聯邦醫療保險特別註冊期（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.
如果您有疑問或需要更改註冊方面的協助，請致電 1-800-聯邦醫療保險 (1-800-633-4227)。
2025 年 LIS 和雙重資格個人聯邦醫療保險標準必要專利的變更
- 聯邦醫療保險已允許獲得或失去 Medi-Cal 資格的個人，或搬到目前計劃無法使用的地方，通過 SEP 更改他們的聯邦醫療保險優惠或處方藥計劃。
- 自一月1 、 2025起，聯邦醫療保險將允許雙重資格和低收入補貼 (LIS) 資格的會員每月進行一次選擇：
- 從聯邦醫療保險優勢轉換為具有獨立處方藥計劃的原始聯邦醫療保險。
- 如果加入原始聯邦醫療保險，則可以在獨立處方藥計劃之間切換。
- 此外，一種新類型的綜合護理服務將允許雙重合資格的會員在一年中的任何一個月選擇 Medi-Medi 計劃或 SCAN 連接一次。 如果會員符合 PACE 註冊標準，則可以在一年中的任何月份繼續註冊PACE 。
- 雙重合資格會員的季度 SEP 將於 2025 年終止。
- 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.
加州醫療補助健康保健計畫配套計畫政策
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 年的範例情境
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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.
除非有其他 SEP 情況，否則會員 1 無法在 2025 年 4 月註冊常規的聯邦醫療保險優惠計劃。 一般而言，會員 1 必須等到 2025 年秋季的聯邦醫療保險開放註冊期為止，如果他們想要註冊一般的聯邦醫療保險優惠計劃，該計劃生效於 1 月 1，2026。
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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.
除非有其他 SEP 情況，否則會員 2 無法在 2025 年 5 月註冊其他聯邦醫療保險優惠計劃。 一般而言，會員 2 必須等到 2025 年秋季的聯邦醫療保險開放註冊期為止，如果他們想參加其他聯邦醫療保險優惠計劃（自 1 月 1 日 2026 生效）。