សិទ្ធិពេញលេញ និងដោយផ្នែក
ត្រឡប់ទៅ ព័ត៌មានសម្រាប់ មនុស្សចាស់ វិញ
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.
Duals ពេញ
“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 Partial-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).
ផ្នែក B តែប៉ុណ្ណោះ
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.
ចំណាំ៖ ប្រសិនបើពីរផ្នែកពេញបាត់បង់ Medi-Cal (ឧ. ដោយសារការកើនឡើងប្រាក់ចំណូល ឬបាត់ឯកសារ) នោះពួកគេមិនក្លាយជាពីរផ្នែកដោយស្វ័យប្រវត្តិទេ លុះត្រាតែពួកគេបានស្នើសុំការវាយតម្លៃសម្រាប់ MSP ប៉ុណ្ណោះ។ ខោនធីធ្វើការកំណត់ឡើងវិញប្រចាំឆ្នាំសម្រាប់ទាំង Medi-Cal និង Medicare ។ មិនមានស្ថានភាពណាមួយដែលសមាជិកនឹងបាត់បង់សិទ្ធិទទួលបាន Medi-Cal និងរក្សា MSP ដោយគ្មានសំណើពិសេសនោះទេ។
Medicare ផ្នែក A កិច្ចព្រមព្រៀងទិញ
ចាប់ពីខែមករា 1, 2025 រដ្ឋកាលីហ្វ័រញ៉ាចូលរួមនៅក្នុងកិច្ចព្រមព្រៀងទិញជាមួយ CMS ដែល Medi-Cal បង់ដោយស្វ័យប្រវត្តិនូវបុព្វលាភធានារ៉ាប់រង Medicare Part A និងការកាត់កងសម្រាប់សមាជិក Medi-Cal ដែល៖
- ត្រូវបានចុះឈ្មោះនៅក្នុងកម្មវិធី Medicare Beneficiary (QMB) មានលក្ខណៈសម្បត្តិគ្រប់គ្រាន់ និង
- មានសិទ្ធិ Medicare ផ្នែក B ដូចដែលបានរាយការណ៍ដោយរដ្ឋបាលសន្តិសុខសង្គម (SSA) ។
For more information about the Part A Buy-In policy, please see this Medicare Premium Payment (Buy-In) Program webpage.