Employer plans
Still the most common route. You usually get a menu of an HMO and a PPO. The HMO is cheaper monthly; the PPO buys flexibility to self-refer and see anyone. Enrollment happens at hire and during your employer's annual open enrollment.
Health Insurance in California
Covered California, employer plans, and how to pick a network that actually covers San Diego doctors.
Last updated
Quick answer
Most Californians get coverage through an employer. If you don't have that, Covered California is the state's Affordable Care Act marketplace, and it's the only place to get income-based subsidies — California adds its own state subsidy on top of the federal one, so check even if you assume you earn too much. Open enrollment generally runs from November into January, but moving to California, losing job coverage, marriage, or a new baby all trigger a special enrollment period, typically 60 days. Medi-Cal covers lower-income residents year-round with no enrollment window. California also has an individual mandate with a state tax penalty for going uninsured. When comparing plans, the metal tier (Bronze through Platinum) sets the premium-versus-deductible tradeoff, and the plan type sets your flexibility: HMO means a medical group and referrals, PPO means self-referral and out-of-network coverage at a cost, EPO means no referrals but no out-of-network coverage at all. In San Diego specifically, check that the plan's network includes the hospital system you'd want to use — Scripps, Sharp, UC San Diego, Palomar, or Kaiser.
Plan types compared
| Type | Referrals needed | Out-of-network | Premium |
|---|---|---|---|
| HMO | Yes — from your PCP | Emergencies only | Lowest |
| EPO | Usually no | Emergencies only | Low to mid |
| PPO | No | Covered at a higher cost share | Highest |
| Kaiser (HMO) | Yes — within Kaiser | Emergencies only | Low, integrated care |
| Medi-Cal | Yes — managed care plan | Limited | No premium for most |
Where coverage comes from
Covered California
The state marketplace for individuals, freelancers, and early retirees. Plans are standardized by metal tier so the same tier has the same deductible and copays across carriers — you're really choosing on premium and network.
Medi-Cal
California's Medicaid program, available year-round based on income. In San Diego County it's delivered through managed care plans, and it covers a large share of county residents.
Medicare
Age 65 and over. San Diego has a deep Medicare Advantage market with plans tied to Sharp, Scripps, and Kaiser — network is the whole decision here.
COBRA and its alternatives
COBRA continues your old employer plan but you pay the full premium. Losing job coverage opens a Covered California special enrollment period, and a subsidized marketplace plan is often far cheaper than COBRA for the same coverage level.
Student and short-term options
Local universities offer student health plans. Short-term plans are heavily restricted in California and generally don't satisfy the state mandate — read carefully before buying one.
Choosing a plan that works in San Diego
The generic advice about deductibles matters less here than the network question. A cheap plan that doesn't include your hospital system is not cheap.
Start with the hospital, work backwards
Decide whether you want access to Scripps, Sharp, UC San Diego, Palomar, or Kaiser, then filter plans that include it. Switching systems mid-treatment is genuinely painful.
Check that your doctors are in network
Use the carrier's provider search, then call the office to confirm. Directories are updated slowly and a wrong assumption here is expensive.
Match the tier to your expected use
Bronze means low premiums and a high deductible — fine if you're healthy and want catastrophic protection. Silver is the default for most people and the only tier eligible for cost-sharing reductions at lower incomes. Gold and Platinum make sense with ongoing prescriptions, a planned surgery, or a pregnancy.
Look at the out-of-pocket maximum, not just the deductible
That number is your worst-case year. It's the figure that matters if something serious happens.
Check the drug formulary
If you take a regular prescription, look it up in each plan's formulary before enrolling. Tier placement can swing your annual cost by thousands.
Get free enrollment help
Covered California certified enrollment counselors and insurance agents help at no cost to you. There is no reason to guess your way through this alone.
Deadlines and moving
Open enrollment
Covered California's open enrollment generally runs from November through January. Coverage start dates depend on when in that window you enroll.
Moving to California triggers special enrollment
A permanent move into the state opens a special enrollment period, usually 60 days. Don't let it lapse — outside it, you're waiting for open enrollment unless something else qualifies.
Other qualifying life events
Losing job-based coverage, marriage, divorce, birth or adoption, and turning 26 all open a 60-day window.
The state penalty
California charges a tax penalty for going without qualifying coverage, unlike the federal mandate. Factor it in when weighing a Bronze plan against nothing.
Things people get wrong
- • Assuming you earn too much for a subsidy. California's state subsidy extends further up the income scale than the federal one — run the numbers before dismissing the marketplace.
- • Buying a PPO you don't need. If your doctors are all in one system anyway, the HMO premium savings are real money.
- • Forgetting dental and vision. Both are separate plans in California, for adults, and are not bundled into medical coverage.
- • Not updating income mid-year on a subsidized plan. Subsidies reconcile at tax time and a large income change can create a surprise bill.
- • This is general orientation, not financial, legal, or insurance advice. Confirm current rules, deadlines, and amounts with Covered California or a licensed agent.
Frequently asked
What is Covered California?
Covered California is the state's Affordable Care Act health insurance marketplace. It's where individuals and families who don't have employer coverage buy plans, and it's the only place to receive income-based federal and California state subsidies. Plans are standardized by metal tier so the same tier offers the same benefits across carriers.
When is open enrollment for health insurance in California?
Covered California's open enrollment generally runs from November into January. Outside that window you need a qualifying life event — moving to California, losing job-based coverage, marriage, or a new child — which typically opens a 60-day special enrollment period. Medi-Cal enrollment is open year-round.
Is there a penalty for not having health insurance in California?
Yes. California has a state individual mandate and charges a tax penalty for residents who go without qualifying coverage, even though the federal penalty was reduced to zero. The amount depends on household size and income.
What's the difference between HMO, EPO, and PPO in California?
An HMO assigns you to a medical group and requires primary care referrals for specialists, with no out-of-network coverage except emergencies — the cheapest option. An EPO drops the referral requirement but still has no out-of-network coverage. A PPO lets you self-refer and covers out-of-network care at a higher cost share, for the highest premium.
Which health insurance is best in San Diego?
Choose by network, not by brand. Decide which hospital system you want access to — Scripps, Sharp, UC San Diego Health, Palomar, or Kaiser — then compare plans that include it. A lower premium on a plan that excludes your hospital and doctors ends up costing more.
Do I qualify for Medi-Cal in San Diego?
Medi-Cal eligibility is income-based and available year-round with no enrollment window. It covers a substantial share of San Diego County residents through managed care plans. Applying through Covered California automatically screens you for Medi-Cal eligibility.
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