पूर्ण और आंशिक दोहरी पात्रता
वृद्ध वयस्कों के लिए जानकारी पर लौटें
Individuals dually eligible for both Medicare and Medi-Cal are known as “dual eligibles” or “Medi-Medis.” The population of dual eligibles in California includes key groups below.
फुल ड्यूल्स
“Full duals” are members who are enrolled in Medicare Parts A, B, and D, and Medi-Cal. Almost all of the 1.7 million dual eligible members in California are enrolled as full duals. Since these members are enrolled in Medicare Parts A and B, they may enroll in Medicare Advantage plans (including Dual Eligible Special Needs Plans, or D-SNPs). Full duals are entitled to full-scope Medi-Cal benefits, including coverage for Medicare cost sharing such as Medicare premiums and copays. Additionally, Medi-Cal covers benefits not provided by Medicare, such as long-term services and supports, dental and vision. Full duals are enrolled in Medi-Cal managed care plans. Medicare providers may not bill full duals for Medicare Parts A and B cost sharing.
मेडिकेयर पार्टियल-बेनिफिट ड्यूल्स
The federal Centers for Medicare &Medicaid Services (CMS) defines partial-benefit duals or “partial duals” as members enrolled in one of several Medicare Savings Programs (MSPs), with Part A and/or Part B coverage, but not enrolled in Medi-Cal. MSP enrollment for this group means that DHCS covers their Part A and/or Part B cost sharing, but they are not enrolled in Medi-Cal and do not receive full Medi-Cal benefits. Partial-benefit duals with Part A and B coverage, but not Medi-Cal coverage, are eligible to enroll in Medicare Advantage plans but not D-SNPs. These members are not enrolled in Medi-Cal managed care plans. Partial duals can be in QMB, SLMB, and QI, but are not QMB+, SLMB+, or full-benefit dual. In California there are relatively few partial-benefit duals, as the income limit for most MSPs in California is similar to the Medi-Cal income limit, and most individuals enrolling in MSPs also choose to also enroll in Medi-Cal and get full benefits. Medicare providers may not bill partial-benefit duals for Medicare Part A and B cost sharing. Individuals may apply for what they want (either Medi-Cal + Medicare Saving Program (MSP) or just MSP).
केवल पार्ट बी
Part B only includes members enrolled in Medicare Part B only (but not Part A) and Medi-Cal. The Part A Buy-In policy transitioned most of these members to full duals as of January 1, 2025. The remaining Part B only members includes those not QMB eligible. Members with Medicare Part B only and Medi-Cal are enrolled in Medi-Cal managed care plans. Medicare providers may not bill Part B only members with Medi-Cal for Medicare Part B cost sharing.
नोट: यदि एक पूर्ण दोहरी मेडी-काल खो देती है (उदाहरण के लिए, आय में वृद्धि या कागजी कार्रवाई गुम होने के कारण), तो वे स्वचालित रूप से आंशिक दोहरे नहीं बन जाते हैं, जब तक कि उन्होंने केवल MSP के लिए मूल्यांकन का अनुरोध नहीं किया हो। काउंटियां मेडी-काल और मेडिकेयर दोनों के लिए वार्षिक पुनर्निर्धारण करती हैं। ऐसी कोई स्थिति नहीं है जहां कोई सदस्य मेडी-काल पात्रता खो दे और बिना किसी विशेष अनुरोध के एमएसपी बनाए रखे।
मेडिकेयर पार्ट ए बाय-इन एग्रीमेंट
जनवरी 1, 2025 तक, कैलिफोर्निया राज्य CMS के साथ एक खरीद-फरोख्त समझौते में भाग लेता है, जिसके तहत Medi-Cal स्वचालित रूप से Medi-Cal सदस्यों के लिए मेडिकेयर पार्ट ए प्रीमियम, सह-बीमा और डिडक्टिबल्स का भुगतान करता है, जो:
- क्वालिफाइड मेडिकेयर बेनिफिशियरी (QMB) प्रोग्राम में नामांकित हैं, और
- सामाजिक सुरक्षा प्रशासन (SSA) की रिपोर्ट के अनुसार मेडिकेयर पार्ट बी पात्रता प्राप्त करें।
For more information about the Part A Buy-In policy, please see this Medicare Premium Payment (Buy-In) Program webpage.