Full and Partial Dual Eligibility
Rov qab mus rau Cov Lus Qhia rau Cov Neeg Laus
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.
Full Duals
“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.
Medicare Ib Feem-Benefit Duals
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).
Part B nkaus xwb
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.
Nco tseg: Yog tias tag nrho dual poob Medi-Cal (xws li, vim nyiaj tau los nce lossis cov ntaub ntawv ploj lawm), lawv tsis tuaj yeem ua ib feem ob, tshwj tsis yog lawv tau thov kev ntsuas rau MSP nkaus xwb. Lub nroog ua qhov kev txiav txim rov qab txhua xyoo rau Medi-Cal thiab Medicare. Tsis muaj ib qho xwm txheej twg uas tus tswv cuab yuav poob Medi-Cal Kev Tsim Nyog thiab khaws MSP yam tsis muaj kev thov tshwj xeeb.
Medicare Tshooj Ib Daim Ntawv Pom Zoo Yuav
Raws li lub Ib Hlis Ntuj Tim 1, 2025, Lub Xeev California koom nrog hauv daim ntawv cog lus yuav nrog CMS, uas Medi-Cal cia li them Medicare Part A cov nqi them, nyiaj npib, thiab txiav tawm rau Medi-Cal cov tswv cuab uas:
- Tau cuv npe rau hauv Qhov Kev Pabcuam Tsim Nyog Medicare (QMB), thiab
- Muaj Medicare Part B txoj cai raws li qhia los ntawm Social Security Administration (SSA).
For more information about the Part A Buy-In policy, please see this Medicare Premium Payment (Buy-In) Program webpage.