A Guide to Health Insurance in California (CA)

Getting California Health Insurance is far more than just a way to guarantee that you and your family get proper care if you are sick or injured. In practice that is the carrot, but the stick is that the whole process of securing a policy that is both reasonably affordable and easy to understand is far from easy in any State, and California is no exception.

According to the United Health Foundation, California is a fairly middle ranking state when it comes to health. Overall coming 24th in rankings of the health of each of the states, but still having 6.9 million adults who are clinically obese (which is two million more than only 10 years ago), and 3.4 million who regularly smoke.  

This would make health insurance in California a tricky issue at the best of times, but if you couple those health challenges with the fact that 23% of the children in California (and by extension their families) are officially classified as living in poverty, then you have a recipe for tough times when it comes to many families paying the often very high costs to secure California Health Insurance Cover which has more than doubled in cost over the last 20 years.

There are Five Main Types of Health Insurance that you can get in California:

1/ Preferred Provider Organizations (PPOs)

This is where there is a list provided of ‘preferred partners’ and you get the most health care benefit when you limit yourself to visiting those providers.

In other words there is a list of Doctors, a list of hospitals, a list of clinics etc. that come under the umbrella of the PPO and as long as you stick to them you get the biggest monetary benefit.

Going outside those providers may either not be covered at all, or else provide substantially less monetary benefit.

2/ Self Insured Health Plans (Single-Employer Self Insured Plans)

This is where a big group like a trade union, school district or a large employer provides a large pool of money, which is then used to provide the health care needs for the members of that group.

3/ Indemnity Policies (Traditional Fee for Service Insurance)

This is a more traditional type of California Health Insurance Plan because you have far fewer limitations with indemnity policies on the doctors that you are able to see, or the hospitals you can visit.

You will often have to pay a deductible (rather like with travel insurance) before care will be administered, and often treatments will work on a percentage basis, so you may have to pay a certain percentage of the cost for different treatments.

There is a lot of flexibility with indemnity policies, but they may end up costing you more money.

4/ Multiple Employer Welfare Arrangements (MEWAs)

MEWAs are rather a throwback to earlier ways of handling health insurance in California, because in the late 1980s and 1990s they received a bad press that has largely led to their demise. They are essentially where a large group, organization or association sets up a trust fund to administer health care for its members.

There was a lot of mishandling of claims during those times, and so since then they have been much more closely regulated, and required to jump through many more legal hoops to stay on the right side of the law, and new ones have actually been stopped from forming.

There are now only around 10 MEWAs operating in California.

5/ Health Maintenance Organizations (Managed Care or HMOs)

HMO or Managed Care Organizations are more regimented then the other options, because you have to go for treatment to your primary HMO Provider (unless it was an emergency); and you also have a primary care Doctor who guides your care, rather than jumping from Doctor to Doctor.

This inflexibility allows tighter structures to be established and costs to be kept to a minimum, so often HMOs offer relatively good value for the health care dollar, even if they don’t offer tremendous flexibility.

It is a good idea to get a variety of California Health Insurance Quotes and see exactly what is available for your particular circumstances.


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