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Modesto Health Insurance


Are you shopping for a Modesto health insurance plan? Are you looking to better understand the health insurance market? Here you will find key resources to help you make an informed decision and an instant quoting tool showing all Modesto health insurance options. Start by entering your zip code above to find plans offered in your area.


Facts and Figures

  • Insured
  • Uninsured
  • Insurance
  • Number of
    Primary Care Physicians
  • Number of

Breakdown of Insureds

  • Private Health Insurance 13%
  • Public Health Insurance 13%
  • Employer-Based Health Insurance<br> 13%
  • Direct Purchase Health Insurance 13%
  • Medicare 13%
  • Medicaid 13%
  • Tricare/Military Health Insurance 13%
  • VA Health Care 9%

Insurance Carriers

What to Know When Shopping for Health Insurance


Below are some of the most commons concerns when shopping for a Modesto health insurance plan.

Are Your Doctors In-NetworkBefore purchasing a health insurance plan you should always make sure that your doctor(s) are part of the network. Going to an out-of-network doctor may cost substantially more than if that doctor is in-network. Don’t just ask the doctor’s office if they accept a certain insurance plan before you enroll. You should always confirm with the insurance company or an agent that your doctors are in-network. Why the concern? Well, keep in mind that if an out-of-network provider suggests services, then all of those services provided by that recommended doctor will be considered out of network, even if the facilities and providers are in-network

Lower Monthly Premium May Result in Higher CostsHealth insurance follows a simple formula: the lower your monthly premium is, the more likely you are to pay higher costs when you use the insurance. If you’re someone who happens to be in good health and does not foresee any health-related issues and doesn’t use medicine on a very regular basis, then perhaps you’re better off opting for a lower costing health insurance plan. However, if you find that your medical expenses and prescription usages are high, then you may save money by purchasing a plan that costs more per month. Be sure to consider your current health condition when shopping for a health insurance plan.

Health Insurance is a ContractWhen purchasing a plan, both parties agree to live up to the contract (usually for a period of one year). If you find that you are not happy with your plan, you can’t go back to your insurance company mid-year and ask them to change coverage. You’ll have to wait for your contract to expire. Additionally, if you buy an individual health plan on your state exchange or through and you allow that plan to lapse or you stop coverage, then you don’t qualify to buy a health plan on that exchange for the rest of that calendar year. As such, be sure to choose the right plan that suits your needs before signing the contract. 

Types of Insurance Coverage – EPO, PPO, POS, HMO, HDHP, and HSA. The first 4 are acronyms that describe different types of health insurance coverage, which provide you with or without the flexibility to see specialists and receive out-of-network and out-of-state care. Also, different plans have different requirements related to the need for referrals. If you’re often seeing specialists out-of-network then you want a plan that offers that flexibility. If you find that you travel often for work or live in multiple states per year, then perhaps a plan that offers that flexibility is needed. The last two types, HDHP and HSA’s allow you to set up a tax-free savings account specifically for qualified medical costs For a better understanding of these types of coverage please refer to the following article.

Metal LevelsIn order to make shopping and comparing health plans easier, a metal system to represent different insurance coverage levels was created. These insurance levels are grouped into 4 metals based on actual metal value. Bronze, silver, gold, and platinum all represent the metal worth and the level of coverage offered under each metal plan. In theory, a bronze plan will cover 60% of your medical costs and provide you with a maximum out-of-pocket dollar amount that does not equal the remaining 40% but instead is a threshold set for most bronze plans. Silver is set at 70%, Gold 80%, and the most valuable metal platinum is set at 90%. Based on your medical needs you should be able to relatively compare an appropriate metal level. For example, if you find that you have minimal health insurance needs then perhaps a bronze plan would best suit you. However, if your health status requires a good deal of care, then perhaps a gold or platinum plan, which costs more, will actually cost you less in the long run.

Are Essential Health Benefits Covered? One way of ensuring the plan you purchase or intend to purchase covers the 10 essential health benefits, is to buy an on-exchange plan. All exchange plans must cover 10 essential health benefits. This provides you with a guaranteed minimum level of coverage, which is the standard set by the Affordable Care Act. Why would we need a minimum standard level? Well, the cost of medical care is prohibitive without insurance in place and can often lead to financial ruin. Ensuring that a plan includes the minimum essential health benefits provides a safeguard.

