About Health Insurance Plans in California

California residents can obtain health insurance coverage through group plans offered by employers, individual plans purchased from insurance companies and publicly funded programs provided by state and local governments. Premiums for group and individual plans can vary, depending on age and health status; public insurance eligibility and premium costs can vary according to family size and income. California residents can find information about a variety of public programs through the Department of Health Care Services (DHCS).

Private Health Plans

• The majority of private health insurance programs in California offer health maintenance organization (HMO) and preferred provider organization (PPO) plans. HMOs require participants to choose a primary physician and receive health care through a network of approved providers. PPO plans do not require selection of a primary doctor and offer health services at reduced fees. Both types of plans can pay for doctor visits, prescription medicines and hospital services.

  The California Office of the Patient Advocate (OPA) ranks Kaiser Permanente of Southern California as the highest rated HMO plan, based on national standards and participant ratings. According to OPA, Aetna PPO, CIGNA PPO and Health Net of California PPO rank among the best PPO plans, based on national standards. Consumers can obtain private HMO and PPO plans through insurance companies or from employers.

Medi-Cal

• Medi-Cal, managed by the California Department of Health Care Services (DHCS), is the state's Medicaid program. Medi-Cal provides health insurance for low-income families and individuals in 16 counties, through HMO plans. Select counties offer the Medi-Cal Managed Care plan, which offers services to participants through a private HMO program. The Medi-Cal program can pay for clinic visits, mental health services, drug and alcohol programs, pharmacy services, hospital stays, surgery and vision care. California residents can apply for Medi-Cal coverage at county social services offices.

Healthy Families

• The Healthy Families program offers low-cost health insurance for teenagers and children (under the age of 19), including major medical coverage, vision care and dental care. The program offers coverage for children who do not have other health care coverage and do not meet eligibility requirements for Medi-Cal. Healthy Families can pay for prescription drugs, doctor visits, hearing tests, immunizations, substance abuse services, laboratory services and mental health care. Premiums vary, depending on family size and income, from $4 to $24 per month, per child.

CalPERS

• The California Public Employees' Retirement System (CalPERS) offers health insurance plans for public employees, their family members and public retirees. CalPERS offers HMO and PPO plans, administered by Blue Shield of California, Kaiser Permanente and Anthem Blue Cross. CalPERS provides programs for both state and local public employees.

Local Government Plans

• Some local governments in California sponsor health insurance for their residents. The City of San Francisco offers the Healthy Workers program for people working in an as-needed capacity for the city and county governments, along with the Healthy San Francisco program, available to uninsured residents. Eligible Los Angeles residents can obtain coverage through the L.A. Care Health Plan Medicare Advantage, which provides combined benefits from Medicare and Medi-Cal.

In the Future -- California Health Benefit Exchange

• On September 30, 2010, Governor Arnold Schwarzenegger signed two bills that pave the way for the creation of the California Health Benefit Exchange. Beginning in 2014, consumers will have the opportunity to buy insurance through a dedicated website, in accordance with federal health care reform. Through the exchange, California residents will have the opportunity to compare plans and find information about eligibility for federal subsidies.