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California Healthcare: An Intriguing Guide

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Health is wealth and Healthcare costs money. Often life happens, so we need to stay ‘covered’. Life Insurance policies give us just that.

California healthcare policies have something for everyone— single individuals, children, families, and businesses. Let us look at some statistics as far as California healthcare is concerned.

eHealth website gives us the following statistics about California medical insurance.

Total number of California residents: 39,188,300

Percentage of Uninsured California Residents: 8%

Total number of California HMO enrolment: 21,414,031

But why is healthcare such a cornerstone, to begin with?

Along with water, food, and shelter; health too is a basic necessity. Health conditions can range from mental illnesses, alcohol or drug abuse, cancer, chronic ailments, or other complicated health issues. It is in the midst of facing such complex issues that one realizes the value of health.

The United States-based Global Health Council has aptly said-

When it comes to global health, there is no ‘them’ only ‘us’.

source: brigespan.org

World Health Organization’s “Measuring Overall Health System Performance for 191 Countries” places France, Italy, and San Marino as rank 1, 2, and 3, respectively.

The Commonwealth Fund conducted a study to rank 11 countries based on their quality of healthcare. The top 3 ranks were— the United Kingdom, Australia, and the Netherlands.

So, what measurements form the basis of such rankings?

Measurement is not simply based on healthcare but on healthcare outcomes. These include— mortality rate, hospital readmission, and experience of patients.

Source: flickr

What is ‘Hospital Readmission’?

In this situation, a patient who has been discharged from the hospital is admitted again for the same or related conditions within a specified time range of 30, 60, or 90 days.

The number of readmissions is used to measure the quality of healthcare provided. This is because the reason for readmissions could be that the follow-up care wasn’t appropriately organised; all complications or side-effects were not ruled out, or simply that the patient was not appropriately treated before discharge.

Therefore, the ‘hospital readmission reduction program’ was launched as a part of the Affordable Care Act as it indicates a lack of quality and increases costs. So, one needs to be patient with patients!

The Healthcare Access and Quality (HAQ) Index ranks the score of healthcare outcomes on a scale of 0 to 100. Even though access to good healthcare shouldn’t depend on where you live, it does. The Netherlands has the highest HAQ score of 96.1.

Some of the other best Healthcare Systems in the World:

Switzerland-has a universal system- healthcare is essential for all people living in the country. It isn’t tax-based or employer-financed. Then, how is it financed?

Switzerland offers Swiss Healthcare Schemes that individuals pay for through their contributions. By combining private, subsidized private, and public healthcare systems, Switzerland provides its citizens with an extensive network of doctors, equipment, and hospitals. What’s more, hospitals here are renowned for having no waiting lists!

Finland- another country that boasts of one of the best healthcare in the world- has a favorably decentralized system. It is funded through taxes and National Health Insurance (NHI). According to a European Commission Survey, 88% of the Finnish population was satisfied with their healthcare system. Way to go Finland!

Now, coming back to California, healthcare should work to ensure that people from all strata of society have equal access to the health services that they need, whenever they need it, and at a cost that they can afford.

The system should be dedicated to advancing meaningful, measurable improvements in the way the California healthcare delivery system provides care to (including) those with low incomes and whose needs are not being fulfilled. But medical insurance is no cakewalk.

Although it shouldn’t, how one obtains their healthcare coverage depends on an array of factors, such as— income, whether employed or unemployed and place of residence. California healthcare should find affordable health insurance for all Californians.

What does California offer?

Covered California website of health insurance coverage gives coverage options of health, dental, and vision care— all in one place.

source: wikimedia

Another website is the California Healthcare Almanac that is home to objective information on health care costs, coverage, quality, and delivery supports effective decision making. The Almanac provides data and analysis on California’s healthcare system.

Types of Healthcare Coverages

California healthcare coverages are of several types: Medical, Medicare, HMOs or Health Maintenance Organizations, and Health Insurance Policies. Each of them follows their own rules formulated and regulated by US government agencies.

Health Insurance Policies are either group policies or individual/family policies. A group policy may be bought by an employer from a small business and issued to the employees. Of course, there are provisions to add family members or dependents to one’s policy.

The employer may also request payment of some or the entire monthly premium. Individual/Family Policies are insurances bought outside of an employer. This is for the individual and his/her family.

One can refer to various information available on official health insurance websites to clarify all pressing doubts. A complete guide to purchasing health insurance coverage is available here.

HMOs or Health Maintenance Organizations

These are different from the above traditional insurance policies. These come under the California Department of Managed Health Care (DMHC).


This is provided by the California Department of Health Care Services. It is a social outreach program for the lower-income Californian individuals and families. The individuals who qualify for it may receive it as a benefit, free of cost. Medi-Cal covers a variety of medical procedures, visits to hospitals, and other health-related expenses.

Apart from the Medi-Cal aid, another program is the MCAP or Medi-Cal Access Program. This low-cost health insurance benefits pregnant women who are not under any other government or private health insurance coverage.

What does it Mean to be ‘Covered’?

After one buys health insurance, the insurer makes sure that the insurance buyer has reasonable access to an adequate number of health centers and hospitals. These then form their network. The insurance covers special health topics and resources such as— Consumer Protection from Medical Bills, Dental Medical Loss Ratio, and Coverage for Autism Spectrum Disorder— that figure in the qualifying life event category.

