Affordable Health Insurance in California
In 2023, about 3.2 million of the over 39 million people in California lacked health insurance coverage. Affordable health insurance or completely free health insurance is available to a large portion of Californians. A variety of affordable health insurance coverage options can be accessed through state and federal-funded programs, by purchasing alternative health plans, and taking advantage of discounts when you buy health plans from the Marketplace.
Some affordable health insurance policies in California are offered as:
- Medi-Cal
- California Medicare
- Medi-Cal Access Program (MCAP)
- California Healthy Families (SCHIP)
- Limited benefit plan
- Subscription plans
- Association plans
- Discount health plans
Speak to a California-licensed insurance agent who can help determine your eligibility for an affordable health plan. An agent will review the policy, ensure they meet your needs, and help with the application process.
Best Low-Cost Health Insurance Options in California
There are many low-cost health insurance options on the California insurance marketplace. The best way to find the low-cost health insurance options that fit you is by talking to a state-licensed health insurance agent, who can professionally assess your needs and provide you with all your options. Agent’s work helping you does not cost you anything and you get professional advice for free. Below is the general list of the best low cost health insurance in California that is available to residents:
- Medi-Cal
- California Medicare
- Medi-Cal Access Program (MCAP)
- California Healthy Families (SCHIP)
- California Health Marketplace
- Employer-sponsored health plans
Note that in 2019, health insurance providers in California were banned from issuing, selling, amending, renewing, or offering short term health insurance policies in the state.
Medi-Cal
Over 13 million Californians receive healthcare benefits from Medi-Cal every year. Medi-Cal (California's Medicaid program) is a state and federal government-funded program that provides healthcare services to low income Americans. It is free or low-cost health coverage that qualified Californians receive as health benefits. You may qualify for Medi-Cal if you reside in California and are:
- Visually impaired
- Under 21
- In a nursing home
- A senior (65 years or older)
- A person with a disability
- A pregnant woman
- On refugee status for a specific period
- Earning less than 138% of the Federal poverty level (FPL), or slightly more
- A parent or caretaker relative of an eligible child
- Suffering from breast and/or cervical cancer (Breast and Cervical Cancer Treatment Program)
- Enrolled in CalFresh, CalWorks (AFDC), SSI/SSP, Refugee Assistance, Foster Care, or Adoption Assistance Program
Medi-Cal provides dental benefits to both children and adults and covers the 10 Essential Health Benefits (EHB) covered under the Affordable Care Act. These benefits are:
- Hospitalization
- Emergency services
- Prescription drugs
- Laboratory services
- Ambulatory patient services
- Pediatric services, including oral and vision care
- Rehabilitative and habilitative services and devices
- Pregnancy, maternity, and newborn care (pre and post-natal)
- Preventive and wellness services and chronic disease management
- Mental health and substance use disorder services (provided through Drug Medi-Cal), including behavioral health treatment
For more information on Medi-Cal, contact the California Department of Health Care Services Medi-Cal Member Help Line at (800) 541-5555 or speak to a California-licensed health insurance agent.
Medicare
Medicare is a free or low cost health care program for seniors (65 years or older), individuals with End-Stage Renal Disease (ESRD), and young people with certain disabilities. Californians can get premium-free Part A Medicare if they:
- Purchase Medicare before they turn 65 years
- Are eligible for retirement or disability benefits from Social Security (or the Railroad Retirement Board).
- Are 65 years or older, and they or their spouses paid Medicare taxes during employment for at least ten years.
Part A Medicare typically covers hospice care, nursing home care, home health care, skilled nursing facility care, and inpatient care in a hospital. It excludes dentures, concierge care, massage therapy, long-term care, routine physical exams, eye exams, hearing aids and exams, routine physical exams, and cosmetic surgery.
