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Shopping for Individual/Family Coverage

Individual/family coverage is another type of health coverage. You can buy health insurance in the individual/family market if you do not get health insurance through your employer and you do not qualify for Medi-Cal or another public program.

Before the Affordable Care Act (ACA), consumers faced many problems in the individual/family market. Now, with the ACA, consumers have more protections. Some of these are:

  • Insurers can no longer deny you coverage if you have a 'pre-existing condition'
  • Insurers can no longer charge you more based on your health status;
  • The Federal government offers subsidies to lower the cost of your premium if you meet certain income critera.
    • For example, a family of four making up to about $94,000 per year may qualify for a subsidy to offset their monthly premium cost.
    • If you qualify for a subsidy, you have to purchase your coverage through Covered California to take advantage of it.

Review our Affordable Care Act page for more information about how healthcare reform impacts you.

How do I purchase Individual/Family Coverage?

  • Call an insurance company directly
  • Contact an agent or broker licensed by the California Department of Insurance (CDI)
    • Health Insurance agents and brokers can help you find the health insurance policy that you need. To protect consumers from fraud and abuse, the California Department of Insurance licenses all brokers in California. If you have a broker help you, you can check to make sure they're license is current by checking their license status.
    • The California Insurance Commissioner put together a Standard Broker Disclosure and Standard Broker Fee Agreement to help you when working with a broker.
  • Purchase a policy through Covered California: California's Health Insurance Marketplace.
    • As part of the Affordable Care Act, California created a healthcare exchange/marketplace called Covered California. Individuals, families, and small businesses can buy private insurance though Covered California. Covered California also helps individuals and families find out if they qualify for the Medi-Cal program.
    • Many people qualify for a premium subsidy when buying private heath insurance for themselves and their family. That subsidy is only available when you purchase a policy through Covered California.

What Should I Keep in Mind When I'm Shopping for Individual/Family Coverage?

For help choosing the health coverage that is right for you, we have provided some considerations when purchasing health insurance.

Remember, cost is not the only thing to think about when you buy health coverage. The quality of health care covered by an insurer is important. Each year, CDI shares a report on quality called the PPO Report Card.

When choosing your plan, you can use California Healthcare Compare to find higher- and lower-performing hospitals and medical groups for childbirth, hip and knee replacement, back pain, colon cancer screening, and diabetes care. You can also see how your costs for the same medical care can vary greatly by exploring what people who live in your area pay in more than 100 different medical situations, from appendicitis to urinary tract infections.

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