California Health Insurance

Need to buy health insurance in California? Below you’ll find a comprehensive guide to answer all your questions. Before you buy a health insurance policy, be sure to read the information and tips below.

Table of Contents

 

When to Buy Health Insurance

You may be able to buy health insurance throughout the year. However, many health insurance programs require you to enroll during an annual open enrollment period unless you qualify for a special enrollment period. You can also contact a health insurance agent for help.

  • To buy health insurance on the Obamacare Marketplace through Covered California, the state Marketplace site, you should enroll during the annual open enrollment period. The open enrollment period starts on November 1 and (barring extensions) ends on December 15. Outside of open enrollment, you may qualify for a special enrollment period based on life events. Enrollment in Medi-Cal, the state’s Medicaid program, is possible throughout the year.
  • To buy Medicare insurance, you should enroll during the initial enrollment period when your turn 65. This period lasts for seven months and includes your birthday month and three months before and after. If you miss it, you might have to wait until the general enrollment period, which starts on January 1 and ends on March 31. Each year, you can change the plan you’re enrolled in during the open enrollment period, which starts on October 15 and ends on December 7. You may also qualify for a special enrollment period.
  • To get insurance through your job, you should contact your employer to find out when you can enroll. You will be able to enroll when you first become eligible. You may be able to change your enrollment each year during the open enrollment period, which will typically take place sometime during the fall.
  • To buy private health insurance, talk to an insurance agent or agency. You may be able to do this throughout the year.
 

Health Insurance Options in California

As of 2017, 93 percent of Californians had health insurance. People in California get their insurance in various ways, including the Marketplace, government programs, employer-based coverage and other private plans. 

 

  • Individual Health Insurance California: You can buy private health insurance in California. Multiple private insurance companies offer individual health insurance.
  • California Health Insurance Exchange: While some states use the federal Marketplace for health insurance, California uses its own program, called Covered California. Californians can use the Covered California website to purchase health insurance and to apply for Medi-Cal, the state’s Medicaid program.
  • Medicare: 11 percent of the California population gets insurance through Medicare, a federal program that covers people aged 65 and older, as well as people with end stage renal disease or who qualify for Social Security Disability benefits. Medicare beneficiaries can choose to enroll in Medicare Advantage plans, which are offered by private insurance companies. 
  • Employer-Sponsored Insurance: In California, approximately 47 percent of the population is insured through an employer-sponsored plan.
  • COBRA: If your employer-sponsored coverage is lost due to a qualifying event, you are entitled to COBRA continuation coverage for a limited period of time. 
  • Association Plans: If you belong to an association or trade group, you may be eligible for health insurance based on your membership. 
  • Other Government Programs: While Medicare and Medicaid insure a significant percentage of the population, only 1 percent of the California population gets insurance through other public plans, which includes health insurance plans for the U.S. military and veterans.  
  • Insurance Agents and Insurance Companies: People can buy health insurance plans outside of the Obamacare Marketplace, through an insurance company or insurance agent. Insurance agents can help with Medicare and Marketplace plans, as well. 

 

 

 

Health Insurance Companies Offering Coverage in California

When shopping for health insurance, Californians have several insurance companies to choose from. Here are a few of the insurance companies offering health plans through Insurance Line One. Your agent can help you see which carriers offer quotes in California. 

 

  • Aetna: Aetna’s plans include Medicare, employer-based health insurance and individual health insurance. 

 

  • Blue Cross Blue Shield: Blue Cross Blue Shield has more than 107 million members. The plans include Medicare, employer-based coverage, individual and family plans. 
  • Cigna: Cigna has options for individuals, families and employers, with plans that include supplemental insurance and Medicare.
  • Humana: Humana’s plan offerings include Medicare and group insurance.
  • Mutual of Omaha: Mutual of Omaha sells Medicare Supplemental Insurance in addition to its financial products. 
  • UnitedHealthcare: UnitedHealthcare offers plans for individuals, families and employers, including Medicare. 
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Buying Your Own Health Insurance

Buying insurance generally involves completing an application and paying a premium. The details will depend on where you are buying insurance. These are the most common ways people enroll. 

  • Buying Employer-Sponsored Health Insurance: If you get your health insurance through your employer, talk to your manager or HR department about how to enroll. Most employers hold an annual open enrollment period when employees can change their coverage for the following year.
  • Buying a Marketplace Plan: Californians can purchase a Marketplace plan though Covered California. To complete your application, you will need to provide your ID, proof of citizenship or lawful presence, your Social Security Number, your ZIP code and information about your income. An insurance agent can help you. You can also qualify for Medi-Cal coverage through Covered California. 
  • Buying a Medicare Plan: You become eligible for Medicare when you turn 65. If you are already receiving Social Security benefits, you may be enrolled automatically. Your initial enrollment period lasts for seven months, starting three months before your birthday month. If you miss this, you may qualify for a special enrollment period. If you don’t, you will have to wait until the general enrollment period, between January 1 and March 31, and you may have to pay a late penalty. You can switch your plan during the annual open enrollment period or during a special enrollment period if you qualify for one. You can find Medicare plans using Medicare’s Plan Finder Tool, and a licensed insurance agent can help you enroll in a Medicare plan.
  • Buying Private Health Insurance: You can buy insurance through a private insurance company outside of the Marketplace. An insurance agent can help you find and enroll in a suitable plan. A licensed insurance agent from Insurance Line One can help you select and enroll in a plan.
 

