加州協調護理計畫 洛杉磯縣.

Presentation on theme: "加州協調護理計畫 洛杉磯縣."— Presentation transcript:

1 加州協調護理計畫 洛杉磯縣

2 Medicare 與 Medi-Cal 現況 Medicare Medi-Cal
Medicare and Medi-Cal are two different government programs to provide health care. Medicare is for seniors and those under 65 with certain disabilities, such as end-stage renal disease (ESRD). Medi-Cal is for low-income Californians. There are some Californians who qualify for BOTH programs, called Medi-Medi or dual eligible beneficiaries. They receive complementary services from each program. Medicare primarily covers medical services and prescription drugs, and Medi-Cal wraps additional services around that: help with transportation, vision, dental, cost sharing, long-term care, and durable medical equipment (DME). Medi-Cal also covers long-term services and supports including in-home supportive services (IHSS), community-based adult services (CBAS), the Multipurpose Senior Services Program (MSSP) and nursing home care.

3 Medicare 與 Medi-Cal 現況 Medicare Medi-Cal 長期服務與支援 醫生 醫院 處方藥 耐久性醫療器材
MSSP:多功能老人服務計畫 IHSS:居家支援服務 CBAS:社區型成人服務 安養機構 耐久性醫療器材 Medicare 費用分攤 醫生 醫院 處方藥 Medicare and Medi-Cal are two different government programs to provide health care. Medicare is for seniors and those under 65 with certain disabilities, such as end-stage renal disease (ESRD). Medi-Cal is for low-income Californians. There are some Californians who qualify for BOTH programs, called Medi-Medi or dual eligible beneficiaries. They receive complementary services from each program. Medicare primarily covers medical services and prescription drugs, and Medi-Cal wraps additional services around that: help with transportation, vision, dental, cost sharing, long-term care, and durable medical equipment (DME). Medi-Cal also covers long-term services and supports including in-home supportive services (IHSS), community-based adult services (CBAS), the Multipurpose Senior Services Program (MSSP) and nursing home care.

4 協調護理計畫：兩部分 Medi-Cal Cal MediConnect 可選 管理的長期 服務與支援 (MLTSS)
對象：具有 Medicare (A 與 B 部份) 與全額 Medi-Cal 理賠的多 數人 對象：僅限 Medi-Cal 受益人，以及 選擇不加入 Cal MediConnect 的 Medicare 與 Medi-Cal 保戶 Many dual eligible beneficiaries in the eight counties will be eligible to enroll in a new program – Cal MediConnect. This program is optional, and beneficiaries will have a choice of plans that will combine their Medicare and Medi-Cal benefits and provide additional benefits and services, including care coordination. Those who are not eligible for Cal MediConnect, or who opt out, will still have to choose a Medi-Cal managed care plan to receive their long-term services and supports. Their Medicare benefits will not change, whether they are in FFS or a Medicare Advantage plan. 可選 必選

5 Cal MediConnect 原始的 Medicare (A, B 與 D 部份) 與 Medi-Cal 服務
一個號碼滿足您所有的健康照護需 求 視力給付：每年一次例行性眼睛檢 查，每二年用於眼鏡/隱形眼鏡的共 同負擔額 $100 交通給付：除了現有的交通給付 以外，每年 30 次單程交通給付 照護協調 請致電健康計畫查詢您的提供者是 否與計畫合作 Cal MediConnect 對象：如果您兼具 Medicare (A, B 與 D 部份) 與完整的 Medi-Cal 可選 Beneficiaries who are not eligible for Cal MediConnect or who choose to opt out will still need to enroll in a Medi-Cal managed care plan Medi-Cal Beneficiaries will receive some supplemental vision benefits. Their Medicare benefits will remain the same, whether they are delivered through Medicare FFS or Medicare Advantage.

6 Cal MediConnect 照護協調 In Cal MediConnect, beneficiaries and their providers will have access to a number of care coordination tools.

7 如果您有 Medicare 與 Medi-Cal 選項 1：選擇 Cal MediConnect
您可以將 Medicare A、B 和 D 與您的 Medi-Cal 給付 整合到 Cal MediConnect 計畫 L.A. Care Cal MediConnect 計畫 Health Net Cal MediConnect 計畫 Care 1st Cal MediConnect 計畫 Care More Cal MediConnect 計畫 Molina Duals Options

8 Cal MediConnect 計畫 洛杉磯 L.A. Care Cal MediConnect 計畫
Care More Cal MediConnect 計畫 Care 1st Cal MediConnect 計畫 Health Net Cal MediConnect Molina Duals Options The health plan options in each county are different. Beneficiaries will receive information about each plan, including their provider networks, 60 days before enrollment. The state will identify the plan that includes the providers beneficiaries currently are seeing.

9 Cal MediConnect 費用與共同負擔
請查詢 Cal MediConnect 計畫關於 Medicare D 部份 的相關費用，以確保您的藥物有給付。 共同負擔將與現在相同。 如果您是 Medi-Medi 保戶，則提供者不應向您收費，而 Cal MediConnect 也維持相同的情況。 Neither Cal MediConnect nor MLTSS should change costs for beneficiaries.

