Welcome to our Consumer Guide to obtaining quality health insurance in California.
The health insurance market in California is completely unique unto itself, with many pro’s and con’s and opinions on what works and what doesn’t. California has its own rules about many weird things, from phlebotomy training requirements to Starbucks card cash refunds (look it up!). We’ve laid it all out for you to help you figure out which health insurance is right for you:
Free California Medical Insurance
If you or someone that you love needs affordable medical insurance in California, quite surprisingly you have a few options.
AIM Program (Access for Infants and Mothers): This is for newborn infants and and pregnant mothers. This is NOT to be confused with AIM Health Plans or GetMed360 which are trumped up discount cards passed off as credible health insurance plans.
CaliforniaKids: California CHIPS program for children ages 2-18.
California Children’s Services (CCS) : this is a state program that provides medical insurance benefits for children with qualifying disabilities and conditions.
Healthy Families: a state run program that provides children from low income families with low cost health and dental benefits.
CalMedicare: provides financial assistance to California seniors, who may need assistance with paying Medicare premiums.
County Medical Services Program (CMSP): A county by county program that assists California residents with low income and finding health benefits.
Medi-Cal: a federal and state health benefits program provided to California residents with low incomes and or expensive disabilities.
Pre-Existing Condition Insurance Plan: a guaranteed issue California medical insurance plan through the state of California that will cover pre-existing conditions if a resident has been declined within the last 12 months and has been uninsured for the last six months. This is not free health insurance applicants must be a premium for coverage
California Group Medical Insurance
Many California small and large businesses purchase medical insurance in California for their employees for a myriad of different reasons. But the most beneficial is that it raises employee morale, and business owners can write 100% of health insurance premiums on their taxes.
Also, quite a few small business owners will use the California Medical Insurance market to provide health benefits for themselves, especially if they can not find affordable California medical insurance on the private market, or are uninsurable.
Health Savings Account eligible plans are also a big hit with group medical insurance clients, not only can they write off 100% of their health insurance premiums under a group plan as an employer, they can also write off covered medical expenses through an HSA account on a PRE-TAX basis! Resulting in literally, cutting their medical costs 30-50%!
Group Health Insurance plans in California are available to groups with as little as only two employees. Many “Mom and Pop” outfits will enroll in a group plan, if they have been declined in the past or want more comprehensive coverage than an individual and family health insurance policy can provide for them.
With all of this being said, California group insurance is not inexpensive to say the least. Remember, group insurance is Guaranteed Issue-they CAN NOT decline to offer you coverage based on your health history, and these plans cover many expenses that individual plans do not like MATERNITY COVERAGE.
Expect a California small group medical plan to run $300-700 for an individual and $700-2000 for a family.
California Individual & Family Medical Insurance
Individual and Family medical insurance in California is not guaranteed issue like California group medical insurance plans. The only final price is the rate that the insurance company issues your policy at.
Private health insurance plans in California are underwritten. Much like when purchasing a home your interest rate is based on your financial history, in a similar manner private health insurance plans are actually based on a client’s health history.
California unfortunately has a pretty restrictive individual health insurance market. There are only a handful of carriers left who can make this business work with the various mandates that the California Department of Insurance requires each plan have.
In California you can purchase an individual and family health insurance plan from carriers such as Blue Cross, Blue Shield, Aetna, HealthNet, and Kasier to name the main carriers who are price competitive.
Even though there are literally over 100 plans in any giving county, there are just three basic types of plans with very little variation across the board.
High Deductible Health Plan: you may have seen these referred to as consumer driven health plans, major medical, catastrophic or an HSA plan. this is a bare bones no-frills full coverage kind of plan. all medical expenses count toward one plan deductible does it matter if the doctor visit lab testing our patience surgery or a prescription medication. once the deductible is met normally you are covered at 100% for the rest of the calendar year.
The value in this kind of plan is the fact that all expenses count towards the deductible.
For example if you were to go with a cadillac styletype plan that cover doctor visits and medications at a co-pay, those $30-$40 co-pays for doctor visits and $30-$60 co-pays for medications plus usually a $500 deductible for brand drugs would not count towards the plan deductible on your California Medical Insurance policy.
If you like knowing you only have to meet your deductible and that’s it nothing else comes out of your pocket then you need to go with a high deductible health plan. Also keep in mind I high deductible health plan is that necessarily need to have a high deductible. Individuals can get a deductible’s low as $1200-$1500.
Copay Plans: these are similar in design to the benefits enjoyed a large group insurance plans. Dr. visits and medications are usually covered at a co-pay or a flat fee-for-service.
Some have said that copay plans are similar to purchasing a used car based on the monthly payment and not the total cost of the vehicle over the term. one important fact to consider when comparing total pay plans to a high deductible health plan is that most California health insurance plans do not cover lab testing under Dr. copay.
Normally what will happen if your doctor will give you a prescription to go to your local lab facility for diagnostic testing.under most California group health insurance plans lap testing would be covered under the doctor co-pay, not so for individual and family health insurance plans purchased in California.
