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California Health Insurance Consumer Guide
Our California health insurance guide, including the FAQs below, is designed to help you understand the health coverage options and possible financial assistance available to you and your family. Having health coverage is especially necessary in California, as there’s a penalty on the state tax return for non-exempt filers who don’t have health coverage.1
California created its own state-run health insurance Marketplace/exchange, called Covered California. A dozen private health insurers offer coverage for individuals and families via the Covered California platform. And California is one of the states where the exchange still offers a platform where small businesses can purchase health coverage for their employees; four insurers offer small group plans through Covered California for 2024.2
California is among the states where state-funded subsidies are available to Marketplace enrollees, in addition to federal subsidies.
Under California rules, all of the plans sold in the exchange are standardized.3 Standardized plans are available in most states. But although most states also have non-standardized plans available through the exchange, California does not.4 This means that for certain services, all of the Covered California plans in a given metal level will have the same out-of-pocket costs.
A Covered California plan can be a great option if you need to buy your own health insurance. This includes people who aren’t eligible for Medicare or Medicaid, or don’t have an offer of affordable health insurance from an employer.
Explore our other comprehensive guides to coverage in California
Dental coverage in California
Looking to improve your smile and save some money at the dentist’s office? Dental insurance may be a valuable supplement to your medical coverage. Our guide explains dental coverage options in California.
Medi-Cal: California’s Medicaid program
Medi-Cal is California’s Medicaid program. Covering nearly 16 million people,5 it is by far the largest Medicaid program in the country.
Medicare enrollment in California
More than 6.7 million Californians were covered by Medicare as of May 2023.6 Our California Medicare guide explains the various parts of Medicare and their coverage options, as well as California regulations regarding Medigap (Medicare Supplement) plans.
Short-term coverage in California
California enacted legislation in 2018 that prohibits the sale of short-term health plans in the state.7 So there are no longer any short-term health plans available in California.8
Frequently asked questions about health insurance in California
Who can buy health insurance on California’s Marketplace?
In order to sign up for private health coverage through Covered California, you must:9
- Be a California resident
- Not be incarcerated
- Not be enrolled in Medicare
- Be lawfully present in the United States. (California has been expanding access to Medi-Cal for low-income undocumented residents. This is available across all age groups as of 2024.)10
By those rules, most Californians can enroll in coverage through the exchange. But a bigger question for most people is financial assistance, and there are a few additional parameters in order to be eligible for subsidies through Covered California. To qualify for income-based Advance Premium Tax Credits (APTC), federal cost-sharing reductions (CSR), or California’s new state-funded cost-sharing subsidies, you must:
- Not have access to affordable health coverage through an employer. If you have access to an employer’s plan but it seems too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies via Covered California.
- Not be eligible for Medi-Cal (California Medicaid).
- Not be eligible for premium-free Medicare Part A.11
- File a joint tax return if you’re married.12
- Not be able to be claimed by someone else as a tax dependent.12
Beyond those basic parameters, qualifying for Covered California subsidies will depend on how much your household earns. Here’s how household income is calculated under the ACA.
California AB570, enacted in October 2021, makes California the first state in the country to provide a pathway for some policyholders to add their parents to their health plan as dependents.13
The legislation, which took effect in 2023, only applies to individual/family health plans (ie, not to plans that people get from an employer). Under the new law, a California resident with individual/family health coverage is allowed to cover parents as dependents, as long as the parents rely on the policyholder for at least 50% of their living expenses.
An earlier version of the bill would have applied to employer-sponsored health plans as well, but was opposed by business groups that worried about the cost. With the modification to make the legislation apply only to individual/family plans, the state expects that only about 15,000 people will use the option to add parents to their health plan.14
When can I enroll in an Affordable Care Act (ACA)-compliant plan in California?
California’s open enrollment period is longer than the window used in most other states. It begins November 1 and continues through January 31.15 (In most states, open enrollment runs from November 1 through January 15.) And for 2024 coverage, an extension through February 9, 2024 was added at the last minute.16
The open enrollment window is your opportunity to select a new plan or switch to a different plan. The enrollment window applies to plans obtained via Covered California or directly from an insurer, but note that subsidies are only available through Covered California.
