I don’t want to use Covered California and would prefer that the state not be involved in my healthcare decisions. I’m the sole earner in a family of five and looking for alternative health insurance options.
Has anyone here used private insurance or something like Medi-Share? Would love to hear your experiences and suggestions.
If you avoid Covered California, your options will be mostly non-ACA-compliant plans, meaning they don’t have to follow the same rules. That means they can deny coverage for pre-existing conditions and may not offer the same protections.
Medi-Share isn’t actually insurance—it’s a cost-sharing program, and it has strict limits. For example, it caps pregnancy coverage at $125,000, which can easily be exceeded in serious cases. It also won’t cover prescriptions for pre-existing conditions and has coverage limits for expensive treatments like cancer care.
Insurance is meant for worst-case scenarios, and ACA-compliant plans ensure you aren’t left with massive bills if something unexpected happens. If you don’t want to go through Covered California, your best bet might be finding an employer plan that fits your needs.
@Dezi
Private insurance can still be ACA-compliant, and some plans might be cheaper depending on your income. You’re right about Medi-Share—it’s not real insurance, but it can work if you’re healthy and don’t visit the doctor often.
Any private insurance plan you buy still follows regulations set by the government, but the decisions about your care are made by the insurance company, not the state. The benefit of ACA plans is that they have protections to ensure you don’t get denied coverage when you need it.
Medi-Share and similar programs might work for routine care, but they aren’t great in emergencies or long-term treatments. If you’re looking for non-Covered California options, you’ll want to work with an independent insurance agent to find a solid plan.
@Hero
California does have a penalty for not having ACA-compliant coverage. It’s around $1,000 per person per year, so for a family of five, it could be a lot more. If you go the private route, make sure the plan meets state requirements to avoid extra costs.
@Niko
That’s a separate issue from how the insurance works. Covered California doesn’t manage the benefits of the plans—it’s just a marketplace where private companies sell insurance. If you get a non-ACA plan, you’ll likely have more restrictions and fewer protections.
Covered California is just a marketplace that offers private insurance with subsidies based on income. The state doesn’t control your healthcare decisions.
If you don’t have employer insurance, you’ll need either a private ACA-compliant plan or a non-ACA plan (which may have big gaps in coverage). Also, skipping ACA coverage means you might owe a state penalty of up to $1,800 per adult.
Private insurance can be ACA-compliant, but many of the plans sold outside of Covered California are not.
I work in healthcare billing and see how different insurance plans impact medical decisions. In general, Medicaid and Medicare leave most decisions up to doctors based on medical necessity. Private insurance, especially non-ACA plans, tends to have more restrictions and higher costs for patients.
@Niko
I do insurance coding, and I see the same thing. Private insurance plans are much more restrictive than people realize, especially the cheaper ones.
Covered California doesn’t control your healthcare. It’s just a platform where you can compare and buy private insurance. If you qualify for a subsidy, it just means you’re getting back some of the tax money you’ve already paid.
If you don’t want to use Covered California, be sure to check that any private plan you buy meets ACA standards, or you could be left paying for a plan that covers very little.
@Sara-11
The issue is that a lot of doctors and medical groups don’t accept Covered California plans. Blue Shield is one of the few widely accepted options, but even that is getting harder to use.
Vesper said:
@Sara-11
The issue is that a lot of doctors and medical groups don’t accept Covered California plans. Blue Shield is one of the few widely accepted options, but even that is getting harder to use.
Kaiser is always an option if you’re okay with their system.
@Sara-11
Kaiser works for some people, but if you already have a care team, switching to Kaiser isn’t always an option. They’re also terrible for behavioral health, and there are multiple lawsuits over it.
Plans on Covered California are still private insurance. The government just makes sure they meet ACA standards, and if you qualify, they help cover part of the cost through subsidies. You can still buy directly from insurers, but the plans will be the same ones available on the marketplace.
I think there’s some confusion here. Covered California is just a marketplace. My insurance is with Blue Shield, and my partner’s is with United Health. We signed up through Covered California, but once we had our plans, everything worked exactly like traditional employer insurance.
Be careful—some providers don’t accept Covered California versions of Blue Shield and other insurers. If you go that route, make sure to confirm that your doctors will actually take the plan before signing up.
@Teagan
I’ve been dealing with this. I’ve called at least five different offices, and they either won’t take Covered California plans or won’t accept my Anthem plan. Finding a provider is turning into a full-time job.