Health insurance carriers form the backbone of California's market-based health care system, serving about two-thirds of the state’s population. In addition to covering the privately insured, these companies also serve enrollees in managed care plans through Medi-Cal, Medicare, and other public programs.

While California health insurers are a strong economic force overall, enrollment was flat in health plans overseen by both the California Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). Comparing information from both regulators whenever possible, this report examines market share, enrollment, financial performance, and consumer satisfaction for the state's health plans and insurers.

Key findings include:

• Five insurance carriers accounted for three-fourths of the $105 billion health insurance revenues in California in 2010. Revenue growth has been faster under CDI-regulated insurers than DMHC-regulated plans.
• The six largest DMHC-regulated plans together lost more than 400,000 commercial enrollees. In contrast, Medi-Cal and Medicare managed care enrollment grew.
• In 2010, over half of all Medi-Cal and more than one-third of Medicare beneficiaries were enrolled in managed care plans.
• Enrollment declined in 2010 for two major CDI-regulated carriers (Anthem Blue Cross and Blue Shield), reversing a growth trend.
• Five of the six largest DMHC-regulated plans posted positive net income. All major CDI-regulated carriers operated in the black in 2010, in contrast to 2009. 
• Large majorities of HMO and PPO members rated their plan highly in terms of getting appointments quickly, finding a doctor, and getting the care they need. HMO enrollees more often rated their care highly than those enrolled in PPOs, while PPO participants were more likely to favorably cite their ability to get an appointment quickly.

The complete Almanac report, as well as a quick reference guide and the 2010 edition, is available as a Document Download.