The insurance market in California is set to undergo enormous changes when the Affordable Care Act takes full effect in 2014 and millions of residents become eligible for public insurance or subsidies for private insurance.

This report provides a performance baseline for health plans and insurers before the law begins to influence the marketplace. Data primarily from the state's two insurance regulators, the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI), were used to examine market share, enrollment, financial performance, share of premiums devoted to medical care, and consumer satisfaction.

Key findings are:

• Six insurance carriers accounted for three-fourths of the $111 billion health insurance revenues in California in 2011.
• Commercial enrollment remained essentially flat. Individual enrollment declined 9.1% from 2010 levels and group enrollment grew by less than 1%.
• Enrollment grew in the public sector, mainly due to increased sign-ups for managed care Medi-Cal.
• DMHC-regulated companies insure the largest share of consumers, with the exception of the individual market, where CDI-regulated carriers insured two of every three enrollees.
• Most of the largest carriers, both under DMHC and CDI, reported positive net income.
• ACA requires insurers to spend a minimum share of premium dollars on medical care or pay a rebate to consumers. In 2012, the first rebates were paid: $74 million was returned to approximately 1.1 million California policyholders.

An interactive graphic shows the largest private insurance carriers in California and their enrollment and revenue figures.

The complete Almanac report, as well as a quick reference guide, guide to county-based health plans, and past years' editions, is available under Document Downloads.