Health Insurance

Open Enrollment Is November 1, 2021, To January 31, 2022

“Your health account, your bank account, they are the same thing. The more you put in, the more you can take out."

– Jack Lalanne

Open Enrollment For 2022
Will Run Between
November 1, 2021, To January 31, 2022,
both on and off-exchange.

California will have a State-based premium subsidy for 2020-2023 for enrollees’ income up to 600% of the poverty level compared to 400% until 2019. Thus, more people will be eligible for a premium subsidy.  

California will have an individual mandate starting in 2020. The penalty for not having health insurance will be a minimum of $695 per uninsured adult and $347 per child OR 2.5% of the annual household income; whichever is greater.

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Individual Health Insurance

Individual Health Insurance - Child Only

Individual Dental Insurance

Group Health

HMO (Health Maintenance Organization) is generally the most affordable, but least flexible network type.

Key concepts of HMO 
  • You are required to select a primary care physician who is your first stop for health care needs.  
  • A referral from your primary care physician is needed to see a specialist.
  • seeing a doctor outside of the network or without a referral will incur out-of-pocket unless it is a true medical emergency. 
  • The physician network is local.   

PPO (Preferred Provider Organization) is generally the most flexible, yet most expensive network type.

Key Concept of PPO: 
  • Any physician or specialist within the network is available for you. 
  • For in-network providers, you only pay for a portion of the bill based on your coverage structure. 
  • Out of network providers will incur a larger out-of-pocket co-payment. 
  • Out-of-state providers are available in-network  

EPO (Exclusive Provider Network) is a hybrid of a HMO and a PPO.

Key Concepts Of An EPO:
  • EPOs are more flexible than an HMO and are typically less expensive than a PPO
  • For in-network providers, you only pay for a portion of the bill based on your coverage structure.
  • Like a PPO, you do not need a referral to get care from a specialist.

Note: Once open enrollment ends, only individuals with the following qualifying life events will be able to enroll

Loss Of Health Coverage

  • Loss Of Health Coverage
  • Losing existing health coverage, including job-based, individual, and student plans
  • Losing eligibility for Medicare, Medicaid, or CHIP

  • Turning 26 and losing coverage through a parent’s plan

  • Changes in household

    • Getting married or divorced

    • Having a baby or adopting a child

    • Death in the family

  • Changes in residence

    • Moving to a different ZIP code or county

    • A student moving to or from the place they attend school

    • A seasonal worker moving to or from the place they both live and work

    • Moving to or from a shelter or other transitional housing

  • Other qualifying events

    • Changes in your income that affect the coverage you qualify for

    • Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder

    • Becoming a U.S. citizen

    • Leaving incarceration (jail or prison)

    • AmeriCorps members starting or ending their service

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