Key Facts: California Health Insurance
- Medicaid Expansion Expanded (2014)
- Marketplace Type State-Based (Covered California)
- Medicaid Program Medi-Cal
- Individual Mandate Yes (State Mandate)
- Open Enrollment Nov 1 - Jan 31
- Uninsured Rate ~6.5%
Medi-Cal: California's Medicaid Program
Medi-Cal is California's Medicaid program, providing free or low-cost health coverage to millions of Californians. California has one of the most expansive Medicaid programs in the nation.
Who Qualifies for Medi-Cal?
You may qualify for Medi-Cal if you meet these requirements:
- California resident
- Income at or below 138% of the Federal Poverty Level (FPL)
- Meet other program requirements
Income limits for 2025:
| Household Size | Annual Income Limit |
|---|---|
| 1 person | $20,783 |
| 2 people | $28,208 |
| 3 people | $35,632 |
| 4 people | $43,056 |
How to Apply for Medi-Cal
You can apply for Medi-Cal year-round through:
- Online: Through Covered California at CoveredCA.com (they'll determine if you qualify for Medi-Cal)
- Phone: Call Covered California at 1-800-300-1506
- County office: Contact your local county social services office
- In-person: Certified enrollment counselors available statewide
Covered California: The State Exchange
Covered California is California's state-based health insurance marketplace. It's one of the largest and most successful exchanges in the nation, known for competitive pricing and strong consumer protections.
Why Covered California Stands Out
- Strong competition: Multiple insurers in every region keeps prices competitive
- Standard benefit designs: Easier to compare plans across insurers
- State subsidies: Additional California subsidies on top of federal tax credits
- Robust outreach: Extensive enrollment assistance available
- Consumer protections: Strong oversight and rate review
2025 Open Enrollment Period
California has an extended open enrollment period:
- Open Enrollment: November 1, 2024 - January 31, 2025
- Deadline for January 1 coverage: December 15, 2024
Insurance Companies on Covered California
Major insurers offering plans through Covered California:
- Anthem Blue Cross
- Blue Shield of California
- Health Net
- Kaiser Permanente
- Molina Healthcare
- Oscar Health
- LA Care (Los Angeles)
- Sharp Health Plan (San Diego)
- Chinese Community Health Plan (San Francisco)
- Valley Health Plan (Santa Clara)
California's Individual Mandate
California has its own individual mandate requiring residents to have health coverage or pay a penalty. This went into effect in 2020 after the federal mandate penalty was reduced to $0.
2025 Penalty Amounts
If you don't have coverage, you may owe:
- $900 per adult and $450 per child, OR
- 2.5% of household income above the filing threshold
- Whichever amount is greater
Average Health Insurance Costs in California
California has competitive pricing due to strong insurer competition and robust state oversight.
| Plan Type | Average Monthly Premium |
|---|---|
| Bronze | $350 - $450 |
| Silver (Benchmark) | $450 - $600 |
| Gold | $520 - $680 |
Regional Variations
- Bay Area: Higher premiums but excellent Kaiser options
- Los Angeles: Many plan choices, competitive pricing
- Central Valley: Fewer options, moderate pricing
- Rural areas: Limited insurers but subsidies help offset costs
Frequently Asked Questions
What is Covered California?
Covered California is California's state-based health insurance exchange, one of the largest and most successful in the nation. It offers ACA-compliant health plans with premium subsidies and additional state subsidies for eligible Californians. Over 1.8 million people enroll through Covered California annually.
What is Medi-Cal and who qualifies?
Medi-Cal is California's Medicaid program. You may qualify if you're a California resident with income up to 138% FPL ($20,783 for an individual). California has expanded Medi-Cal to cover all income-eligible adults regardless of immigration status, making it one of the most inclusive programs in the nation.
Does California have an individual mandate?
Yes, California has its own individual mandate requiring residents to have health coverage or pay a penalty. The penalty for 2025 is $900 per adult and $450 per child, or 2.5% of household income above the filing threshold, whichever is greater. Exemptions are available for various circumstances.
How much does health insurance cost in California?
Average Silver plan premiums in California range from $450-600/month before subsidies. However, California offers state subsidies on top of federal tax credits, and many Californians pay $50-150/month after subsidies. Those under 150% FPL may pay $0-1/month for Silver plans.
Need Help Finding Coverage in California?
Whether you need Medi-Cal or Covered California, our licensed agents can help you navigate your options and find the best plan for your needs.
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