By Angela Gott
As open-enrollment season for health insurance approaches, I’m once again spending hours on the phone with neighbors, friends and fellow older adults who are confused and anxious about what their coverage will look like next year.
We’re told that open enrollment is our time to choose the plan that best fits us – and our needs – but I think that promise is ringing hollow right now.
For years, I volunteered at the Marin County Senior Information Fair and other community events to make sure my neighbors understand the health plan options available to them. But this year, for the first time, I can’t give anyone clear answers.
California’s CalAIM initiative, meant to simplify care, is instead creating new barriers for the very people it’s supposed to help. Starting next year, most dual-eligible Californians – those who qualify for both Medicare and Medi-Cal (aka Medi-Medi enrollees) and typically experience the most complex health and social needs – will have far fewer commercial plans to choose from. On paper, this may sound like streamlining. In reality, it’s boxing vulnerable older Californians into a “one size fits all” box. And, here in Marin County, that box will only include one plan: Kaiser.
Information from the state is limited, but it seems that existing Medi-Medi enrollees will be allowed to stay on their same plans in 2026. However, anyone newly qualifying for both Medicare and Medi-Cal will be forced to choose Kaiser for their health care next year. So, while current members might be safe for now, nobody knows when that may change. The uncertainty is leaving many anxious about what’s next.
It’s a crisis. By restricting the plans available county by county, the state is cutting off thousands of our most vulnerable seniors from the coverage and care they depend on. If you qualify for a Medi-Medi plan and don’t want Kaiser, you can try to remain on traditional Medicare or enroll in a Medicare Advantage plan, but those options often won’t coordinate services with Medi-Cal and lack the wraparound support that make Medi-Medi plans so vital.
For dual-eligible Californians, many of whom are managing multiple chronic conditions and/or limited mobility, this decision by CalAIM is not just an inconvenience, it’s a forced choice between coverage and care. And for providers like Marin Community Clinic, which serves a large population of duals, patients will lose their trusted doctors or settle for lower-quality coverage. Earlier this year, when Meritage Medical Network shut down, Marin seniors were suddenly moved to Brown and Toland with little notice or information. The confusion is only getting worse.
What has been happening in Marin isn’t an isolated problem – it’s the result of the state wanting to deal with fewer plans under the guise of streamlined care. I know firsthand that when plan options are reduced, care becomes fragmented, stress rises and confidence in the system begins to crumble. A recent white paper from the Pacific Research Institute makes the case, too, finding that narrowing patient choice exacerbates existing challenges with cost, reduces innovation, and hurts overall care quality.
CalAIM’s policy doesn’t just undermine choice, it punishes patients who need the most help. Among the specialized plans managing care for dual-eligibles are Dual Eligible Special Needs Plans (D-SNPs), an integrated Medicare Advantage plan designed to coordinate medical, behavioral and social services for people who qualify for both Medicare and Medi-Cal. These plans provide critical wraparound support for Californians with the most complex needs. Yet under the new rules, these plans are being shut out – not because they failed patients, but because the state wants fewer plans to manage.
This is not reform – it’s rationing.
As open enrollment begins, policymakers should remember what this season is supposed to represent: empowerment, real choice and the ability for patients, especially those who rely on both Medicare and Medi-Cal, to find the plan that best meets their unique needs.
If California truly cares about affordability, quality and equity, we must fix this now. Our elected officials must step in to allow multiple D-SNPs to operate in every county. The state also needs to be transparent about how these changes will affect local providers – like Marin Community Clinics and MarinHealth – and reassure patients that they’ll still have access to their trusted doctors and specialists. For older adults like me and the neighbors I help, health care isn’t a policy debate – it’s our lifeline.
Better care, more options, and lower costs – that’s what health care reform should be centered around.
Angela Gott, of Strawberry, is a senior advocate and volunteer assisting low-income and dual-eligible Medicare-Medi-Cal patients in Marin County.