Do you need to buy individual or family health insurance in California? State residents have several options, including coverage through Affordable Care Act plans and government-funded plans for low-income Californians. HealthMarkets is here to help answer common questions so you can be informed before you purchase a policy.
When you’re ready to buy California health insurance, HealthMarkets offers plans from a variety of insurance companies. We can help you quickly and easily compare policies, then apply for a plan that meets your financial and coverage needs. Compare plans now.
What’s the Current State of Health in California?Wonder how California health insurance stacks up against other states? Here’s some quick facts on the state’s insurance enrollment:
- Over 1.5 million Californians signed up for plans on the Affordable Care Act (ACA) exchange in 2020. Only Florida had a larger enrollment.1
- In 2010, before the enactment of the ACA, California’s uninsured rate was 18.5%. In 2019, it dropped to 7.7%.2
- California had 3 million uninsured residents in 2019, the second-highest in the nation. Only Texas had more uninsured residents.3
- Approximately one-third of the state’s population is enrolled in a Medi-Cal plan, with over 13 million participants in 2020.4
How Do I Purchase Health Insurance in California?If you do not have health insurance benefits through an employer, you have options for where you can purchase health coverage in California:
- An online shopping site such as HealthMarkets
- A licensed agent in person or over the phone, also available from HealthMarkets
- The California state insurance exchange
- Directly from an insurance company
- State-funded programs for low-income residents
Should I Buy Health Insurance Through Covered California or HealthMarkets?
The state health insurance exchange can only offer you health insurance products that are listed on the ACA marketplace. At HealthMarkets, we can offer additional coverage options, like dental and vision, to help you enroll in the plans that fit all your needs.
We’re also available 24/7 to answer your questions and provide personalized advice throughout the health insurance buying process at no charge to you. These services are not necessarily available through your state’s exchange.
Is There a Penalty for Not Having Health Insurance in California?5Yes, there is a penalty in California for not having health insurance. Although there is no longer a penalty imposed on your federal income tax for being without health insurance, California has issued a state income tax penalty. The penalty amount you would pay is based on whichever is higher:
- A flat amount of $750 per adult and $375 per child, or
- 2.5% of the amount of gross income that exceeds the filing threshold requirements based on your tax filing status and number of dependents. For a married couple, the filing threshold is $49,085 for the 2019 tax year.
There are some exceptions to the penalty including for religious conscience, financial hardship, some non-citizens, incarceration, and Medi-Cal enrollees. For a full list of exemptions, visit the California Franchise Tax Board web page.
How Much Is Health Insurance in California?The amount you pay for health insurance coverage will differ based on a variety of factors, including the type of plan you choose, your age, location, tobacco use, and whether the plan covers dependents.6 The average premium for a California ACA plan without a tax subsidy in 2020 is $569. With a tax subsidy, it’s $185.7
- Premium: what you pay your insurance company each month for coverage.
- Deductible: a set amount you must pay to providers before your insurance company starts paying its share of the bills. Your deductible resets each plan year.
- Copayments and Coinsurance: Copays are a flat fee (e.g., $20 to visit a doctor’s office). Coinsurance is a percentage of costs (for example, 25% of the cost of a prescription drug).
How You Can Reduce Your Health Insurance Costs
Since costs are often a major factor in choosing a plan, keep in mind that there is help available to most California residents. In 2020, 85% of California residents received premium tax credits that reduced their monthly premiums, and 43% received cost-sharing that reduced out-of-pocket expenses (such as deductibles, copays, and coinsurance).9
Monthly Premium Reductions
Californians earning between 139% and 600% of the Federal Poverty Level10 can lower or cover the cost of premiums either in direct payment to the health insurance provider or expensed in their annual tax return.11 In 2020, eligible income is from $17,237 to $72,840 for an individual and from $35,535 to $150,600 for a family of four.12
Premium tax credits may be applied toward any metal-level ACA plan.11
Families earning between 100% and 250% of the FPL can have the health insurance provider lower or cover more out-of-pocket costs when health services are received. In 2021, that means individuals earning between $12,760 to $31,900 per year.11
Cost sharing reductions are available only to qualified people who purchase silver plans.11
What Does the Affordable Care Act Cover?
The Affordable Care Act was signed into law by President Barack Obama in March 2010 to make health care more affordable and accessible.13 Some of the benefits of the Affordable Care Act include:
- No denial of coverage because of a pre-existing condition14
- Preventive care at no cost15
- Annual and lifetime coverage limits are lifted16
- Children up to age 26 can be covered on a parent’s plan17
- Prescription drug coverage18
- Emergency service coverage18
- Hospitalization coverage18
- Pregnancy, maternity and newborn care18
There are four main levels of ACA plans available: platinum, gold, silver, and bronze. These plan levels, often called “metal levels,” vary based on the percentage of out-of-pocket costs you are responsible for paying after you’ve met your deductible versus what your plan will pay (on average). In general, the higher your share of costs, the lower your monthly premiums will be.19
Bronze plans have the lowest premium costs and the highest out-of-pocket share, while platinum plans have the highest premiums and lowest out-of-pocket expense. What plan is best for you depends on your medical needs and budget.19
When Can You Enroll in a California ACA Plan?
