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When you get sick or hurt and need to see a doctor, your health insurance will pay for it. If you don’t have health insurance coverage, it could be far more painful for you than your injury because medical bills can be as high as the sky.
Get some peace of mind with some health insurance coverage. We’ve done research to help you pick a cheap health insurance plan in California.
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The Best Health Insurance in California
What is Health Insurance?
Health insurance is a type of insurance coverage that pays for your medical, surgical and routine healthcare expenses. It also pays for immediate care if you break a leg, have a heart attack or suffer a stroke.
Your health insurance can reimburse you for your expenses while you’re sick or injured, or it will directly pay money you owe to your doctors, the urgent care center or hospital for providing your medical care.
Average Cost of Health Insurance in California
The average cost of health insurance in California is $435 per month. But you may qualify for a subsidy, which can help cover some of your costs and lower your monthly expenses. That compares to the $477 per month national average health insurance premium the Kaiser Family Foundation reported.
Health insurance can be extremely expensive, and it can be so costly that you may not be able to afford it. There are ways to make your health insurance more affordable.
One way is to enroll to get a subsidy or help paying through the Affordable Care Act (ACA), which will help you get coverage when you can’t otherwise afford it. The ACA provides ways to help reduce your premiums and out-of-pocket expenses for people with low and average income levels.
Some policy deductibles cost so much, you may not be able to use your insurance benefits until paying amounts as high as $7,900 before the insurer starts paying your medical bills.
One study showed Los Angeles residents who had a subsidy paid an average of $207 per month instead of the $384 a month (without a subsidy). Visit the California online marketplace or talk to an insurance representative to enroll in a plan and see if you qualify for a subsidy.
Types of Health Coverage
Health insurance plans can be like alphabet soup with a lot of letters, levels of quality and price. You can choose from these types of health care plans:
HMO: Health Maintenance Organizations offer a wide range of healthcare services through a network of providers who offer services to members. You’ll likely have coverage for a range of preventive healthcare services than with other types of plans.
You’ll have to choose a primary care physician (PCP) who takes care of most of your healthcare needs. You’ll need a referral to see a specialist. But you probably won’t have coverage if you get services from out-of-network providers. You may not be required to pay a deductible before coverage starts and your copays will likely be minimal.
PPO: A Preferred Provider Organization is a type of health insurance plan that provides maximum benefits if you visit an in-network provider. It provides some out-of-network coverage, and you don’t need a referral from your doctor.
You’ll probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a $10–$30 copay for certain services and have to pay a percentage of your medical bills.
EPO: An Exclusive Provider Organization plan allows you to use the doctors and hospitals within the EPO network. But EPO patients cannot go outside the network for medical care.
This type of plan could be right for you if you don’t want to get a referral to see a specialist and you want to get a much cheaper rate than an HMO or PPO.
POS: A Point of Service plan has some qualities of an HMO and PPO. Your benefit levels depend on whether you get care in or out of network.
You’ll be required to choose a PCP, and you may not have to pay a deductible. Preventive care benefits usually are included. Like a PPO, you can get services outside the network, but you’ll be paying more for them.You also will have copays, coinsurance and annual deductibles.
What Does Health Insurance Cover?
Health insurance in California must cover at least 10 essential health benefits. If you’re insured through a company that is self-insured, most of these benefits are covered, depending on the company’s plan.
Ambulatory patient services: These are out-patient services when you are not being admitted to a hospital.
Emergency services: These services or treatment you receive in a hospital emergency department are delivered whether or not you have health insurance coverage.
Hospitalization: Services are covered when you have at least one overnight hospital stay or you have surgery and are admitted to the hospital for recovery.
Pregnancy, maternity or newborn care: These services include prenatal care, when you give birth to a child, and care for the new baby while in the hospital.
Mental health and substance use disorder services: This coverage includes services like counseling, psychotherapy and drug treatment services.
Rehabilitative and habilitative services and devices: Services and devices to help people with injuries, disabilities and chronic conditions to gain or recover mental and physical skills.
