Before you start

California residence
Income information for Medi-Cal or subsidy eligibility
An SSN or ITIN for marketplace applications
A qualifying life event, if enrolling outside the annual window

Step-by-step

1
Use Covered California and its calendar, not HealthCare.gov's
California runs a state-based exchange with its own enrolment window, which historically runs longer than the federal one. One application screens you for Medi-Cal and for a subsidised commercial plan. Confirm the current dates on Covered California's own site rather than applying a national article's federal deadline — that is the single commonest coverage mistake made in California.
OnlineWho: YouWeek 1–2
2
Check Medi-Cal eligibility before buying anything
Medi-Cal covers adults with income up to 138% of the federal poverty level and children up to 266%. California has extended full-scope Medi-Cal further than any other state, and the terms have been changing with both state budget decisions and new federal requirements — so check the current position with the Department of Health Care Services rather than an article, and respond to every renewal notice you receive.
OnlineWho: You
3
Enrol in your employer's plan inside the new-hire window
Typically 30 days from your start date. Compare deductibles and out-of-pocket maximums rather than premiums, and check the network against Community Regional Medical Center, Saint Agnes, Kaiser and Valley Children's — between them they hold most of the region's capacity, and Community Regional runs the only Level I trauma centre between Los Angeles and Sacramento.
Via employerWho: YouFirst 30 days of employment
4
Make air quality part of the household routine
Check the daily air index the way you would check the weather. Summer ozone spikes in the afternoon, so shift exercise to early morning; winter particulates spike under inversions, which is what the Valley's wood-burning restrictions exist to limit. A HEPA filter in the bedroom is the cheapest single intervention. If anyone in the household has asthma or COPD, get a management plan in place before the first bad week rather than during it.
Mobile appWho: You
5
Learn what Valley fever looks like, and say the words to a doctor
Coccidioidomycosis comes from inhaling fungal spores in Valley soil, and the California Department of Public Health reports the San Joaquin Valley has the most cases in the state — nearly 12,500 statewide in 2024, the highest on record, against under a thousand a year before 2000. Symptoms are a persistent cough, fever, chest pain and exhaustion, and they are routinely mistaken for pneumonia. Wet soil before digging, wear a mask on dusty outdoor work, and if a cough will not clear after dusty exposure, name the condition to the doctor. Newcomers are more susceptible than people who grew up here.
In personWho: You
6
Register with a primary care physician while you are well
Your PCP gates specialist access on most plans, and the central Valley has a well-documented shortage of primary care physicians relative to its population. Start looking in your first fortnight, confirm network status with the practice rather than the insurer's directory, and use a federally qualified health centre as the fallback — the Valley has a substantial network of them.
OnlineWho: You

Documents you’ll need

Proof of California residence
Income documentation for Medi-Cal or marketplace subsidies
SSN or ITIN
Immigration documents where relevant to the eligibility category
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Valley fever is a genuine reason to change your behaviour, not local colour.

The California Department of Public Health records nearly 12,500 cases in 2024 — the state's highest ever, against under a thousand a year before 2000 and around 9,000 in 2019 — with the San Joaquin Valley reporting the most. The fungus lives in the soil and is raised by wind and digging, so gardeners, construction workers and outdoor crews carry the most exposure. Newcomers have not built the partial immunity long-term residents often have. Wet the soil, mask up for dusty work, and know the symptom pattern.

Source: California Department of Public Health — coccidioidomycosis

The air is the single biggest health difference between Fresno and coastal California.

Mountains on three sides and a persistent inversion trap summer ozone and winter particulates over the Valley floor, and the basin is consistently among the most polluted in the country. It is why the Valley's winter wood-burning restrictions exist and why they are enforced. This is the trade you are making for the housing cost, and it is worth making the trade knowingly rather than discovering it in your first December.

Source: US EPA — Green Book nonattainment areas

California runs its own exchange, with its own calendar.

Covered California is not a HealthCare.gov storefront, and its enrolment window has historically run past the federal one. Someone following a generic US relocation checklist applies federal dates, misses the state's, and loses a plan year. Start at Covered California, and let it screen you for Medi-Cal at the same time.

Source: Covered California

The deductible is what actually shocks people from national health systems.

US plans commonly require you to pay the first several thousand dollars of care each year before the insurer contributes. Someone arriving from the UK, Canada or India reads 'I have insurance' as 'I am covered', then receives a four-figure bill for a scan. Read the deductible and the annual out-of-pocket maximum before the premium — that is where plans genuinely differ.

Source: community-reported

Common mistakes to avoid

Applying HealthCare.gov's dates in California — Covered California runs its own calendar.
Buying a marketplace plan without checking Medi-Cal eligibility first.
Treating the air quality index as advisory rather than as something to plan the week around.
Digging dry Valley soil without wetting it, and not mentioning the exposure when a cough will not clear.
Waiting until you are unwell to find a primary care physician in a region short of them.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.