California Medicare Cov Tswv Yim Hauv Xyoo 2021

Zoo Siab

• Medicare yog dab tsi?
• Tshooj A (pw hauv tsev khomob thiab tsev khomob)
• Tshooj B (kho mob sab nrauv thiab kho mob)
• Tshooj D (kev pab them tshuaj yuav tshuaj)
• Medicare Advantage
• Cov phiaj xwm Medicare Advantage twg muaj nyob hauv California?
• HMO
• PPO
• SNP
• Cov kws zov me nyuam hauv California
• Leej twg thiaj muaj feem tau txais Medicare nyob hauv California?
• Thaum twg kuv thiaj tuaj yeem muaj npe tau txais Medicare hauv California?
• Lub sij hawm pab nkag thaum xub thawj
• Kev xaiv tsa txhua xyoo
• Medicare Advantage qhib kev rau npe nkag
• General lub sij hawm rau npe nkag
• Lub sijhawm sau npe tshwj xeeb
• Cov lus qhia rau kev cuv npe hauv Medicare hauv California
• California cov chaw muab kev pab
• Sab Laj Kev Noj Qab Haus Huv Kev Sab Laj thiab Kev Pab Nyiaj (HICAP)
• Medicare
• Kev pab tiv thaiv cov tswv zog
• Kuv yuav ua licas txuas ntxiv mus?

Medicare yog dab tsi?

Medicare yog ntawv pov hwm them nqi kho mob rau cov neeg muaj hnub nyoog 65 thiab laus dua. Koj kuj yuav tsim nyog muaj npe rau Medicare yog koj muaj hnub nyoog qis dua 65 xyoos thiab nyob nrog kev tsis taus los yog kab mob kev nkeeg.

Cov phiaj xwm Medicare nyob hauv California suav nrog:

• thawj Medicare: tsoomfwv txoj kev npaj fajseeb khomob uas tau tswjfwm los ntawm Lub Chaw rau Medicare & Medicaid Cov Kev Pabcuam (CMS)
• Qhov zoo rau Medicare: cov phiaj xwm npaj muaj los ntawm cov tuam txhab kev tuav pov hwm ntiag tug uas cog lus nrog CMS
• Cov phiaj xwm tshuaj Medicare: cov phiaj xwm pov hwm uas duav cov nqi tshuaj uas kws kho mob muab

Tshooj A (pw hauv tsev khomob thiab tsev khomob)

Ntu A pab them kev kho mob uas koj tau txais thaum nyob hauv tsev kho mob, nkag mus rau hauv cov tsev kho mob tseem ceeb, thiab tsuas siv sijhawm tsawg tsawg hauv cov tsev laus. Cov neeg feem coob tsis them tus nqi txhua hli rau Tshooj A cov kev npaj, tab sis yeej muaj feem them tawm tau yog tias koj mus pw hauv tsev kho mob.

Tshooj B (kho mob sab nrauv thiab kho mob)

Ntu B npog kev saib xyuas sab nraum lub tsev kho mob rau tej yam li:

• mus ntsib kws kho mob
• kev kuaj mob
• kev kuaj sim
• ruaj cov khoom siv kho mob

Koj yuav them ib qho nqi ntxiv rau Tshooj B cov phiaj xwm. Cov nqi hluav taws xob tau tsim los ntawm CMS thiab hloov txhua xyoo raws li cov nqi kho mob tag nrho.

Tshooj D (kev pab them tshuaj yuav tshuaj)

Txhua tus neeg nyob hauv Medicare muaj feem tau txais (Ntu D), tab sis koj yuav tsum tau txais los ntawm tus tuav pov hwm ntiag tug. Nws yog ib qho tseem ceeb kom sib piv cov phiaj xwm no vim tias tus nqi thiab cov kev pab them nqi sib txawv.

Medicare Advantage

Medicare Advantage cov kev pab them nqi (Tshooj C) yog muaj los ntawm cov pab kas phais ntiag tug uas sau tag nrho koj cov kev pab them rau feem A thiab B, thiab qee zaum kev pab them cov tshuaj, rau hauv tib hom phiaj. Nrog rau Medicare cov phiaj xwm Advantage, koj tseem them rau Medicare Tshooj B tus nqi them.