Laboratory services: This pays to have blood, urine and other samples drawn and tested by a lab.
Preventive and wellness services: This is the care you receive to prevent illnesses or diseases. Services include doctor’s visits, standard immunizations, and screenings for blood pressure, cancer, cholesterol, depression, obesity and Type 2 diabetes. Coverage includes annual physical exams.
Pediatric services: These services include all care for children including dental and vision services.
Plans also must include birth control and breastfeeding coverage, which means you can have free contraceptives like birth control pills. The health care law also requires that all new health plans cover prenatal and postnatal breastfeeding support and counseling without any additional cost as long as a new mother is breastfeeding.
What Does Health Insurance Not Cover?
Most health insurance plans don’t cover some healthcare services like adult dental services, hearing aids and vision services. Here are some other services that most insurance plans do not cover:
Some prescription drugs: If your plan won’t pay for prescriptions, your doctor may be able to prescribe a substitute drug your insurance will cover or can ask your insurance carrier to make an exception because of medical necessity. If your request is denied, you can file an appeal with your carrier.
Acupuncture and other alternative therapies: You also can appeal if your carrier won’t cover alternative treatments you believe you need. You may win and get the therapy covered.
Weight loss programs and surgery: While most insurance plans do not cover these services, some cover nutritional counseling, weight loss programs and bariatric and other types of weight loss surgeries.
Cosmetic surgery: Most insurance only covers plastic surgery if medically necessary.
Infertility treatment: Most insurers do not cover diagnosis and treatment of infertility.
Sterilization reversal: Most plans don’t cover reversals of sterilization surgery.
Private nursing: Most insurers won’t pay for you to have a private nurse.
Travel vaccines: Travel vaccines are viewed as elective and nonessential.
LASIK: LASIK is viewed as nonessential and elective, and often is not covered by insurance.
Cheapest Health Insurance Providers in California
Cost of health insurance policies in California are determined by county and “metal” tiers such as gold, bronze and silver, which depend on age and health status. Not all carriers are available in every county. To help you find the best-priced coverage, we found the cheapest Silver rates in the 4 largest counties in the state.
1. L.A. Care Health Plan
If you live in Los Angeles County, the L.A. Care Health Plan offers the cheapest rates through the Silver 70 HMO. Monthly rates are $283.50 for a 21- year-old, $362.31 for a 40-year-old and $769.41 for a 60-year-old.
Depending on the plan you choose, platinum, gold, silver and bronze, annual deductibles range from $75 to $7,900 for an individual plan and $150 to $15,800 for a family plan. The company’s mission is to provide quality care for Los Angeles County’s vulnerable and low-income communities and residents and to support the safety net.
2. Molina Healthcare
If you live in San Diego County, you can get the cheapest Silver rates with the Silver 70 HMO plan. Monthly rates are $306.29 for 21-year-olds, $391.44 for 40-year-olds and $831.27 for 60-year-olds.
Deductibles range from $75 to $7,350 for individual plans and $150 to $14,700 for family plans. Molina also offers health and wellness resources for conditions like asthma, diabetes and senior health.
Orange County residents can get the cheapest rate with HealthNet’s Silver 70 Community Care Plan. Monthly rates are $318.18 for 21-year-olds, $406.64 for 40-year-olds and $863.55 for 60-year-olds.
Health Net plans include a nurse advice line, health coaching program, disease management and more. Health Net also offers free in-home health assessments. The price of your plan is a balance of the price of your monthly premium and how much you pay for care.
4. Blue Shield of California
If you live in Riverside County, you can get the best rates through Blue Shield’s Silver 70 Trio HMO. Monthly premiums cost $292.79 for 21-year-olds, $374.18 for 40-year-olds and $794.62 for 60-year-olds.
The plan includes a 24/7 nurse help line, care programs, gym discounts, individual and family plans through Covered CA. Your benefits, deductibles and out-of-pocket costs vary depending on the plan you choose.
You Also Should Know
Choosing a health insurance plan can be a tedious and time-consuming task. For more information to help you choose an affordable health insurance plan, we have other resources for you.