When you get sick or hurt and need to see a doctor, your health insurance will pay. If you don’t have health insurance coverage, it could be much more painful for you than your injury because the medical bills can be as high as the sky.
Get some peace of mind with some health insurance coverage. We’ve done the research to help you choose affordable health insurance in California.
quick look: the best health insurance in california
- most affordable: l.a. health plan
- best for preventative care: molina healthcare
- best for orange county residents: healthnet
- best for national coverage: california blue shield
the best health insurance in california
The cost of health insurance policies in California is determined by county and “metal” levels such as gold, bronze, and silver, which depend on age and health status. not all providers are available in all counties. To help you find coverage at the best price, we found the lowest silver rates in the 4 largest counties in the state.
1. the. health care plan
if you live in los angeles county, l.a. care health plan offers the lowest rates through 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 from $150 to $15,800 for a family plan. The company’s mission is to provide quality care to the low-income and vulnerable communities and residents of Los Angeles County and support the safety net.
2. molina health
if you live in san diego county, you can get the lowest 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.
3. health network
orange county residents can get the lowest 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, a health coaching program, disease management and more. health net also offers free home health screenings. Your plan price is a balance of your monthly premium price and how much you pay for care.
4. california blue shield
if you live in riverside county, you can get the best rates through blue shield silver 70 trio hmo. monthly premiums are $292.79 for 21-year-olds, $374.18 for 40-year-olds, and $794.62 for 60-year-olds.
plan includes 24/7 nurse helpline, 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.
what is health insurance?
Health insurance is a type of insurance coverage that pays for your medical, surgical, and routine health care expenses. it also pays for immediate care if you break a leg, have a heart attack or have a stroke.
Your health insurance may reimburse you for expenses while you are sick or injured, or it will directly pay money you owe your doctors, urgent care center, or hospital for providing 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 national average health insurance premium of $477 per month reported by the Kaiser Family Foundation.
Health insurance can be extremely expensive and can be so expensive that you may not be able to afford it. There are ways to make your health insurance more affordable.
One way is to sign up for a subsidy or help paying through the Affordable Care Act (ACA), which will help you get coverage when you can’t otherwise afford it. here provides ways to help lower your premiums and out-of-pocket costs for people with low and middle income levels.
Some policy deductibles cost so much that you may not be able to use your insurance benefits until you pay amounts as high as $7,900 before the insurer starts paying your medical bills.
one study showed that Los Angeles residents who had a subsidy paid an average of $207 per month instead of $384 per month (without subsidy). visit the california online marketplace or speak with 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 an alphabet soup with many 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 health care services through a network of providers serving members. You are likely to be covered for a variety of preventive health care services than with other types of plans.
You will need to choose a Primary Care Physician (PCP) who takes care of most of your health care needs. You will need a referral to see a specialist. but you probably won’t be covered if you get services from out-of-network providers. You may not have to pay a deductible before coverage kicks in, and your copays are likely to be minimal.
ppo: A preferred provider organization is a type of health insurance plan that provides the most benefits if you visit an in-network provider. provides some out-of-network coverage and does not require a referral from your doctor.
You will likely have to pay an annual deductible before the insurance company begins to cover your medical bills. You may also have a $10-$30 copay for certain services and must pay a percentage of your medical bills.
epo: an exclusive provider organization plan allows you to use doctors and hospitals within the epo network. but epo patients cannot go out of network to receive medical care.
This type of plan might be right for you if you don’t want a referral to see a specialist and want 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 receive care in-network or out-of-network.
You will be asked to choose a pcp and you may not have to pay a deductible. preventive care benefits are usually included. Like a PPO, you can get services outside of the network, but you’ll pay more for them. You’ll also 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 are insured through a self-insured company, most of these benefits are covered, depending on the company’s plan.
Outpatient Services: Are outpatient services when you are not admitted to a hospital.
Emergency Services: These services or treatments you receive in a hospital emergency department are provided whether or not you have insurance coverage.
Hospitalization: Services are covered when you have at least an overnight hospital stay or 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 your new baby while you are in the hospital.
Mental health and substance use disorder services: This coverage includes services such as counseling, psychotherapy, and drug treatment services.
Rehabilitative and Habilitative Services and Devices: Services and devices to help people with injuries, disabilities, and chronic conditions gain or regain mental and physical skills.
Lab Services:This pays for a lab to draw and test blood, urine, and other samples.
Preventive and wellness services: This is care you get to prevent illness or disease. Services include doctor visits, standard immunizations, and screenings for blood pressure, cancer, cholesterol, depression, obesity, and type 2 diabetes. Coverage includes annual physicals.
Pediatric Services: These services include all care for children, including dental and vision services.
Plans must also include birth control and breastfeeding coverage, which means you can have free contraception, like birth control pills. The health care law also requires all new health plans to cover prenatal and postnatal breastfeeding counseling and support at no additional cost, as long as the new mother is breastfeeding.
what does health insurance not cover?
Most health insurance plans do not cover some health care services, such as adult dental services, hearing aids, and vision services. Here are some other services that most insurance plans don’t cover:
Some Prescription Drugs: If your plan doesn’t pay for prescription drugs, your doctor may prescribe a substitute drug that your insurance will cover or may ask your insurance company to make an exception due to medical necessity . If your request is denied, you can file an appeal with your provider.
Acupuncture and other alternative therapies: You can also appeal if your provider doesn’t cover alternative treatments you think you need. you can win and get the therapy covered.
Weight-loss programs and surgery: Although most insurance plans don’t cover these services, some do cover nutritional counseling, weight-loss programs, and bariatric and other weight-loss surgeries.
Cosmetic surgery: Most insurances only cover plastic surgery if it is medically necessary.
Infertility treatment: Most insurers do not cover the diagnosis and treatment of infertility.
reversal of sterilization: most plans do not cover reversals of sterilization surgery.
private duty nursing: Most insurers won’t pay for you to have a private duty nurse.
Vaccines for travel: Travel vaccines are considered optional and non-essential.
Lasik: Lasik is considered non-essential and elective and is often not covered by insurance.
find the best health insurance in california
Choosing a California 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.
There’s a lot more to learn about getting health insurance that’s affordable and meets your needs. We’ve also done the legwork for you to find the best health insurance.