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Medical Insurance Plans California

California health insurance

1.52 million enrolled in the exchange for 2018. Open enrollment schedule set to October 15 – January 15 for all future years

  • Louise Norris
  • Individual health insurance and health reform authority; broker
  • March 19, 2018

California enrollment updates

California health insurance overview

In 2017, California lawmakers considered S.B.562, the Californians for a Healthy California Act. Introduced in February 2017 by Senator Ricardo Lara (D, Bell Gardens) and Senator Toni G. Atkins (D,San Diego), the bill would create a single-payer system in California, although the details of the financing and coverage specifics were not finalized when the bill was brought for consideration. Although the measure passed the Senate in June 2017, the California Assembly pended it indefinitely.

California residents voted on two healthcare-related propositions in November 2016: Proposition 61, The California Drug Price Relief Act, did not pass (it would have prohibited state agencies from paying more for any prescription drug than the lowest price the U.S. Department of Veterans Affairs pays for the same drug). But Proposition 56 passed, increasing the per-pack cigarette tax from $0.87 to $2.87; a majority of revenues are slated to fund health care for low-income Californians.

California’s state-run exchange, Covered California, is widely regarded as one of the most successful established under the Affordable Care Act. During the 2017 open enrollment period, 1.56 million people enrolled in private plans through Covered California, including 412,000 enrollees who were new to the exchange. For 2018 coverage, 1.52 million people had enrolled in coverage during the open enrollment period, which was slightly lower than the previous year’s enrollment (probably because California encouraged unsubsidized silver-plan enrollees to shop off-exchange for 2018 coverage, in order to avoid having to pay the extra premiums that were added to on-exchange silver plans to cover the cost of CSR).

Covered California’s open enrollment for 2018 coverage continued until January 31, 2018. This was the same schedule that was used for 2017 coverage, but Covered California was one of just three exchanges that maintained the full three-month open enrollment schedule for 2018. For 2019 coverage and beyond, California has enacted legislation that sets open enrollment dates that will differ from the rest of the country. California will continue to have a three-month open enrollment period, running from October 15 to January 15. So open enrollment for 2019 coverage will begin on October 15, 2018, and will continue until January 15, 2019. People who enroll between October 15 and December 15 will have coverage effective January 1, while those who enroll between December 16 and January 15 will have coverage effective February 1. The same October 15 – January 15 schedule will be used off-exchange as well.

Residents can also enroll in Medi-Cal (Medicaid) through Covered California; MediCal enrollment has grown by 56 percent since 2013, thanks to the ACA’s expansion of Medicaid.

Most of the Golden State has at least three insurers offering coverage in the exchange for 2018, but there are ten counties that have just one or two insurers offering plans. Rates for health insurance plans sold on Covered California would have increased by an average of 12.5 percent for 2018 if the federal government had continued to fund cost-sharing reductions. But the Trump Administration eliminated that funding, which resulted in an additional 12.4 percent surcharge added to silver plan premiums for 2018. But California’s approach to handling the cost-sharing reduction funding issue protected most consumers from bearing the extra cost, and was a model that many other states ended up adopting as well. Since silver plan rates grew sharply, and since the ACA’s premium subsidies are based on the cost of silver plans, the subsidies are much larger for 2018 than they would otherwise have been.

California health ratings

America’s Health Rankings, compiled by the United Health Foundation, ranked California 16th overall in 2016, the same spot the state held in 2015. In the 2017 edition of the rankings, California fell one place, to 17th. Air pollution, pertussis, and disparity in health status by education level are the state’s biggest public health challenges. But the state has a low incidence of tobacco use, preventable hospitalizations, and infant mortality.

By comparison, the Commonwealth Fund’s Scorecard on State Health System Performance 2015 placed California 26th, but the state jumped 12 spots, to 14th place, in the 2017 Scorecard. While the majority of the state’s health indicators had relatively middle-of-the-road placement, the state fared very well in terms of tobacco use and percentage of the population that suffered from tooth loss (2nd place in both cases). But California ranked 50th in terms of the percentage of children with a medical home.

