Do I Need Health Insurance in California?

Los Angeles residents can purchase affordable health insurance coverage on the California state exchange marketplace. Plans offered there must meet certain standards and minimum essential coverage requirements, making shopping for coverage simple and accessible.

Individuals without qualifying health insurance will face a penalty when filing their taxes unless they qualify for an exemption. To avoid this expense, individuals and families can obtain affordable health coverage on Covered California exchange.

How Much Does Health Insurance Cost?

Health care costs can be an immense drain on families’ finances. Over the past decade, household spending on health has doubled its growth relative to wages – now comprising 10.5% of median household income. Meanwhile, state spending on healthcare and human services accounts for almost one-third of state budgets.

Monthly premiums represent only part of the overall costs associated with health care. Other important expenses, such as deductibles and copayments, can quickly add up for families with multiple children or those who require complex medical attention. The newly formed California Office of Health Care Affordability will help address these concerns by conducting an investigation of all areas within health care to identify causes of rising prices.

The federal Affordable Care Act permits individuals to purchase private health insurance through Covered California, a state exchange. There are various plan options tailored specifically for different ages and needs that fit any budget, with subsidies available to help pay the cost of premiums if eligible. You can use our handy calculator to see your potential savings or visit Covered California to determine eligibility for assistance.

Health coverage can come from various sources, including your employer, COBRA plans and individual or family policies purchased privately. Medi-Cal is another state program designed to cover low-income residents. If you want coverage immediately following a significant life event such as birth or change of job status (i.e. when having a baby or changing jobs) then an open enrollment period will provide the ideal time and place to sign up. If not then an eligibility event such as having a baby can also provide the impetus.

Cost of health insurance varies by plan tier, age and county; with an average premium for Covered California’s most popular plan being $63 monthly. Cost is further affected by choosing between HMO or PPO plans: HMO plans typically require referrals from primary care physicians for specialists while PPO plans allow more freedom when choosing doctors and hospitals, with PPO plans typically having more flexible selection criteria allowing more freedom when making choices about doctor care and hospitals than HMO plans do.

What Is Covered by Covered California?

Under the Affordable Care Act (ACA, or Obamacare), states have created health insurance marketplaces known as State Exchanges to offer health plans at discounted rates to individuals and families qualifying. Covered California serves California State Exchange needs by offering access to well-known company plans at reduced rates to all who qualify; it also helps link those whose household income falls below 400% of FPL to state Medi-Cal programs.

All health plans sold on the California State Exchange must provide a comprehensive package of items and services known as essential benefits, which includes hospital care (ambulatory patient services or outpatient clinic care), hospitalization, pregnancy and newborn care, mental health and substance use disorder treatment as well as rehabilitative and habilitative devices (services that help people with injuries, disabilities or chronic conditions perform daily activities more easily) plus dental and vision coverage. In addition, Covered California plans offer dental and vision coverage.

Individuals and small businesses alike can use Covered California to find the plan best suited to their needs by using its website or call center to compare costs, benefits and other pertinent details of each plan directly against each other in an apples-to-apples comparison. All plans offered to individuals and small groups fall into four metal levels – Bronze, Silver, Gold and Platinum. Each level provides different benefits and cost sharing arrangements; for example a Platinum plan generally covers 90% of healthcare costs while you pay only 10%; Silver plans often cover 80-90% while Bronze usually covers 60-70% while paying 30% – thus finding their perfect plan!

A premium is the monthly payment you make to maintain active medical insurance coverage. There may also be out-of-pocket healthcare expenses such as deductibles and coinsurance which you incur prior to receiving benefits under your plan.

The Affordable Care Act made health insurance more accessible and affordable for millions of Americans by offering financial assistance – also known as subsidies – for those who qualify. Insurers were forbidden from denying coverage based on preexisting medical conditions, while individuals eligible for subsidies could enroll in private medical plans such as our Sharp Health Plan individual plans through California State Exchange during open enrollment or apply for special enrollment periods if there was an event such as loss of employment, moving, changing marital status or the birth of a child that occurred within their qualifying life events such as loss of employment, move, change in marital status or birth of child birth.

How Can I Avoid the Penalty for Not Having Health Insurance?

Although the federal penalty for not having health insurance was eliminated with the passage of the Tax Cuts and Jobs Act in 2019, states still have the power to establish their own penalties for those without qualifying health coverage. California currently imposes financial penalties against individuals and families who do not possess qualifying coverage – either based on household size or percentage of household income (whichever is greater), with an estimator tool helping individuals determine how much their fine may be.

No matter if California residents are subject to penalties for failing to have qualifying coverage, it’s critical that they have access to affordable and comprehensive health insurance options. More people with access to quality health care means less strain on public resources. Also, people who go without coverage often require costly treatments in the future that taxpayers are ultimately forced to cover costs for.

As such, HR managers must educate their employees on the new individual mandate laws and its associated penalties. By doing so, HR can assist their employees in finding affordable and qualified health insurance plans that provide coverage while helping avoid tax penalties.

As well as affordability requirements, the new law also mandates that qualified health plans provide minimum essential coverage. This applies to Medi-Cal plans, employer-sponsored health plans and most private marketplace/open market plans sold privately. There may be circumstances when an exemption or waiver may apply – for instance if an individual or family would pay more than certain percentage of income on insurance coverage due to moving into or within California or imprisonment.

Remind individuals and families that when filing taxes they must report their coverage status; otherwise they risk incurring costly penalties. If individuals or families need help reporting or applying for health insurance plans they should consult a licensed agent.

What Can I Do to Avoid an Insurance Penalty?

Though the federal penalty for failing to have health insurance has no longer been in effect, California still enforces it, with those without coverage facing fines when filing their taxes. The penalty aims to encourage people to sign up for plans; most forms meet minimum essential coverage requirements but short-term or low-cost plans may still fall subject to individual mandate penalties.

Good news is there are various ways to avoid penalties, such as signing up for a qualified health plan. Covered California offers options that meet ACA standards; in fact, eligible residents may even qualify for subsidies to help with costs. Furthermore, private insurers also offer plans considered “qualified” that can be found on open markets.

People whose incomes fall within 400% of the poverty level can qualify for Medi-Cal, which provides free or low-cost health care to children, pregnant women, seniors and individuals with disabilities. If these programs don’t apply to them, a new law allows people to purchase affordable quality private health insurance on the marketplace – many families and individuals have discovered they can save thousands each year by choosing an ideal plan.

While eliminating the individual mandate penalty is beneficial for Californians, affordability remains a primary barrier to enrollment. Deductibles and out-of-pocket costs have increased, leading many people to opt out or find an inexpensive plan which does not meet their needs.

To address these concerns, California lawmakers are taking steps to lower costs and increase subsidies for middle-income residents, while its new Healthy California for All Commission will research options including single payer. While these changes are encouraging steps toward universal, cost-effective healthcare in California, more must be done.