Medicare thiab D-SNP Basics

Medicare yog tsoomfwv txoj kev pabcuam kev noj qab haus huv rau cov neeg muaj hnub nyoog 65 xyoos thiab tshaj saud. Qee cov neeg muaj hnub nyoog qis dua 65 xyoos uas muaj kev xiam oob qhab tuaj yeem tau txais ib yam nkaus. Nws muaj plaub ntu. Qhov tseem ceeb yog A thiab B, hu ua Original Medicare. Ntu C thiab D yog cov phiaj xwm ntxiv los ntawm cov tuam txhab pov hwm ntiag tug xws li Alliance's TotalCare (HMO D-SNP).

Original Medicare

Ntu A pab them rau cov kev pabcuam xws li:

• Kev kho mob hauv tsev kho mob.
• Kev saib xyuas hauv tsev laus (tsis yog kev saib xyuas mus sij hawm ntev).
• Kev kho mob hauv tsev (yog tias koj nyob hauv tsev feem ntau).
• Hospice care (rau cov neeg muaj mob hnyav nyob ze ntawm lub neej kawg).

Ntu B pab them rau:

• Kws kho mob mus ntsib.
• Cov kev kuaj sim ua tiav sab nraum lub tsev kho mob.
• Kev pab kho mob sab nraud thiab kev phais.
• Kev teem sijhawm tiv thaiv kev noj qab haus huv.
• Qee cov khoom siv kho mob, xws li cov neeg taug kev lossis cov pa oxygen.

Txoj Kev Npaj Ntxiv

Ntu C tseem hu ua Medicare Advantage. Cov phiaj xwm no muab cov tsev kho mob, kev kho mob thiab feem ntau yog Part D daim ntawv kho mob, tag nrho rau hauv ib txoj kev npaj. Lawv feem ntau muab cov txiaj ntsig ntxiv uas Original Medicare tsis them.

Ntu D pab them cov tshuaj noj. Nws tuaj yeem ua ke nrog Part C txoj kev npaj lossis yuav los ua ib txoj kev npaj cais.

TotalCare (HMO D-SNP) yog hom tshwj xeeb ntawm Medicare Advantage txoj kev npaj los ntawm Alliance. Nws suav nrog Part D kev pab them nqi tshuaj thiab yog li hu ua MA-PD txoj kev npaj.

TotalCare yog qhov tshwj xeeb hauv lwm txoj hauv kev - nws yog ib txoj kev npaj tshwj xeeb rau cov neeg uas tau cuv npe hauv Medicaid (Medi-Cal) thiab Medicare, hu ua Dual Eligible Special Needs Plan lossis "D-SNP."

Thaum twg kuv tuaj yeem sau npe?

Koj Lub Sijhawm Teev Npe Kawm Tiav (IEP) pib 3 lub hlis ua ntej koj muaj hnub nyoog 65 xyoos. Koj tuaj yeem sau npe rau lub sijhawm ntawd lossis lub hli hnub yug. Tom qab koj lub hli hnub yug, koj yuav muaj 3 lub hlis ntxiv rau npe. Qhov no muab tag nrho 7 lub hlis rau koj rau npe.

Lub Sijhawm Teev Npe Tshwj Xeeb (SEP)

Koj tuaj yeem sau npe rau Medicare Advantage lossis Part D txoj kev npaj rau lwm lub sijhawm yog tias muaj qee yam tshwm sim hauv koj lub neej. Cov no yuav suav nrog (tab sis tsis txwv rau) hloov txoj haujlwm, tsiv tawm ntawm koj lub phiaj xwm thaj chaw pabcuam, tsiv tawm hauv lossis tawm hauv tsev laus, lossis tsim nyog tau txais Medicaid. SEP kuj tseem siv tau rau cov neeg uas xiam oob qhab tsawg kawg 24 lub hlis.

Lub Sijhawm Teev Npe Kawm Ntawv Ib xyoos - Lub Kaum Hli 15 txog Lub Kaum Ob Hlis 7
Nov yog lub sijhawm txhua xyoo los rau npe lossis hloov koj li Medicare Advantage lossis Part D txoj kev npaj. Koj tuaj yeem hloov mus rau Original Medicare (Tshooj A thiab B) nkaus xwb. Koj qhov kev pab them nqi tshiab pib lub Ib Hlis tim 1 ntawm txhua xyoo.

