Understanding Individual Health Insurance in California 

What if staying on top of your well-being and safety was easier than you ever imagined? 

It’s important for everyone to have good medical coverage. Unfortunately, the average resident doesn’t always understand individual health insurance in California. Without the right knowledge, it may very well be impossible to make the best decisions regarding your medical care. 

Fortunately, that goes both ways. Once you learn enough about California health insurance plans, you can make the kind of decisions that help you save money without compromising your level of care. Keep reading to discover everything you need to know about buying individual protection in California! 

Introduction to Individual Health Insurance in California 

Want to learn more about individual health insurance in California? First, you need to understand the basics, like the importance of investing in a comprehensive medical plan. 

Below, you’ll find more info about the importance of being insured and the different coverage plans offered in the state. This information can help you take better care of yourself, now and in the future. 

The Importance of Being Insured in the Golden State 

One financial reason you need California health insurance is that without it, you may have to pay a penalty on your tax returns. Beyond that, medical care services are important because they can help you maintain your overall health and fitness, whether that means dealing with major problems or keeping small issues from developing into something bigger. 

Overview of California’s Health Insurance Landscape 

As a state resident, the best way for you to explore plans in California is by visiting the Covered California website. This helps individuals such as yourself shop for the best California medical plans and also helps you discover if you qualify for Medi-Cal or any government subsidies on healthcare services. It can be confusing to navigate all your choices, so if you need help, call the knowledgeable agents at Cost-U-Less for help at 800-390-4071.  

Deciphering the Health Insurance Market 

It can be difficult for residents to learn about individual health coverage in California because they may be used to relying on their employers to provide coverage. Purchasing your own plan can be daunting if you don’t know how to decipher choices like plan names and decutibles. 

Below, you’ll learn more about the plans available to you and some key terminology. This should clear up some of the confusion and help you make the best possible choices for yourself. 

Types of Health Insurance Plans Available to Individuals 

There are generally four types of plans available in the California marketplace. This includes: 

• Exclusive Provider Organization plans: Where non-emergency medical services are only available if you use in-network doctors.
• Health Maintenance Organization plans: Where you are typically limited to only HMO doctors in-network and may have to live in a certain area.
• Point of Service plans: Where you get discounts for doctors in your network but need a primary care referral to see specialists.
• Preferred Provider Organization plans: Where you pay less for in-network doctors but can use out-of-network professionals without a referral. 

Key Health Insurance Terms You Need to Know 

Just like with other types of insurance, there are phrases and words with health insurance that you may not completely understand. Here are a few examples: 

• Deductible: An amount that you must reach every year before your plan pays for anything. The lower your deductible, the higher your premium.
• Premium: This is what you pay for your policy in California … basically, the regular bill for your coverage. Most people pay each month, though some customers pay quarterly or annually.
• Health Savings Account (HSA): A special savings account where you can deposit pre-tax money. You can then make tax-free withdrawals to pay for qualified medical costs and lower your overall tax obligation.
• Out-of-Pocket Maximum: Even with good coverage, the cost of individual health insurance in California can get pricey thanks to out-of-pocket costs. Fortunately, there is a maximum amount of such costs you can be charged ($9,450 for individuals in 2024). Afterward, the carrier will pay the costs of any essential care you receive.
• In-network providers: The list of medical professionals covered by your particular plan. In order to keep the cost of individual medical insurance plans in California as low as possible, you should always use providers within your network if possible. 

Shopping for the Right Coverage 

Buying individual health insurance in California can be pretty intimidating. That’s because you need to find the proper balance between coverage that meets all your needs and a premium that doesn’t break the bank each month. 

Fortunately, there are a few tips that can help you when shopping for health plans. With these tips, you can get a plan that meets all your individual.

What to Look for When Picking a Plan 

The first step in picking your California insurance plan is to determine whether you will get coverage through your employer or through the Covered California marketplace. If you are mostly looking to save money, keep in mind employer coverage tends to be cheaper. 

If you are going through the marketplace, you need to review the benefits summary of different kinds of plans. This includes learning what the out-of-pocket costs will be and what the pros and cons are (for example, HMOs can be annoying due to requiring physician referrals, but these plans tend to be cheaper than others). 

Finally, you’ll need to determine how large you want your network to be. Most residents prefer larger networks to give themselves more options. 

The Enrollment Process: Dates and Deadlines 

When purchasing health insurance in California for individuals, one of the most important things to know about open enrollment is that it runs from November 1 through January 31 each year. If you experience a qualifying life event (including getting married, having a baby, or losing existing coverage), then you can enroll at other times throughout the year. Otherwise, you cannot purchase a health policy or change your plan outside of the enrollment period. 

Cost Considerations for Consumers 

With most plans, your goal is simple: you want the best coverage at the lowest price. Of course, in order to save, you need to know about certain cost considerations. After doing your research, you’ll find that it’s possible to get low-cost or free health insurance in California. 

Below, you’ll find a breakdown of what you need to know to save, as well as financial assistance options that may be available. 

Understanding Premiums, Deductibles, and Out-of-Pocket Costs 

Your premium is basically your coverage bill — the amount you pay each month (unless you pay annually). Your deductible is how much you have to pay for medical bills before the insurance kicks in to pay a percentage or the entire cost. Different plans (like HMO versus PPO) will have different out-of-pocket costs, and this should be considered when selecting plans. Thoroughly reviewing your options can ultimately help you choose the right California health plan. 

Financial Assistance Options: Subsidies and Medi-Cal 

You can use this online tool to determine if you qualify for Inflation Reduction Act savings that replaced the previous state subsidies on medical insurance in California for individuals. If you apply for a policy through Covered California and meet certain requirements (including your income, your other plans, and various other factors), you may qualify for Medi-Cal, which is the state’s Medicaid health care program. 

Going Beyond Basic Health Insurance 

Most people think of medical insurance in California as standard coverage for individuals. However, there are a variety of additional coverages that you can add. These provide more protection but at an additional cost. 

What other forms of coverage are available, and are they really worth it? Below, you’ll find more information about your options so you can discover which policy you can’t live without. 

Exploring Dental, Vision, and Supplemental Insurance Plans 

Does California health cover extras? The basic plan only covers so much, and this coverage doesn’t extend to dental care or eye care. If you want to reduce the cost of such care, you can purchase a separate dental and vision policy. Additionally, if you are currently on Medicare, there are a number of additional plans to supplement your existing coverage and ultimately lower how much you have to pay for care. 

Mental Health Coverage and California’s Mental Health Parity Laws 

As detailed above, there are limits to what California medical protection covers, which sometimes requires the purchase of additional plans. Fortunately, the state’s Mental Health Parity Act ensures that mental care and treatment for substance abuse disorders must be fully covered by your policy. 

Secure Your Future: Get Your Individual Health Insurance Today! 

Now, you know more about how to research and purchase individual health insurance in California. This includes important enrollment deadlines and how to select the plans that best suit your needs. If needed, you also know how to research and purchase additional coverage, including dental and vision. 

However, do you know where to find the best coverage at the most competitive prices in California? Here at Cost-U-Less, we know you don’t deserve just any plan. You deserve coverage from a carrier that works just as hard as you do. When you’re ready to get the best for yourself, just give us a call at 877-423-5652 or get a fast health insurance quote online. You can also find a Cost-U-Less office near you.