Your Guide to California Health Insurance

california health insurance

Before we jump right into California health insurance and everything you need to know, let’s start with a little background information. In 2010, the Affordable Care Act (a.k.a “Obamacare” or ACA) was passed with the goal of getting all Americans access to affordable health insurance. To meet this goal, one measure Obamacare took was to create the ACA health insurance marketplaces, or health exchanges: one-stop shops where Americans can choose from a range of standardized, government-regulated health care plans. Health exchanges are also where eligible people can get subsidies, which lower the cost of their health plans.

States were given the option to run their own local exchange, take part in a multi-state exchange, or use the federal exchange (aka States that run their own exchanges get to customize many elements, including the time frame during which their residents can sign up for a plan. Several states decided to operate their own state exchanges and continue to do so to this day. California is one of those states.

California’s Health Insurance Landscape: Then and Now

The California health insurance exchange is called Covered California. Before the ACA, 20 percent of Californians were uninsured. Since the introduction of Covered California, the percent of Californians without health insurance has dropped to 6.8! These people fall into four primary groups:

1. Ineligible due to immigration status (59 percent)

2. Eligible to buy, but don’t qualify for subsidies (18 percent)

3. Eligible to buy and qualify for subsidies (13 percent)

4. Eligible for Medi-Cal, but not enrolled (11 percent)

1.4 million people have enrolled for health insurance through Covered California, which is one of the reasons it is considered one of the most successful state exchanges out there.

The California Health Insurance Exchange

Covered California is where eligible people throughout the state can find subsidized ACA plans. Open Enrollment for 2019 in California begins October 15 and ends January 15. If you sign up by December 15, your coverage will start January 1. However, if you sign up after December 15, your will have to wait until February 1 to use your plan. Lucky you – this sign up window is significantly longer than the window given on the federal exchange!

Covered California uses an active purchaser model for their exchange. This means that Covered California negotiates with health insurance carriers directly to get the best rates, networks, and benefits possible for you. Covered California is unique in that it is the only exchange that requires all plans within a metal tier to offer all the same benefits.

Like all other state exchanges, each plan on Covered California covers 10 essential health benefits. These include things like prescription coverage, maternity and mental health care, and laboratory services.

In true health insurance fashion, each of these steps can be trickier than you expect. Many people need help navigating the website, estimating their income, figuring out if they are eligible for subsidies, and understanding what documents are needed for proof of income, citizenship, or identity. Oftentimes, working with Stride makes this process much faster and easier, while still enrolling through Covered California with the same plan at the same price.

Covered California’s Intricacies: What You Need to Know for 2019

All insurers that offered plans on Covered California for 2018 will continue to do so for 2019. This means all 11 carriers are returning to the exchange. These 11 carriers include:

  • Anthem Blue Cross of California

  • Blue Shield of California

  • Chinese Community Health Plan

  • Kaiser Permanente

  • Health Net, Sharp Health Plan

  • Western Health Advantage

  • Molina Healthcare

  • Valley Health Plan, L.A. Care Health Plan

  • Oscar Health Plan of California

As of 2017, Kaiser, Blue Shield, Anthem, Molina, and Health Net made up the majority of the California health insurance market. Californians are lucky because there is a wide variety of carriers participating in the exchange. This means you have a pretty good selection when choosing a plan.

According to a recent Covered California press release, insurance plan prices are increasing. The amount by which it increases depends on where in California you live. On average across the state, your monthly premium will increase by 8.7 percent (or 6 percent if you qualify for a subsidy) if you choose to keep your current health plan. While this may seem scary, most health insurance shoppers can generally avoid rate increases entirely by switching to the cheapest plan within their metal tier. Not to mention, you will likely qualify for a health insurance subsidy, which can help make your plan more affordable; of the 1.4 million people enrolled through Covered California, 85 percent receive federal subsidies.

If you live in California, the start of Open Enrollment (the time of year when you can enroll in a new health plan) is just around the corner. Start preparing now to find your most affordable plan, and you’ll be well on your way for smarter, better savings all year long. And don’t forget – if you need help finding a subsidy or picking a plan, our experts are here to help!

Sydney Frazer2 Comments