For coverage to take effect on January 1, you need to complete your application by December 31. (This is later than the deadline in many other states.) If you enroll between January 1 and January 31, your coverage will take effect on February 1.17 (For 2024 coverage, the extension of open enrollment through February 9, 2024 gives people an additional nine days to sign up with coverage backdated to February 1.)16
After the annual open enrollment window ends, you may still be eligible to enroll or make a plan change if you experience a qualifying life event such as giving birth or losing other health coverage. And some people can enroll year-round even without a specific qualifying life event.18
In addition to the standard list of qualifying events that trigger special enrollment periods nationwide, Covered California will also grant a special enrollment period to a person whose medical provider leaves their health plan’s network while the person is undergoing treatment for one of the following:19
- Pregnancy
- A terminal illness
- An acute condition or serious chronic condition
- The care of a child during its first 36 months.
- A surgery or other procedure scheduled in the next 180 days
There is also a special enrollment period available if you have to pay the California penalty for not having health coverage the prior year.19
In 2022, California enacted SB967, which creates an easy enrollment program in California as of the 2023 tax year (ie, for tax returns filed in early 2024).20
Unlike most of the other states that have created or considered similar programs, the California legislation did not specifically create a special enrollment period for people who are deemed eligible for marketplace coverage (as opposed to Medicaid/CHIP, which is available year-round). If Covered California creates a special enrollment period for this purpose (which is likely, as eligible enrollees would otherwise have to wait until the annual open enrollment period to obtain coverage), it will appear on this list.
Enrollment in Medi-Cal (California Medicaid) is available year-round.
How do I enroll in a Covered California Marketplace plan?
To enroll in an ACA Marketplace/exchange plan in California, you can:
- Visit Covered California, California’s health insurance exchange (Marketplace). Using this online platform, you can compare plans, determine whether you’re eligible for financial assistance, and enroll in coverage. You can reach the Covered California call center at 1-800-300-1506, Monday to Friday between 8 a.m. and 6 p.m.
- Enroll in a plan through Covered California with the help of an insurance agent or certified enrollment counselor.21
- Covered California has a “help on demand” program that allows you to submit your contact information and then receive a call from a certified enrollment assister who will help you sort out the details.
How can I find affordable health insurance in California?
The Affordable Care Act (ACA) provides income-based subsidies that can reduce the amount you pay for your coverage each month. In California, these subsidies are available to applicants who meet the eligibility requirements and enroll in a health plan through Covered California.
More than 80% of Covered California enrollees were receiving premium subsidies as of early 2023. These subsidies averaged $486/month, and after the subsidies were applied, the average enrollee’s premium was about $134/month.22
If your household income isn’t more than 250% of the federal poverty level, you’ll also be eligible for federal cost-sharing reductions (CSR), which will reduce your deductible and other out-of-pocket expenses. These benefits are built into Silver-level plans if the applicant is eligible for them. Forty-one percent of Covered California enrollees were receiving CSR benefits as of 2023.23
And as of 2024, California is supplementing the federal CSR benefits with additional state-funded cost-sharing subsidies. Eligible Silver-plan enrollees have $0 deductibles and lower costs for other out-of-pocket expenses.24
Covered California and Medi-Cal (California Medicaid) use the same application, and the system will let you know whether you’re eligible for Medi-Cal or a private plan through Covered California – with subsidies if you qualify for them.
Source: CMS.gov25
California does not allow short-term health insurance policies to be sold, under the terms of legislation that the state enacted in 2018.26
How many insurers offer coverage in California’s Marketplace?
For 2024 coverage, 12 insurers offer plans through California’s exchange. This is the same as the number of participating insurers in 2023, but there was one insurer exit at the end of 2023 and one newcomer for 2024. (Oscar Health Plan of California left at the end of 2023, while Inland Empire Health Plan is new for 2024.)27
Are Marketplace health insurance premiums increasing in California?
