Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Cov Kev Xaiv Medicare Advantage rau Cov Neeg Tau Txais Txiaj Ntsig Ob Leeg ​​ 

Medicare Advantage Options rau Dual Tsim Nyog tau txais txiaj ntsig​​  

Rov qab mus rau Integrated Care rau Dual Tsim Nyog tau txais txiaj ntsig​​ 

Qee tus neeg tsim nyog tau txais Medicare thiab Medi-Cal thiab yog "dual tsim nyog" lossis Medi Medi tau txais txiaj ntsig. Thaum ib tus neeg muaj Medicare Tshooj A thiab B, Medicare yog thawj daim ntawv pov hwm thiab them nyiaj rau kev kho mob feem ntau. Medi-Cal yog qhov kev pov hwm thib ob, thiab nws them rau cov nqi uas tsis them los ntawm Medicare thiab muab cov txiaj ntsig ntxiv uas tsis tau them los ntawm Medicare.​​ 

Like all Medicare beneficiaries, dual eligible beneficiaries can choose whether to receive care through Original Medicare, or enroll in a Medicare Advantage plan, sometimes called “Part C” or “MA Plans.” In California there are several types of Medicare Advantage plans, and plan options vary by county.​​   

Some plans provide integrated care, across both Medicare and Medi-Cal benefits. The My Care My Choice website provides information about integrated care options in each county, and local HICAP organizations can also provide assistance.​​ 

Hom Medicare Advantage Plans​​ 

Kwv yees li ntawm 55 feem pua ntawm cov neeg tau txais txiaj ntsig tau txais txiaj ntsig zoo hauv California yog nyob hauv Original Medicare. Cov seem, kwv yees li 45 feem pua, tau tso npe rau hauv qee hom Medicare Advantage. Thov saib cov ntawv ceeb toom hauv qab no rau ob qhov tsim nyog Medicare Advantage cov ntaub ntawv sau npe, los ntawm hom phiaj xwm:​​ 

"Raws li" Medicare Advantage Plans (rau txhua tus neeg tau txais txiaj ntsig Medicare)​​ 

Cov phiaj xwm "Regular" Medicare Advantage pab rau ob qho tib si tsim nyog thiab Medicare nkaus xwb cov tswv cuab thiab tsis tas yuav tsum tau sau ntawv cog lus nrog lub xeev Medicaid cov koom haum, xws li DHCS, kom tau txais txiaj ntsig thiab kev sib koom tes saib xyuas rau ob tus neeg tau txais txiaj ntsig.​​ 

Medicare Medi-Cal Plans (MMPs lossis Medi-Medi Plans)​​ 

Medicare Medi-Cal Plans (MMPs lossis Medi-Medi Plans) yog ib hom Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) uas ua tau raws li cov kev xav tau ntawm kev saib xyuas kev sib koom ua ke, muaj cov ntaub ntawv koom ua ke, thiab muaj kev koom ua tswv cuab txwv rau cov tib neeg tsim nyog tau txais ob qho tib si uas tau cuv npe hauv Medi-Calated kev saib xyuas nrog NP. Qhov kev tso npe kawm sib raug zoo no muab kev saib xyuas sib koom ua ke thiab sib koom ua ke ntau dua li lwm cov D-SNPs, qhov twg cov tswv cuab yuav tsis nyob hauv Medi-Cal txoj kev npaj ua raws li lawv txoj kev npaj Medicare. Thaum ob tus neeg tau txais txiaj ntsig tau txais txiaj ntsig xaiv Medicare txoj kev npaj uas yog MMP, lawv tau tso npe rau hauv Medi-Cal txoj kev npaj ua raws li lawv txoj kev npaj Medicare, yog li muaj ib lub koom haum tswj xyuas kev saib xyuas thoob plaws ob qho txiaj ntsig. Medi-Medi Plans yog California lub npe tshwj xeeb rau kev tso npe kawm tshwj xeeb (EAE) D-SNPs.​​ 

Cov phiaj xwm Medi-Medi muaj nyob rau hauv kaum ob lub nroog hauv xyoo 2024. Daim ntawv teev cov nroog thiab cov phiaj xwm muaj nyob rau ntawm nplooj ntawv web MMP Outreach.​​ 

Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs)​​ 

D-SNPs yog hom phiaj xwm Medicare Advantage uas muab kev saib xyuas tshwj xeeb thiab cov kev pab cuam nyob ib puag ncig rau ob tus neeg tau txais txiaj ntsig. Kev cuv npe tsuas yog txwv rau ob tus neeg tau txais txiaj ntsig nrog Tshooj A thiab Tshooj B Medicare. D-SNPs yuav tsum muaj daim ntawv cog lus hauv Xeev Medicaid Agency (SMAC) nrog DHCS, uas tsim kom muaj kev sib koom tes saib xyuas thiab Medicare-Medi-Cal kev sib koom tes cov kev pab cuam rau txoj kev npaj. Raws li lub xeev txoj cai lij choj, DHCS txiav txim siab seb puas yuav cog lus nrog D-SNPs tshwj xeeb hauv txhua lub nroog.​​   

D-SNPs uas tsis yog Medi-Medi Plans kuj hu ua Non-EAE D-SNPs.  Hom D-SNP no suav nrog cov phiaj xwm nrog Medi-Cal txoj kev npaj, nrog rau cov phiaj xwm uas tsis muaj Medi-Cal txoj kev npaj koom nrog hauv lub nroog ntawd. Thaum D-SNP cov tswv cuab raug tso npe rau hauv cov phiaj xwm Medi-Cal tsis koom nrog, qhov ntawd txhais tau hais tias cov tswv cuab nyob hauv ob txoj kev npaj kho mob sib txawv rau lawv cov txiaj ntsig Medicare thiab Medi-Cal.​​   

Lus Cim: Cov phiaj xwm "zoo ib yam" ntawm D-SNP yog cov phiaj xwm MA uas tau muag rau, thiab muaj cov tswv cuab uas muaj feem pua ntau ntawm cov neeg tau txais txiaj ntsig ob leeg. Txawm li cas los xij, cov phiaj xwm zoo ib yam li D-SNP tsis muab kev sib koom tes saib xyuas lossis kev pabcuam qhwv ib puag ncig. Xav paub ntxiv txog cov phiaj xwm "zoo ib yam" ntawm D-SNP tuaj yeem pom ntawm nplooj ntawv web MA D-SNP Look-Alike Plans.​​ 

Qhov Kev Pabcuam Txhua-Inclusive Care rau Cov Neeg Laus (PACE):​​ 

Kev Pab Cuam Saib Xyuas Txhua Yam Rau Cov Neeg Laus (PACE): PACE them rau cov txiaj ntsig Medicare thiab Medi-Cal, suav nrog cov tshuaj uas kws kho mob sau ntawv kom yuav.  Nws yuav koom tes saib xyuas kev kho mob, kev saib xyuas hauv tsev, kev thauj mus los, thiab kev kho hniav. Yog xav paub seb PACE puas muaj nyob rau hauv koj cheeb tsam, thiab xav sau npe, thov mus rau nplooj ntawv web CalPACE.​​ 

SCAN kev sib txuas thiab kev sib txuas hauv tsev:​​ 

SCAN Connections, and Connections at Home, is a Medicare Advantage Special Needs Plan that covers Medicare and Medi-Cal benefits, including prescription drugs, dental, healthcare, homecare, transportation, and related benefits. To find out if SCAN Connections at Home is available in your area, and to enroll, please go to SCAN Health Plan webpage.​​