Premium, Deductible, and Out-Of-Pocket Costs. Each term relates to the cost of using and maintaining your plan.

Premium is the cost of the insurance that you usually pay on a monthly basis to the insurance company. Premiums are often locked in for a period of one year, meaning the insurance carrier cannot arbitrarily charge you a higher premium within that year

Deductible is a yearly dollar threshold that you must meet prior to the insurance company paying for medical services. This almost always excludes preventative care.

Out-of-pocket costs are the maximum annual dollar amount that you can spend on health care services and medicine.

Health Insurance Subsidies A Subsidy is a dollar amount provided by the federal government paid directly to your insurance company based on your current yearly income. This money does not have to be paid back, however, if your income does increase, there is a strong possibility that your subsidy may change, which would then increase your monthly premium (retroactively). Conversely, if your income decreases within the year, that may reduce your monthly premium at which point you have the right to contact your insurance company and inform them of your income change.


Essential Health Benefits


What Are Essential Health Benefits? Essential Health Benefits are a set of 10 health care benefits established by the federal government under the Affordable Care Act of 2014. The purpose is to ensure that all persons are covered by a set of minimum standards. Specific insurance services may vary by state and all plans must provide dental coverage for children.

1.Ambulatory Patient ServicesMedical care provided without admission to a hospital, including doctor’s office visits, clinics, and outpatient surgery centers.

2.Emergency ServicesOrganizations that are responsible to deal with emergencies when they occur. This includes medical care that if not treated could lead to serious conditions or disabilities.

3.HospitalizationMedical care that patients receive when they are hospitalized. This includes the care of nurses, doctors, and other staff. This also includes medication received, room and board, tests, and laboratory work.

4.MaternityMedical care that a woman receives during pregnancy and post-pregnancy. This includes labor, delivery, post-delivery, and the care for newborn babies.

5.Mental Health Services and Addiction Treatment – Patient care provided to evaluate, diagnose, and treat any mental health conditions or substance abuse disorders.

6.Rehabilitative Services and DevicesServices provided after an injury, accident, disability, or a chronic condition. The purpose is to attempt to help regain the patient’s mental and/or physical skills that were lost (to make the person whole again).

7.Pediatric Services – Medical care that is provided to children and infants, including regular check-ups, recommended vaccines, dental and vision care.

8.Prescription Drugs – Medicine that is prescribed by a doctor, and nurse practitioner, to treat any illness or existing condition.

9.Preventative and Wellness Services and Chronic Disease Treatment – Physicals, Immunizations, and cancer screenings to prevent or detect certain medical conditions, and to provide care for chronic conditions.

10.Laboratory Services Medical tests that are usually ordered by your doctor which include coverage for X-Rays and diagnostic imaging, blood and fluid tests, biopsies, pathology, and pregnancy tests.



Which Types of Insurance Plans are Not Required to Cover the Essential Health Benefits? The following insurance plan types are not required to include essential health benefits and most often don’t.

Short Term Medical Insurance


Critical Illness/Cancer

Hospital Confinement

Association Health Plans

Faith-Based Healthcare

Large Group Insurance plans (50 employees or more)

Travel Insurance

Dual Citizenship insurance (As long as you have proof of Identification)



State Government Insurance Programs Offered

Ability Tools (f/k/a AT Network)

Ability Tools
1000 G ST
STE #100
Sacramento, CA 95814
TEL: 800-390-2699


Examples of AT include (but not limited to): wheelchairs/motorized scooters; hearing aids; computers; home modifications (grab bars, ramps, widened doorways, etc.); aids for communication, etc.

A resident of this state; physically or mentally disabled (regardless of age).