Covered California’s insurers have implemented the following average rate changes for 2024,28 which amount to an overall average rate increase of about 9.6%:29
California’s ACA Marketplace Plan 2024 Approved Rate Increases by Insurance Company |
|
---|---|
Issuer | Percent Increase |
Aetna CVS Health | -0.9% |
Anthem Blue Cross | 10.8% |
Blue Shield of California | 15.0% |
Chinese Community Health Plan | 5.0% |
Health Net | 8.3% |
Kaiser Permanente | 7.3% |
LA Care Health Plan (Local Initiative Health Authority for Los Angeles County) | 6.0% |
Molina Healthcare | 8.6% |
Sharp Health Plan | 6.1% |
Valley Health Plan (County of Santa Clara) | 7.1% |
Western Health Advantage | 5.5% |
Inland Empire Health Plan | New for 2024 |
Source: Covered California and the federal rate review database30
It’s important to remember that average rate changes are for full-price plans (i.e. before any subsidies are applied), and most enrollees do not pay full price: Nearly nine out of ten of Covered California enrollees were receiving premium subsidies in 2023, to offset some or all of their monthly payments.31
The subsidy amount is different for each enrollee and changes each year depending on the cost of the second-lowest-cost Silver plan relative to the enrollee’s household income. Under the American Rescue Plan and the Inflation Reduction Act, subsidies are larger and more widely available than they used to be, and that will continue to be true at least through 2025.
Full-price (unsubsidized) premium changes depend on the specific plan (for each insurer, premium changes vary from one plan to another), as well as the enrollee’s age and zip code.
So, for the majority of Covered California enrollees, net premium changes will depend on how their specific plan’s rate changes, as well as year-over-year changes in their subsidy amount.
If the cost of your current plan is increasing for the coming year, you may want to consider some of the other plans that are available via Covered California. You might find some that are less expensive and offer similar benefits.
Here’s a look at how average full-price (pre-subsidy) premiums have changed over the years in California’s individual/family market:
How many people are insured through California’s Marketplace?
CMS reported that 1,736,391 people had enrolled in 2024 plans through Covered California by January 13, 2024.41 There were still a few weeks left in open enrollment at that point (through February 9).
During the open enrollment period for 2023 coverage, a total of 1,739,368 people selected private plans through Covered California.42
Here’s a summary of historical enrollment numbers for Covered California:
Source: 2014,43 2015,44 2016,45 2017,46 2018,47 2019,48 2020,49 2021,50 2022,51 202342
What health insurance resources are available to California residents?
Covered California: This is California’s Marketplace/exchange. Residents can use Covered California to enroll in individual/family health plans and receive income-based subsidies, and also to enroll in Medi-Cal. You can contact Covered California at 800-300-1506.
California Department of Health Care Services: The agency that administers Medi-Cal and various other health care programs.
California Department of Managed Health Care (DMHC): Regulates the vast majority of California’s commercial (non-self-insured) health plans, and assists consumers and businesses with insurance-related questions and concerns.
California Department of Insurance: Regulates California’s insurance plans that aren’t regulated by the DMHC. If a complaint or concern is filed with the DMHC and it’s for a product that’s regulated by the Department of Insurance, it will be forwarded to the Department of Insurance.
California Health Insurance Counseling and Advocacy Program (HICAP): A service for California Medicare beneficiaries and their caregivers. HICAP provides information and assistance with questions related to Medicare eligibility, enrollment, and claims.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- “Penalty” CoveredCA.com, Accessed August 2023 ⤶
- Covered California for Small Business, Health and Dental Plans. Covered California. Accessed December 2023. ⤶
- “Covered California 2024 Patient-Centered Benefit Plan Designs” CoveredCA.com, June 16, 2022 ⤶
- “Standardized Plans in the Health Care Marketplace: Changing Requirements” KFF.org, May 8, 2023 ⤶
- “July 2023 Medicaid & CHIP Enrollment Data Highlights” Medicaid.gov, Accessed September 2023 ⤶
- “Medicare Monthly Enrollment” CMS.gov, May 2023 ⤶
