The California Health Care Insurance Market

Health care insurance in California can be a daunting task. To begin with, California actually has one of the most competitive healthcare insurance markets in the Country with many more competing companies than most (if not all) States. This is good news for the consumer but it also provides a level of complexity in trying to compare the available options to individuals, families, companies, and seniors. Let’s first take a high level view of the marketplace and then dig a little deeper into how to successfully find the best health care plan available. First, some broad strokes about the market.

Segmentation of the California healthcare insurance market

The Golden State’s health care insurance market is separated by how current law treats various groups that are seeking insurance. Let’s look at the three main categories and also touch on the various options that are not considered personal health insurance. We’ll list them in size of the total California population.

Group or Employer Sponsored Health Care Insurance

This is how most people still get their health care coverage but at a decreasing level going forward. This includes insurance through an employer including the various government employers such as State, Federal, and Local government. Group health care insurance is under a separate subset of laws and rules ever since the passing of AB1672 which mandates guaranteed issue for group health care along with other requirements. Much of what is included in the Reform bill already exists in the Group health care market for California due to AB1672. You can find more information on how the group market works at our California Group Health Center

Individual and Family Health Care Insurance

The next group is comprised of people who generally do not have group health care insurance (above) and must buy their own personal coverage. They constitute self-employed individuals, employees and/or dependents who do not receive group health care benefits, students, retirees (under age 65). This segment will undergo the biggest change with health reform as the coverage will be made guaranteed issue, have health subsidies available depending on income level, and see a complete change to the plans available on the market. This health care insurance market is the most price sensitive since people are paying their entire premium. It is currently medically underwritten which means you can be declined coverage or rated up depending on health but again, this is going away Jan 1st 2014. More detail is available at our California individual Family Health Care Center

Senior Health Care Market in California

For people age 65 and over, there is separate market altogether as Medicare becomes the dominant center of gravity around which private options orbit (and supplement). Medicare is a Federally provided health care insurance for Seniors which insures the vast majority of people over age 65 (and permanently disabled under age 65). There are two approaches to health care insurance to fill in the holes of traditional Medicare. One is to purchase a Medicare Supplement which addresses deductibles and co-insurance required by Medicare. Medicare Supplements offer the most flexibility in terms of provider selection but are more costly. Alternatively, there are Medicare Advantage plans which function as Medicare HMO’s. They can be no or low cost but will narrow access to providers and have more rules in terms of accessing health care. You can find more information at our California Senior Health Care Center

Federal and State Health Care Options

There are a number of Californians that receive their health care insurance through government-sponsored programs such as MediCal (California’s version of Medi-Cal), Health Families, AIM, MRMIP, PCIP, and other agencies. These programs are generally geared towards helping people which are unable to partake in the other three categories of health care insurance markets due to health, income, or other qualifying events and they provide a vital safety net to the market.

Finding affordable Health Care Insurance

Each market is very different and the approach is equally different. We advise to first check out the Centers mentioned above for more detail in how they work. You can always run a free insurance quote by market segment and if you’re new to the market, we advise discussing your health care needs with a licensed professional. Although we have 100’s of articles on almost any aspect of each market, the simplest approach is to email or call an experienced and impartial third party advocate. That’s us!