ກັບຄືນໄປຫາລາຍການແຜນ Medicare Medi-Cal​​ 

ຄວາມເປັນມາ​​ 

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. ​​ 

ຖ້າທ່ານມີຄຳຖາມ ຫຼືຕ້ອງການຄວາມຊ່ວຍເຫຼືອໃນການປ່ຽນແປງການລົງທະບຽນ, ໃຫ້ໂທຫາ 1-800-MEDICARE (1-800-633-4227).​​ 

ການປ່ຽນແປງໃນ Medicare SEPs ສໍາລັບ LIS ແລະບຸກຄົນທີ່ມີເງື່ອນໄຂສອງເທົ່າສໍາລັບ 2025​​ 

• Medicare ອະນຸຍາດໃຫ້ບຸກຄົນທີ່ໄດ້ຮັບ ຫຼືສູນເສຍສິດ Medi-Cal ແລ້ວ, ຫຼືຜູ້ທີ່ຍ້າຍໄປຢູ່ບ່ອນທີ່ແຜນການປະຈຸບັນຂອງເຂົາເຈົ້າບໍ່ມີ, ເພື່ອປ່ຽນແປງ Medicare Advantage ຫຼືແຜນການຢາຕາມໃບສັ່ງແພດ, ຜ່ານ SEP.​​  
• ເລີ່ມແຕ່ເດືອນມັງກອນ 1, 2025, Medicare ຈະອະນຸຍາດໃຫ້ສະມາຊິກທີ່ມີສິດໄດ້ຮັບເງິນອຸດໜູນສອງເທົ່າ ແລະລາຍຮັບຕໍ່າ (LIS) ໃຫ້ມີການເລືອກຕັ້ງປະຈໍາເດືອນເພື່ອ:​​  
• ປ່ຽນຈາກ Medicare Advantage ໄປ Medicare ຕົ້ນສະບັບດ້ວຍແຜນຢາຕາມໃບສັ່ງແພດແບບດ່ຽວ.​​ 
• ປ່ຽນລະຫວ່າງແຜນການຢາຕາມໃບສັ່ງແພດແບບດ່ຽວ ຖ້າລົງທະບຽນຢູ່ໃນ Original Medicare.​​ 
• ນອກຈາກນັ້ນ, ປະເພດໃຫມ່ຂອງ SEP ສໍາລັບການດູແລແບບປະສົມປະສານຈະອະນຸຍາດໃຫ້ສະມາຊິກທີ່ມີເງື່ອນໄຂສອງທາງເລືອກທີ່ຈະເລືອກເອົາ ແຜນ Medi-Medi ຫຼື SCAN Connections ຫນຶ່ງຄັ້ງຕໍ່ເດືອນ, ໃນທຸກໆເດືອນຂອງປີ.  ສະມາຊິກສາມາດສືບຕໍ່ລົງທະບຽນໃນ PACE ໃນເດືອນໃດກໍໄດ້ຂອງປີ, ຖ້າພວກເຂົາບັນລຸເງື່ອນໄຂການລົງທະບຽນ PACE.​​ 
• SEP ປະຈໍາໄຕມາດສໍາລັບສະມາຊິກທີ່ມີສິດໄດ້ຮັບສອງຄັ້ງຈະຢຸດເຊົາໃນປີ 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.​​ 

ນະໂຍບາຍແຜນການຈັບຄູ່ Medi-Cal​​ 

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.​​  

ຕົວຢ່າງສະຖານະການສຳລັບປີ 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.​​ 

   ສະມາຊິກ 1 ບໍ່ສາມາດລົງທະບຽນຢູ່ໃນແຜນ Medicare Advantage ປົກກະຕິໃນເດືອນເມສາ 2025, ເວັ້ນເສຍແຕ່ວ່າມີສະຖານະການ SEP ອື່ນໆ. ໂດຍທົ່ວໄປແລ້ວ, ສະມາຊິກ 1 ຕ້ອງລໍຖ້າຈົນກ່ວາໄລຍະເວລາການລົງທະບຽນເປີດ Medicare ໃນລະດູໃບໄມ້ຫຼົ່ນ 2025 ຖ້າພວກເຂົາຕ້ອງການລົງທະບຽນໃນແຜນ Medicare Advantage ປົກກະຕິ, ມີຜົນບັງຄັບໃຊ້ໃນເດືອນມັງກອນ 1, 2026.​​  

2. 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.​​ 

   ສະມາຊິກ 2 ບໍ່ສາມາດລົງທະບຽນໃນແຜນ Medicare Advantage ທີ່ແຕກຕ່າງກັນໃນເດືອນພຶດສະພາ 2025, ເວັ້ນເສຍແຕ່ວ່າມີສະຖານະການ SEP ອື່ນໆ.  ໂດຍທົ່ວໄປແລ້ວ, ສະມາຊິກ 2 ຕ້ອງລໍຖ້າຈົນກ່ວາໄລຍະເວລາການລົງທະບຽນເປີດ Medicare ໃນລະດູໃບໄມ້ຫຼົ່ນ 2025 ຖ້າພວກເຂົາຕ້ອງການລົງທະບຽນໃນແຜນ Medicare Advantage ທີ່ແຕກຕ່າງກັນ, ມີຜົນບັງຄັບໃຊ້ໃນເດືອນມັງກອນ 1, 2026.​​