California Health Insurance

Overview

If you live in California and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

  • Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
  • Compare private health plans using U.S. News & World Report's health insurance ratings for California

Do I Qualify for a Tax Break on Health Insurance?

Use the calculator below to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.

What Plan Type is Right For Me?
How Many Need Coverage
Total Annual Income
 
 

You may qualify for Medicaid, a free, state-sponsored health insurance program. Call 888-975-1142 or go to the Covered California website to find out if you can enroll in Medicaid.

You qualify for a subsidy (tax credit) that will save you money if you buy a plan on California's new insurance marketplace, called Covered California. Plans should be offered there starting October 1, 2013. While your subsidy will cover part of the monthly premium for any of the marketplace's plans, a plan that's in the "silver tier" probably offers the best deal. That's because you also qualify for a second subsidy that increases the value of benefits you'd get from any silver plan.

You qualify for a subsidy (tax credit) that will save you money if you buy a health plan on California's new insurance marketplace, called Covered California. Plans should be offered there starting October 1, 2013. Your subsidy will cover part of the monthly premium for any of the marketplace's plans, known as Qualified Health Plans.

You don't qualify for a subsidy. You can either buy a plan on the Covered California website or click the button below to compare U.S. News-rated plans in your state's private insurance market. Plans on Covered California will generally offer more health coverage than plans in the private market, but they also tend to cost more in monthly premiums. The Covered California website should offer plans beginning October 1, 2013.

Any children in your household may be eligible for Medicaid. Call 888-975-1142 or go to the Covered California website to find out if your children are Medicaid-eligible.

See Plans

If You Qualify: Plans That Cost Less

Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of California. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage. 

Note: you had until March 31 to enroll for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty.

If You Don't Qualify: Private Plans

If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in California’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage.  What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.

Do I Have To Buy Health Insurance?

You may have heard that everyone in California must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more. 

U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

Where To Buy Health Insurance

California's Official Marketplace

Covered California is California’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on Covered California, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

  • Social security numbers for everyone in your household
  • Your employer’s name and address
  • Your most-recent pay stub or recent records of your wages
  • Information about other types of income you receive, such as alimony, unemployment benefits or a pension

 

Insurance Companies and Brokers

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the Covered California website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

U.S. News & World Report has teamed up with eHealth.com, an online broker licensed to sell health insurance, to help you buy the health plan you want. The eHealth customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.

Qualified Plans on Covered California

Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.

You should also look at a Covered California plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a Covered California plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"

Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.

Participating Companies

With some careful shopping on Covered California, you can likely find a subsidized plan with reasonable choices in in-network hospitals. Our analysis of plans with higher deductibles reveals you don't necessarily have to pay top dollar to get access to decent choice in hospitals.

Southern California

Certain insurers, including some of those selling the least expensive plans, offer consumers access to only a limited number of doctors and hospitals. Health Net Inc., for example, only has 920 doctors on its network in Orange County, where Blue Shield members have more than 2,500 to choose from, reported the Los Angeles Times. In San Diego, similarly, Health Net has fewer than 800 doctors in its network, compared to Anthem Blue Cross's nearly 3,000 and Sharp Health’s 2,600. But in exchange for tolerating Health Net's narrower network of doctors, that insurer's members reap savings. Across Southern California, its plans are up to $100 cheaper per month than its competitors', according to the L.A. Times analysis. 

In addition, some desirable hospitals may be available through one insurer but not another. Anthem Blue Cross, for example, claims to be the only insurer whose network includes University of California-affiliated hospitals such as UCLA Medical Center, according to the L.A. Times. And doctors who accept a particular insurer's employer-based plans may or may not accept its exchange plans. Reportedly only about half of Blue Shield's overall network of physicians is available to members of Blue Shield's exchange plans. 

Whether you live in the northern or southern part of the state, you will want to check the details of any Marketplace plan to see if your doctor or hospital is in the network. 

Anthem Blue Cross of California. Anthem Blue Cross has more policyholders in California than any other insurer and serves all regions of the state. Its network includes approximately 300 hospitals and 30,000 physicians.

Blue Shield of California. This California-based nonprofit health insurance company serves all regions of the state. Its network includes 223 hospitals and 22,048 physicians, not counting hospital-based physicians.

