2022 Edition — California Health Insurers

Staying the Course

Katherine Wilson, Wilson Analytics


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California Health Insurers: Staying the Course provides a snapshot of the insurance market in California at the end of 2020. Data from the state’s two insurance regulators — the California Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) — and other sources were used to examine market share, enrollment, financial performance, and consumer satisfaction.

Key findings include:

  • California health insurance had $222 billion in revenue in 2020, up from $195 billion in 2018.
  • Most of the largest insurers, under both DMHC and CDI, were profitable in 2020. The average margin (net income divided by total revenues) across all DMHC-regulated plans was 4.1% in 2020, slightly down from 5.1% in 2019.
  • Health insurance enrollment in California increased in 2020 by over a million enrollees, mainly due to growth in Medi-Cal managed care (9.2%) and individual enrollment (9.7%).
  • At the end of 2020, California’s insurers covered 33.8 million people — 14.4 million were commercial enrollees and 13.8 million were public managed care enrollees. There were also 5.6 million people enrolled through administrative services only arrangements for self-insured employers.
  • At the end of 2020, 94% of individual, 95% of small group, and 93% of large group enrollees were in plans regulated by DMHC.
  • The Affordable Care Act requires insurers to spend a minimum share of premium dollars on medical care or pay a rebate to consumers. In 2020, California insurers owed $95 million in rebates. Rebates averaged $117 per person for about 816,000 people.

The full report, a quick reference guide, the data file, and all the charts found in the report are available for download below.

These materials are part of CHCF’s California Health Care Almanac, an online clearinghouse for key data and analyses describing the state’s health care landscape. See our entire collection of current and past editions of California Health Insurers and Enrollment.

Resources about the medical loss ratio are also available.