Medicare Advantage cov phiaj xwm yuav tsum them rau cov khoom sib thooj ib yam li Medicare seem A thiab B, tab sis qee qhov muaj pab them ntxiv (thiab nqi ntxiv) rau qee yam xws li:

• kho hniav lossis kho qhov muag
• lub rooj zaum muaj log hauv tsev
• zaub mov xa tuaj
• tsheb thauj mus thiab los ntawm kev teem caij kho mob

Cov phiaj xwm Medicare Advantage twg muaj nyob hauv California?

Hauv California, Medicare Advantage cov phiaj xwm poob rau hauv peb pawg: Cov Koom Haum Saib Xyuas Kev Noj Qab Haus Huv (HMOs), Cov Chaw Pabcuam Xav Tau Tshwj Xeeb (PPOs), thiab Cov Kev Xav Tau Tshwj Xeeb (SNPs).

HMO

Nrog HMO, koj xaiv thawj tus kws kho mob uas tswj hwm koj txoj kev tu thiab xa koj mus cuag cov kws kho mob tshwj xeeb raws li xav tau. Cov phiaj xwm feem ntau xav kom koj tau txais kev saib xyuas los ntawm cov muab kev pab hauv HMO network.

Kev saib xyuas sab nraum lub HMO network feem ntau yuav tsis duav tshwj tsis yog kev saib xyuas xwm txheej kub ntxhov ceev, saib xyuas chaw kho mob maj nrawm lossis thaj chaw lim ntshav sab nrauv.

Qee lub HMO txoj kev pab them nqi xav kom koj yuav cov kev yuav tshuaj noj uas tseem tshuav nyob hauv (Tshooj D).

Muaj HMO cov phiaj xwm kho mob hauv California txawv nyob rau cheeb nroog, thiab lawv tsis muaj nyob hauv txhua qhov chaw.

PPO

Nrog rau PPO, koj tuaj yeem tau txais kev saib xyuas los ntawm cov koom tes ntawm cov kws kho mob thiab cov chaw uas muab kev pabcuam raws li koj txoj kev npaj.

Koj tseem tuaj yeem tau txais kev saib xyuas los ntawm cov kws kho mob sab nraud cov koom tes, tab sis koj cov kev siv nyiaj hauv hnab tshos feem ntau yuav siab dua.

PPO feem ntau tsis tas yuav xa koj mus ntsib tus kws kho mob tshwj xeeb.

California tsis muaj phiaj xwm Medicare Advantage PPO thoob plaws xeev, tab sis 21 lub nroog muaj cov phiaj xwm PPO hauv zos muaj.

SNP

SNPs muaj rau cov neeg uas xav tau qib siab ntawm kev saib xyuas kev tswjhwm thiab kev saib xyuas. Koj tuaj yeem tau txais SNP yog tias koj:

• muaj ib tug mob mus ntev los yog xiam oob qhab mob, xws li mob ntshav qab zib lossis mob plawv tsis xwm yeem
• yog "ob leeg tsim nyog tau txais" rau ob qho Medicare thiab Medicaid
• nyob hauv cov tsev laus lossis cov tuam haujlwm zoo sib xws lossis nyob hauv tsev tab sis tau txais kev saib xyuas zoo ib yam li ib tus neeg hauv tsev laus

Cov kws zov me nyuam hauv California

Cov tuam txhab no muab cov kev pab Medicare Advantage hauv California:

• Aetna Medicare
• Dlhos Ntawv Npaj Kho Mob
• Anthem Blue Hla
• Blue Hla California
• Xov Xwm Tshiab Hnub
• Qhov Kev Npaj Saib Xyuas Kev Nyab Xeeb Hauv Nruab Nrab
• Clever Care Txoj Kev Npaj Khomob
• Xeev Golden
• Health Net Zej Zog Kev daws teeb meem, Inc.
• Health Net ntawm California
• Neej Neeg Dab
• Imperial Health Plan ntawm California, Inc.
• Kaiser Permanente
• Luam Ntawv Txoj Kev Npaj Khomob
• UnitedHealthcare
• WellCare

Tsis yog txhua tus cab kuj muaj cov phiaj xwm thoob plaws lub xeev, yog li cov kev xaiv uas koj muaj muaj yuav txawv nyob ntawm koj lub nroog qhov chaw nyob.