Hospital Surgical Plans: these types of california medical insurance plans leave the consumer with all the risk in their lap.
You see a California hospital surgical health insurance plan only pays out if you are hospitalized or needed surgery.
Okay you might be saying to yourself that’s fine that’s all I need insurance for, but the truth is most large claims are for medical services received outside of a hospital setting.
Even though each carrier that offers a hospital surgical plan will have variation and plan design both of these plans are generically the same.
They don’t cover doctor visits lab testing medications durable medical equipment like pacemakers unless they are directly related to an inpatient hospital he stationed and/or inpatient outpatient surgery.
Think for a moment what medical expenses drain the largest health insurance plan in the country Medicare.
It’s not hospital stays that surgeries its prescription medications. Prescription drugs account for at least 25% of all california medical insurance claims.
Some studies show even up to 35 to 45%. Now that should show you that if the health insurance carriers and the government are concerned prescription drugs you should be concerned about making sure your persuasion drug coverage as well.
Because after all if you see yourself unhealthy now I don’t need drug coverage and go with a hospital surgical plan doesn’t cover prescription drugs than if you end up needing medications you will be able to change to a plan that will cover it because you be deemed uninsurable.
Blue Shield of California is actually a not for profit health plan that was founded in 1939 in San Francisco, California.
California Blue Shield serves almost 3.5 million health plan members and gives clients access to over 65,000 physicians throughout the state of California.
California Blue Shield was founded by the California medical Association.
Blue Shield of California has actually been in the California Health Insurance business for over 60 years serving California residents with innovative health insurance products for individuals and families, groups, and Medicare insurance products for seniors.
California Blue Shield is a sister company if you will to Anthem Blue Cross of California.
They used to be one company, like in most states , however they split off many years ago to better serve their clients.
Blue Shield of California and healthcare reform:
Back in 2002, Blue Shield of California became the first health insurance carrier that proposed a solution for universal health coverage for Americans.
They called it “universal coverage universal responsibility”, and essentially required everybody from individuals, business owners and the state and federal government to chip it. Sadly, it really never went anywhere.
Blue Shield of California reviews:
Back in 2009, Blue Shield of California received three out of four stars on the California healthcare quality report card.
Blue Shield of California PPO
California Blue Shield does offer individual and family health insurance plans that utilize a preferred provider organization.
So if you want a plan where you can pick and choose any Dr. to you want, with the understanding that you’ll have higher deductibles and coinsurance. Then an PPO plan from Blue Shield of California, will probably fit the bill for your situation.
Blue Shield of California HMO
California Blue Shield also offers HMO products.
Essentially, the way the plan would work is in exchange for low co-payments and deductibles and most services being covered at a co-pay the California Blue Shield HMO is essentially in charge of your health care choices.
With a PPO plan your Dr. only gets paid when they provide a service.
With a HMO plan they get paid a set amount for every client or patient that is assigned to them regardless of the amount of services that are provided.
Blue Shield of California health plans:
Blue Shield in California offers health insurance products for individuals and families, small and large group, as well as Medicare products for seniors:
Blue Shield of California health insurance
Blue Shield of California life insurance
Blue Shield of California Medicare insurance
Blue Shield of California group insurance
Blue Shield of California contact info:
Blue Shield of California
50 Beale Street
San Francisco, CA
Top 10 California Health Insurance Providers:
So there are about a handful of health insurance companies in California that are affordable and offer competitive health insurance plans
- Pacific Care
- Aetna (AARP Brand)
- Blue Shield of California
- Anthem Blue Cross
- Health Net
What you will find in California is that only a small handful of carriers are actually a good fit.
Some California Health Insurance Providers, aren’t competitive due to a number of reasons such as:
If a carrier has a small selection of providers, what happens when you travel to another state?
You will have an out of network deductible, which pretty much means that bill is coming out of your pocket, because it’s unlikely you will meet your out of network deductible.
Even travelling within California, it’s important to consider a carriers network of doctor’s and hospitals.
What if they are great let’s say is San Diego, but if you go up to Santa Barbara for a new job and find the “pickin’s are slim”?
Small Client base;
Unless you specifically want an HMO plan from Kasier, you really want to stick with the bigger carriers like Blue Cross and Blue Shield and Aetna.
The reason for this is the less consumers who sign up and then what ends up happening is the insured already on the plan experience large rate increases since there isn’t any “fresh blood” coming in to offset their medical claims.
Another consideration when looking at a regional local carrier is that, the smaller the network, the higher your costs will be until your deductible is met.
If you are looking for a PPO plan from health insurance companies in california such as Aetna, Blue Cross and Blue Shield for example, you will find that your costs until your deductible are met will be lower vs a non player such as Celtic or Assurant Health.
Compare california health insurance plans that are similar in deductible , copays and design from the major players in your country.
Also if you need California Dental Insurance, California Group Health Insurance, California Life Insurance or California Auto Insurance comparisons we can help with that as well!
