Before you start

California residence
Income information for subsidy eligibility
An SSN or ITIN for marketplace applications
A qualifying life event, if enrolling outside the annual window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date. Compare the deductible and out-of-pocket maximum, not just the premium.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use Covered California
California runs its own exchange rather than HealthCare.gov and typically operates a longer open-enrolment window than federally-run states.
OnlineWho: You
3
Check Medi-Cal eligibility first
California expanded Medi-Cal to cover all income-eligible adults regardless of immigration status. Newcomers on modest early incomes frequently qualify and never check.
OnlineWho: You
4
Register with a primary care physician
Your PCP gates specialist access in most plans. Confirm network status with the practice directly; insurer directories are frequently out of date.
OnlineWho: You
5
Understand cross-border care before you need it
Dental, optical and pharmacy care in Tijuana costs a fraction of US prices and is used routinely by San Diego residents, including insured ones with high deductibles. Quality varies enormously — go on a personal recommendation, verify credentials, and understand that US malpractice recourse does not apply.
In personWho: You
6
Learn the urgent care versus emergency room distinction
An ER visit for something a clinic could treat can cost thousands even insured. Urgent care handles fractures, stitches and infections far more cheaply.
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 eligibility categories
Passport, if seeking care across the border

Things most newcomers don’t know

Cross-border dental and optical care is mainstream here, not fringe.

US dental insurance typically caps annual benefits at a level that a single crown exhausts, so San Diego residents — including well-insured ones — routinely cross to Tijuana for dental work at a fraction of the price. It is an established practice with an established industry around it. The caveats are real: quality varies widely, credentials should be checked, and US malpractice remedies do not follow you.

Source: community-reported

California levies its own penalty for going uninsured.

The federal individual mandate penalty went to zero in 2019, but California reinstated a state-level one assessed through the state tax return. People who read that 'the US mandate was repealed' are caught by this.

Source: Covered California — penalty for no health insurance

Medi-Cal covers income-eligible adults regardless of immigration status.

California phased in full-scope Medi-Cal without an immigration-status requirement across all age groups. In a border county with a large mixed-status population, this is a materially different position from Texas or Florida.

Source: California Department of Health Care Services — Medi-Cal

The deductible is what will surprise you, not the premium.

US plans commonly require you to pay the first several thousand dollars of care each year. Someone from a national health service reads 'I have insurance' as 'I am covered', then receives a $2,800 bill for a scan.

Source: community-reported

Common mistakes to avoid

Missing the 30-day new-hire enrolment window.
Choosing on premium alone and meeting a five-figure deductible.
Not realising California penalises going uninsured, unlike most states.
Choosing a cross-border dentist on price alone without checking credentials or recommendations.
Assuming a provider is in-network because the insurer's directory lists them.

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