Chinese Community Health Plan. This insurer formed in 1986 as an alternative health maintenance organization (HMO) for patients served by the Chinese Hospital Health System, which was created more than a century ago to serve Chinese-Americans who were often excluded from mainstream health care. Chinese Community Health Plan focuses on offering culturally competent care and is available to those who are employed or reside in San Francisco and northern San Mateo counties. Its network includes 9 hospitals and 315 physicians.

Contra Costa Health Plan. CCHP is the first county-sponsored health insurance company in the nation to receive federal qualification and to offer Medicare. Contra Costa Health began enrollment of Medi-Cal patients in 1973. Today, the plan delivers services to Contra Costa county employees, small and large business groups, seniors, people with disabilities, children and low-income patients. CCHP currently cares for the county residents in the Low Income Health Program (LIHP), many of whom will be eligible for Covered California and may be able to keep their current physician and medical home. CCHP offers 24/7 advice nurse assistance, as well as case management and transition care nurses to assist patients being discharged from hospitals to receive timely appointments with their doctors. Its network includes 10 hospitals and approximately 5,000 physicians.

Health Net. A publicly traded managed care organization, Health Net delivers managed health care services through health plans and government-sponsored managed care plans. The insurer serves many but not all regions of the state, including Los Angeles, San Francisco, San Diego and the Inland Empire. Its network includes 204 hospitals and approximately 44,000 physicians.

Kaiser Permanente. Since 1945, Kaiser Permanente has grown to be one of the nation’s largest nonprofit health insurance companies. It claims to be a pioneer in online tools to let members e-mail their doctor, make appointments and get lab results and prescription refills all online. Kaiser Permanente, which serves more than 7 million Californians, offers coverage in most but not all parts of California; the region including Santa Cruz and Monterey is an exception. Its network includes 35 hospitals and 14,219 physicians.

L.A. Care Health Plan. Founded fifteen years ago, L.A. Care Health Plan is the nation’s largest publicly operated health insurance company. It is an independent local public agency created by the state of California and Los Angeles County to serve especially vulnerable and low-income populations. To address the diverse population of Los Angeles, L.A. Care produces member materials in ten languages, provides face-to-face interpretation services in fifty languages annually and renders telephonic interpretation services in 180 languages each year. Its network includes 35 hospitals and 1,005 physicians.

Molina Healthcare Inc. From its beginning thirty-three years ago as a single clinic providing care for low-income individuals, Molina has grown into a nationally managed care organization. It serves Los Angeles, San Diego and the Inland Empire (San Bernardino and Riverside counties). Its network includes 29 hospitals and 4,568 physicians.

Sharp Health Plan. Formed in 1979, this nonprofit is San Diego’s only locally based commercial health insurance company. It serves only the San Diego region with a network that includes 10 hospitals and 2,600 physicians.

Valley Health Plan. Licensed in 1985, VHP offers health insurance through Covered California for individuals living or working within, and small businesses located within, Santa Clara County. It also insures some employees of employer groups such as the County of Santa Clara. Its network includes Santa Clara Valley Medical Center and three additional area hospitals, 993 physicians, eleven community-based federally qualified health centers, eight clinics operated by the County of Santa Clara and a range of specialty services such as behavioral health.

Western Health Advantage. This nonprofit health insurance company was founded by UC Davis Health System, Dignity Health and NorthBay Healthcare System. Western Health Advantage offers services to northern California individuals, families and employees in the counties of Napa, Sonoma, Solano, Marin, Sacramento, Placer, El Dorado and Yolo. Its network includes 15 hospitals and 3,000 physicians.

*Insurance company information was obtained from Covered California's website. 

Need More Help?

If you need help choosing a health insurance plan or filling out your application, California has trained nongovernment groups to guide you through the process. Sometimes called “Navigators,” these groups can answer technical questions on insurance, Medicaid, and tax credits (subsidies on monthly premiums) . Navigators also specialize in assisting non-English speaking populations. For more information, contact the Covered California call center at 800-300-1506. The center is open Monday through Friday from 8:00 a.m. to 8:00 p.m. and on Saturdays from 8:00 a.m. to 6:00 p.m.

The California Department of Managed Healthcare exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. The office can be reached at 888-466-2219 or emailed through an online contact form. Residents can file an insurance complaint online.
 

Health Insurance Guide

U.S. News offers information on how to buy health insurance and publishes plan ratings for every state. If you’re over 65, see the guide to Medicare plans. Otherwise, start by looking up the Health Insurance Guide for your state.

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2014-05-01