Leej twg thiaj muaj feem tau txais Medicare nyob hauv California?

Cov neeg nyob hauv California muaj cai tau txais Medicare thiab Medicare Advantage cov kev npaj yog:

• koj yog ib tus pej xeem hauv Tebchaws Meskas lossis ib tus neeg muaj ntaub ntawv nyob hauv tebchaws tau 5 xyoos lossis tshaj ntawd
• koj muaj hnub nyoog 65 xyoos lossis tshaj saud, thiab koj lossis tus txij nkawm muaj qhov ua tau raws li txoj cai ntawm kev ua haujlwm hauv Medicare txoj haujlwm txhawb nqa

Cov neeg hnub nyoog qis dua 65 xyoo yuav muaj cai yog tias:

• koj muaj mob xiam oob qhab thiab tau txais nyiaj Social Security Disability Insurance (SSDI) lossis Railroad Retirement Board cov nyiaj xiam oob qhab
• koj muaj amyotrophic lateral sclerosis (ALS) lossis mob rau cov mob raum ntu kawg (ESRD)

Yog tias koj tseem muaj lus nug txog seb koj puas tsim nyog tau txais, koj tuaj yeem siv Medicare li twj tau ntawm online.

Thaum twg kuv thiaj tuaj yeem muaj npe tau txais Medicare hauv California?

Lub sij hawm pab nkag thaum xub thawj

Thawj lub sijhawm nkag rau npe nkag (EIP) yog lub sijhawm 7-hlis uas pib peb lub hlis ua ntej koj hnub yug 65 xyoos thiab xaus 3 lub hlis tom qab koj muaj 65 xyoos. Yog tias koj rau npe, koj cov kev pab yuav pib thawj hnub ntawm lub hlis uas koj muaj 65 xyoo.

Yog tias koj ncua kev tso npe kom txog thaum lub hli lossis tom qab koj hnub yug, koj yuav muaj qhov tsis sib luag ntawm koj cov nyiaj pov hwm kev noj qab haus huv.

Kev xaiv tsa txhua xyoo

Koj tuaj yeem tso npe tau rau hauv Medicare Advantage cov kev npaj nruab nrab Lub Kaum Hli 15 thiab Kaum Ob Hlis 7 txhua xyoo. Cov nyiaj no pib lub Ib Hlis 1.

Medicare Advantage qhib kev rau npe nkag

Yog tias koj twb tau txais Medicare Advantage txoj kev pab them nqi lawm thiab xav hloov mus rau lwm qhov phiaj xwm Medicare Advantage lossis mus rau Medicare thawj, koj tuaj yeem ua nyob nruab nrab ntawm Lub Ib Hlis 1 thiab Peb Hlis 31 txhua xyoo.

General lub sij hawm rau npe nkag

Txoj kev rau npe nkag dav dav yog nyob nruab nrab Lub Ib Hlis 1 thiab Peb Hlis 31 txhua xyoo. Yog tias koj muaj Medicare Tshooj A thiab xav sau npe rau Tshooj B, Medicare Advantage txoj kev npaj, lossis Tshooj D koj yuav them rau lub sijhawm no. Kev pab them nqi yog siv tau Lub Xya hli ntuj 1.

Lub sijhawm sau npe tshwj xeeb

Lub sijhawm sau npe tshwj xeeb pub koj sau npe sab nraud lub sijhawm sau npe ib txwm muaj tshwj xeeb. Piv txwv, lub sijhawm sau npe tshwj xeeb tso cai rau koj nkag mus rau hauv phiaj xwm tshiab tsis muaj kev rau txim dab tsi yog tias koj poob ib qho kev tuav pov hwm los ntawm chaw ua haujlwm thiab xav tau rau npe rau Ntu B, lossis tsiv tawm hauv thaj chaw muab kev pab tam sim no.

