California health insurance

Health insurance in California

● The California state exchange is considered one of the most successful.

● California state implemented an individual mandate and subsidies for state premiums in 2020.

● California's state open enrollment continues until January 31 each year. A special enrollment period due to COVID-19 continues until August 31, 2020 for uninsured residents.

● Eleven insurers offer 2020 coverage in California's individual market, with an average premium increase of less than 1% for 2020.

● California's state new law means that many independent contractors were reclassified as employees in February 2020 and eligible for labor law protections.

● About 1.54 million Californians signed up for 2020 coverage through the exchange.

● California state accepted the ACA's Medicaid expansion in 2013; total membership in MediCal was about 12.5 million people in mid-2020.

● California state law prohibits the sale or renewal of short-term health insurance as of 2019.

● Nearly 6.4 million Californians were enrolled in Medicare in early 2020.

The website healthinsurance.org was created to provide assistance to people evaluating their individual health insurance options, and this page is specifically focused on resources on health insurance options in California. Here you will find information about the many types of health insurance coverage available. You can find the basics of the health insurance market and sign up during the next open enrollment period; a brief overview of Medicaid expansion in California; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of California health insurance resources for residents.

California's health insurance marketplace

You can use the insurance market to sign up for health care and to see if your income level makes you eligible for subsidies or cost-sharing reductions (CSR) to help you pay monthly premiums and other expensive out-of-pocket expenses (such as a deductible or copay). The health insurance market is a good option for people

or households that own a small business or are employed by an organization that does not provide health insurance coverage.

California's state exchange, Covered California, is widely regarded as one of the most successful established under the Affordable Care Act. During the open enrollment period for 2020 coverage, 1.54 million people enrolled in private plans through Covered California.

California enacted legislation in 2019 to create a state-based individual mandate and a state-based premium grant program, both of which went into effect in 2020. The individual warrant has a non-compliance sanction that reflects the federal sanction in place in 2018. California has allocated $295 million in state funds to provide premium subsidies to people earning between 400 and 600% of the poverty level (i.e., people who are not eligible for federal premium subsidies), as well as additional subsidies for enrollees with income between 200 and 400% of the poverty level.

Open enrollment period and dates in California

California enacted legislation in 2019 that permanently sets open enrollment dates that differ from the rest of the country. California will continue to have an open three-month enrollment period, which will run from November 1 to January 31 each year.

Due to the COVID-19 pandemic, Covered California has opened a special enrollment period for uninsured residents who do not have qualifying events, giving them until August 31 to enroll in a plan through exchange.

There are 11 insurers offering individual health plans through Covered California for 2020. Average rate changes for California medical insurance in 2020 vary by region, but the overall weighted average increase for individual plans was less than 1%, the smallest since Covered CA opened for business. The modest rate hike is largely due to California's reinstatement of an individual mandate in December 2020.

New California law requires some independent contractors to be classified as employees in May 2020

California AB5, enacted in September 2019, went into effect in January 2020 and requires some companies to reclassify some independent contractors as employees (here's a summary of the legislation). Employees are

entitlement to various benefits that are not provided to independent contractors, including minimum wage ($12/hour in California), worker compensation, employer contributions to Social Security and Medicare (FICA taxes), and overtime pay.

And under the mandate of the ACA employer, large employers (over 50 full-time equivalent employees) are required to offer their full-time employees (over 30 hours per week) health insurance that is affordable and provides a minimum value. Coverage should not be offered to independent contractors, but large employers must offer health benefits to people who are recently reclassified as full-time employees.

Employers will generally be able to use the research method to determine whether newly reclassified workers work full-time. which will give them up to a year to make the determination and start offering coverage to those who work more than 30 hours a week (the look-back method is only available for use if an employee is seasonal or has variable hours, but employers would generally be able to consider newly reclassified workers - who have flexible hours and schedule their working hours - as employees at variable hours).

Medicaid expansion in California

Medicaid in a health insurance option available to people on low or very low incomes or those with disabilities. Medicaid is a joint state and federal program. The federal government defines broad requirements and the state determines eligibility levels and manages the program. Some people qualify for both Medicaid and Medicare.

California embraced the ACA's Medicaid expansion in 2013, as then-Gov. Gov. Jerry Brown signed legislation that was supposed to expand Medicaid coverage to more than a million Californians.

