전체 및 부분 이중 자격
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.
풀 듀얼
“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 부분 혜택 듀얼
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).
파트 B 전용
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.
참고: 전체 이중 가입자가 소득 증가 또는 서류 누락 등의 이유로 Medi-Cal 자격을 상실한 경우, MSP만을 위한 평가를 요청하지 않는 한 자동으로 부분 이중 가입자가 되지 않습니다. 카운티에서는 매년 Medi-Cal 및 Medicare에 대한 재결정을 수행합니다. 가입자가 특별한 요청 없이 Medi-Cal 자격을 상실하고 MSP를 유지할 수 있는 상황은 없습니다.
메디케어 파트 A 바이인 계약
1}년 1월 2025일부터 캘리포니아주는 CMS와의 바이인 계약에 참여하여 Medi-Cal이 메디케어 파트 A 보험료, 공동 보험 및 공제액을 자동으로 지불하는 메디칼 가입자를 위한 메디케어 파트 A 보험료, 공동 보험 및 공제액을 지불합니다:
- 적격 의료 보험 수혜자(QMB) 프로그램에 등록되어 있어야 합니다.
- 사회보장국(SSA)에 보고된 메디케어 파트 B 자격이 있어야 합니다.
For more information about the Part A Buy-In policy, please see this Medicare Premium Payment (Buy-In) Program webpage.