California's Medicare Savings Program helps residents who meet the eligibility requirements save money on Medicare part A and B premiums, deductibles, coinsurance, and copayments. To qualify for a Medicare Savings Program, Californians must have an annual income of less than $18,347 for an individual or $24,719 for a couple, with an asset limit of under $130,000, with an additional $65,000 for each additional family member.
| The Provisions of Medicare Savings Programs | ||
| Program | Gross income limits for 2022 | Benefit |
| Qualified disabled and working individual (lost Medicare Part and cannot also receive Medi-Cal) | Individual: $4,615 per month and $55,380 per year
Couple: $6,189 per month and $74,268 per year |
Payment of Medicare Part A premiums |
| Specified low-income beneficiary (must have Medicare Part A) | Individual: $1,379 every month and $16,548 every year
Couple: $1,851 per month and $22,212 per year |
Pays for Medicare Part B premiums |
| Qualifying individual (must have Medicare Part A and cannot also receive Medi-Cal) | Individual: $1,549 per month and $18,588 per year
Couple: $2,080 per month and $24.960 per year |
Pays for Medicare Part B premium |
| Qualified Medicare beneficiary (must be entitled to Medicare Part A) | Individual: $1,153 every month and $13,836 every year
Couple: $1,546 every month and $18,552 every year |
Pays for Medicare Part A and Part B premiums, deductibles, and copayments |
Medi-Cal Access Program (MCAP)
Medi-Cal Access Program (MCAP) provides comprehensive health care coverage to eligible individuals for free (no deductibles and copayments). To qualify for MCAP, you must be a pregnant California resident, who is not enrolled in other government-sponsored health programs, and earns an income within the MCAP income guidelines.
Additionally, MCAP provides coverage to women with other health insurance plans that exclude maternity services or a maternity-only copayment or deductible above $500. Newborns of MCAP enrollees remain covered under Medi-Cal Access Infant Program for the first two years of their life.
California Healthy Families (SCHIP)
California healthy families (SCHIP) is a low-cost health coverage provider for children and teens who do not qualify for Medi-Cal and whose household income ranges between 0% and 300% of the Federal Poverty Level (FPL). To qualify for SCHIP:
- You must be a California resident
- a U.S. citizen, national, or non-citizen legally admitted into the U.S.
- You must be uninsured and be under 19 years, pregnant, or a primary caregiver with a child(ren) under 19 years.
Eligible individuals can apply for SCHIP during the open enrollment period, which runs from April 15th to May 31st every year. SCHIP covers mental health, skilled maternity care, prescription drugs, dental & vision care, home-based care, professional nursing care, emergency health care services, laboratory and X-ray services, inpatient/outpatient hospital services, alcohol and substance abuse, and durable medical equipment. It also covers physician services, physical, occupational, and speech therapy, preventive care, and emergency and non-emergency medical transportation.
California Health Insurance Marketplace
The California health insurance Marketplace is called Covered California. Individuals who purchase their health insurance policies through Covered California health insurance Marketplace can save money if they qualify for premium tax credits and cost-sharing reductions, which are based on how your income compares with the annually-set federal poverty level:
- Premium tax credits: Helps insureds to lower their monthly premiums based on their income estimate and household information. To be eligible for the premium tax credit, your income must be between 100% and 400% of the FPL ($13,590-$54,360 in 2023). In 2022, the premium tax credit became open to individuals earning above 400% FPL .
- Cost-sharing reductions (also called extra savings): CSR helps to reduce deductibles (out-of-pocket costs), copayments, and coinsurance costs. To be eligible for CSRs, your income can be up to 250% of FPL ($33,975 in 2023). An eligible insured must enroll in the silver plan to get the extra savings.
Employer-sponsored health plans
An employer sponsored health plan is a job-based plan bought by large and small businesses on behalf of their employees. It provides medical coverage that typically includes pharmacy benefits, vision services, and dental services. An employer can decide to cover the partial or full cost of health insurance premiums for their employees. Most California employers split the cost of coverage with their employees down the middle, which makes health insurance much more affordable compared to what one may qualify for through the Covered CA health marketplace.
