Medicare Lub Sijhawm Teev Npe Tshwj Xeeb (SEPs)
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.
- Pib txij Lub Ib Hlis Ntuj Tim 1, 2025, Medicare yuav tso cai rau cov tswv cuab uas tsim nyog tau txais kev pab cuam ob leeg thiab tau nyiaj tsawg (LIS) los xaiv tsa txhua hli rau:
- 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.
- Dually eligible members will not be able to enroll in, or change, Regular Medicare Advantage plans or other Special Needs Plans outside of the usual times, except if a different SEP applies, such as moving out of the plan’s service area.
- 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
In 2025 the Medi-Cal Matching Plan Policy will continue in 17 counties. Under this policy, a member’s Medicare plan choice is the lead, and the Medi-Cal plan follows. This means that for dually eligible members that choose to enroll in any type of Medicare plan in those 17 counties (including Medi-Medi Plans), their Medi-Cal plan must align with their Medicare plan choice, if there is a Medi-Cal plan affiliated with their Medicare plan. The Medi-Cal Matching Plan Policy does not change or impact a member’s Medicare plan choice.
Piv txwv Scenarios rau 2025
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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.
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Member 2 in San Francisco County is enrolled in a regular Medicare Advantage plan, and a matching Medi-Cal plan. In May 2025 this member changes to Original Medicare and a Part D Drug plan, and can choose any Medi-Cal plan in their county. If this member remains in their Medicare plan in May 2025, they will also remain in their matching Medi-Cal plan.
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.