Citizen Guide for California

Written By Jerdon Johnston

Understanding Your Healthcare Options in California

Navigating healthcare coverage can be overwhelming, but California offers several programs to help residents access quality care. Whether you are uninsured, underinsured, or seeking assistance with medical costs, this guide introduces key options available to Californians.

Who Needs This Guide?

  • You are uninsured or struggling to afford health insurance.

  • You want to explore healthcare coverage options in California.

  • You need financial assistance for medical costs.

  • You want to maximize the benefits of your current healthcare plan.

 

Key Healthcare Programs in California

1. Medi-Cal (California’s Medicaid Program)

  • Who Qualifies? Low-income individuals, families, pregnant women, children, and people with disabilities.

  • What It Covers? Doctor visits, hospital care, prescriptions, preventive services, and more.

  • How to Apply? Visit Covered California or apply through the county social services office.

2. Covered California (ACA Health Plans)

  • Who Qualifies? Anyone who doesn’t get insurance through an employer, Medicare, or Medi-Cal.

  • What It Covers? Comprehensive health coverage, including preventive care, emergency services, and mental health care.

  • How to Apply? Visit Covered California to explore and enroll in ACA plans.

3. Medicare

  • Who Qualifies? Individuals 65+ or those with certain disabilities.

  • What It Covers? Hospital stays (Part A), doctor visits (Part B), and optional prescription drug coverage (Part D).

  • How to Apply? Visit Medicare.gov to enroll.

4. Employer-Sponsored Health Insurance

Many employers in California offer group health insurance plans, often covering part of the premium. If you have a job, check with your employer about available health benefits. COBRA may be available for those who recently lost job-based insurance.

5. Short-Term & Supplemental Health Plans

These plans provide temporary coverage or fill gaps in traditional insurance. Options include:

  • Short-term health plans for temporary needs.

  • Accident or critical illness insurance to help cover unexpected medical expenses.

Financial Assistance Programs

  • Premium Tax Credits – Reduce the cost of ACA marketplace plans.

  • Cost-Sharing Reductions – Lower out-of-pocket costs for qualifying individuals.

  • California-Specific Assistance Programs – Medi-Cal expansion and state-funded premium subsidies help lower costs for eligible individuals.

Where to Get Help

  • Covered California – Compare and enroll in ACA plans.

  • Medi-Cal Office – Apply for Medi-Cal or CHIP based on eligibility.

  • Local Community Health Centers – Get low-cost or free healthcare services.

  • Tsunami Advisors – Personalized guidance to find the best plan for your needs.

➡ Need Help? Schedule a free consultation with a Tsunami Advisor today!

Business Owner Guide for California

Healthcare Options for Your Business & Employees in California

As a business owner, offering health benefits can improve employee retention, productivity, and overall satisfaction. Whether you’re a small business owner or running a larger company, here’s a breakdown of healthcare options in California.

Who Needs This Guide?

  • You own a business and want to provide affordable health benefits.

  • You need to understand employer healthcare obligations.

  • You’re looking for cost-saving strategies for offering insurance.

Healthcare Coverage Options for Employers

1. Covered California for Small Business (SHOP)

  • Who Qualifies? Small businesses with 1-100 employees.

  • What It Covers? Employer-sponsored ACA-compliant plans.

  • How to Apply? Visit Covered California for Small Business.

2. Group Health Insurance Plans

Many private insurers offer group health plans for businesses of various sizes. These plans often provide better rates and broader coverage than individual plans.

3. Health Reimbursement Arrangements (HRAs)

HRAs allow businesses to reimburse employees for medical expenses, including health insurance premiums. Options include:

  • Qualified Small Employer HRA (QSEHRA) – For businesses with fewer than 50 employees.

  • Individual Coverage HRA (ICHRA) – Lets employers contribute toward individual health plans.

4. Self-Funded or Level-Funded Health Plans

Larger businesses may choose to self-fund their insurance, taking on financial risk in exchange for potential cost savings.

Legal Requirements for Businesses

✔ Employers with 50+ employees must offer health insurance under the Affordable Care Act (ACA) or pay a penalty.
✔ Employers with fewer than 50 employees are not required to offer insurance but may qualify for tax credits if they do.

Cost-Saving Strategies for Employers

💰 Small Business Health Care Tax Credit – Available for companies with fewer than 25 employees offering health coverage.
💰 Wellness Programs – Lower premiums and improve employee health.
💰 Telemedicine & Supplemental Benefits – Reduce overall healthcare expenses.

Where to Get Help

  • Tsunami Advisors – Get expert recommendations for cost-effective coverage.

  • Covered California for Small Business – Explore employer-sponsored plan options.

  • IRS Small Business Tax Guide – Learn about tax credits and compliance.

➡ Need Guidance? Speak with a Tsunami Advisor to create a healthcare strategy tailored to your business!

 
Jerdon Johnston
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California