Kaiser Permanente is a non-for profit health plan that was started back in 1945 and is headquartered in Oakland, California.
Kaiser offers individual and family health insurance, group health insurance not only in California but also in Georgia, Ohio, Maryland, Virginia, Washington state, and the District of Columbia.
As a non-for profit health plan. Kaiser Permanente is organized and three organizations which are Kaiser foundation health plans, Kaiser foundation hospitals, and the permanent day medical groups which is a for profit professional organization for physicians.
Kaiser is actually the largest non-profits health plan in the US and they serve over 9 million consumers in nine different states plus the District of Columbia
What makes Kaiser Permanente special?
Kaiser Permanente is not a traditional California health insurance company, it is a group health plan.
So if you are approved, and become a member of the Kaiser health plan you will pick a doctor, and then you and your chosen doctor will make decisions based on your health care together.
One important fact to keep in mind when comparing Kaiser health insurance plans, is that Kaiser is an HMO.
If you are not familiar with how an HMO works, with most HMO plans, especially those offered by Kaiser in California, you must use their network of providers or essentially won’t be covered for non-emergency services.
That is why HMO plans have very low out-of-pocket costs when you use medical services and that is why the premiums for an HMO are much higher than a PPO plan, within HMO you are basically pre-paying for services you may or may not use, maybe because most people are used to having a benefit rich HMO from an employer in the past.
What kind of services do Kaiser plans cover?
well-baby and prenatal care
hospital and medical services
Kaiser California Health Insurance Plans are also big on giving back to the community by:
providing assistance to the uninsured and special populations
training new health professionals
introducing new delivery methods into the health care field
developing and sharing better ways of caring for patients
Kaiser Permanente offers individual and family coverage for individuals who may be: self-employed, working for a company that does not offer a group plan, a student or recent graduate, overage or not covered on their parent’s plan, between jobs, waiting for an employer’s group coverage to begin, a part-time employee who isn’t eligible for group coverage, or an early retiree.
Here are just a few of the advantages Kaiser Permanente offers members:
Our commitment that you’re in control of your health care decisions
A diverse choice of plans and plan types
Protection when you need it, as well as coverage for routine preventive health care needs
Special services for members only, such as online access to your personal health record, e-mail connection with your doctor’s office, and online prescription refills
Products and services targeted specifically to individuals, as well as to small, mid-sized, and large employers, plus Medicare-eligible individuals
The trust and recognition that comes from decades of service to the communities we serve
Strong, stable financial performance year after year, augmented by our reinvestment of earnings into our care delivery model and our community health programs
Our integrated health care system means that our doctors, nurses, pharmacists, and other health care professionals are all focused on one goal – our patients’ well-being. Since the Health Plan is integrated into health care delivery through our hospitals and medical offices, our doctors are empowered to work with you on vital decisions about your treatment without needing to defer to an outside decision-maker, such as an unrelated insurance company, for an approval – or denial – of care.
Where are Kaiser health plans available?
California: Capital, Central, East Bay, Golden Gate, North East Bay, South Bay, Coachella Valley, Inland Empire, metropolitan Los Angeles/West Los Angeles, Orange County, San Diego County, The Valleys, Tri-Central, Western Ventura County
Colorado: Denver, Boulder
Georgia: metropolitan Atlanta
Hawaii: Hawaii, Oahu, Kauai, Maui
Mid-Atlantic: Baltimore, northern Virginia, Washington, D.C.
Oregon: Portland, Longview-Vancouver, Salem
Ohio: Akron, Cleveland
Kaiser Permanente: California Health Insurance Plan Benefits Review
Physician Office Visits: $30 after ded.
Hospital Co-payment: $500/day after ded. In Network
Maternity: $500/day after ded.
Prescription Drugs: $10G $35BF ($250 ded) $50 Copayment
Physician Office Visits: $50
Hospital Co-payment: $500/day In Network
Prescription Drugs: Not Covered
Physician Office Visits: $20 after ded.
Hospital Co-payment: $100/day after ded. In Network
Maternity: $100/day after ded.
Prescription Drugs: $10G $35BF ($250 ded) $25 Copayment
Physician Office Visits: $25
Hospital Co-payment: $200/day In Network
Prescription Drugs: $10G $35BF ($250 ded)
Aetna California History
Many residents shopping for a California health insurance policy are quite surprised to learn that Aetna in CA has been in business for over 150 years.
Aetna has a wide and diverse provider network with over 800,000 primary care and specialist physicians. In addition to thousands of hospitals across the country.
Aetna California Insurance Plans
California Aetna health insurance plans are available for individuals and families, groups and seniors who need a Medicare supplement or advantage plan.
California Aetna health insurance plans
California Aetna life insurance plans
California Aetna dental insurance plans
California Aetna Medicare insurance plans
California Aetna Contact Information
2625 Shadelands Drive
Walnut Creek, CA 94598
Customer service phone number:
Customer service TTY/TDD number:
Customer service hours/availability:
8 a.m. – 6 p.m., M – F