Health Insurance in California: Your Complete Guide

. Overview of California’s Health Insurance Market

California operates its own state-run health insurance marketplace (Covered California) under the Affordable Care Act (ACA). With over 1.5 million enrollees, it offers:

• ACA-compliant plans from 12 private insurers

• Expanded Medicaid (Medi-Cal) coverage

• Strong consumer protections

• Some of the nation’s most generous subsidies

2. Coverage Options in California

A. Covered California (State Marketplace)

Plan Types:

• Bronze (60% coverage)

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• Silver (70% coverage + CSR eligibility)

• Gold (80% coverage)

• Platinum (90% coverage)

• Catastrophic (under 30/hardship)

2024 Premium Averages:

• Individual: $432/month

• Family: $1,332/month
  *(After subsidies, most pay under $100/month)*

B. Medi-Cal (California Medicaid)

• Free/low-cost coverage

• Income limits: $1,732/month (individual)

• Covers dental, vision, prescriptions

C. Employer-Sponsored Insurance

• Covers 57% of Californians

• Must meet affordability standards

D. Private Off-Marketplace Plans

• Available directly from insurers

• Must still meet ACA requirements

3. California-Specific Features

State Mandate

• California requires health coverage (or pays penalty)

• 2024 penalty: $900/adult or 2.5% income

Enhanced Subsidies

• State-funded “Enhanced Silver” plans

• Extra help for middle-income residents

Immigrant Coverage

• Medi-Cal expanded to all low-income adults

• Regardless of immigration status

4. Top Insurers in California

5. Enrollment Process

Open Enrollment:

• November 1 – January 31

Special Enrollment:

• Qualifying life events (moving, marriage, etc.)

How to Apply:

1. Online at CoveredCA.com

2. Through certified enrollers

3. By phone (800-300-1506)

4. Paper application

6. Cost-Saving Tips

✅ Choose Silver if subsidy-eligible (best CSR value)
✅ Check provider networks before enrolling
✅ Use Covered California’s Shop and Compare tool
✅ Consider health savings accounts with HSA-eligible plans

7. Unique California Programs

• Health for All (immigrant coverage expansion)

• County Medical Services Program (safety net for uninsured)

• Prescription drug cost assistance programs

8. Recent Changes (2024 Updates)

• New state-funded subsidies for incomes 400-600% FPL

• Insulin copay cap ($35/month)

• Mental health parity enforcement

• Expanded reproductive health coverage

9. Frequently Asked Questions

Q: Can undocumented immigrants get coverage?
A: Yes – full-scope Medi-Cal now available regardless of status

Q: What’s the cheapest plan available?
A: Medi-Cal (free if eligible) or Bronze plans (~$10/month after subsidies)

Q: How do California premiums compare nationally?
A: About 7% below national average for marketplace plans

10. Helpful Resources

• Covered California: CoveredCA.com

• Medi-Cal: www.dhcs.ca.gov

• Consumer Assistance: HealthConsumer.org

• Provider Lookup: PhysicianCompare.cms.gov

Final Recommendation

California offers some of America’s most robust health insurance options. Whether through Covered California, an employer, or Medi-Cal, virtually all residents can access affordable coverage.

Next Steps:
✔ Calculate subsidies at CoveredCA.com
✔ Compare plans using the Shop Tool
✔ Contact a certified enroller for free help