Before you start

California residence
Income information for subsidy or Medi-Cal eligibility
An SSN or ITIN for the marketplace application
A qualifying life event, if enrolling outside the annual open-enrolment window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date, and missing it can mean waiting for the next open enrolment. Compare the deductible and out-of-pocket maximum, not just the premium. If you are joining state service, the CalPERS health programme is the plan set you will be choosing from.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use Covered California — not HealthCare.gov
California runs its own exchange. Covered California has its own open-enrolment calendar, which has historically run longer than the federal window, and its own state subsidies on top of the federal ones. Going to HealthCare.gov will simply redirect you, but the deadlines and the assistance available are the state's.
OnlineWho: You
3
Check Medi-Cal eligibility
California expanded Medi-Cal well beyond the standard expansion, including to income-qualifying adults in groups most states exclude. Eligibility is assessed through Covered California or the county, and it enrols year-round rather than only in an annual window. Check each household member separately. The 2025 state budget changed enrolment and cost-sharing rules for some adult groups — verify the current position with DHCS.
OnlineWho: You
4
Register with a primary care physician in month one
Do it while you are well. An established relationship is what gets you referrals and urgent slots later, and confirming the practice is in your network before the first visit avoids an out-of-network bill for a routine appointment.
In personWho: YouMonth 1
5
Know where the trauma centre is
UC Davis Medical Center on Stockton Boulevard is the region's academic hospital and the Level I trauma centre — adult and paediatric — for an inland catchment reaching far beyond Sacramento County. Serious cases from a very wide area route here, which is a genuine advantage of living in the city rather than the foothills.
In personWho: You
6
Prepare for heat and for smoke, and treat both as medical
Sacramento's record high is 116°F and long stretches above 40°C are ordinary. Separately, late summer and autumn wildfire smoke has repeatedly produced some of the worst air quality readings in the world here for days at a time. A portable HEPA air purifier sized for your main room, a supply of N95 masks and a plan to stay indoors on the worst days are standard local preparation, particularly with asthma or a young child in the household.
In personWho: You
7
Learn the urgent care versus emergency room distinction
An emergency room visit for something a clinic could treat can cost thousands even when insured. Urgent care handles fractures, stitches and infections far more cheaply, and Sacramento has a dense urgent care network across all four major systems.
In personWho: You

Documents you’ll need

Proof of California residence
Income documentation for subsidies or Medi-Cal
SSN or ITIN
Immigration documents for marketplace and Medi-Cal eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

California runs its own marketplace, and that changes the deadlines.

Texas, Indiana and most of the country use HealthCare.gov, whose open-enrolment window is short and fixed. Covered California sets its own calendar, has historically run a longer window, and layers state subsidies on top of the federal ones. Someone applying federal deadlines to a California situation will get the dates wrong in the direction that costs them a year of coverage.

Source: Covered California

The Medi-Cal safety net here is genuinely deeper than most states', and it is in flux.

California expanded Medi-Cal beyond the standard expansion, which is why a low-income adult in Sacramento has cover where an identical person in Fort Worth has none. The 2025 state budget changed enrolment and cost-sharing for some adult groups, so this is precisely the topic where a two-year-old article will be confidently wrong. Check DHCS directly.

Source: California Department of Health Care Services

Wildfire smoke is a recurring public health event here, not a freak one.

Sacramento has repeatedly recorded some of the worst air quality in the world during Northern California fire seasons, for days at a stretch. Unlike heat, it is not something you acclimatise to. A HEPA purifier and N95 masks bought in June cost a fraction of what they cost in September, when they are sold out.

Source: National Weather Service — Sacramento

Living in the city puts you where the region's serious care is.

UC Davis Medical Center is the Level I trauma centre — adult and paediatric — for a catchment reaching into the foothills, the northern valley and the Sierra. People in the surrounding counties are transported here. It is an under-appreciated argument for the city over the outer suburbs, particularly for families.

Source: community-reported

Common mistakes to avoid

Going to HealthCare.gov and applying federal open-enrolment dates to a California situation.
Assuming Medi-Cal rules are the same as they were two years ago.
Missing the 30-day new-hire enrolment window at a new employer.
Buying an air purifier in September rather than June.
Walking into an emergency room for something urgent care handles.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.