Between fall 2013 and April 2020, enrollment in Medicaid plans in California increased from about 7.75 million to more than 11.5 million , an increase of 49%. California's Medicaid program is by far the largest in the nation. (About 16 percent of the nation's Medicaid enrollees are in California.)

Officials expected medical enrollment to grow to 14.5 million people due to widespread job losses from the COVID-19 pandemic, but enrollment was poised at about 12.5 million as of July 2020.

If you have any questions about Medi-Cal, visit the California Department of Health Services website. Note: California's Children's Health Insurance Program (CHIP) was formerly known as Healthy Families. In 2013, California passed healthy families enrollees to Medi-Cal.

Short-term health insurance in California

California lawmakers passed a law in 2018 that prohibits the sale or renewal of short-term health insurance plans in California starting January 1, 2019. (Other plans that do not comply with the ACA, such as fixed compensation products and critical illness plans, continue to be allowed to be sold.)

How did Obamacare help California?

California has embraced health care reform, creating a state health insurance market and expanding Medicaid. According to U.S. Census data, the uns insured rate in California fell from 17.2% in 2013, to just 7.2% in 2018.

Covered California has also helped Californians reduce the cost of prescription drugs. In 2016, the state exchange implemented a limit on prescription costs. Also available to consumers who purchase out-of-stock plans, the limit is linked to the metal level of the purchased plan and is $250 per special drug per month for most consumers.

Does California have a high-risk pool?

Prior to the ACA's reforms within the individual insurance market, medical record was an element in eligibility for personal plans in nearly every state, including California. Candidates with pre-existing conditions were often unable to purchase individual plans on the private market, or if coverage was available, it came with a higher premium or exclusions on pre-existing terms.

The California Major Risk Medical Insurance Board (MRMIB) was created in 1991 to provide a coverage option for people who were not eligible for coverage under a private plan because of medical history.

Under the ACA, all new health insurance policies have become a guaranteed issue as of January 1, 2014. This change has largely eliminated the need for high-risk pools, as pre-existing conditions are no longer an obstacle to obtaining coverage.

The California Budget Act of 2014 included a provision for the MRMIB to cease operations as of July 1, 2014. Most MRMIB policyholders had already been ready to get coverage through the exchange or expanded Medicaid, but the remaining members were transitioned to the California Department of Health Services on July 1.

Medicare coverage and enrollment in California

Medicare covers people over the age of 65, some people with disabilities, and people with end-stage kidney disease (ESRD). Eligible people can sign up for "original" Medicare or Medicare Advantage. Under original or "traditional" Medicare, the federal government pays directly for the health service you receive. In Medicare Advantage, you've chosen from one of the many private health plans in your state, and the federal government pays for the health care plan you receive. Medicare Advantage is required to provide all services covered by the original Medicare, and individual plans may offer optional additional services within the premium you pay.

There were 6,362,817 California residents enrolled in Medicare plans as of March 2020. About 45% were enrolled in Medicare Advantage plans, while the other 55% were enrolled in Original Medicare.

California Health Insurance Resources

● California Association of Health Plans

● California Department of Health Services

● California Department of Managed Health

● California HealthCare Foundation

● California Nurses Association

● California One Care

● California Department of Insurance

● Access to Health California

California Health Reform Legislation

Here's a summary of several important health-care reform laws that California has enacted in recent years:

SB4 – This legislation, renamed the Health for All Kids Act, focuses on medi-cal access for undocumented immigrant children under the age of 19. SBF went into effect in May 2016, making undocumented immigrant children eligible for Medi-Cal based on family income alone.

SB10 - This bill was signed by Governor Brown in June 2016. It would allow undocumented immigrants to purchase coverage not underobjective in the exchange, but the state needed a waiver from HHS to implement the law. (The ACA does not allow undocumented immigrants to purchase coverage in exchange for a state, even if they pay the full price.) California submitted a waiver proposal to HHS, but eventually withdrew its waiver two days before President Trump took office. California State Senator Ricardo Lara (D, Bell Gardens) had introduced and supported SB10, but called for the waiver proposal to be withdrawn (and Governor Brown agreed) because the state was concerned that the Trump Administration might use the exchange information to deport undocumented immigrants.

California enacted legislation in 2018 to ban short-term health plans and limit enrollment in associations' health plans.

In 2019, California enacted legislation to restore an individual mandate in California to from 2020 and to create a state-based temporary grant program.