California health care options, from individual and family insurance plans to state programs

0


Health care in California is among the issues that have been raised as the state’s recall election begins on September 14.

The Los Angeles Times California Gov. Gavin Newsom reported on Friday that Republicans are seeking to “cut access to health care for those in need,” according to his statement in the voter guide sent to residents ahead of the election.

Health care in the state is accessible through a variety of types of coverage, from public programs for those with low incomes to individual / family health insurance plans and those provided by an employer. Each operates by its own rules and is regulated by different government agencies.

Here we outline the various basic health care options currently available to California residents.

Individual and family health insurance

Residents can purchase health insurance as an individual if they are not covered by their employer and are not eligible for any of the state’s public health programs.

Once a person has purchased the health insurance of their choice, their family members (as well as other dependents in some cases) can be added to be covered by their health insurance policy.

The California Department of Insurance (CDI), which regulates insurance in the state, including health insurance, says that following the Affordable Care Act (ACA), consumers now have more protections when purchase of health insurance.

As stated on the CDI website:

  • Insurers can no longer deny you coverage if you have a “pre-existing condition”.
  • Insurers can no longer charge you more based on your state of health.
  • The federal government offers grants to lower the cost of your premium if you meet certain income criteria.

Residents can contact businesses directly to purchase individual or family health insurance. See the CDI website for a list of health insurance companies licensed by CDI.

Through the Affordable Care Act, California also created a health insurance market known as Covered California, through which individuals, families and small businesses can purchase health insurance from private insurers.

Covered California also helps residents determine if they are eligible for public health insurance programs, such as Medi-Cali (more on Medi-Cal below).

A logo for Covered California, a subsidized health insurance scholarship and Medicaid administrator for California, seen on a piece of paper in August 2019.
Smith / Gado / Getty Images Collection

Employer health insurance and self-insured plans

Employers and other associations purchase group health insurance policies, which are issued to individual employees or members of the group. Depending on the company, you may be able to add family members or dependents to your health insurance policy and your employer may require you to pay some or all of the monthly premium, depending on the CDI.

Many large companies are self-insured. The CDI says it’s important to know whether or not your employer is self-insured because you may not have the same protections and benefits as other types of health insurance coverage. Self-insured plans are not required to follow California essential health benefits, complaints, and coverage laws.

The CDI website states: “Self-insured plans issued by private (non-public) companies follow the Federal Employees Retirement Income Security Act of 1974 (ERISA) and are regulated by the United States Department of Labor, the Employee Benefits Security Administration (EBSA). “Check out the EBSA website for more information.

Medical

Medi-Cal is the state’s Medicaid healthcare program, which provides free or low-cost medical coverage to millions of Americans, including those on low incomes.

Funded by federal and state taxes, Medi-Cal, which is made up of many different programs, offers several medical services for children and adults with limited incomes and resources, explains the government’s Benefits.gov website.

To be eligible for California Medicaid, applicants must be a California resident, US national, citizen, permanent resident, or legal alien, in need of Medicare assistance, and “whose financial standing is characterized. like low or very low income, “says Benefits.gov. They must also fall into one of the following categories:

  • To be pregnant
  • Be responsible for a child aged 21 or under
  • be blind
  • Have a disability or have a family member in your household with a disability
  • Be 65 years of age or older

In late July, Newsom signed a bill expanding the Medi-Cal program to include undocumented Californians aged 50 and over and extending eligibility for Medi-Cal for those in postpartum.

Some uninsured middle-income pregnant women may also be eligible for the Medi-Cal Access Program (MCAP).

Health Insurance

Some California residents can also access Medicare, a federally funded health insurance program for people 65 and older, people under 65 with certain disabilities, and people of all ages with disabilities. End-stage renal disease (ESRD), which is a condition of kidney failure that requires dialysis or a kidney transplant.

The California government website states that Medicare does not cover all health care costs, and residents may wish to purchase other types of Medicare-related insurance, such as Medicare Advantage or a Medicare supplement policy.

See the CDI website for more information on Medicare supplemental insurance (also known as Medigap).

HMOs and managed care plans

Health maintenance organizations (HMOs) and managed care plans are different from traditional health insurance policies and operate under a different set of laws in California. As with health insurance policies, health care coverage can be purchased as an “individual / family” or “group” plan, explains CDI.

For HMOs, you are limited to using healthcare providers within the HMO network. Those who benefit from an HMO plan usually have a primary care physician, who provides basic care and can refer you to specialists.

Services accessible from a health care provider outside of your HMO network will not be covered by your HMO except for emergencies and urgent care. Other restrictions may apply to HMO plans.

HMOs and managed care plans are regulated by the California Department of Managed Health Care (DMHC).

Check the CDI website and the DMHC website for more information, including a list of managed health care plans in California.

Protesters in San Francisco.
Protesters protesting against proposed cuts to California’s Med-Cal and Medicare programs, seen outside San Francisco City Hall in September 2011.
Justin Sullivan / Getty Images


Share.

About Author

Comments are closed.