医疗保险特殊登记期 (SEP)
背景
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.
如果您有疑问或需要帮助更改注册，请拨打 1-800-MEDICARE（1-800-633-4227）。
2025 年针对 LIS 和双重合格个人的 Medicare SEP 变更
- 医疗保险已经允许获得或失去 Medi-Cal 资格的个人，或搬到无法使用其现有计划的地方的个人，通过 SEP 更改其医疗保险优势计划或处方药计划。
- 从1年2025月开始，联邦医疗保险 (Medicare) 将允许双重资格和低收入补贴 (LIS) 资格成员每月进行一次选择：
- 通过独立的处方药计划从 Medicare Advantage 转换为 Original Medicare。
- 如果加入了原始医疗保险，则可以在独立处方药计划之间切换。
- 此外，一种新型的综合护理 SEP 将允许双重合格成员在一年中的任何月份每月选择一次Medi-Medi 计划或SCAN 连接。 如果符合 PACE 注册标准，会员可以在一年中的任何月份继续注册PACE 。
- 双重合格会员的季度 SEP 将于 2025 年停止。
- 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 配套计划政策
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.
2025 年示例情景
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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.
会员 1 不能在 2025 年 4 月加入常规 Medicare Advantage 计划，除非存在其他 SEP 情况。 一般来说，会员 1 如果想加入常规 Medicare Advantage 计划，则必须等到 2025 年秋季的 Medicare 开放注册期，该期从 1 月1日、 2026日生效。
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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.
会员 2 不能在 2025 年 5 月加入不同的 Medicare Advantage 计划，除非存在其他 SEP 情况。 一般来说，会员 2 如果想加入其他 Medicare Advantage 计划，则必须等到 2025 年秋季的 Medicare 开放注册期，该期限从 1 月1日、 2026日生效。