- “CA SB910” BillTrack*50*, Accessed August 2023 ⤶
- “Availability of short-term health insurance in California” healthinsurance.org, Aug. 14, 2023 ⤶
- “Who can get a health plan through Covered California?” CoveredCA.com, Accessed August 2023 ⤶
- “Medicaid eligibility and enrollment in California” healthinsurance.org, March 15, 2023 ⤶
- Medicare and the Marketplace, Master FAQ. Centers for Medicare and Medicaid Services. Accessed November 2023. ⤶
- Premium Tax Credit — The Basics. Internal Revenue Service. Accessed MONTH. ⤶ ⤶
- California Assembly Bill 570. BillTrack50. Enacted October 2021. ⤶
- California Now 1st State To Let Parents Be Added To Their Children’s Insurance Plans. CBS News Sacramento. October 2021. ⤶
- “Dates and Deadlines” CoveredCA.com Accessed August 2023 ⤶
- Covered California Announces More Time to Enroll for Coverage in 2024. Covered California. January 31, 2024. ⤶ ⤶
- “When will my coverage start?” CoveredCA.com, Accessed August 2023 ⤶
- “Who doesn’t need a special enrollment period?“ healthinsurance.org, Accessed August 2023 ⤶
- Qualifying Life Events. Covered California. Accessed December 2023. ⤶ ⤶
- California Senate Bill 967. BillTrack50. Enacted August 2022. ⤶
- “Help With Your Application” CoveredCA.com, Accessed August 2023 ⤶
- ”2023 OEP State-Level Public Use File (ZIP)” CMS.gov, March 23, 2023 ⤶
- “Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average” CMS.gov, March 15, 2023 ⤶
- “Covered California to Launch State-Enhanced Cost-Sharing Reduction Program in 2024 to Improve Health Care Affordability for Enrollees” CoveredCA.com, July 20, 2023 ⤶
- “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, March 2023 ⤶
- California Senate Bill 910. BillTrack50. Enacted September 2018. ⤶
- “Covered California’s Health Plans and Rates for 2024: More Affordability Support and Consumer Choices Will Shield Many From Rate Increase” CoveredCA.com, July 25, 2023 ⤶
- California Rate Review Submissions. RateReview.HealthCare.gov. Accessed December 2023. ⤶
- Covered California’s Health Plans and Rates for 2024: More Affordability Support and Consumer Choices Will Shield Many From Rate Increase. CoveredCA.com, July 25, 2023 ⤶
- “Covered California’s Health Plans and Rates for 2024: More Affordability Support and Consumer Choices Will Shield Many From Rate Increase” CoveredCA.com, July 25, 2023. And California Rate Review Submissions. RateReview.HealthCare.gov. Accessed December 2023. ⤶
- “Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average” CMS.gov, March 15, 2023 ⤶
- Covered California Announces Rates for 2015; Rigorous Negotiations with Health Insurance Companies Keep Rate Increases Low and Choices Robust. Covered California. July 2014. ⤶
- Covered California Holds Rate Increases Down For Second Consecutive Year. Covered California. July 2015. ⤶
- Covered California Health Plan Rates To Jump 13.2 Percent In 2017. KFF Health News. July 2016. ⤶
- 2018 Rate Hikes. ACA Signups. October 2017. ⤶
- Covered California Releases 2019 Individual Market Rates: Average Rate Change Will Be 8.7 Percent, With Federal Policies Raising Costs. Covered California. July 2018. ⤶
- 2020 Rate Changes. ACA Signups. October 2019. ⤶
- California’s Efforts to Build on the Affordable Care Act Lead to a Record-Low Rate Change for the Second Consecutive Year. Covered California. August 2020. ⤶
- Covered California Announces 2022 Plans: Full Year of American Rescue Plan Benefits, More Consumer Choice and Low Rate Change. Covered California. July 2021. ⤶
- UPDATED: FINAL Unsubsidized 2023 Premiums: +6.2% Across All 50 States +DC. ACA Signups. Accessed November 2023. ⤶
- Marketplace 2024 Open Enrollment Period Report: Final National Snapshot. Centers for Medicare and Medicaid Services. January 2024. ⤶
- “Health Insurance Marketplaces 2023 Open Enrollment Report” CMS.gov, 2023 ⤶ ⤶
- “Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period” HHS; ASPE, 2015 ⤶
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report ”, HHS; ASPE, 2015 ⤶
- “Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report” HHS; ASPE, 2016 ⤶
- “2017 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2017 ⤶
- “ 2018 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2018 ⤶
- “2019 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2019 ⤶
- “ 2020 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2020 ⤶
- “ 2021 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2021 ⤶
- “ 2022 Marketplace Open Enrollment Period Public Use Files ” CMS.gov, 2022 ⤶