Aging & Disability Resource Connection (ADRC)/CA

CA Department of Aging
1300 National Drive
STE 200
Sacramento, CA 95834
TEL: 800-510-2020


Staff members are trained and knowledgeable about programs/agencies that specialize in older adults and the disabled. Examples of potential issues include health issues such as nutrition and management of chronic medical conditions; adaptive equipment; assistive technology; long term care options; low-income housing; assisted living; financial issues such as paying your bills; elderly and disability benefits; community resources; adult protective services, etc. Staff can help with completing applications for public and private benefits programs including but not limited to Social Security, SSI, Medicare, Medicaid, etc. This is a federal/state program.

An elderly or disabled adult resident of this state (or their caregiver).

Breast and Cervical Cancer Treatment Program/BCCTP

Medi-Cal Eligibility Branch
1501 Capitol Ave MS 4607
PO Box 997417
Sacramento, CA 95899
TEL: 800-824-0088


No-cost Medi-Cal (Medicaid) coverage for the duration of cancer treatment

Applicant must be a female resident of California, under the age of 65, uninsured or underinsured, meet income guidelines, and have been screened by a state-funded Breast Cancer Early Detection Program. Please visit the program’s website for a complete list of eligibility requirements.

Breast Cancer Program at DCF

Desert Cancer Foundation (DCF)
-Suzanne Jackson Breast Cancer Fund
74091 Larrea ST
Palm Desert, CA 92260
TEL: 760-773-6554


Mammogram, core biopsy, and breast ultrasound.

Residents of Coachella Valley who are uninsured, cannot afford to test, and who meet income requirements (same income guidelines as California Breast Cancer Early Detection Program). There is no age restriction.

California Children’s Services (CCS)

Children’s Medical Services Branch
MS 8100
PO Box 997413
Sacramento, CA 95899
TEL: 916-327-1400


Doctor visits, early intervention services, hospital care, immunizations, lab tests, prescription drugs, routine physical exams, screening services, care coordination, social services, home health care, etc.

Children under age 21 that reside in this state; have a qualifying chronic condition, and meet income guidelines

California Telephone Access Program (CTAP)

Deaf & Disabled Telecommunications
Program (DDTP)
1333 Broadway
STE 500
Oakland, CA 94612
TEL: 800-806-1191


Specialized telephone equipment and services which provide equal access to basic telephone service for those with disabilities. See the program website for toll-free numbers in Spanish, Mandarin, Cantonese, Hmong, Vietnamese, Russian, and a Spanish TTY number.

California residents who are deaf, hard of hearing, speech-disabled, cognitively-disabled, blind or diminished vision, or who have restricted mobility.

Camarillo Medical Supply Project

300 Mission Drive
Camarillo, CA 93010
TEL: 805-491-1028


Medical equipment available includes walkers, canes, crutches, wheelchairs, and bedside equipment.

None. Any individual in need of durable medical equipment should call the program number. The main phone number is direct to the program; the Alternative phone (for general program information) is to the Camarillo Health Care District.

Cancer Treatment Assistance Program at DCF

Desert Cancer Foundation
(DCF) -Client Services
74091 Larrea ST
Palm Desert, CA 92260
TEL: 760-773-6554


Diagnosis of and treatment for cancer. Insured patients who become unable to work may qualify to have their monthly insurance premiums paid.

Cancer patients who reside in Coachella Valley and who are uninsured or underinsured with significant financial needs.,

Early Start

Department Developmental Services
1600 9th ST
PO Box 944202
Sacramento, CA 94244
TEL: 800-515-2229


Diagnosis and evaluation; physical and occupational therapies, speech-language pathology, and other appropriate health services which may include assistive technology, audiology, medical (limited), nursing, nutrition, psychological, etc.

Children birth to age 3 who are experiencing developmental delays or who have a diagnosed condition that has a high probability of resulting in a developmental delay.

Every Woman Counts (EWC)

Cancer Detection/Treatment Branch
1501 Capitol AVE STE 71.4001
PO Box 997417 MS 4600
Sacramento, CA 95814
TEL: 800-511-2300


Breast cancer screening (clinical exam, mammograms) for eligible women age 40 and over. Cervical Cancer screening (pelvic exams, PAP tests) for eligible women age 21 and over. If diagnosed with cancer, you may qualify for the Breast/Cervical Cancer Treatment Program.

