California health insurance: Your options, costs and how to buy a plan

Types of California health insurance

Californians choose between four health insurance tiers in Covered California. Plans are divided into four metal levels, which are based on premiums and out-of-pocket costs. 

Here are the differences between the four plans:

Which metal tier is best? It depends on your financial situation and what you want from a health plan.  

Who may benefit from a Bronze plan:

• Young, healthy people who don’t expect to need many health care services.
• People who want to pay the lowest premiums possible.

Who may benefit from a Silver plan:

• Households who qualify for additional subsidies that are found in Silver plans.
• People who want low premiums but don’t want huge out-of-pocket costs.

Who may benefit from a Gold plan:

• Californians who expect to need many health care services over the next year.
• Those who don’t mind paying higher premiums while not spending as much when you need health care.

Who may benefit from a Platinum plan:

• Someone who wants to pay the least out-of-pocket costs with the understanding they’ll pay the highest premiums.
• People who expect to use many health care services, visit the doctor often and have multiple prescriptions. 

Best health insurance in California

Eleven insurers offer health plans via Covered California:

• Anthem
• Blue California
• Balance by CCHP
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Oscar
• Sharp Health Plan
• Valley Health Plan
• Western Health Advantage

The best health insurance for you depends on what you want out of a health plan. Are your doctors in the plan’s network? Would you rather pay higher premiums and less when you need health care? Or would you prefer paying low premiums but higher out-of-pocket costs when you need to see a doctor? Does the plan cover your prescriptions? 

Covered California offers three different benefit designs: 

• Health maintenance organization (HMO): These plans are usually cheaper than other plans. They’re also more restrictive. You typically must name a primary care provider, you need a referral from that provider to see specialists and the plan won’t pay for out-of-network care unless it’s an emergency. 
• Preferred provider organization (PPO): The plans are usually the most expensive, but you have more flexibility. You can get care outside of your network, though you’ll likely pay more, and don’t need to get referrals to see specialists. 
• Exclusive provider organization (EPO): The plans are a hybrid of HMOs and PPOs. They require you to stay within your plan’s network, similar to an HMO. However, you don't need to name a primary care provider and don’t need a referral to see a specialist, like a PPO.

Find out more about the differences between health plans.

Also, you may be able to get a plan for dental benefits. These insurers offer dental coverage in Covered California: 

• Access Dental Plan
• Anthem Blue Cross
• California Dental Network
• Delta Dental of California
• Dental Health Services
• Liberty Dental Plan 
• Premier Access

Covered California offers two dental plan designs: HMOs and PPOs. 

Individual mandate requires health insurance in California

Not long ago, nearly all Americans needed to have health insurance. However, Congress has since stopped the individual mandate penalty on the federal level. 

California implemented its own individual mandate. Californians must have health insurance or face a fine at tax time.  

Here are the penalties:

• At least $750 per adult
• $375 per dependent child under 18

So, a family of four with two parents and two children would be fined $2,250 if they don’t have health insurance. 

Expanded health insurance subsidies in California

Americans from all states benefit from cost-saving subsidies in the Affordable Care Act exchanges if their household income qualifies. These subsidies help pay premiums and reduce out-of-pocket costs. The federal subsidies are for people whose household income is under 400% of the federal poverty level. 

California is more generous with its eligibility. People with a household income of 600% of the federal poverty level or below qualify for subsidies to reduce Covered California plan costs. California also offers expanded subsidies for specific ZIP codes.

Here are the subsidy eligibility by household size in Covered California:

• 1 -- $17,609 to $75,560
• 2 -- $23,792 to $103,440
• 3 -- $29,974 to $130,320
• 4 -- $36,156 to $157,200
• 5 -- $42,339 to $184,080
• 6 -- $48,521 to $210,960

Households below subsidy eligibility are eligible for Medicaid through Medi-Cal. Medi-Cal offers low-cost, comprehensive plans. Plan costs are based on household income. 

Covered California estimates that more than 90% of people with a Covered California plan receive subsidies that reduce costs.

