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Health Plans & Coverage

The Department of Managed Health Care (DMHC) oversees all HMOs in California and some other kinds of health plans.

The information in this section can help you understand different types of health plans and compare plans. There is also information for people who are not insured.

This website can help you learn about keeping your group health plans or buying individual health insurance. Group health insurance is health insurance you have through an employer or union. Individual health insurance is health insurance you buy on your own.

Receive your Free How to Use Your Health Plan guide from California's Office of the Patient Advocate.

HMOs

An HMO is a health maintenance organization.

  • An HMO is a kind of health insurance that has a list of providers, such as doctors, medical groups, hospitals, and labs. You must get all of your health care from the providers on this list. This list is called a network.
  • Usually you have a main doctor, who is part of a medical group that has a contract with the HMO. Your main doctor is your primary care doctor and manages your care. If you need to see specialists, get tests, or be in the hospital, your doctor and the medical group must approve the service.
  • Usually you pay a fee, called a co-pay, for each service.
  • You may also have a yearly deductible. This is the amount you must pay each year before your HMO pays for any services.
  • An HMO has a service area. You must live or work in one of the zip codes in the service area to join the HMO.

Other Kinds of Medical Health Plans

These plans are like HMOs in some ways. The DMHC oversees some of these plans.

Specialized Plans

DMHC also oversees some dental and vision care plans, behavioral or mental health plans, and chiropractic plans. These are called specialized plans and cover only certain kinds of care. HMOs and PPOs often use these plans to give specialized care to their members.