
Kaiser Permanente
Kaiser Permanente plans include a range of benefits. Benefits include wellness coaching, free preventive care, health classes, online wellness tools, and more. Members can choose doctors from adult medicine, family medicine, or pediatrics. The company also has facilities that offer several services under one roof. Plans also include a 24/7 travel line that allows you to get care from wherever you are. If you don’t qualify for Medicaid, you may qualify for Charitable Health Coverage. The program covers most services and helps you pay all premiums.
Kaiser Permanente has been offering health plans for over 60 years across several states.
L.A. Care Health Plan
L.A. Care Health Plan offers two plan options. Members can choose from L.A. Care Covered and L.A. Care Covered Direct. The plans offer different metal levels that determine cost-sharing. Metal levels include platinum, gold, silver, and bronze. Annual deductibles range from $75 to $7,900 for an individual plan and $150 to $15,800 for a family plan. You may also be eligible for a catastrophic coverage plan if you are under 30.
Founded in 1997, L.A. Care Health Plan serves over two million members with nearly 2,000 employees. The company’s mission is “to provide access to quality health care for Los Angeles County’s vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.”
Molina Healthcare
Molina Healthcare offers individual and family plans through the Molina Marketplace. Plans include: minimum coverage, bronze, several silver levels, gold, and platinum. Deductibles range from $75 to $7,350 for individual plans and $150 to $14,700 for family plans. The company also offers health and wellness resources. These resources educate members on women’s wellness, health conditions like asthma and diabetes, and senior health.
Molina began in southern CA in 1980 and became a licensed health place with 100,000 members in 1994. As of 2015, Molina had grown to 3.5 million members. The company’s mission is to “provide quality health care to people receiving government assistance.”
Oscar Health Plan of California
Oscar Health Plan of CA customers enjoy plenty of benefits. These include unlimited 24/7 calls with doctors, money for step tracking, over-the-phone prescriptions, and more. Under an Oscar health plan, four of the five top hospitals in L.A. are covered. Oscar’s top three plans in L.A. are the Classic Silver, the Saver Bronze, and the Classic Bronze. Plan premiums range from $265 to $428, with deductibles ranging from $2,500 to $6,300.
Oscar health was founded in 2012. Their mission is, “to be a health insurance company centered around the patient.” Oscar has over 700 employees and 250,000 members.
Sharp Health Plan
Sharp Health Plan offers a variety of plans. There are eight individual and family plans within two networks. There are two networks: premier and performance. Premier is designed to offer the most cost savings within a network of doctors, hospitals, and medical groups. Performance offers a network with more choice and geographic coverage. Plans include these benefits: emergency travel services, an online nurse advice tool, wellness programs, and more.
Sharp Health began offering health care to San Diego residents in 2001. The company’s care philosophy is “treating people, not patients, and transforming the health care experience for our entire community.”
Valley Health Plan
Valley Health Plan offers several plan options for CA residents. Plans offer prevention services with no copay, a 24/7 doctor advice line, and free health and wellness classes. Plan options include platinum, gold, silver, bronze, and minimum coverage. Members have coverage for maternity and newborn care, prescription drugs, lab services, and more.
Valley Health Plan was founded in 1985. It offers health plans for employer groups, Covered CA, and individuals and families. Their mission is to provide “the most affordable managed care products available in the marketplace to purchasers and consumers across a wide spectrum.”
Western Health Advantage
Western Health Advantage serves 14 northern CA counties. Plans include a 24/7 nurse line, disease management, gym discounts, alternative medicine, and more. Preventive care services are included with no additional cost in WHA health plans. The company also offers resources for women’s wellness, infant wellness, disease management, and more.
Founded in 1996, Western Health Advantage is a non-profit HMO health plan in Sacramento. They offer coverage to employer groups, individuals, and families. The company’s mission is to “expand access to health care and respond to the changing needs of [their] members, providers and community to improve the health and well-being of all.”
Some of these options vary based on where you are in the state, so check the provider's website.
California health insurance laws
When the Affordable Care Act was passed in 2014, changes were made among what factors insurance companies can use when pricing your policy. Here are some things companies can't use for pricing your policy:
- Pre-existing conditions: Before the ACA, insurance companies often charged people with pre-existing conditions more for coverage. Now, insurance companies can't charge higher rates to people with pre-existing conditions.
- Gender: According to a Health Services Study, women historically pay more for health care. However, the Affordable Care Act doesn't allow insurance companies to charge men and women a different premium for the same plan.
- Insurance and medical history: Insurance companies also used to analyze your medical history and your past insurance coverage. Those with medical problems historically had to face steeper premiums, if coverage was even provided. This changed with the implementation of the ACA, which made it so that insurance companies could not price your policy based on insurance and medical history.
For a 2020 marketplace plan, there are out-of-pocket maximum limits. This year, out-of-pocket maximums are $8,150 for an individual plan and $16,300 for a family plan.
According to the California Department of Insurance, California law requires health insurance policies to include these benefits:
- Hospital care
- Visits to primary care doctors
- Pregnancy and newborn care
- Mental health care
- Emergency and urgent care
- Oral and vision care for children
- Prescription drugs
- Preventative and routine care
- Substance abuse treatment
Plus more! Check out the full list on the California Department of Insurance's website.
Medicare and Medicaid in California
California has the nation's largest Medicaid program, called Medi-Cal. This program is available to low-income families and individuals. Residents over 65-years-old are eligible for Medicare, another government-funded program.
Medicare
Medicare is a health care program available to people over 65 years of age. Coverage comes in options A, B, C, or D, as well as supplemental coverage plans. In California, there are multiple Medicare Savings Programs, which are outlined below with their requirements.
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Nationally, the rate of Americans with no health insurance has improved considerably since 2010 when the Affordable Care Act (ACA) was passed. Medicaid expansion was a big part of reducing California’s overall uninsured rate.
In 2013, 17.2% of California’s residents did not have health insurance. After California expanded its Medicaid program in 2014, the state’s uninsured rate dropped 36.6% by 2019. This was helped by the 11.4% increase — or 1,003,700 California residents — in Medicaid enrollment from 2014 to 2019.
California has an expanded Medicaid system called Medi-Cal. This program covers more than 12 million Californians. Here are the financial requirements for Medi-Cal:
- Children up to age 18 with family incomes up to 266 percent of the Federal Poverty Line (FPL)
- Pregnant women with incomes up to 213 percent of the FPL
- Adults (with or without dependents) with incomes up to 138 percent of the FPL
- Pregnant women with an income up to 322 percent of the FPL are eligible for MCAP
For full Medi-Cal requirements, check out this resource from Covered California.
California Office of the Insurance Commissioner
- Website:
- Homepage
- Insurance Commissioner:
- Dave Jones
- Insurance Hotline:
- (800) 927 – 4357 (HELP)
- Office Hours:
- Monday - Friday
9:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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