Meet age requirements; household income at or below 200% of FPL (see website for details); uninsured or underinsured; not receiving these benefits thru another government program; California resident.

Genetically Handicapped Persons Program (GHPP)

Children’s Medical Services (CMS)
PO Box 997413 MS 8100
Sacramento, CA 95899
TEL: 800-639-0597


Special care center services, hospital stay, outpatient medical care, pharmaceutical services, surgeries, nutrition products and medical foods, durable medical equipment, and other services

A resident of this state, 21 years of age or older; diagnosed with a genetic condition covered by GHPP. If applicant has health insurance, GHPP pays after insurance pays. There is no income limit; however, depending on income and family size, an enrollment fee may be required.

Health Insurance Counseling & Advocacy Program (HICAP)

Long-Term Care & Aging Services Division
1300 National DR
STE 200
Sacramento, CA 95834
TEL: 916-419-7500


Assistance with Medicare: eligibility, enrollment, benefits; premiums, costs and claims; comparison of Part D prescription drug plans; Medigap supplemental insurance; health plan options; and programs which help pay Medicare premiums, deductibles, etc. Also help with finding prescription assistance programs.

Seniors 60 and over that reside in California.

High-Risk Infant Follow-Up Program (HRIF)

Children’s Medical Services Branch
PO Box 997413 – MS 8100
Sacramento, CA 95899
TEL: 916-322-8702


Screening, assessment, and case management

Infants with any of the following: birth weight under 1500 grams, assisted ventilation for more than 48 hours, seizure activity within the first week of life, sustained hypoglycemia or hyper-bilirubinemia, frequent apnea requiring stimulation, potential neurological problems

HIV Care Program (HCP)

CA Department of Public Health
(CDPH) -Office of AIDS
PO Box 997377 MS 0500
Sacramento, CA 95814
TEL: 916-558-1784


Financial assistance for specific HIV/AIDS related FDA approved prescription drugs; specific outpatient medical and support services; case management; insurance premiums/deductibles/co-payments; mental health services; substance abuse, etc.

Applicant must be at least 18 years old, be a resident of CA, have an HIV diagnosis, have limited or no prescription drug benefits from another source, uninsured or underinsured and meet income guidelines.

Housing Opportunites for Persons with AIDS – CA HOPWA

Office of AIDS MS 0500
PO Box 997377
Sacramento, CA 95899
TEL: 916-558-1784


Assistance in paying rent, mortgage payments, utility payments, basic phone service, and other payments essential to stable housing. Services are provided by locally funded agencies (e.g. Housing authorities, Health Departments, community-based organizations).

A resident of this state who has been diagnosed with HIV/AIDS; meets income requirements; be homeless or at risk for homelessness.

iCanConnect – Nevada

c/o Helen Keller National Center
(HKNC) Region 9 SW
9939 Hibert ST #108
San Diego, CA 92131
TEL: 858-578-1600


Telephones (including wireless phones); interoperable video conferencing services; computers and access to the Internet; etc. Equipment may be hardware, software, applications, etc. Installation and training may be provided.

A resident of Nevada; have a combined vision and hearing loss that causes extreme difficulty in attaining independence in daily life activities or working; household income equal to or less than 400% of the Federal Poverty Level. See web site for details.

iCanConnect CA a/k/a FCC Free Equipment Program

Lighthouse for Blind/Visually Impaired
1155 Market ST 10th FL
San Francisco, CA 94103
TEL: 415-694-7336


Provides hardware, software, applications, etc.; installation and training may be provided. Examples include telephones (including wireless phones); interoperable video conferencing services; computers, access to the Internet, etc.

A resident of this state; have a combined vision and hearing loss that causes extreme difficulty in attaining independence in daily life activities or working; household income equal to or less than 400% of the FPL. See web site for details.

