Whether you need to find new insurance, better insurance or different insurance, the task of researching and understanding the right information can be overwhelming.
Fortunately, there is a competent expert there to guide you: your local health insurance agent.
Health Insurance Plans: So Many Details!
So, you need health insurance.
In California, this is no longer an option even though the current administration managed to do away with the Affordable Care Act (ACA) tax penalty for not having coverage. The state of California just passed a new law that goes into effect January 1, 2020 that essentially replicates that mandate.
Tax penalties aside, it makes good sense to have health care coverage, especially if you have a family.
While many employees in California can take advantage of the insurance plan or plans offered through their work, there are situations where you may still want to seek out your own coverage. That’s when an agent is a valuable and vital resource.
And, depending on the size of the company you work for, your employer may not be required to offer health insurance.
According to a post at PeopleKeep.com,
“Although the ACA’s individual mandate was eliminated beginning 2019, the employer mandate is still in place, requiring applicable large employers (ALEs) to provide a certain percentage of their full-time-equivalent (FTE) employees with minimum essential coverage (MEC).
In 2019, ALEs are defined as any business that employed a combination of 50 or more FTE employees during six months or more of 2018.
Small businesses that don’t meet this definition aren’t subject to the employer mandate and thus don’t have to offer health insurance coverage.”
The SBA estimates that there are over 1,000,000 small businesses in California with employees. Since smaller businesses make up most employers in California with almost seven million employees, odds are high that your employer might not offer health coverage, or the coverage is not sufficient for your needs.
Calling In A Professional
The good news is that you can go to a local health insurance agent to help you through the process of finding and purchasing a plan that is right for you, or for you and your family.
There are many advantages to going with a local agent. Because you are working directly with an assigned insurance agent who is local to your area it’s possible that they may be someone you know personally or know someone who does.
Another advantage to having a local agent is the accessibility and personal relationship that is so vital when a crisis occurs. Whether it’s an unexpected life change, a move to a new job or a sudden major health issue, having an agent to work with directly can be critical to assuring your insurance needs are met. In addition, a good agent will advocate for you if you have issues with your insurance company. And, because some insurance agents also are licensed to sell multiple products, they can be your one source for all your insurance needs.
Here are a few other ways that your local health insurance agent can help you:
A local health insurance agent does all the hard work for you. Because your local agent understands the insurance industry and which insurers offer specific coverage types. This relieves you from having to spend hours learning about your options and trying to determine the best deals.
Some agents are only authorized to represent one insurance company, which means you can only choose between the policies they offer. However, there are local insurance agents like JC Lewis Insurance that offer California health insurance plans from leading health insurance carriers licensed to do business in California. This makes it possible to personalize your coverage for your specific needs.
Good local health insurance agents know their industry, understand policy terminology, and follows recent changes in health coverage requirements. This means that they can simplify the buying process for you, while providing knowledgeable advice minimizing your costs. They can also answer your questions and explain the more ambiguous aspects of health coverage.
By working with a local health insurance agent, you can build a long-term relationship, which is beneficial over time. Because they get to know you and your insurance needs, they are prepared to help quickly and efficiently when it is time for a necessary change.
Understanding Special Enrollment Periods (SEP)
Life happens—and thankfully, so does health coverage flexibility. If you miss the annual Open Enrollment window, you’re not completely out of luck. That’s where Special Enrollment Periods (SEP) come into play. These are triggered by major life changes—think getting married, having a baby, losing job-based coverage, or moving to a different ZIP code. In California, even changes in income can qualify you. This flexibility is especially important in 2025, as more families are navigating remote work, freelance gigs, and other non-traditional income streams.
Pro tip: You only have 60 days after a qualifying event to enroll, so don’t sit on it. A local health insurance agent can walk you through the SEP maze so you don’t miss your window.
Dental and Vision Plans Are Often Overlooked (But They Matter!)
Let’s be real—most people forget about dental and vision coverage until they’re staring down a root canal or blurry road signs. What a lot of folks don’t know is that most health plans on or off Covered California don’t automatically include dental and vision insurance for adults. And even when they do, the coverage can be pretty bare-bones.
Here’s the good news: In 2025, there are more standalone dental and vision plans available than ever, many of which offer low deductibles and great preventive care benefits. Whether you’re self-employed or your employer’s health plan is lacking, bundling supplemental plans with your primary health insurance can actually save you money in the long run.
The Rise of Telehealth and Mental Health Coverage in 2025
One of the biggest health insurance trends in 2025? Telehealth and mental health coverage. Post-pandemic demand has skyrocketed, and insurers have taken notice. Plans now offer broader networks of virtual care providers, covering everything from urgent care consultations to therapy sessions—all from your phone.
Better yet, California now requires many individual and small-group plans to offer mental health and substance use disorder services at the same cost-sharing levels as other medical treatments. That’s a big win, especially with more people prioritizing emotional wellness in today’s fast-paced world. Your local insurance agent can help you find plans with strong telehealth support and coverage for things like therapy, psychiatry, and even wellness coaching.
What About Covered California?
When you purchase a California health insurance plan today, it is acquired either “on-exchange” or what is referred to as “off-exchange.” Purchasing a health plan on-exchange means that you buy a plan directly through your state or federal government exchange. In California that means going through the state exchange, which is known as Covered California.
Purchasing a plan off-exchange simply means enrolling in a plan directly through an insurance carrier. This option can be done either through the plans offered by your employer, or on your own as we have discussed in this post.
An advantage of the state exchange is that you may qualify for premium assistance based on your annual modified adjusted gross income (MAGI). This means that your monthly premium will be partially subsidized through tax credits. You can only receive premium assistance when buying a plan on-exchange, that is, Covered California.
A number of residents probably qualify for premium assistance and the Covered California Marketplace may be the best option for purchasing affordable health insurance. This includes individuals, families, and small businesses, all of whom can receive tax credits toward their monthly insurance premiums. Although limited to only choosing a plan from carriers participating in the marketplace, for individuals and families, this currently includes carriers such as Blue Shield of California, Anthem Blue Cross, Health Net, Western Health Advantage, and Kaiser Permanente among others.
At J.C. Lewis Insurance, our agents are licensed by the state of California and are certified to sell policies through Covered California. In addition, we offer accountability, explanations, and over 60 years of experience in the insurance industry. Contact us today at 866-745-9555 or fill out our online contact form.