Buying Health Insurance Without a Job

Approximately half of the population gets their health insurance through a job. Many employers pay a portion of the costs, which can make this an affordable option. However, not everyone has access to employer-sponsored health insurance.

Under the ACA, large employers must provide full-time employees with affordable health insurance that provides minimum essential coverage. Employers that do not meet this requirement will have to pay a fine. However, people who are not employed full time and people who work for small employers may not have access to employer-sponsored health insurance. If you fall into this group, you have several options for health insurance.

If you are losing your employer-sponsored coverage, you may qualify for COBRA continuation coverage. In California, federal COBRA and Cal-COBRA laws require employers with two or more employees to offer COBRA continuation coverage for 36 months. The downside is that employers can charge beneficiaries 102 percent of premium costs, which includes a 2 percent administrative fee. This means that COBRA insurance can be much more expensive than insurance provided through active employment. 

Some people turn to Covered California, the state’s ACA Marketplace Exchange, to purchase insurance. Depending on your financial situation, you may qualify for financial assistance or enrollment in Medi-Cal.

You can also purchase private insurance outside of the Marketplace using a private insurance company like Insurance Line One. An insurance agent can help you find a plan that meets your needs. 

 

Buying Family Health Insurance

Many people need coverage for an entire family. 

If you qualify for Medicare based on your age, you will not be able to enroll family members in your plan, although your family members can purchase Medicare coverage separately if they also qualify for coverage. For example, if both you and your spouse are at least 65 years old and qualify for Medicare, you can both enroll. If your spouse is younger than 65, your spouse will not be able to enroll, even if you are eligible. 

Other types of health insurance – including employer-sponsored coverage, Marketplace coverage and other private plans – typically provide options for spouse and dependent coverage. This means that you can enroll your spouse and your children in your plan, although you can expect to pay more for family coverage than you would for individual coverage. 

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Buying Health Insurance for Parents

In addition to securing coverage for your spouse and children, you may need to find coverage for your parents. 

If your parents qualify for Medicare, they can purchase Medicare coverage. Depending on where they live, they will likely have multiple Medicare Advantage and prescription drug plans to choose from.

If your parents do not qualify for Medicare, you may be able to enroll them in your health plan. In order to do this, you will need to establish that your parents qualify as your dependents.  

 

Buying Health Insurance Coverage with a Pre-Existing Condition

The ACA includes protections for people with pre-existing conditions. Starting January 1, 2014, plans cannot deny coverage or charge more based on pre-existing conditions, although some older plans were grandfathered in and are exempt from this law.

The ACA protections for pre-existing conditions apply to health insurance plans that provide minimum essential coverage. Supplemental plans may have restrictions on pre-existing conditions. Additionally, other types of insurance products may deny coverage or charge more because of pre-existing conditions. This includes life, disability, long-term care and critical illness insurance. Short-term health insurance plans, which are no longer allowed in California, may also place restrictions on pre-existing conditions. 

 

Applying for Health Insurance Coverage

When you apply for health insurance coverage, you will need to provide information about yourself and, if you are applying for family coverage, your family. 

Once your application is approved, you will need to pay your premium. Most plans have a monthly premium, so you will need to keep paying your premium bill in order to maintain coverage.

Your insurer will send you a member ID card. You will use this card when you see your doctor, go to the hospital or buy prescription drugs. Keep your member ID card safe. To prevent medical identity fraud, you should be careful about who sees it. 

Read over your plan details to make sure you understand how your coverage works.

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Find out about coverage options, discounts and get a free quote.
800 606-1671
 

Comparing Health Insurance Options – Key Policy Features to Review

You may have several health plans to choose from. Although comparing plans can be overwhelming, it’s important to know how plans differ so you can select the plan that is most suitable for your needs. Here are some key policy features to consider:

  • Premiums and Out-of-Pocket Costs: The premium is how much you pay, usually on a monthly basis, to buy coverage. The deductible is the amount you pay before your coverage kicks in, although preventative care is typically covered before the deductible is paid. The copay or coinsurance is what you pay every time you see a provider or buy a prescription drug. You should also look at your out-of-pocket maximum, which is the most you will pay in a coverage period.
  • Networks and Plan Types: Plans typically use networks of providers and hospitals. If you receive care outside your network, the costs may not be covered, or the copay you’re responsible for may be higher. Networks function slightly differently depending on whether your plan is a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO), a Point of Service Plan (POS) or an Exclusive Provider Organization (EPO).
  • Formulary: If you take one or more prescriptions, you should see if they are included in the plan’s formulary, a list of prescriptions that are covered by the plan. 
  • Benefits and Exclusions: Look over the plan details to see which benefits are included in coverage. Some benefits may be excluded, meaning they are not covered. 
 

Using a Critical Illness Policy to Fill Health Insurance Gaps

Health insurance plans can leave many out-of-pocket costs, including deductibles, copays and out-of-network charges. If you experience cancer, heart disease or another critical illness, these costs can add up quickly. At the same time, you may be dealing with lost wages if you have to take time off work to deal with your illness. The resulting financial strain can complicate your recovery. 

Critical illness insurance can protect you against the coverage gaps left by health insurance. Consider purchasing a critical illness insurance policy to supplement your health insurance plan. 

 

Need to Buy Health Insurance in California? 

Take the first step. Get a health insurance quote from an Insurance Line One agent now.

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