California Health Insurance
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Need help understanding health coverage? Learn about California health care insurance laws and regulations, California high-risk pools, and financial assistance information.
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California Health Insurance Stats
Total California Residents: 37,370,100
California Health Care Expenditures (in millions): $230,090
Median Annual Household Income: $56,074
Households with at least 1 Full Time Worker: 16,617,300
California Health Insurance Coverage based on Total Population:
- Employer: 45%
- Individual: 6%
- Medicaid: 19%
- Medicare: 10%
- Uninsured: 20%
Avg. Monthly California Individual Premiums: $157
Total California HMO Enrollment: 15,992,025
Want more information about cities in California? View the following information at:
As a California health insurance shopper, there are a few different laws to be aware of as you search for a plan.
Under California health insurance law, any HIPAA-eligible resident is guaranteed to be able to purchase a health insurance plan from any company. California health insurance companies are also prohibited from requiring exclusion periods for HIPAA-eligible residents.
Residents who have left their employer's group health plan are protected under the federal law COBRA.
Once a resident is accepted for coverage, their policy is guaranteed renewable and insurance companies cannot cancel their coverage if they get sick.
California health insurance law also requires that private health plans cover certain medical services. These required services include:
- Routine care for cancer clinical trials
- Breast, prostate and cervical cancer screenings
- Continuity of medical care for pregnant women
- Some care services for residents with diabetes
The law also requires California health insurance companies to have the same coverage limits and benefits for mental health conditions also known as mental health parity.
All insurance rate reductions or increases must be approved by the state's insurance commissioner before the change goes into effect.
Also, group health insurance for small groups of 2 to 50 people is guaranteed issue in California.
Here are the California health insurance programs for low-income residents:
Medi-Cal is the Medicaid program in California that provides health insurance for some low-income residents. If you want to learn more about Medi-Cal, visit them online. Eligibility requirements for Medi-Cal coverage can be found here.
- Healthy Families
Healthy Families is the State Children's Health Insurance Program (SCHIP) in California, designed for children under age 19 who do not qualify for Medi-Cal and cannot afford private coverage. To learn more about Healthy Families, visit their website.
- Major Risk Medical Insurance Program (MRMIP)
California also offers a high-risk pool (MRMIP) for residents with pre-existing conditions who are unable to find health insurance through a private company. To learn more about this California health insurance program, visit http://www.mrmib.ca.gov/.
- Access For Infants and Mothers (AIM)
This program provides health insurance coverage for some pregnant women who have no insurance or are underinsured. Visit http://www.aim.ca.gov/ for more information.
- Every Woman Counts
California's Breast and Cervical Cancer Treatment Program offers Medicaid coverage to eligible women who are diagnosed with breast or cervical cancer. The website for this California health insurance program can be found here.
- California Medicare
Seniors eligible for Medicare can get health insurance coverage through Medicare Advantage, Supplement and Original Medicare.
Some residents in California may also be eligible for the Federal Health Coverage Tax Credit for assistance in purchasing a plan. Visit the Internal Revenue Service (IRS) online for more information.
Universal Health Care in California
San Francisco is the only city in California that provides all uninsured residents with access to health insurance coverage. Residents earning up to 500 percent of the federal poverty level qualify for the program, Healthy San Francisco.
Only residents of the city qualify for the universal coverage, and they must receive care within the city limits. Their website is at http://www.healthysanfrancisco.org/.
The Patient Protection and Affordable Care Act established temporary national high risk pools to provide health insurance to people with medical conditions.
The Pre-Existing Condition Insurance Plan (PCIP) in California is not a public program and enrollees will have to pay monthly premiums and out-of-pocket costs similar to regular California health insurance policies.
Participants will pay around the same amount that an individual without pre-existing conditions would pay on the private insurance market. The estimated monthly cost for California residents will range between $127 for a 15 year old and $1,003 for a 74 year old. Enrollees will have to meet a $1,500 deductible and have a $2,500 out-of-pocket limit.
Enrollees in the PCIP will have coverage for physician and hospital visits, emergency services, prescription drug coverage, and more.
Individuals are eligible to enroll in the California PCIP if they have a pre-existing condition, are a United States citizen and have been without health insurance for six months.
For more information on the California health insurance high risk pool visit http://www.healthcare.gov/index.html.
The following list of companies offer California health insurance plans:
Aetna is one of the largest health insurance providers in America with more than 30 million members. Their network includes over 787,000 health care professionals.
Aetna covers more than 30 million members and is one of the largest health insurance companies in the country. Policyholders have access to over 787,000 doctors, hospitals and other health care providers.
Since 1937, Anthem BlueCross has made healthcare more affordable for California residents. Today, they have over 6.8 million members.
Assurant Health, headquartered in Milwaukee, has been offering quality insurance products and coverage to over 1 million members since 1982. Assurant is committed to providing health insurance plans that have broad coverage while providing valuable protection.
Since 1939, Blue Shield of California has been a leading health insurance provider. Today, they're a non-profit company with 3.2 million members.
Celtic concentrates on individual health insurance, offering a wide variety of plans for both individuals and families.
CIGNA is one of the oldest insurance companies in America, providing health insurance and other coverage solutions to millions of consumers around the country.
Health Net is one of the top health insurance providers in Arizona offering a wide array of plans for a diverse set of needs.
Almost 7 million Americans from coast to coast are members of Health Net. With affordable health insurance plans, policyholders get access to high-quality care.
For residents of California, Nationwide provides affordable access to health care with plans for individuals, families, and seniors.
John Alden Life Insurance has been selling health coverage throughout America since 1961. Today, they are part of Assurant. John Alden plans include individual health and small group coverage. They also sell Health Savings Account plans.
Kaiser Permanente is the nation's largest non-profit health insurance provider with 8.2 million members across 9 states in the U.S.
Today, Time Insurance is known as Assurant Health with insurance coverage for individuals, students, families, seniors, and businesses.
Today, Time Short Term health insurance is offered through the Assurant name. Time short term health plans provide comprehensive coverage for a temporary period of time at affordable rates.
World Insurance offers several types of individual health insurance ranging from dental coverage to comprehensive major medical plans.
Find the contact information for the California health insurance and health care services departments at:
Consumer Services Division
300 South Spring Street, South Tower
Los Angeles, CA 90013
Phone: (916) 322-3555
P.O. Box 997413
Sacramento, CA 95899-7413
Phone: (916) 445-4171