See California’s Scorecard for additional scoring and details.

The 2016 edition of Trust for America’s Health also evaluates a variety of public health indicators. Visit the site for Key Health Data About California.

Given California’s size and diversity, a statewide view might not provide the level of information you want. Get county-by-county health rankings for California, which were developed by the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.

2018 health insurance rates and carriers

While California’s exchange has more carrier options than many others, rates increased more in 2018 than they had in any of the years since the exchanges were implemented in 2014. Covered California announced in August 2017 that the average rate increase for 2018 would be 12.5 percent, but that was based on the assumption that cost-sharing reduction funding would continue in 2018. The federal government ultimately cut off funding for cost-sharing reductions; to cover the cost, an extra surcharge, averaging 12.4 percent, was added to silver plan premiums in Covered California. But that approach ended up protecting most consumers, and it was widely adoped by other states in the lead-up to open enrollment for 2018 coverage.

The following 11 carriers offer coverage through Covered California in 2018:

  • Anthem Blue Cross of California
  • Blue Shield of California
  • Chinese Community Health Plan (only San Francisco county and San Mateo county)
  • Health Net
  • Kaiser Permanente
  • A. Care Health Plan
  • Molina Healthcare
  • Oscar Health Plan of California
  • Sharp Health Plan (only San Diego county)
  • Valley Health Plan (only Santa Clara County)
  • Western Health Advantage (only North Bay area and Greater Sacramento)

These are the same 11 insurers that offered plans for 2017, although there have been some coverage area changes. Most notable, Anthem significantly reduced their coverage area for 2018. But Blue Shield, HealthNet, and Oscar all increased their coverage areas.

How has Obamacare helped California?

California embraced healthcare reform, creating a state-based exchange and expanding Medicaid. And, following the 2014 ACA open enrollment period, the state saw its uninsured rate significantly decline. According to U.S. Census data, the uninsured rate in California dropped from 17.2 percent in 2013, to just 7.3 percent in 2016.

HHS reported that 3,826,000 California residents gained coverage as a result of the ACA, between 2010 and 2015.

Covered California has also helped Californians lower their prescription medication costs. In 2016, the state exchange rolled out a cap on prescription costs. Available to consumers purchasing off-exchange plans as well, the cap is linked to the metal level of the plan purchased and is $250 per specialty medication per month for the majority of consumers.

Californians’ enrollment in qualified health plans

Covered California reported that 1,414,668 individuals signed up for qualified health plans (QHPs) during the 2014 open enrollment period. Of that 1.4 million, about 1.1 million individuals paid their premiums and had their coverage take effect.

During the 2016 open enrollment period, there were 439,000 new private plan enrollees through Covered California. As of March 31, effectuated enrollment stood at 1,415,428. Of these enrollees, 87.6 percent were receiving premium subsidies that averaged $309 per month.

During the 2017 open enrollment period, 1.56 million people enrolled in QHPs through Covered California, including 412,000 new enrollees.

For 2018 coverage, 1.42 million people had enrolled as of December 15, 2017. That was halfway through open enrollment, although the majority of the enrollees tend to enroll by mid-December in any given year, in order to have coverage effective January 1 of the coming year.

California and the Affordable Care Act

The Affordable Care Act was signed into law in March 2010. California’s Congressional delegation voted along party lines. Both Democratic senators voted yes, as did 34 Democratic representatives. Nineteen Republican representatives voted “No.”

At the state level, legislators moved quickly to pass bills in support of a state-based marketplace – making California the first state to do so. Former Gov. Arnold Schwarzenegger, Republican, signed both the Assembly and Senate bills into law on September 30, 2010.

Current Gov. Jerry Brown, a Democrat, called a special session in late 2012, enabling additional legislation to implement the ACA in California.

California Medicaid/CHIP

California embraced Medicaid expansion in addition to implementing a state-run marketplace. Expanding Medicaid eligibility to include nearly all non-elderly adults with incomes at or below 138 percent of poverty is one of the ACA’s main strategies to reduce uninsured rates. Between October 2013 and November 2017, California’s Medicaid enrollment increased by about 4.4 million people, or 57 percent.

