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 your new-hire window
Typically 30 days from your start date. Miss it and you generally wait for the next annual open enrolment. Compare the deductible and out-of-pocket maximum, not just the premium — Bay Area employers often offer several tiers and the cheapest is rarely the best value if you use care at all.
Via employerWho: YouFirst 30 days of employment
2
Without an employer plan, use Covered California
California runs its own exchange, not HealthCare.gov. Open enrolment for 2026 plans ran from 1 November 2025, and California typically operates a longer window than federally-run states — check the current dates on the site rather than assuming the federal deadline.
OnlineWho: You
3
Check Medi-Cal eligibility before assuming you must buy
Medi-Cal is California's Medicaid programme and covers a broader population than most states', including regardless of immigration status for some groups. Newcomers on modest early salaries frequently qualify and never check.
OnlineWho: You
4
Register with a primary care physician early
Your PCP gates access to specialists in most plan designs, and finding one accepting new patients in-network can take weeks in San Francisco. Do it before you are ill, and confirm network status with the practice directly — insurer directories are frequently wrong.
OnlineWho: You
5
Learn the urgent care versus emergency room distinction
An emergency-room visit for something a clinic could handle can cost thousands even with insurance. Urgent care handles fractures, stitches and infections at a fraction of the cost. Find your nearest and save it in your phone now.
In personWho: You
6
If you end up uninsured, look at Healthy San Francisco
The city runs a programme providing access to a clinic and hospital network for uninsured residents on a sliding scale, with no immigration-status requirement. It is not insurance and does not travel outside the city, but it exists and it is underused.
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
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

California has its own state penalty for going uninsured.

The federal individual mandate penalty was reduced to zero in 2019, but California reinstated a state-level one. Going without minimum essential coverage can produce a state tax penalty at filing, which surprises people who read that the US mandate 'was repealed'. Massachusetts, New Jersey, Rhode Island and DC do the same.

Source: Covered California — penalty for no health insurance

Losing employer coverage opens a special enrolment window.

You do not have to wait for annual open enrolment if you lose job-based coverage, move to California, marry or have a child. Each triggers a limited special enrolment period, typically 60 days. People who don't know this go uninsured for months unnecessarily.

Source: HealthCare.gov — dates and deadlines

The deductible is what will actually surprise you.

US plans commonly require you to pay the first several thousand dollars of care yourself each year. Someone arriving from a national health service reads 'I have insurance' as 'I am covered', then receives a $2,800 bill for a scan. Read the deductible and out-of-pocket maximum before the premium.

Source: community-reported

Healthy San Francisco predates the ACA and still fills a real gap.

The city built its own access programme in 2007, and it continues to serve residents who fall outside insurance — including undocumented residents. It is a city programme with no state or federal equivalent, and it is the reason being uninsured in San Francisco is less dangerous than in most American cities.

Source: San Francisco Department of Public Health — Healthy San Francisco

Common mistakes to avoid

Missing the 30-day new-hire enrolment window and waiting a year.
Choosing on premium alone and meeting a five-figure deductible when you need care.
Going to an emergency room for something urgent care handles.
Assuming a provider is in-network because the insurer's directory lists them.
Not realising California levies its own penalty for going uninsured, unlike most states.

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

Make it your personal checklist

Globe Quest turns this into a tracked, AI-personalized plan for San Francisco — timed to your move date, with reminders so nothing slips. Free to start.