Low-Cost Health Insurance Alternatives in California
Most Californians purchase health insurance alternatives to save money on health care costs. Unfortunately, health insurance alternatives in California do not follow the provisions set forth by the California Affordable Care Act (ACA). Unlike ACA plans, alternative health plans exclude some injuries or illnesses, including chronic and pre-existing conditions. They also typically have waiting periods and do not offer federal assistance that helps to reduce premiums and out-of-pocket costs. Below are the types of alternative low cost health care plans available in California:
- Limited benefit plan
- Subscription plans
- Association plans
- Discount health plans
Limited Benefit Plan
Limited benefit plans (LPB) are also known as mini-meds. Although limited benefits plans are California low cost health insurance policies, they do not provide comprehensive coverage like traditional health insurance policies that are sold on the Covered CA marketplace. LPBs were designed to supplement traditional health insurance policies and not as an alternative to them, even though they can be used as stand-alone coverage - some with cash amounts paid out directly to you. You then decide how to apply the money, to help you cover your bills.
Some types of limited benefit plans in California are:
- Critical illness insurance: Provides extra coverage for medical emergencies like strokes, heart attacks, organ transplants, or cancer.
- Hospital indemnity plan: It supplements standard health insurance policies by covering the cost of medical expenses and hospital stays.
- Accident-only plans: These are supplemental insurance policies that cover certain types of medical care needed after an accident. Accident-only plans cover ambulance costs, intensive care costs, therapy charges, major diagnostic tests and exam fees, rehabilitation costs, and family support benefits.
- Basic hospital expense: It covers important hospital expenses like X-rays, room and board, IVs, drugs, lab fees, and anesthesia within a given timeframe.
- Accidental death and dismemberment: It offers financial help when an insured dies or loses a body part due to an accident.
- Disease-only plan: The plan offers coverage to insureds when diagnosed with certain diseases.
- Fixed indemnity plan: It is a supplemental health coverage that pays a certain amount on a per-period or per-incident basis for medical treatments, events, or services.
- Basic surgical expense: Covers costs associated with surgical procedures.
Subscription Plans
A subscription health plan is a low-cost alternative health coverage that allows members to pay monthly, quarterly or annual fees for using physicians or services covered in the plans. The number of doctor visits members can make is usually limited, and they must carry their membership IDs when visiting participating health care providers.
The two major subscription health plans available in California are:
- Concierge medicine (also known as concierge care): It is a membership-based health care that provides unlimited office and telehealth visits for a flat monthly fee.
- Direct primary care (DPC): It is a low-cost financial arrangement between a patient and a health care provider without the involvement of health insurance providers. DPC patients do not pay premiums, deductibles, or copays. Instead, they pay flat monthly, quarterly, or annual fees to access several primary care services. These fees cover all or most primary care services like consultative services, comprehensive care management, clinical and laboratory services, and care coordination.
Association Health Plans
California association health plans are group health plans that allow multiple small companies to come together under a single coverage to access medical care benefits available to large group companies. With association health plans, small companies can negotiate lower health insurance premiums with their CA health insurance companies. Small business owners, associations, sole proprietors, and self-employers can benefit from association health plans. Talk to a California-licensed insurance agent who can help you negotiate your health insurance premiums so you and the members of your organization can get a group health insurance policy at an affordable rate.
Since all employer group plans must comply with ACA requirements, all association health plans, when used to provide coverage to employees, offer ACA compliant and low cost coverage.
Discount Health Plans
Discount health plans are not health insurance policies. They are organizations that provide a certain percentage off health services to help people save on health care expenses. Members of discount health plans are usually issued discount cards from participating doctors, dentists, hospitals, and pharmacies. Discount health plans do not cover major health problems or medical emergencies. You will need to get a health insurance policy for that. Californians who want to purchase discount health plans should contact the company they want to do business with for more information. Before buying the policy:
- Make inquiries about the list of participating providers so you can know if the discounts apply to the doctors and hospitals where you get care.
- Call the participating providers and inquire about the services and discounts they offer.
- Check the California Department of Insurance (CDI) website to see if the company offering the plan is registered to sell insurance in the state.
It is best to speak to a California-licensed insurance agent who can help you purchase a good discount health plan that can help you reduce medical bills.
How Much is Cheap Health Insurance in California?
