🧱 Where Do I Actually Start?

In California, 1–50 employees is small group and 51+ is large group — the rules, rate structure, and plan options differ between the two. Sole proprietors and businesses with only one health-plan-eligible employee generally don’t qualify for small-group coverage and are usually better served by individual or family coverage instead.

Carriers typically require two minimums to be met before a small-group plan can be issued: Both figures can shift slightly by carrier and by year, so they’re always confirmed against the current plan documents before a group is quoted.

Most groups can shop and switch carriers at renewal, which usually means a 45–60 day window before your plan year ends. Starting that comparison early is what actually gives you leverage — waiting until the last couple of weeks limits you to whatever quotes can be turned around in time.

Usually, yes. A benchmark compares your current plan’s cost and coverage against what’s actually available in the market right now — it doesn’t commit you to switching anything. Many employers who benchmark find they’re either overpaying for similar coverage or could get better benefits for close to the same price; the only way to know is to actually run the comparison.

Open enrollment for individual & family coverage runs November 1 – January 31 each year.

• Enroll by December 31 and coverage starts January 1.
• Enroll between January 1 – 31 and coverage starts February 1.

Outside that window, a 60-day Special Enrollment Period opens after qualifying life events (job loss, marriage, a new baby, moving, and similar). Medi-Cal enrollment is year-round — there’s no deadline if you qualify.

It comes down to income. Generally, household income at or below 138% of the Federal Poverty Level qualifies for Medi-Cal (no premium). Above that line, Covered California is where subsidies (premium tax credits) are available based on income. Off-exchange, bought directly from a carrier, makes sense mainly if you don’t qualify for a subsidy or want a plan that isn’t sold on the exchange.

Yes — your subsidy is based on estimated annual income, so a raise, a new job, or a drop in hours should be reported to Covered California when it happens, not just at tax time. Reporting changes as they happen avoids a larger reconciliation bill (or a missed credit) when you file your taxes the following year.

Yes — health coverage and life insurance are priced and underwritten completely separately, so they’re always discussed as two distinct decisions, never bundled into one quote. Many clients handle both with the same conversation simply for convenience, not because the policies are connected in any way.