Health Insurance For Individuals Under 65 Years Old
Marketplace health insurance in California is offered through Covered California, the state’s official exchange created under the Affordable Care Act (ACA). It allows individuals and families to compare private health plans in one place, all of which must cover essential health benefits like doctor visits, hospital care, prescriptions, and preventive services. Plans cannot deny coverage for pre-existing conditions, and the application also screens for Medi-Cal eligibility, California’s Medicaid program, through the same process.
One major benefit of Covered California is access to financial assistance. Many enrollees qualify for federal tax credits and state subsidies that lower monthly premiums and sometimes reduce out-of-pocket costs. Subsidy eligibility is based on income and household size, and this financial help is only available through the Marketplace. Coverage is open to California residents who are lawfully present in the U.S., regardless of health status.
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Benefits you are eligible for will depend on your area and plan providers.
If you are interested in learning more about what plans offer in your county, please reach out and schedule an appointment.
Understanding Covered California
Financial help is available through federal tax credits and state subsidies to lower monthly premiums and out-of-pocket costs.
One application checks Medi-Cal eligibility, California’s Medicaid program, at the same time.
Pre-existing conditions are always covered—no denials or higher premiums based on health history.
Plans must cover essential health benefits, including prescriptions, hospital care, preventive services, and mental health.
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Different Types of Health Insurance Plans
HMO
In health insurance, an HMO (Health Maintenance Organization) plan requires members to use a network of doctors, hospitals, and other providers for their healthcare, except in emergencies. Typically, HMO plans also require a referral from a primary care doctor to see specialists.
PPO
In health insurance, a PPO (Preferred Provider Organization) plan offers more flexibility, allowing members to see any doctor or specialist, both in-network and out-of-network, though out-of-network care typically costs more. PPO plans do not require referrals to see specialists, providing greater freedom in choosing healthcare providers.
HSA Eligible Plans
HSA-eligible plans are high-deductible health plans (HDHPs) that allow you to contribute to a Health Savings Account for tax-advantaged medical savings. Contributions are tax-deductible, grow tax-free, and can be withdrawn tax-free when used for qualified medical expenses. These plans are often paired with lower monthly premiums, making them a popular option for people who want more control over healthcare costs.
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