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The CHCF Almanac regularly publishes data and analysis on California's health care market.


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California Health Insurers: Brink of Change

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California Health Insurers: Brink of Change

Katherine Wilson

California's insurance market is set to undergo enormous changes as health reform takes full effect and millions become eligible for public insurance or private subsidies.

February 2015
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This report provides a snapshot of the insurance market in California at the end of 2013, just before the major provisions of the Affordable Care Act (ACA) took effect. It also includes some initial figures from 2014 that point to large shifts in both Medi-Cal and individual coverage levels.

Data from the Department of Managed Health Care (DMHC), the California Department of Insurance (CDI), and other sources were used to examine market share, enrollment, financial performance, premiums, public coverage, and consumer satisfaction.

Key findings include:

  • Health insurance was a $123-billion business in California in 2013, with six carriers accounting for more than three-fourths of all revenues and most insurers operating in the black.
  • In 2013, enrollment shifts were small, except in the pre-ACA individual market.
  • State and federal policy actions brought significant growth to Medi-Cal managed care — about 2.8 million enrollees, a 58% increase in the 18 months ending in June 2014.
  • Covered California enrolled 1.4 million individuals in health insurance plans through 11 carriers in the first enrollment period ending March 31, 2014.
  • Product choice differed by market, with only 20% of individuals enrolled in HMOs and 79% of large group enrollees in HMOs in 2013. This could change in 2014 as the ACA implements sliding-scale premium subsidies and mandates freedom for individual enrollees to choose their product and insurer. 

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

The complete Almanac report, as well as a quick reference guide, is available under Document Downloads. Also see resources on the medical loss ratio.