Cov lus qhia rau kev cuv npe hauv Medicare hauv California

Cov phiaj xwm Medicare thiab Medicare Advantage hauv California tuaj yeem ua kom tsis meej pem, yog li ua ntej koj kos npe nws yog ib qho tseem ceeb los soj ntsuam koj cov kev xaiv thiab sib piv cov ntsiab lus zoo li:

• nqi
• kev pab them nyiaj
• cov chaw muab kev pab thiab chaw nyob hauv phiaj xwm qhov phiaj xwm (network)
• CMS cov hnub qub kev ntaus nqi rau Tshooj C thiab Tshooj D cov phiaj xwm

Yog tias koj xav tau kev pab txiav txim seb cov phiaj xwm twg yog qhov zoo tshaj rau koj cov kev xav tau lossis koj muaj lus nug txog cov kev xaiv uas muaj, nws muaj ntau cov peev txheej los pab koj.

California cov chaw muab kev pab

Sab Laj Kev Noj Qab Haus Huv Kev Sab Laj thiab Kev Pab Nyiaj (HICAP)

California Lub Caj Meem Laus muaj cov lus ntuas Medicare los ntawm HICAP. Lawv muab:

• ntaub ntawv hais txog kev cuv npe Medicare
• cov lus piav qhia ntawm Ntu A, B, thiab C, thiab kev txiav txim siab li cas koj xav tau kev pab them nqi
• cov lus teb rau cov lus nug txog Ntu D kev pab them tshuaj, nqi, thiab tsim nyog tau txais

HICAP tsis pub leej twg paub thiab pub dawb rau ib tus neeg tsim nyog tau txais Medicare lossis yuav los ua neeg tsim nyog. Koj tuaj yeem tshawb nrhiav HICAP cov kev pabcuam hauv nroog los ntawm county lossis hu 800-434-0222.

Medicare

Hu rau Medicare ncaj qha rau kev pab nrog sau npe lossis npaj cov lus nug uas yog hu rau 800-MEDICARE (800-633-4227) lossis mus saib hauv medicare.gov. Koj tseem tuaj yeem hu lub chaw haujlwm hauv cheeb tsam CMS hauv San Francisco ntawm 415-744-3501.

Kev pab tiv thaiv cov tswv zog

Yog tias koj muaj kev txhawj xeeb lossis xav tau kev pab nrog Medicare California cov kev pab them yuav los ntawm cov tswv ntiav haujlwm, tiv tauj California Lub Chaw Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ntawm 888-466-2219 lossis email [email protected].

Kuv yuav ua licas txuas ntxiv mus?

Thaum koj npaj tau tso npe rau Medicare hauv California:

• txiav txim siab qhov kev pab them nyiaj koj xav tau thiab tshawb fawb cov phiaj xwm uas muaj, kev xaiv kev tiv thaiv, thiab nqi
• Hu rau HICAP lossis Medicare yog tias koj muaj lus nug txog kev tsim nyog lossis kev tiv thaiv
• xyuas seb lub sijhawm sau npe kawm tom ntej yuav pib licas

Kab lus no tau hloov kho thaum Lub Kaum Hlis 5, 2020 kom pom zoo 2021 cov ntaub ntawv Medicare.

Cov ntaub ntawv ntawm lub vev xaib no tuaj yeem pab koj txiav txim siab tus kheej txog kev tuav pov hwm, tab sis nws tsis yog yuav pab tswv yim txog kev yuav khoom lossis kev siv cov khoom pov hwm lossis kev tuav pov hwm. Healthline Media yuav tsis hloov lag luam ntawm kev tuav pov hwm tsis hais yam twg thiab tsis tau ntawv tso cai raws li cov tuam txhab pov hwm lossis cov neeg tsim khoom hauv ib cheeb tsam ntawm Teb Chaws Asmeskas. Healthline Media tsis tau qhia lossis pom zoo rau ib tog neeg thib peb uas ua lag luam ntawm kev tuav pov hwm.