10 Medi-Cal 這僅影響您的 Medi-Cal 服務。 您將持續接受相同的 Medi-Cal 服務，現在將透過健康計畫提 供。
管理的長期 服務與支援 這僅影響您的 Medi-Cal 服務。 您將持續接受相同的 Medi-Cal 服務，現在將透過健康計畫提 供。 如果您有 Medicare 與 Medi- Cal，且您選擇加入本計畫，您 的醫生、醫院與其他 Medicare 服務將維持現況。 對象： 如果您只有 Medi-Cal 或您有 Medicare 與 Medi-Cal，且您不加入 Cal MediConnect 必選 Beneficiaries who are not eligible for Cal MediConnect or who choose to opt out will still need to enroll in a Medi-Cal managed care plan Medi-Cal Beneficiaries will receive some supplemental vision benefits. Their Medicare benefits will remain the same, whether they are delivered through Medicare FFS or Medicare Advantage.

11 如果您有 Medicare 與 Medi-Cal
您的 Medicare (包括您 的 D 部份 計畫) 將維持不變 您將繼續使用相同的 Medicare 提供者 您的 Medi-Cal 給付將轉 至 Medi-Cal 健康計畫 Health Net L.A. Care Medi-Cal 計畫 Molina 健康計畫 Care 1st 健康計畫 Kaiser Permanente Anthem

12 您必須為您的 Medi-Cal 給付選擇一個 Medi-Cal 計畫
Health Net L.A. Care Medi-Cal 計畫 Molina 健康計畫 Care 1st 健康計畫 Kaiser Permanente Anthem

13 Medi-Cal 計畫 洛杉磯 L.A. Care Medi-Cal 計畫 Anthem Care 1st 健康計畫
Kaiser Permanente Health Net Molina 健康計畫 The health plan options in each county are different. Beneficiaries will receive information about each plan, including their provider networks, 60 days before enrollment. The state will identify the plan that includes the providers beneficiaries currently are seeing.

14 PACE 您可能符合 PACE 方案的資格 老年照護 包醫方案
對象：如果您有 Medicare 與 Medi-Cal 或只有 Medi-Cal 合格者的可用選項 如果您： 年滿 55 歲以上 安居在家或社區中 需要殘疾或慢性病況的高階照護 居住在 PACE 健康計畫所服務的郵遞區號範圍內 One option for those who do not want to go into Cal MediConnect is the PACE program. This is available only to some Medi-Medi beneficiaries. It is similar to Cal MediConnect in that it combines Medicare and Medi-Cal services to help provide care coordination to beneficiaries, but it has more restrictions than Cal MediConnect.

15 PACE 計畫 Altamed Senior BuenaCare 1-877-462-2582 Brandman 老年照護中心
洛杉磯 Altamed Senior BuenaCare Brandman 老年照護中心 The health plan options in each county are different. Beneficiaries will receive information about each plan, including their provider networks, 60 days before enrollment. The state will identify the plan that includes the providers beneficiaries currently are seeing.

16 通知時間 您將於保險日期之前的 90、60 與 30 天收到 通知。 多數人的保險日期是出生月的第一天。
您將於保險日期之前的 90、60 與 30 天收到 通知。 多數人的保險日期是出生月的第一天。 本州的 Cal MediConnect 官方資訊將僅以藍色信封 寄發。 Most beneficiaries will receive three notices prior to their coverage date – this is for beneficiaries who are eligible for Cal MediConnect and beneficiaries who are currently enrolled in Medi-Cal fee-for-service. Beneficiaries who are already in Medi-Cal managed care plans and will only see their LTSS benefits move to the managed care plan will receive a notice 45 days before that occurs. Coverage dates for individuals will vary by county and by eligibility status. For many it will be their birth month. Cal MediConnect official information will arrive in blue envelopes. Beneficiaries in San Mateo County will receive notices from their local health plan. MLTSS eligible beneficiaries in other counties will receive regular notices from the state.

17 請留意藍色信封

18 Cal MediConnect 通知 90 天通知 60 天通知 30 天通知

19 Cal MediConnect 指南

20 MLTSS 90 天通知 60 天通知 30 天通知

21 請致電健康計畫選項 1-844-580-7272 致電健康計畫選項： 投保 Cal MediConnect 計畫，或
投保 Medi-Cal 計畫 (並維持 Medicare 的現況)，或 投保 PACE 計畫

22 使用選擇表選擇希望的計畫 如果您具有 Medicare 與 Medi-Cal 且您未採取任 何行動：
您將會被指定最適合您的 Cal MediConnect 計畫。 如果您只有 Medi-cal 且您未採取任何行動： 您將會取得最適合您的 Medi-Cal 計畫指定。 這樣您不會失去您的 Medicare 或 Medi-Cal 給付或 服務。 Neither Cal MediConnect nor MLTSS should change costs for beneficiaries.

23 尋求健康計畫的協助 Cal MediConnect 計畫
L.A. Care Cal MediConnect 計畫 Care More Cal MediConnect 計畫 Care 1st Cal MediConnect 計畫 Health Net Cal MediConnect Molina Dual Options There are county-specific fact sheets that will be posting to Cal Duals with phone numbers for plans and HICAPs in each area.

24 致電求助機構 如果您要申訴，請致電您的健康計畫。 如果您需要更多協助，您可以致電： Cal MediConnect 行政監察專員方案
(855) Medi-Cal 管理照護行政監察專員 (888) 病患權益促進辦事處 (866)

25 Cal MediConnect 行政監察專員方案
行政監察專員將協助您填寫申訴與抱怨表格 (855)

26 其他資源 醫療保險顧問和權益促進計畫 (HICAP) 電子郵件 info@calduals.org
熱線： 電子郵件