Insurance Fraud

The California Department of Insurance or CDI has several health information related guidelines, and it takes insurance fraud seriously. In fact, it has a division that primarily deals with insurance fraud. Their task is to protect the unassuming public from getting cheated of their money, economic loss and distress by arresting fraudsters.

California Healthcare Reform

Affordable Care Act or ACA was passed in 2010, and since then, a lot has changed in the California healthcare system. The aim is to reduce the number of uninsured Californians, improve the quality, accessibility, and affordability of the care.

ACA offers a ‘subsidy’ based on the annual income of the individual or family. Individuals, by the new act, are now required to have health coverage by law. Even if one goes for two months without coverage, he/she could face a tax penalty. One way to expand its reach!

It’s never too late to give your physical and emotional wellness some attention; maybe this is the kickstart that was needed. The reduction of hospital readmissions is also a program under the ACA, as mentioned above.

What if I don’t Qualify for Any Insurance Plan?

So, if one qualifies for the Employer Health Insurance Plan, Medicare, Medi-Cal, or the Covered California Plan, they can visit the respective official websites and get the ball rolling. They can find options for open enrolment, apart from— the address, and phone number— that they need. If one does not qualify for any plan, consider buying health insurance plans in California from an insurance company.

There are quite a few options, so how do you choose one? Choosing a healthcare plan should not be like shooting an arrow in the dark— one must be aware of the sea of options they are wading through. Yes, it can be overwhelming, but it is indispensable. Remember, the penalty?

In such situations, younger people prefer to buy short term insurance plans which are at the lowest prices. These plans can also be purchased in special enrolment periods between insurance policy plans. As is rightly said, “Inch by inch, health is a cinch. Yard by yard, health is hard”!

Some Insurance Companies to Approach

Anthem is an insurance organization that provides plans to many states in the US. For the California healthcare insurance plans, it offers different budgets for different health care needs. This is essential as the cost of health insurance can be a major chunk of one’s family budget.

The payments on the Anthem plan are made monthly. The most/maximum that one has to pay out of one’s pocket for the California healthcare services that Anthem provides each year is called ‘out of pocket maximum’.

The higher one’s monthly premium is, the lower the share of the cost will be. People who, in general, are healthy and rarely go to the doctor’s, might choose a plan with a low monthly premium and higher cost share.

On the other hand, people suffering from chronic ailments and having health complications may need to visit the doctor frequently, ergo they might choose a plan with a higher premium, and lower cost share. After all, it costs money to stay healthy, but it’s even more expensive to get sick.

However much of an oxymoron it might sound, one must be prepared for the unexpected! As important as it is to learn as you go, you have to be prepared for the curveballs. For instance, what if one loses their job?

Undoubtedly, losing one’s job is difficult, but does that mean that one has to bid adieu to his/her healthcare as well? Not with Anthem. Here, one does not have to lose coverage for themselves or family as Anthem provides health insurance for the unemployed as well.

In addition, Anthem’s California healthcare plans have made insurance accessible and less cumbersome. How is that? They provide a single bill, one ID card, one team for service, and finally one website under which shopping for plans and availing its benefits is just a click away. Imagine the runs and the paper that is saved!

Another famous California healthcare provider is the Blue Shield California. They offer Medicare plans for a wide range of needs and budgets. In addition, if one qualifies for Medi-Cal plans, they can get the exact care that they need.

Also, the healthcare coverage plans are flexible for the individual and families. They offer member discounts so that Californians can be proactive with their health without it leaving a hole in their pockets.

Their care programs make sure that a member feels peace of mind while managing their health. Apart from their network of professional and qualified doctors and physicians, a registered nurse is available 24*7, on the website, to answer questions.

A scroll through their website will reveal that everything is well-organized. What is eye-catching is the section- ‘featured articles’. The articles are on interesting and cutting-edge topics such as— “BlueSky initiative reimagines youth mental health”, “Myth busting: 7 facts about the flu shot”, and “Helping children meet trauma with mindfulness” to name a few.

Blue Shield California also offers medical advice over email, phone, or video call so that that unnecessary runs can be saved as far as possible. In fact, now the innovative teledentistry allows you to consult a dentist from the safety of your homes.


Non-discriminatory nature

Being non-discriminatory where race, colour, ethnicity, religion, class, gender, age, or disability are concerned, should be primary for any healthcare provider. This is not merely complying with state and federal civil rights laws regarding the same but showing basic humanity; something that the medical profession originally stands for and upholds. In case of failure to do so, Blue Shield California allows filing grievances with its Civil Rights Coordinator.

How to choose a California Healthcare provider?

When comparing plans, a good way to compare the cost share would be to compare the costs of specific services. For example- emergency service care, ambulance costs, hospital admission and stay costs, X-rays, MRIs, prescription medicines, pregnancy and prenatal care, psychiatric consultations and mental health care, and substance abuse disorder care.

Looking at the variety of plans to choose from can be overwhelming. Still, if one were to keep in mind the costs of the above specific care, as an underlying basis for comparison, one could quickly narrow down the options. What’s more, you now feel empowered in making the decision for yourself and family.

If you liked our article on California Healthcare, be sure to check out more articles like this.


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