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California health insurance  -  Understand California Health Insurance  -  Health Insurance Consumer Guide

California Consumer Guide to Health Insurance

We have articles to cover every little aspect of the California health insurance market available here but we want to provide a quick overview of various facets a consumer may need to move forward.

It's a daunting undertaking but we're going to try and keep the content at a high level realizing that you can always drill down further if you need to. We'll break into types of Insurance, Market Segments, Important Entities, Carrier Landscape, and Health Reform.

Types of Health Insurance in the California market

Currently, the main types of health insurance on the market are PPO, HMO, HSA, HRA, Self-Insurance, and Indemnity in decreasing trending popularity. At a summary level:
PPO - Preferred Provider Organization. Combines managed care with a discounted network of participating providers. Offer great flexibility and more cost sharing than HMOs.
HMO- Health Maintenance Organization. Group of providers band together to provide care to members on capitated basis (amount of money per person). More structured but richer benefits.
HSA - Combines high deductible with tax-favored checking out. Usually based on PPO-network health plan.
HRA - Health Reimbursement Arrangement. Similar to HSA but amount funded into account for insured to manage and use.
Self-Insured (or partially self-insured). Usually used by large companies to self-insure their medical needs up to a stop gap or catastrophic level.
Indemnity - Little or no restrictions and/or networks. Has since phased out by PPO and HMO type models.

Market Segments

Individual and Family. Private market for pre-65 individuals in California.
Small Group. Generally 2-50 employees in California which can be guaranteed issue.
Large Group. Companies generally larger than 50 employees.
Medicare. For individuals age 65 and over or disabled (under age 65). Federal program with private supplemental insurance market (called Medigap).

Important Entities

We created a page here with the various entities but these are the big ones:
California Department of Insurance (DOI). Regulates the California insurance market, carriers, and agents. Federal website for Medicare program. Prexisting Condition Insurance Plan for people who can't qualify for individual coverage
MRMIP. High risk pool for people who can't qualify. Includes AIM program for pregnant women
Medi-Cal. Low or no cost health insurance based on income.
Find more California health insurance resources here.
Carrier Landscape

We have one of the most competitive carrier landscapes in the United States. The market segment can affect which carriers dominate but currently, the dominant carriers are:

  1. Anthem Blue Cross of California
  2. Blue Shield of California
  3. Kaiser
  4. Health Net of California
  5. United/Pacificare


Health Reform

The roll out of Health Reform is in full swing and the information is changing daily. We'll continue to add information as it finalizes. You can find updated articles on health reform from the  home page.


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