How much will you save? Covered California asks you for household size, income and ZIP code and figures out cost estimates with subsidies in mind. 

Covered California sends subsidies directly to the health insurance company. You can either use subsidies to lower monthly premiums or get paid back to you when you file your taxes.

How much is health insurance in California?

Health insurance costs vary based on premiums, deductibles, out-of-pocket costs, how you receive coverage and various other metrics.

Kaiser Family Foundation estimates the average monthly costs for the cheapest California health plans are:

• Average lowest-cost Bronze plan: $323
• Average lowest-cost Silver plan: $400
• Average lowest-cost Gold plan: $444

Kaiser Family Foundation didn’t provide estimates for Platinum plans, which make up a tiny portion of Affordable Care Act plans. 

These averages don’t take into account subsidies. People eligible for subsidies may pay much less than these averages. 

Here is the median premium by county for a 21-year-old for Bronze plans, which are the cheapest health insurance plans on Covered California:

Median monthly Bronze level premium by county

Source: Covered California

How to buy health insurance in California

Californians can get a Covered California plan during the annual open enrollment, which typically runs from Nov. 1 to Jan. 31. 

However, you can sign up for a Covered California plan during other times if you qualify for a special enrollment period. You may qualify to get a Covered California plan if you experience any of these life events:

• Lost your job
• Lost health insurance
• Moved
• Turned 26 and not eligible to stay on parents’ plan
• Married or entered into a domestic partnership
• New child 
• Affected by wildfires
• Became a U.S. citizen
• Household size changed
• Return from active military service
• Released from jail or prison

These events spark a special enrollment period. You have 60 days to sign up or make changes to your plan if you have a qualifying event. 

To enroll, you can go through the Covered California site, apply with a certified enroller or by phone. 

To sign up, you’ll need:

• Social security numbers or immigration documents
• Federal tax information if you file
• Employer and income information for your household

Covered California confirms the information on government databases. 

Shop around for California health insurance

It’s best to shop and compare multiple health insurance plans and companies. 

Covered California estimates that people in Los Angeles, San Diego and Orange counties can save more than 10% on their health insurance by comparing plans. Californians in Riverside, San Bernardino, Santa Clara and San Francisco can also save hundreds by shopping around. 

Covered California estimates the average person saves more than 7% by comparing plans. 

COBRA insurance in California

People who recently lost their employer-sponsored health insurance can sign up for a COBRA plan. COBRA allows you to extend your former employer’s plan for a limited time. 

However, you have to pay for all the costs. The former employer doesn’t contribute money to help pay premiums. 

The federal COBRA law only pertains to employers with 20 or more employees. However, California has a so-called mini-COBRA law that pertains to smaller businesses. The law allows Californians who previously worked at a small business to keep COBRA coverage up to 36 months. 

Other ways to get health insurance in California

Besides Covered California, an employer plan, Medicare and Medi-Cal, Californians may also get coverage in other ways: 

• An individual plan outside of Covered California
• A catastrophic plan

Individual plans outside Covered California may give you other plan options. However, those plans aren’t eligible for subsidies. So, if you qualify for subsidies, you may want to stay with Covered California. 

Meanwhile, eligible Californians can sign up for a catastrophic plan. These plans are only available for people under 30 and those who qualify for a hardship exemption. 

Catastrophic plans offer many benefits found in a regular health plan, but with much higher out-of-pocket costs.

You can sign up for a catastrophic plan directly from an insurer if you qualify. However, Covered California suggests a Bronze plan might make more sense since:

• Bronze and catastrophic plan premiums are similar
• Bronze has lower deductibles
• You may be eligible for subsidies with a Bronze plan 

One option not available in California is short-term health insurance. These plans, which are available in most states, have low premiums but high out-of-pocket costs. They also don’t usually cover health care services found in regular health insurance, such as mental health, prescription drugs and maternity care.

However, California doesn't allow insurers to sell those plans, so they’re not an option for Californians.

Still not sure about health insurance eligibility? Check out Insurance.com’s Health Plan Finder tool to explore your health insurance eligibility.

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