California Health Insurance: 2021 Coverage Guide

Fran
Fran Majidi
September 2, 2020

California Affordable Healthcare Insurance

Not only does California have one of the earliest and longest open enrollment periods in the country but if you live in this state you have several options when it comes to getting the health plan you need. It’s always best to try and enroll within the open enrollment period, otherwise you may need to wait another year to buy health insurance. However, if you have a qualifying event, you may buy health care coverage right now..

When Is Open Enrollment in California?

November 1, 2020 - December 15, 2020. Coverage begins January 1, 2021.

How to Get Health Insurance in California

Take a look at last year’s health insurance costs, the type of coverage you had and what tier it was. What were your out-of-pocket expenses for medications and copays/coinsurance? If you want to save some money consider how much each tier covers: bronze: 60%, silver: 70%, gold: 80% and platinum: 90%. But note that the higher coverage plans cost more each month. Calculate which one would’ve saved you the most money last year so you can choose that plan now! If you anticipate surgeries and many doctor visits, even more than you had last year, you may consider bumping up a tier for 2021.

Regardless of which level of coverage fits your needs, you should always compare health insurance companies and health insurance quotes. After you submit the form from SmartFinancial you’ll get several competing health insurance rates to choose from, and we’ll connect you with an agent in your area so you can buy the coverage or ask questions about the plan you’re considering.

What Types of Health Insurance Are Available in California?

Most people in California purchase HMOs, EPOs, PPOs and POS plans.

Does Health Insurance Cover Pre-existing Conditions?

The Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

Compare Health Insurance Plans in California

Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • If you start a new business, lose a job, quit a job or change jobs where health insurance is not offered, you may buy a new health insurance plan.
  • When you turn 26, you are no longer able to remain on your parent’s health insurance plan, but you may buy a new plan.
  • Some insurance carriers only cover members in certain areas or states. If you move and become ineligible for coverage with your current carrier, you may buy a new health plan.
  • If your Cobra extension reaches the deadline, you can buy a new health insurance policy.
  • If you were married and shared a health plan with your spouse but you divorced, you can enroll in an individual health plan.
  • Married people often share health insurance. If you were in this situation but you divorced, you can buy a new health plan.
  • If you recently got married, you can buy a new plan as an individual or as a couple.
  • New parents may buy a health insurance plan for the child.
  • If you shared health insurance coverage with a spouse or partner and that person dies, you are eligible to buy a new plan.
  • If you shared health insurance coverage with a spouse or partner and that person loses coverage for a qualifying reason, you can buy another plan together. You can also buy an individual plan if you prefer.

Is Health Insurance Required in California?

Yes, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty.

How Much Is Health Insurance in California?

The average cost of health insurance in California for a 40 year old is about $576 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in California

The best way to save on health insurance in California is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs


Medicare in California

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in California?

Only 16% of the residents of California are on Medicare.

How Much Is Medicare in California?

If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in California

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in California?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.


California State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2019 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the California Health System is listed below:

  • California: Overall State Ranking: 14 of 50
  • California: Overall Performance: Better Than Average
  • California: Access & Affordability: 22
  • California: Prevention & Treatment: 35
  • California: Avoidable Hospital Use & Cost: 14
  • California: Healthy Lives: 5
  • California: Health Care Disparities: 4
Find Affordable Health Insurance in California

California Health Insurance Coverage

The people of California have different kinds of health insurance while some California residents are not insured at all. See the breakdown below:

  • Private coverage: 50%
  • Medicaid: 26%
  • Medicare: 16%
  • Uninsured: 8%

Report: America's Health Insurance Plans

California Health Insurance Companies

The following carriers offer health insurance and/or medicare in California.

Get a Free Health Insurance Quote Online Now.

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