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Individual Health Insurance

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Individual Health Insurance in California 2011 - A Snapshot

CA Individual Health Insurance 2000-2009 Trend - Column&Line.png - Nearly 2 million Californians have health insurance coverage through individual health insurance plans. - Following its peak in 2006, individual coverage enrollment declined by three-quarters of a million insured a 25% decline due to the recession. - Three health insurance companies - Anthem Blue Cross, Kaiser Permanente, and Blue Shield of California, with a total of about 1.5 million enrollees, serve over three-fourths of the individual market. PPO products cover the majority of individual enrollees. - Individual insurance purchasers, who pay 100 percent of their premium, are far more likely to be enrolled in high-deductible plans. Individual health insurance buyers ofte trade off higher out-of-pocket costs at the time of service for lower premiums. - Actuarial values confirm that the coverage obtained through the individual market is substantially less comprehensive than that provided by employers. A typical individual plan pays an estimated 55 percent of expenses incurred, compared to 80 to 90 percent for employer plans. - Individual premiums vary by age as much as five-fold. In 2014, health reform rules will limit these differences to a 3:1 ratio, increasing premiums for younger enrollees and reducing them for older ones in many instances. - One-third of individual purchasers are self-employed. One-fourth have a head of family who works for a large firm. Only one-tenth are non-workers. - Almost half of individual purchasers have a college degree, compared to just 14 percent of uninsured Californians.

Responding to incentives and penalties in 2014, many people now buying individual coverage and uninsured people as well as those currently in employer sponsored health plans will likely seek coverage in the Exchange. The individual market is expected to explode with estimates of upwards of 5 million Californians insured by individual health plans in 2016.

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