If you are a U.S. citizen living in the state,20 you can purchase a California Affordable Care Act plan during the Open Enrollment Period, which runs from November 1 through January 31.21
But there is some flexibility when you can enroll depending on certain circumstances. You can enroll in a plan within 60 days of a “qualifying event,” which includes but isn’t limited to:22
- Getting married or divorced
- Having a baby or adopting a child
- Losing health coverage
- Relocation to or within California
- Becoming a U.S. citizen
Low-Income Health Insurance in California
Med-Cal is California’s state government-funded Medicaid program that provides health coverage to children and adults23 earning up to 138% of the Federal Poverty Level. In 2020, income eligibility is up to $17,609 for adult individuals and $36,156 for a family of four. You are also eligible if you are:24
- 65 or older
- Under 21
- In a skilled nursing or intermediate care home
- On refugee status for a limited time, depending how long you have been in the United States
- A parent or caretaker relative of an age eligible child
- Have been screened for breast and/or cervical cancer
Can You Buy Short-Term Insurance in California?
Short-term health insurance plans are not available in California.25 For help finding a plan that can provide coverage temporarily, visit our shopper experience or talk to a HealthMarkets licensed agent at xxx-xxx-xxxx who can provide guidance at no charge to you.
Ready to Buy a California Health Insurance Plan?
If you’re ready to purchase a health insurance plan in California, or are just curious about what’s available, shop and compare plans now. The HealthMarkets FitScore® can take your preferences and find plans that match—the higher the FitScore, the closer the match. Shop, compare, and apply all in one place.
1.Kaiser Family Foundation. 2021. Retrieved from https://www.kff.org/health-reform/state-indicator/marketplace-enrollment/. | 2.United Health Foundation. 2021. Retrieved from https://www.americashealthrankings.org/explore/annual/measure/HealthInsurance/state/CA. | 3.Kaiser Family Foundation. 2021. Retrieved from https://www.kff.org/other/state-indicator/total-population/. | 4.California Department of Health Care Services. December 28, 2020. Retrieved from https://www.dhcs.ca.gov/dataandstats/Pages/Medi-Cal-Eligibility-Statistics.aspx. | 5.California Franchise Tax Board. January 14, 2021. Retrieved from https://www.ftb.ca.gov/about-ftb/newsroom/health-care-mandate/personal.html#Penalty. | 6.U.S. Centers for Medicare and Medicaid Services. Retrieved from https://www.healthcare.gov/how-plans-set-your-premiums/. Accessed January 20, 2021. | 7.Kaiser Family Foundation. 2021. Retrieved from https://www.kff.org/health-reform/state-indicator/marketplace-average-premiums-and-average-advanced-premium-tax-credit-aptc/. | 8.U.S. Centers for Medicare and Medicaid Services. Retrieved from https://www.healthcare.gov/choose-a-plan/your-total-costs/. Accessed January 20, 2021. | 9.Kaiser Family Foundation. 2021. Retrieved from https://www.kff.org/other/state-indicator/effectuated-marketplace-enrollment-and-financial-assistance/ | 10. California Legislative Information. February 18, 2020. Retrieved from https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB2347 | 11.Kaiser Family Foundation. October 30, 2020. Retrieved from https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health-insurance-subsidies/ | 12.Health Access. 2020. Retrieved from https://health-access.org/wp-content/uploads/2019/06/CA-Budget-Affordability-Assistance-Fact-Sheet_6.24.19.pdf. | 13.U.S. Centers for Medicare and Medicaid Services. Retrieved from https://www.healthcare.gov/glossary/affordable-care-act/. Accessed January 21, 2021. | 14.https://www.hhs.gov/answers/affordable-care-act/can-i-get-coverage-if-i-have-a-pre-existing-condition/index.html | 15.U.S. Department of Health and Human Services. Retrieved from https://www.healthcare.gov/preventive-care-adults/. Accessed January 21, 2021. | 16.U.S. Department of Health and Human Services. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/index.html. Accessed January 21, 2021. | 17.U.S, Centers for Medicare and Medicaid Services. Retrieved from https://www.healthcare.gov/young-adults/children-under-26/. Accessed January 21, 2021. | 18. U.S, Centers for Medicare and Medicaid Services. Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/. Accessed January 21, 2021. | 19. U.S, Centers for Medicare and Medicaid Services. Retrieved from https://www.healthcare.gov/choose-a-plan/plans-categories. Accessed January 12, 2021. | 20. U.S, Centers for Medicare and Medicaid Services. Retrieved from https://www.healthcare.gov/quick-guide/eligibility/. Accessed January 21, 2021. | 21.Covered California. 2021. Retrieved from https://www.coveredca.com/support/before-you-buy/enrollment-dates-and-deadlines/ | 22.Covered California. 2021. Retrieved from https://www.coveredca.com/special-enrollment/. | 23.California Department of Health Care Services. https://www.dhcs.ca.gov/services/medi-cal/pages/whatismedi-cal.aspx. Accessed January 21, 2021. | 24.California Department of Health Care Services. May 7, 2020. https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx | 25. California Legislative Information. September 24, 2018. Retrieved from http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB910
HealthMarkets’ FitScore intends to identify plans that fit your needs. You should carefully review official plan materials.