How the Healthcare System Works
You are Responsible
In our society, the consumer is responsible for getting health coverage.
If you are uninsured, it is important that you understand your choices, as this will keep you from having to pay high cash prices for care.
It is also important to get health coverage and medical care before you need it to prevent the worsening of your condition. Any condition or symptom left untreated can lead to health complications that can be life threatening.
Ways to find health coverage
You may obtain coverage through:
- An employer.
- Privately buying a plan for yourself (such as Kaiser, Blue Cross, CIGNA).
- Enrolling in a government funded program.
- Accessing Local County Health Services (these programs vary by county).
- Going to a non-profit clinic or provider for discounted care (if you are uninsured).
- If you are a Veteran, there are veteran-government services available to you.
Try an Elibility tool:
About Government Funded Programs
Government funded programs are paid for with your tax dollars. They include the programs such as:
Medicare
Medicare is a federal health insurance program for: people 65 years of age or older, people younger than 65 with a disability, and people with kidney failure. There are several types of coverage: hospital care (Part A), doctor and outpatient services (Part B) and prescription drugs (Part D).
Learn more:
MediCare
Medi-Cal
Medi-Cal is California's Medicaid program and provides health insurance for low-income and disabled persons and children. There are different types of Medi-Cal programs, such as straight Medi-Cal, share of cost and Managed Care - Medi-Cal.
Learn more:
Medi-Cal
Healthy Families
Healthy Families is low cost insurance for children and teens. It provides health, dental and vision coverage to uninsured children who do not qualify for free Medi-Cal.
Learn more:
Healthy Families
Local Children's Health Initiatives
California Children's Health Initiatives (CCHI) is a collaboration of local Children's Health Initiatives (CHI) in 30 counties accross California. They have insured more than 88,000 previously uninsured children into the locally funded Healthy Kids Program.
Learn more:
Local Children's Health Initiatives
County and Local Programs
County-Local Programs
Counties and certain cities have local programs for aging and long term care, alcohol and drug abuse, mental health, the Medically Indigent Services Program, In-Home Supportive Services (IHSS) and other services.
Learn more:
County-Local Programs
Additional programs and resources for low-cost or no-cost health insurance for uninsured individuals and families.
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Other Programs - Uninsured
HMOs, or Health Maintenance Organizations
Health Maintenance Organizations
HMOs are Health Maintenance Organizations (a managed care plan) where typically you have one primary doctor and a network of labs and hospitals where you must receive care.
Learn more:
Health Maintenance Organizations
Preferred Provider Options
In a PPO you get most of your health care from a network of providers (like an HMO), but you can choose to go outside of the network and pay more. POS Plans let you choose between an HMO and PPO each time you need care.
Learn more:
Preferred Provider Options
About Private Consumer Programs
Private Consumer Driven Programs are sometimes offered by your employer, but these programs do not necessarily mean you are insured.
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Flexible Spending - are tax free accounts to pay health care costs.
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Health Savings Accounts - are tax free savings accounts sometimes used with high deductible health plans.
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High Deductible Health Plans - are plans with high out of pocket costs.
More Definitions of Health Plan Types
Learn more:
Other Health Plan Types
What is Managed Care?
Managed Care is a term used to describe a variety of ways intended to reduce the cost of providing health care benefits and improve quality of care to consumers. Medicare and Medi-Cal benefits can be 'signed over' to a managed care carrier. HMOs and PPOs follow managed care practices.
Learn More:
About Managed Care