How to Shop for Health Insurance in California

Start by determining what type of health insurance plan you currently have. Are you on:

• Your employer’s group health insurance plan?
• Your parents’ employer group health insurance plan?
• Your former or soon to be ex-spouse’s health plan?
• An individual health insurance plan?
• A Cobra or Cal-Cobra plan?
• A guarantee-issue HIPAA plan?
• A guarantee-issue high risk plan like California’s MRMIP (Major Risk Medical Insurance Program) or AIM (Access for Infoants and Mothers)?
• An employer group plan?
• A college-sponsored campus health insurance plan, with or without off campus coverage?
• A government-sponsored health insurance plan like Medicare, Medicaid, MediCal?
• A military health insurance plan like Tricare or medical coverage through the Veterans Administration?

If you don’t know the answer, you should start by asking your health insurance agent, your current health insurance carrier, your current or former employer, or your employer’s health insurance administrator, also known as a TPA (third party administrator).

In addition, if you don’t know already, find out what the premiums, costs and benefits of your current health plan are, i.e. the:

• Monthly Premium
• Office Visit Copay
• Annual Deductible
• Copays and deductibles for Brand Name and Generic drugs.
• Annual Maximum Out of Pocket Costs
• Maximum lifetime benefits
• Co-insurance percentage
• Hospital Copays or Coinsurance amounts
• Maximum daily or annual benefits if any.
• Maternity coverage if any
• Coverage for Preventive care such as annual Physical Exams, pap smear, mammogram, PSA antigen prostate test.
• Benefit limits not covered above

Once you know the details of your current plan, then you need to determine what your individual circumstances are:

• Are you terminating your employment from your employer?
• Is your former employer going out of business?
• Are you going to be offered Cobra?
• Are you in the election period of federal Cobra or Cal-Cobra?
• Are you being offered Cobra as a dependent spouse?
• Are you past the required Cobra Election period?
• Are you already on Cobra?
• Do you qualify for a guarantee-issue HIPAA plans?
• Do you have any pre-existing health conditions that would preclude you from being accepted into an individual or family health plan?
• Would your pre-existing condition be mild enough to allow you to still be accepted, but at a higher rate level?
• Do you own a small business with 2 or more full time employees including yourself?
• Does your profession have an association that offers guarantee-issue health plans?
• Are you in a low enough income bracket to allow you to qualify for coverage from certain government-sponsored health plans?
• Are you well covered by an employer, but are required to pay a substantial contribution from your paycheck in order to cover your spouse and your children?
• Are you turning 65 within the next 6 months?
• Are you between ages 18 and 23 and on your parents health insurance plan?
• Are you on your parents health insurance plan and about to leave college?

Next, you need to determine which health insurance “universe” or “market” you should be shopping in. The available markets are:

• Individual and family health insurance plan market
• Medicare senior health plans market
• Small business group health care plan market for companies with 2-50 employees.
• Mid market employer group health care plan market for companies with 51 to 200 employees
• Large employer group health care plan market for companies with over 200 employees.
• Association plans market for Individuals or small businesses in certain industries.
• Guarantee issue HIPAA plans market for those coming off of Cobra plans whose plans are ending.
• Government subsidized plans like Medical, Medicaid, Healthy Families, AIM, MRMIP (Major Risk Medical Insurance Plan)

Once you have gone through this exercise and know what type of health insurance plan you have now and what your options will be. Then it should be clear what steps to take next.

If it is still unclear to you what steps to take, then you should consult an experienced health insurance agent. Try to figure out with his/her assistance whether you should start applying to an individual health insurance plan first, or because of health conditions, not waste your time and go directly to a guarantee-issue plan, or try to set up a small group plan, etc., etc.
You may contact an agent at 800-286-7445. By email at, or go to

© Philip W Lee,,


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Lee Health Insurance Services | Healthcare Insurance Agency, Individual Health Insurance, Family Health Plans, Group Medical Insurance, Small Business Health Insurance, Whole & Term Life Insurance, Dental Insurance, Health Care Reform Assistance, Covered California Insurance Exchange Plans, Medicare Supplement Insurance, Medicare Advantage, Medigap Plans, Anthem Blue Cross, Kaiser Permanente, Blue Shield of CA, Health Net, Cigna, Aetna, Contra Costa County CA, Pleasant Hill, Danville, Concord, Berkeley, Martinez, Albany, Oakland, San Ramon, Alameda, Santa Clara, Campbell, Milpitas, Cupertino, Sunnyvale, Saratoga, Fremont, Palo Alto, Newark | 935 Moraga Road, Suite 240, Lafayette CA 94549 (925) 284-2000 or Toll-Free, (800) 286-7445