Department Health Care Services
P.O. Box 957180
Los Angeles, CA 90095
TEL: 800-409-8252


Brachytherapy, chemotherapy, external beam radiation therapy, hormone therapy, radical prostatectomy, watchful waiting

Applicant must be a resident of California, 18 years of age or older, currently, be uninsured or underinsured, have an income at or below 200% of the Federal Poverty Level, have an abnormal DRE or elevated PSA, have been diagnosed with prostate cancer

Major Risk Medical Insurance Program (MRMIP)

Department of Health Care Services
PO Box 2769
Sacramento, CA 95812
TEL: 800-289-6574


Comprehensive medical benefits for those unable to secure affordable health coverage due to high risk, preexisting conditions etc. There are premiums which are subsidized by the State. See web site for details. There may be a waitlist.

Resident of California and: not eligible for Medicare Parts A and B (unless eligible solely due to end-stage renal disease); not eligible for health coverage under COBRA or CalCobra; health coverage has been terminated or application rejected within last 12 months; or offered individual plan with excessive rates. See program web site for more details.

Medi-Cal (California MEDICAID)

Department of Health Care Services (DHCS)
1501 Capitol Ave
PO Box 997417 MS 4607
Sacramento, CA 95814
TEL: 916-552-9200


Comprehensive medical care, including, but not limited to, physician visits, hospitalization, dental, emergency ambulance, lab & x-ray services, etc. There is no cost for those who meet income guidelines. Within Medicaid there are several programs that address the needs of specific groups; e.g. pregnant women, HIV/Aids, etc.

A U.S. citizen or qualified alien who resides in this state and has a low income, limited resources, and is: age 65 or over; families with dependent children 18 years or younger; pregnant women; disabled adults; blind, have permanent kidney failure; etc. See web site for details.

Medi-Cal Access Program (MCAP)

P.O. Box 15559
Sacramento, CA 95852
TEL: 800-433-2611


Covers all medically necessary services from your effective date of coverage in the program until 60 days after your pregnancy has ended. Program is for middle-income, uninsured/underinsured women whose income is too high for no-cost Medi-Cal.
Applicant must be pregnant, a resident of California, within the AIM income guidelines, must not be covered by private insurance costing less than $500, must not be receiving no-cost Medi-Cal or Medicare Part A or Part B as of application date

Medi-Cal for All Children

Medi-Cal Eligibility
MS 4607 POB 997417
Sacramento, CA 95899
TEL: 916-327-1400


Free or affordable premiums based on income for comprehensive medical coverage (full Medicaid benefits) including but not limited to: Well-child exams, immunizations, doctor visits, hospital and emergency care, prescriptions, dental care, etc.

Children must be under the age of 19, not currently covered by health insurance (private nor government), and must be a US citizen or a legal resident; the family must meet income guidelines. Undocumented immigrant children are now eligible if other requirements are met; contact program for details.

Medical Therapy Program (MTP)

CA Children’s Services (CCS)
PO Box 997413 MS 8100
Sacramento, CA 95899
TEL: 916-327-1400


Physical therapy, occupational therapy, medical therapy conference to determine the child’s medical case management and recommendations for specialized equipment

Child must be medically eligible having a condition such as cerebral palsy, spina bifida, muscular dystrophy, rheumatoid arthritis, spinal cord injuries, arthrogryposis, osteogenesis imperfecta, and head injury. There is no financial eligibility requirement for the program. Contact the program directly for financial requirements for specialized equipment.

Medicare Savings Programs (CA)

Department Health Care Services -Medi-Cal Eligibility
1501 Capitol Ave
PO Box 997417 MS 4607
Sacramento, CA 95814
TEL: 916-552-9200


QMB helps pay for Part A & B premiums, deductibles, copays, and coinsurance. SLMB and QI both help pay for Part B premiums only; however, their income guidelines differ. QDWI helps pay for Part A premiums. If you qualify for QMB, SLMB, or QI, you automatically qualify for another program, Extra Help, which helps pay for Medicare prescription drug coverage.

For all 4 programs: Must be enrolled in or eligible for Medicare Part A and meet assets (resources) and income guidelines. Income limits vary by program. Resource limits are the same for QMB, SLMB, and SLMB but differ for QDWI. For QDWI, you must be disabled, employed, and not enrolled in full-benefit Medicaid. For details on income/resource requirements etc., see website.