Qhib Lub Sijhawm Teev Npe - Lub Ib Hlis 1 txog Lub Peb Hlis 31
Qhov no yog lub sijhawm ntxiv txhua xyoo thaum koj tuaj yeem hloov pauv rau npe rau koj qhov kev npaj Medicare Advantage uas twb muaj lawm. Koj tuaj yeem ua ib qho ntawm cov hauv qab no:

• Hloov mus rau lwm txoj kev npaj Medicare Advantage.
• Tso koj daim phiaj xwm Medicare Advantage thiab rov qab mus rau Original Medicare nkaus xwb. Yog tias koj ua qhov no thiab xav tau kev pab them nqi kho mob, koj muaj sijhawm txog Lub Peb Hlis 31 txhawm rau ntxiv Medicare Part D (cov tshuaj noj tshuaj).

Yog xav paub ntxiv txog Medicare, koj tuaj yeem nyeem phau ntawv Medicare & Koj. Yog tias koj tsis muaj daim ntawv theej ntawm phau ntawv no, koj tuaj yeem nkag mus rau hauv online ntawm Medicare lub vev xaib (www.medicare.gov/medicare-and-you) lossis thov ib daim qauv los ntawm kev hu rau 800-MEDICARE (800-633-4227), 24 teev ib hnub, 7 hnub hauv ib lub lis piam. Cov neeg siv TTY yuav tsum hu rau 877-486-2048.

Dual Tsim Nyog Cov Kev Xav Tau Tshwj Xeeb (D-SNPs) yog hom phiaj xwm Medicare Advantage rau cov neeg uas tsim nyog rau Medicare thiab Medicaid. Medicare yog tsoomfwv txoj kev pabcuam kev noj qab haus huv feem ntau rau cov neeg muaj hnub nyoog 65 xyoos thiab laus dua. Medicaid yog ib qho kev pab kho mob rau cov neeg uas tau nyiaj tsawg. Qee lub xeev kuj them rau lwm tus neeg, raws li lawv lub xeev txoj cai. D-SNPs tswj xyuas koj txoj kev kho mob thiab feem ntau suav nrog cov txiaj ntsig ntxiv uas cov phiaj xwm Medicare Advantage tsis muaj.

Exclusively Aligned Enrollment (EAE) D-SNPs
Daim phiaj xwm TotalCare yog hom tshwj xeeb ntawm D-SNP hu ua Exclusively Aligned Enrollment (EAE) D-SNP. "Kev sau npe tshwj xeeb tshwj xeeb" txhais tau hais tias koj tau txais koj ob qho txiaj ntsig Medicare thiab Medicaid los ntawm tib lub koom haum - hauv qhov no, Alliance.

Raws li tus tswv cuab TotalCare, koj yuav muaj ib txoj kev npaj rau Medicare thiab Medi-Cal. Tus nqi ntawm hom phiaj xwm no suav nrog:

• Ib txoj kev npaj tswj xyuas tag nrho koj cov kev saib xyuas.
• Cov nyiaj pab ntxiv tshaj li Medicare thiab Medicaid cov kev pab them nqi kho mob.
• Ib daim npav ID tus tswv cuab thiab phau ntawv qhia tswv cuab nrog cov ntsiab lus hais txog ob qho kev pab cuam.
• Kev saib xyuas kev sib koom tes thiab kev tswj hwm rooj plaub los ntawm tus kws saib xyuas kev noj qab haus huv uas yog koj lub ntsiab lus tseem ceeb ntawm kev sib cuag.
• Kev sib txuas lus meej dua rau koj thiab koj cov neeg muab kev pabcuam.
• Nkag mus rau cov kws kho mob tshwj xeeb uas lees txais Medicare thiab Medicaid.

Peb lub hom phiaj yog ua kom yooj yim rau koj kom tau txais kev saib xyuas koj xav tau thiab pab koj noj qab haus huv thiab xav tias koj zoo tshaj plaws.