California Medicaid is called Medi-Cal and is the largest Medicaid program in the nation, covering 12.15 million people as of late 2017 (about 16 percent of the nation’s Medicaid enrollees are in California). Since 2013, Medi-Cal enrollment has increased 57 percent, versus an average increase of 29 percent nationwide (19 states did not expand Medicaid under the ACA, so their Medicaid populations have generally increased by much smaller percentages than states that did expand coverage).

To learn more about California’s Medicaid program visit the California Department of Health Care Services. Note: California’s Children’s Health Insurance Program (CHIP) was previously known as Healthy Families. In 2013, California transitioned Healthy Families enrollees to Medi-Cal.

Does California have a high-risk pool?

Prior to the ACA’s reforms in the individual health insurance market, medical history was a factor in eligibility for private plans in nearly every state, including California. Applicants with pre-existing conditions were often unable to buy individual plans in the private market, or if coverage was available it came with a higher premium or with exclusions on pre-existing conditions.

The California Major Risk Medical Insurance Board (MRMIB) was created in 1991 to provide a coverage option for people who were ineligible for coverage under a private plan because of medical history.

Under the ACA, all new health insurance policies became guaranteed issue starting on January 1, 2014. This change largely eliminated the need for high-risk pools, since pre-existing conditions are no longer a barrier to obtaining coverage.

The California Budget Act of 2014 included a provision for MRMIB to cease operations as of July 1, 2014. Most of the MRMIB insureds had already been able to obtain coverage through the exchange or expanded Medicaid, but remaining members were transitioned to the California Department of Health Care Services on July 1.

Medicare in the state of California

In 2015, California Medicare enrollment reached 5.6 million, about 14 percent of the state’s population. For comparison, 17 percent of the U.S. population is enrolled in Medicare.

Eighty-six percent of California Medicare recipients qualify based on their age alone, while 14 percent are on Medicare as the result of a disability.

Medicare spends about $8,598 per enrollee each year in California. At $50.6 billion per year, in 2009, the state ranked No. 1 in terms of overall Medicare spending.

Medicare Advantage plans offer additional benefits to Medicare-eligible individuals who want them. Medicare beneficiaries may select a Medicare Advantage instead of Original Medicare, and 39 percent of California’s Medicare beneficiaries were enrolled in Medicare Advantage in 2016. Nationwide, 31 percent of Medicare recipients are enrolled in Medicare Advantage plans.

About 37 percent of California Medicare beneficiaries are enrolled in Medicare Part D plans for stand-alone prescription drug coverage, compared with 45 percent nationwide.

California health insurance resources

Health reform legislation in California

Here’s a summary of recent legislative action regarding healthcare reform at the state level in California:

  • SB4 – The California Senate passed SB4 in early June 2015, the Assembly in September, and on October 9, 2015, Gov. Brown signed it into law. The legislation, renamed the Health for All Kids Act, focuses on Medi-Cal access for undocumented immigrant children under the age of 19. SBF will take effect in May 2016, and it has been estimated that 170,000 undocumented immigrant children will then become eligible for Medi-Cal based on their household income alone.
  • SB10 – This bill was introduced in 2015 and was signed into law by Gov. Brown in June 2016. It would have allowed undocumented immigrants to purchase unsubsidized coverage in the exchange, but the state needed a waiver from HHS in order to implement the law (the ACA does not allow undocumented immigrants to purchase coverage in any state’s exchange, even if they pay full price). California submitted a waiver proposal to HHS, but ultimately withdrew the waiver two days prior to President Trump’s inauguration. California State Senator Ricardo Lara (D, Bell Gardens) had introduced and championed SB10, but he requested that the waiver proposal be withdrawn (and Gov. Brown agreed) because the state was concerned that the Trump Administration could use information from the exchange to deport undocumented immigrants.
  • AB339 – Signed into law in October 2015, this bill applies to all non-grandfathered individual and small group plans in California. It limits the copayment for a 30-day supply of any medication to no more than $250. It took effect January 1, 2017, and will last until January 1, 2020. For high-deductible health plans, the copay limit will apply after the deductible has been met (Covered California already implemented a similar restriction, starting in 2016).

