#United States #Gold Coast Health Plan #Ventura County #Total Care Advantage #Medi-Cal Medicare

Gold Coast Health Plan Launches Total Care Advantage

Gold Coast Health Plan (GCHP) has unveiled its latest initiative, the Total Care Advantage, aimed at residents of Ventura County who qualify for both Medi-Cal and Medicare, commonly referred to as Medi-Medi members. This new plan is designed to streamline healthcare for those who have previously faced fragmented services between these two vital programs.

Starting in October 2025, individuals living in Ventura County will now have the option to enroll in a coordinated care plan, allowing them to manage their healthcare under a single umbrella. This significant step is in line with the California Department of Health Care Services' initiative, known as CalAIM, which seeks to integrate care for dual eligible members throughout most California counties starting in 2026.

Dr. Felix Nuñez, the CEO of GCHP, expressed enthusiasm about the new offering, highlighting the importance of eliminating barriers resulting from having separate plans. He stated, "We are thrilled to introduce an integrated Medi-Medi plan that combines services for our community, crafted by a local team they have trusted for years."

Total Care Advantage (HMO D-SNP) will bring together essential services for low-income seniors and individuals with disabilities. This includes seamless access to both Medi-Cal benefits—such as dental, vision, and transportation—and Medicare benefits, which cover inpatient hospital stays and skilled nursing facilities. Furthermore, the plan enhances support systems with supplemental benefits like hearing exams, gym memberships, and community support services—all available without premiums or co-pays.

Eve Gelb, GCHP's Chief Innovation Officer, highlighted that this plan would provide better quality care for a demographic that previously relied on GCHP primarily as a secondary plan. She emphasized the enhanced quality of life that this integrated approach aims to deliver.

The eligibility criteria to enroll in Total Care Advantage are straightforward: applicants need to reside in Ventura County, be at least 21 years old, possess both Medicare Parts A and B, and have full-scope Medi-Cal coverage. Open enrollment for this new plan will run from October 15 to December 7, 2025, with ongoing enrollment options available for those who meet the qualifications at any time throughout the year.

As of now, GCHP serves around 27,000 Medi-Medi members who currently utilize services from other Medicare plans. Transitioning to Total Care Advantage allows these members to consolidate their healthcare management, promoting a more organized and accessible system.

In addition to healthcare services, GCHP emphasizes the importance of community involvement. With a network that includes primary care physicians, specialists, and behavioral health providers, GCHP is committed to improving health outcomes for Ventura County residents. Founded in 2011, GCHP prides itself on its extensive reach, serving approximately 240,000 Medi-Cal members, which includes a significant portion of the county's population.

To explore more about Total Care Advantage and additional services offered by Gold Coast Health Plan, visit their official website at www.goldcoasthealthplan.org. This new initiative reflects GCHP's ongoing commitment to fostering integrated, quality healthcare solutions for its members, ensuring they receive the comprehensive care they deserve.