PACE-CA- Program of All-Inclusive Care for Elderly

DHCS -Long-Term Care Division
MS 0018
PO Box 997437
Sacramento, CA 95899
TEL: 916-552-9105


Primary and specialty medical care, emergency care, prescription drugs, physical therapy, adult day care, etc.; i.e. all the care and services covered by Medicaid and Medicare. There are neither co-pays nor deductibles. If you are not on Medicaid, there is a premium for the long-term care portion of your care. For most enrollees, you must use PACE physicians. The program is voluntary and you can leave the program at any time.

Age 55 years or older who: require a “nursing facility level of care”; must be able to live safely in the community at the time of initial enrollment, and live in the service area of a PACE organization. You can be on Medicaid or Medicare or both; if you are in neither program, you may privately pay. Note: “nursing facility level of care” is defined by the State’s Medicaid office.

Presumptive Eligibility for Pregnant Women (PE4PW)

Department Health Care Services -Medi-Cal
1501 Capitol Avenue
Mail to: PO Box 997417 MS 4607
Sacramento, CA 95899
TEL: 800-541-5555


Specific walk-in prenatal care and prescription drugs for conditions related to pregnancy.

Any woman who thinks she is pregnant and whose family income is below a certain amount is eligible for this program. The applicant must ask their provider if he/she offers this coverage and how to apply.

Operation Access
1119 Market ST
STE 400
San Francisco, CA 94103
TEL: 415-733-0052


Consultation with a surgeon, medical interpreter to accompany patients to all surgical appointments, medically necessary outpatient surgery, other medical services associated with the surgery

Applicant must be a resident of one of the following six counties: Alameda, Contra Costa, Marin, San Francisco, San Mateo, or Sonoma; must be uninsured and unable to qualify for health insurance including Medi-Cal, Medicare, Healthy Families, employer-sponsored coverage, workers compensation, and spousal/partner coverage; must be referred for elective, outpatient surgery or specialty procedure with a low risk of complication or hospitalization. Please visit the program’s website for a complete list of income eligibility requirements.

Vaccines for Children Program (VFC) – CA

Immunization Branch
Department of Public Health
850 Marina Bay Parkway Bldg P
Richmond, CA 94804
TEL: 877-243-8832


Diseases preventable by vaccines include Diphtheria, hepatitis, influenza, measles, pneumococcal, mumps pertussis, polio, tetanus, etc. A small administrative fee (amount regulated by State) may be charged; also an office visit charge may be applicable.

Children thru age 18 who meet one of the following criteria: the child is Medicaid eligible, or uninsured; or American Indian or Alaska Native; or qualifying underinsured. See CDC web site for details including maximum admin fee by state:

WISEWOMAN (Heart of the Family)- Heart/Stroke Screening

California Department of Public Health (CDPH)
-Chronic Disease Control Branch
1616 Capitol Ave Suite 74.420
PO Box 997377 MS 7208
Sacramento, CA 95814
TEL: 916-552-9900


Free or low-cost heart disease and stroke risk factor screening, which includes blood pressure, cholesterol, glucose, weight, height, personal medical history, family medical history, and health behavior and readiness to change assessments. The program also includes advice on a heart-healthy diet/lifestyle and medical referral as appropriate.

Must: be a resident of this state; be a woman at least 40 years old and not older than 64 years; be participating in the Breast and Cervical Cancer Early Detection Program (there is a program in every state); meet income guidelines, and be uninsured or underinsured. In addition, if you are eligible for Medicare, you have not enrolled in Medicare Part B due to the inability to pay the monthly premium.

Women Infants & Children Program (WIC)

California Department of Public Health
(CDPH) -WIC Division
3901 Lennane DR
Sacramento, CA 95834
TEL: 800-852-5770


Provides the following at no cost: health screening at initial appointment for all applying family members; nutritional foods; nutrition education; help finding health care; breastfeeding support.

Low income and nutritionally at risk; resident of this state; and are one of the following: pregnant, breast-feeding a baby under age 1, just had a baby, or have an infant or child under the age of 5. See web site for details.

"Vista Health Solutions" Tel (888)215-4045 Email [email protected]