Covered California adds CalOptima Health to its lineup, expanding its reach in OC

CalOptima Health, Orange County’s health insurer for the poor, will be added next year to the medical insurance plans offered by Covered California.

The move means that CalOptima members who lose their Medi-Cal coverage can stay with CalOptima — and its doctors — through Covered California, the health insurance marketplace established by the Affordable Care Act.

At Covered California, state residents can find financial assistance as well as health coverage from such providers as Kaiser Permanente and Blue Shield. Consumers can shop and compare health insurance plans and choose the one that best fits their needs and budget.

CalOptima’s offering has been dubbed “CalOptima Health Covered.” Open enrollment through Covered California begins Nov. 1 and ends Jan. 31 for the 2027 benefit year.

“They can stay with us. We know them. They know us. They can stay with their doctors,” said Yunkyung Kim, CalOptima chief operating officer. “(Their) healthcare services don’t have to be disrupted.”

Other Orange County residents who don’t qualify for Medi-Cal, such as certain small business owners, also will be able to access CalOptima Health through Covered California.

“This is an opportunity for CalOptima to provide some stability,” Kim said.

CalOptima has 820,000 members, a quarter of Orange County’s population, and figures to add another 20,000 who could transition out of Medi-Cal and into Covered California.

CalOptima Health Covered will be the lowest-cost “silver” plan in Orange County. The plans are ranked according to metal tiers, with platinum being the most costly with the lowest deductibles.

“CalOptima Health Covered is part of CalOptima Health’s continuing commitment to ensuring Orange County residents have reliable, high-quality health care,” said Vicente Sarmiento, Orange County supervisor and chair of the CalOptima Health Board of Directors. “We are glad to be able to assist families with a new option to maintain the continuity of their care with a plan that gives them a high-value, low-cost option from a trusted local organization.”

CalOptima is the third managed public health care plan to be offered by Covered California.

“With health coverage top of mind for many Californians, Covered California is pleased to welcome CalOptima Health to the marketplace in 2027,” said Jessica Altman, executive director of Covered California. “At a crucial time, this addition will give consumers — including more than 170,000 Covered California enrollees in Orange County — more opportunities to compare plans and choose the coverage that best meets their needs.”

Covered California announced CalOptima’s entry to the marketplace Tuesday, along with an expected average rate increase of 9.9% for the state in 2027. In Orange County, the increase would be 10.4%.

The proposed rate change was attributed to the increasing cost of health care and pharmacy expenditures alongside actions taken by the federal government. Last year, federal lawmakers did not extend enhanced tax credits that helped millions of Americans pay their monthly premiums. This year, the Trump administration cut eligibility for lawfully present immigrants such as green card holders and asylum seekers, added administrative burdens to families applying for financial aid and made it more difficult for gig workers who have to recalculate their income on an annual basis, said a statement by Altman.

The U.S. Department of Health and Human Services did not immediately respond to a request for comment.

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