Other California state-level health reform legislation includes:

More California coverage

News, history, and enrollment info for your state marketplace

Individual Health Insurance California

Health insurance is among the most important purchases you’ll ever make. Comparing health plans and obtaining individual insurance quotes and information has never been easy. Thanks to the Affordable Care Act, also known as Obamacare, you have consumer protection on your side.

Before 2014, one could purchase an individual health insurance plan at any time of the year. But as of now, one can only buy individual health insurance during the open enrollment, except for special circumstances.s

Why Individual Health Insurance?

The Obamacare mandate requires that most people obtain medical insurance coverage. If you are not already enrolled in a health plan that meets the Affordable Care Act minimum essential benefits requirements, you may need to switch plans.

The mandate requires that most Americans and legal residents obtain health insurance that meets the standards set by the Covered California Exchange. Those who do not get covered for health insurance may face a penalty.

You may also need to get Individual Health Insurance in California if:

  • You are self-employed.
  • Your employer does not offer group plans.
  • You are enrolled in a group plan, but it does not cover your spouse or dependents.
  • You are enrolled in a health plan, but the premiums are too high.
  • You are enrolled in a health plan, but your benefit needs have changed.

Types of Individual Health Insurance

Individual health plans vary in how they are structured and how much they pay for your health costs. Under the ACA, all health plans must meet certain minimum essential coverage, meaning that no one can be denied during the Open Enrollment Period for any pre-existing medical conditions.

Health plans are classified under five major categories to make comparing them easier. The categories are divided according to the percentage of health care costs they pay, and they include the following:

  • Platinum – Plan pays 90% of your health costs. You pay 10%.
  • Gold – Plan pays 80% of your health costs. You pay 20%.
  • Silver – Plan pays 70% of your health costs. You pay 30%.
  • Bronze – Plan pays 60% of your health costs. You pay 40%.
  • Catastrophic – These plans are only for people under 30 years or those experiencing financial hardship. These plans pay less than 60% of your health care costs.

Buying California Individual Health Insurance

Before purchasing individual health insurance, you need to think about your health care needs and budget. Then, compare various plans to find the most suitable fit. Here are some questions you need to consider.

  • How is the plan structured?
  • Which providers are in the network?
  • What is covered by the plan?
  • How much out-of-pocket costs do you pay?
  • How much does the plan pay for your coverage?

Think about your budget as well as your health care needs, and find out how much it will cost you in insurance premiums and out-of-pocket costs for every plan you consider. Covered California makes it easier to compare different plans and choose the one that fits your individual health needs and budget.

Making a smart choice in health insurance isn’t easy, but the research you do now will pay off later when you need health care for yourself and your family. Take advantage of our online services at Health for CA Insurance Center to get free, instant quotes on California health insurance plans for individuals. Just fill out our confidential form to get started.

What Is
Covered California?

The Covered California Health Exchange is the government agency offering subsidized Obamacare plans for this state. The California Health Exchange was created to assist citizens and legal residents with applying for marketplace coverage in order to comply with the Affordable Care Act (“ACA”). When the law was passed in 2010, each of the 50 states had to decide to either create a state-run health insurance exchange or offer enrollment through a federally-operated exchange. This state chose to create their own exchange and called it “Covered California”.

What Does The California Health Exchange Do?

