Medicare Trends and Tactics in California 

As California’s aging population grows and diversifies, the state’s Medicare system is facing major transformation. From the rising popularity of Medicare Advantage to urgent workforce shortages and new value-based care models, stakeholders across the state are reimagining how to deliver high-quality, accessible care to over six million Medicare beneficiaries.

Here are the top Medicare trends shaping California in 2025, and what they mean for providers, policymakers, and older adults alike.

1. The Aging Population is Booming—and Diversifying

By 2030, nearly one in five Californians will be 65 or older. That’s more than 7.6 million older adults, most of whom will be Medicare beneficiaries with complex medical and social needs. This growth is accompanied by significant racial, ethnic, and linguistic diversification. As of 2019, 15% of California’s Medicare beneficiaries had limited English proficiency, the highest rate in the nation.

What this means: Health systems must prioritize culturally and linguistically competent care delivery to meet this population's needs, including building a workforce that reflects California’s diversity.

2. Medicare Advantage is on the Rise—But Access Isn’t Equal

As of 2024, 56% of California’s Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, compared to 42% in 2014. MA enrollment is especially high among Black, Hispanic, and Asian beneficiaries. Yet, regional disparities persist: rural counties often offer far fewer MA plan options, with some counties providing fewer than 10 choices compared to 60+ in Southern California counties like Orange.

What this means: While MA offers attractive benefits, California’s highly delegated insurance market has created inconsistencies in access, plan quality, and administrative burden for providers. Some have even stopped accepting MA plans altogether.

3. Chronic Illness and Care Coordination are Critical Challenges

More than half of Californians with Original Medicare had four or more chronic conditions in 2021, yet only 22% had a care manager or individualized care plan. The California Medicare Collaborative recommends investing in Advanced Primary Care (APC) models and value-based payment reforms to improve care coordination and outcomes.

What this means: There’s a growing need to fund team-based care, remote patient monitoring, and care managers, especially for beneficiaries managing multiple chronic illnesses.

4. Healthcare Access Remains an Unmet Imperative

California’s Medicare-only population includes nearly 5 million people, 13% of whom fall between 139–200% of the federal poverty level, too high for Medi-Cal but still financially vulnerable. Many people in this group often lack access to care.

Race, income, geography, and language continue to shape health outcomes. For example, Black Californians have the highest mortality rates from several cancers and are more likely to experience unmanaged chronic conditions.

What this means: Closing disparities requires better data collection, integration with community-based organizations (CBOs), and targeted investments in underserved areas and populations.

5. The Behavioral Health Crisis Among Older Adults is Growing

Cognitive and behavioral health needs are rising, but access to services remains limited. The number of Californians with Alzheimer’s or related dementias is expected to double by 2040, with the highest increases projected among Black and Hispanic communities. Yet, less than one-third of older adults in need of mental health services receive care.

What this means: Reducing stigma, training providers, expanding screenings, and investing in caregiver support are top priorities identified by the California Medicare Collaborative.

So What Comes Next?

The California Medicare Collaborative’s 2025 issue brief outlines actionable recommendations to improve chronic illness management, reduce disparities, enhance behavioral health care, and simplify beneficiary choice, all without requiring federal regulatory changes.

With the support of state agencies, providers, health plans, and community leaders, California is uniquely positioned to become a national leader in modernizing Medicare delivery. But making that vision a reality will require bold collaboration and urgent action.

How Blooming Health Supports Medicare Providers

As California reimagines Medicare delivery, organizations like Blooming Health are helping providers build patient-centered social care workflows.

Blooming Health supports Medicare providers by:

• Automating Social Care Referrals: Using AI-driven needs detection, BH connects patients to the right community resources—fast.

• Scaling Outreach with Fewer Resources: Custom automated workflows engage patients through voice, text, or email in over 80 languages, reducing staff workload while boosting reach.

• Improving Outcomes and Reducing Readmissions: BH helps providers track patient outcomes, close the loop on referrals, and reduce avoidable ER visits.

• Seamless Integration with EHRs: This makes it easy to embed social care into existing clinical workflows without adding complexity.

• Generating Actionable Population Health Data: Through built-in screeners and surveys, BH enables healthcare teams to identify trends, respond quickly to needs, and improve care equity at scale.

Contact us today to learn how Blooming Health can support your team in reducing friction and delivering whole-person care.

Sources:

• CQC Medicare Collaborative Issue Brief, March 2025. California Quality Collaborative. Download the full PDF here.

• CMS Medicare Enrollment Dashboard. https://data.cms.gov

• California Department of Aging. Master Plan for Aging Dashboard. https://mpa.aging.ca.gov