Rov qab mus rau Medicare Medi-Cal Plan List​​ 

Keeb kwm​​ 

People dually eligible for Medicare and Medi-Cal can change their Medicare Advantage and Medicare drug coverage for any reason.  The usual times to make changes are the Medicare Open Enrollment Period (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31).  In addition, Medicare Special Enrollment Periods (SEPs) allow dually eligible members to make changes at other times of the year.  The full list of SEPs is available on the CMS website. ​​ 

Yog tias koj muaj lus nug lossis xav tau kev pab hloov kev tso npe nkag, hu rau 1-800-MEDICARE (1-800-633-4227).​​ 

Hloov pauv hauv Medicare SEPs rau LIS thiab Ob Tus Neeg Tsim Nyog Tsim Nyog rau 2025​​ 

• Medicare twb tso cai rau cov tib neeg uas tau txais lossis poob Medi-Cal kev tsim nyog, lossis cov uas tsiv mus rau qhov chaw uas lawv cov phiaj xwm tam sim no tsis muaj, hloov pauv lawv qhov Medicare Advantage lossis Prescription Drug Plan, dhau ntawm SEP.​​  
• Txij li Lub Ib Hlis Ntuj hnub tim 1, 2025, Medicare yuav tso cai rau cov tswv cuab uas tsim nyog tau txais kev pab nyiaj ob tog thiab cov neeg tau nyiaj tsawg (LIS) los xaiv tsa txhua hli los ua:​​  
• Hloov los ntawm Medicare Advantage mus rau Original Medicare nrog ib qho kev npaj tshuaj noj ib leeg.​​ 
• Hloov ntawm cov kev npaj tshuaj kho mob nyob ib leeg yog rau npe rau hauv Original Medicare.​​ 
• Tsis tas li ntawd, ib hom tshiab ntawm SEP rau kev saib xyuas kev sib koom ua ke yuav tso cai rau cov tswv cuab uas tsim nyog tau txais ob qho kev xaiv Medi-Medi Plan lossis SCAN Connections ib zaug ib hlis, hauv ib hlis ntawm lub xyoo.  Cov tswv cuab tseem tuaj yeem tso npe rau hauv PACE hauv txhua lub hlis ntawm lub xyoo, yog tias lawv ua tau raws li PACE cov txheej txheem rau npe.​​ 
• Peb lub hlis twg SEP rau ob tus tswv cuab tsim nyog yuav raug txiav tawm hauv 2025.​​  
• Cov tswv cuab uas tsim nyog ob yam yuav tsis tuaj yeem sau npe rau hauv, lossis hloov pauv, cov phiaj xwm Medicare Advantage Ib Txwm lossis lwm cov phiaj xwm Kev Xav Tau Tshwj Xeeb sab nraum lub sijhawm ib txwm muaj, tshwj tsis yog tias muaj SEP sib txawv siv tau, xws li tsiv tawm ntawm thaj chaw pabcuam ntawm txoj kev npaj.​​ 
• CMS released an additional resource to provide an overview of the new SEPs for dually eligible and LIS-only eligible individuals.​​ 

Medi-Cal Matching Plan Policy​​ 

Xyoo 2025 Txoj Cai Npaj Sib Tw Medi-Cal yuav txuas ntxiv mus rau hauv 17 lub nroog.  Raws li txoj cai no, tus tswv cuab txoj kev xaiv txoj kev npaj Medicare yog qhov tseem ceeb tshaj plaws, thiab txoj kev npaj Medi-Cal yog qhov ua raws. Qhov no txhais tau tias rau cov tswv cuab uas tsim nyog ob yam uas xaiv rau npe rau hauv txhua hom kev npaj Medicare hauv 17 lub nroog ntawd (suav nrog Medi-Medi Plans), lawv txoj kev npaj Medi-Cal yuav tsum sib haum nrog lawv txoj kev xaiv Medicare, yog tias muaj kev npaj Medi-Cal koom nrog lawv txoj kev npaj Medicare. Txoj Cai Npaj Sib Tham Medi-Cal tsis hloov lossis cuam tshuam rau tus tswv cuab txoj kev xaiv phiaj xwm Medicare.​​  

Piv txwv Scenarios rau 2025​​ 

1. Member 1 in Los Angeles County has Original (Traditional) Medicare and a Part D Prescription Drug plan, plus a Medi-Cal managed care plan.  In April 2025 this member uses the new SEP for integrated care to enroll in a Medi-Medi Plan.  They will be automatically enrolled in the Medi-Cal plan that is aligned with their new Medicare plan.  This member can also change back to Original Medicare with a Part D Drug plan in any month after April 2025, and enroll in any Medi-Cal plan.​​ 

   Tus tswv cuab 1 tsis tuaj yeem tso npe rau hauv Medicare Advantage txoj kev npaj ua ntu zus thaum lub Plaub Hlis 2025, tshwj tsis yog tias muaj lwm yam xwm txheej SEP. Feem ntau, Tus Tswv Cuab 1 yuav tsum tau tos kom txog thaum Medicare Qhib Lub Sijhawm Teev Npe rau lub caij nplooj zeeg xyoo 2025 yog tias lawv xav tso npe rau hauv Medicare Advantage txoj kev npaj, pib lub Ib Hlis 1, 2026.​​  

2. Tus neeg thib 2 hauv San Francisco County tau rau npe rau hauv daim phiaj xwm Medicare Advantage ib txwm muaj, thiab daim phiaj xwm Medi-Cal sib phim.  Thaum lub Tsib Hlis Ntuj xyoo 2025, tus tswv cuab no hloov mus rau Original Medicare thiab Part D Drug plan, thiab tuaj yeem xaiv ib qho Medi-Cal plan hauv lawv lub nroog.  Yog tias tus tswv cuab no tseem nyob hauv lawv txoj kev npaj Medicare thaum lub Tsib Hlis 2025, lawv kuj tseem yuav nyob hauv lawv txoj kev npaj Medi-Cal uas phim.​​ 

   Tus tswv cuab 2 tsis tuaj yeem tso npe rau hauv Medicare Advantage txoj kev npaj sib txawv thaum lub Tsib Hlis 2025, tshwj tsis yog tias muaj lwm yam xwm txheej SEP.  Feem ntau, Tus Tswv Cuab 2 yuav tsum tau tos kom txog thaum Medicare Qhib Lub Sijhawm Teev Npe rau lub caij nplooj zeeg 2025 yog tias lawv xav tso npe rau hauv lwm txoj kev npaj Medicare Advantage, pib lub Ib Hlis 1, 2026.​​