The Exchange helps Californians comply with the Obamacare mandate. It helps individuals and families obtain health coverage that includes the minimum essential benefits required by the law. Certain carriers are certified to offer subsidized Obama Care Plans and Prices plans and dental plans through the Exchange. These Covered California plans can sell insurance on or off the Exchange. But for qualified consumers, rates can be better if the medical plan is purchased through the marketplace. For people with a household income that is below 400% of the Federal Poverty Level (“FPL”), Covered Ca may qualify them to receive financial assistance, also called a “Subsidy”, which reduces their premium. And if income is between 138% and 250% of the FPL, the State Exchange may also qualify individuals for extra discounts that reduce their cost for medical services. These extra discounts are referred to as “Cost Sharing Reductions”. To be eligible for a subsidy and potentially for cost sharing reductions, you must fall within Covered California income limits and not be offered affordable, full coverage healthcare through an employer, Medicare, etc. Enrollments need to be submitted through the State Marketplace, a Certified Insurance Agent, or a Certified Enrollment Counselor.

The Obama Care Mandate: What is required?

The “mandate” refers to the federal law that requires all American citizens and legal residents to have qualified medical insurance. This medical coverage may be acquired off-exchange or through Covered California. The mandate is also known as the Affordable Care Act, or Obama Care. For more information, visit Obama Care California. Under the mandate, Americans and legal residents are required to do one of the following:

* You can be uninsured for part of the calendar year and not be subject to a penalty so long as you are uninsured for less than three consecutive months.

What is a qualified health plan?

For Californians to be in compliance with the mandate, they’ll need to be enrolled on a qualified health plan, plan that meets the government’s requirements for minimum essential coverage. The main coverage requirement is that the insurance must cover the 10 minimum essential benefits, such as preventive services, Prescription Drug Coverage, and maternity and newborn care. A medical plan can still be a qualified health plan without the minimum essential benefits if the plan is a grandfathered plan, which is a medical plan that was in force before March 23, 2010 when the mandate was passed and which has not undergone major changes. Qualified health plans may be acquired through Covered California, Medi-Cal, Medicare, group insurance, a plan through the military, or off-exchange directly through the carrier.

How do I enroll in a Covered California Marketplace Health Plan?

Update: Open-Enrollment begins October 15th, 2018. However, individuals and families with a qualifying life event may enroll now.

California State health insurance applications are accepted once a year at open enrollment. The next open enrollment period is October 15th, 2018 through January 15th, 2019. During this time frame, you may apply for a new plan or switch Covered California plans. You do not have to have a special reason to apply. If you miss enrolling during this period, you will not be able to apply for Obamacare coverage until the next open enrollment. Exceptions apply.

You may apply for Covered California health insurance outside of open enrollment if any of the following apply to you:

  • You have a qualifying life event, such as an involuntary loss of coverage, relocation, a change in marital status, or the birth of a child. To apply for a special enrollment, you must submit an application within 60 days of the event date.
  • You are part of a Federally-recognized American Indian tribe or are an Alaska Native. The open enrollment period does not apply to you. You may apply or switch Covered California plans once a month, if desired.
  • You are eligible for Medi-Cal. You may apply year-round.

Begin by getting California health insurance quotes. Select the plan of your choice and submit the online application. If you qualify for Medi-Cal, you can go to www.coveredca.com or contact your local Medi-Cal office.

After you submit an application, you are not officially enrolled until you pay the first month’s premium. It must be remitted by the due date or your application will not be processed.

As part of the application process, the State Insurance Exchange will electronically verify your identity, citizenship or *immigration status, and your income. Records of other government agencies will be used. If Covered California is unable to verify your information, your application may be processed in one of the following ways:

  • Your application may be marked as “conditionally eligible”. You will be covered for the next 90 days but you will be requested to provide supporting documents in order for the insurance or the subsidy to continue.
  • Your application may be processed for Medi-Cal insurance instead of the health plan you requested through Covered California. Usually, this action is taken if your IRS income records from the prior year were lower than the income listed on your application.

*Note: Verification of immigration status will not be used for the purpose of enforcing immigration laws.

Group Medical Insurance Plans on the California Health Exchange

If you are a business owner, you may be able to obtain group health insurance California coverage. This would allow you to offer coverage from multiple carriers and still have only one bill. Prices will be the same on all group health Covered California plans whether they are purchased on the State Exchange or not.

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