The average cost of cheap California health insurance policies varies depending on the location, policy type, family size, age, and tobacco use. Speak to a California-licensed insurance agent who can help you compare plans and quotes from several insurance companies to get a cheap health insurance policy that will suit your needs.
| Average Cost of Cheap Health Insurance in California | ||
| Type of Health Insurance Policies | Subtype of Health Insurance Policies | Cost |
| Major health insurance plan | Medi-Cal | Medi-Cal could come at no cost, low-cost, or a monthly premium of $13 per child up to a family maximum of $39 per month, depending on eligibility |
| California Medicare | Enrollees can benefit from premium-free Part A if they qualify. However, Part A Medicare monthly premiums cost $278 or $506, depending on how long you or your spouse worked and paid Medicare taxes, while Part B costs $164.90 per month | |
| Medi-Cal Access Program (MCAP) | Coverage is free | |
| California Healthy Families (SCHIP) | The monthly premium for children is determined by family income and size, and it costs between $4 and $17 per child, but charges do not exceed $51. Co-payment costs $5 each for doctor visits or other health care services (preventive health is free) | |
| Alternative health insurance plan | Limited benefit plan | The cost of limited benefit plans varies by plan type. For example:
Critical illness insurance: It costs between $15 and $25 per month for a $25,000 coverage. Hospital indemnity plan: It can cost $12-$15 for a 30-year-old who wants $500 a day for a qualifying hospitalization, while a 60-year-old with a $1,000 daily payment would have to pay $70 per month for the same policy. Accident-only plans: Cost between $5 and $50 per month per person. Fixed indemnity plan: Costs between $25 and $50 per month Accidental death and dismemberment: Costs between $7 and $10 per month for a $100,000 coverage. |
| Subscription plans | Cost varies | |
| Discount health plans | A discount health plan’s monthly premiums cost between $8 and $148 with a one-time non-refundable enrollment fee of $200. | |
| Association plans | Costs vary | |
How to Get Affordable Health Insurance in California?
The process of getting affordable health insurance in California differs by policy type. The table shows how state residents can get low-cost health insurance plans:
| How to Get Affordable Health Insurance in California | ||
| Type of Health Insurance Plans | Subtype of Health Insurance Policies | How to Purchase Low-Cost Health Insurance |
| Major health insurance plan | Medi-Cal | Californians can get Medi-Cal at their local County Medi-Cal Offices. For example, individuals who want to get Medi-Cal at Alameda County can do so online, by phone (510) 272-3663, by mail, or in person at the Alameda County Social Services Agency. A mail applicant can call (510) 272-3663 or (800) 698-1118 (toll-free) to request the mail-in application form and instructions booklet or complete the printable application form. In-person requests can be made at any of the Alameda County Social Services offices, Monday through Friday between 8:30 a.m. and 5:00 p.m. Alternatively, individuals can apply for Medi-Cal online, by phone, or by certified enrollers at Covered California. |
| California Medicare | Some people may automatically get Medicare Part A and B, while others might have to sign up for it. Sign-up can be done online, by phone at (800) 772-1213, or at local Social Security offices. | |
| Medi-Cal Access Program (MCAP) | Individuals can get MCAP by application online at Covered California. | |
| California Healthy Families (SCHIP) | You can buy SCHIP online or download the application form and mail it to
Healthy Families/Medi-Cal for Children & Pregnant Women PO Box 138005 Sacramento, CA 95813-8010 |
|
| Alternative health insurance plan | Limited benefit plan | Can be bought online or in person at California health insurance companies or through a licensed health insurance agent. |
| Subscription plans | You can get subscription health plans from a licensed health insurance company or an insurance agent. | |
| Association plans | You can purchase association health plans directly from a licensed health insurance company, insurance agent, or broker. | |
| Discount health plans | Individuals can buy discount health plans from licensed health insurance companies or California health insurance agents. | |
The best way to get affordable health insurance policies is through a California-licensed insurance agent. An agent will help you compare health insurance quotes from several health insurance companies and ensure you have the most cost-effective policy to fit your needs. Agents are familiar with health insurance discounts, subsidies, alternative health plans, and government-funded policies you can get for free or at low costs.
