California Health Plans and Insurers
Katherine Wilson
January 2009
Private health insurance carriers form the backbone of California's market-based health care system, providing coverage to 67% of its population. Health insurance carriers serve not only the privately insured, but also large portions of the publicly insured, in Medi-Cal, Healthy Families, Medicare, and other public programs.
In California, regulation and oversight of health insurance lies in the hands of two entities: the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). DMHC primarily regulates health plans — health maintenance organizations (HMOs) and certain preferred provider organizations (PPOs) — while CDI has jurisdiction over traditional health insurers. Different statutes and regulations govern plans under the two bodies, resulting in separate reporting and operating requirements. This report, which provides comparable information from both regulators wherever possible, provides an overview of market share, enrollment, financial performance, consumer satisfaction, and pay for performance participation for California’s health plans and insurers. It is published as part of CHCF's California Health Care Almanac.
Key findings include:
- Five insurers account for 76% of $91.9 billion in health insurance revenue.
- From 2003 to 2007, DMHC enrollment averaged losses of nearly 1% per year, while CDI enrollment grew 22% per year.
- In 2007, revenue grew faster in CDI-regulated plans than in their DMHC-regulated counterparts, with Blue Shield revenues growing 58% (vs. 3% under its DMHC entity) and Anthem Blue Cross growing at 20% (vs. 2% under its DMHC-regulated company).
- Medicare Advantage plans cover nearly a third of California's Medicare beneficiaries.
- Half of all Medi-Cal beneficiaries are enrolled in managed care plans.
The complete report is available under Document Downloads.