Kodi Medicare Dual Eligible Needs Plan Ndi Chiyani?

Zamkati

• Kodi Medicare Dual Eligible Special Needs Plan (D-SNP) ndi chiyani?
• Ndani ali woyenera ku Medicare Dual Eligible SNPs?
• Kuyenerera kwa Medicare
• Kuyenerera kwa Medicaid
• Kodi mungalembetse bwanji mu SNP Yoyenera?
• Kodi SNP Yoyenerera Pawiri imaphimba chiyani?
• Kodi SNP Yoyenerera Yapawiri imakhala yotani?
• Mitengo yodziwika ya D-SNPs mu 2020
• Kutenga

• Dipatimenti ya Medicare Dual Eligible Special Needs Plan (D-SNP) ndi njira ya Medicare Advantage yomwe idapangidwa kuti ipereke mwayi wapadera kwa anthu omwe adalembetsa ku Medicare (gawo A ndi B) ndi Medicaid.
• Mapulaniwa amathandiza anthu omwe ali ndi zosowa zazikulu kwambiri kuti aziphimba ndalama zomwe angakhale nazo pantchito zachikhalidwe za Medicare.

Ngati muli ndi zaka zopitilira 65 kapena muli ndi zikhalidwe zina zathanzi - ndipo muli ndi ndalama zochepa zolipirira chisamaliro chanu - mutha kulowa mgulu la anthu omwe akuyenerera inshuwaransi ya boma ndi boma. M'malo mwake, anthu aku America pafupifupi 12 miliyoni ali ndi mwayi wopeza chithandizo cha Medicare ndi Medicaid, kutengera msinkhu wawo komanso thanzi lawo. Ngati ndinu m'modzi wawo, mutha kulandira D-SNP.

Pemphani kuti muphunzire za D-SNP komanso ngati mukuyenera kulandira.

Kodi Medicare Dual Eligible Special Needs Plan (D-SNP) ndi chiyani?

A Medicare Special Needs Plan (SNP) ndi mtundu wa Medicare Advantage (Gawo C) lomwe limapereka mtundu wa kufalikira kwa Medicare. Mapulani achinsinsiwa amathandizira kusamalira chisamaliro ndi maubwino pakati pa Medicare, yomwe ndi pulogalamu yaboma, ndi Medicaid, yomwe ndi pulogalamu yaboma.

D-SNPs ndizovuta kwambiri pa SNP potengera zonse zomwe zimafunikira komanso kuyenerera, koma zimapereka zabwino kwambiri kwa anthu omwe amafunikira kwambiri.

Kuti muyenerere D-SNP, muyenera kutsimikizira kuti ndinu oyenerera. Muyenera kulembetsa ku Medicare ndi boma lanu pulogalamu ya Medicaid, ndipo muyenera kulemba izi.

Wopangidwa mu 2003 ndi Congress, Medicare SNPs amapezeka kwa iwo omwe ali kale ndi mbali za Medicare A ndi B. SNPs ndi mtundu wa dongosolo la Medicare Part C (Advantage) loyendetsedwa ndi boma ndipo limaperekedwa ndi makampani a inshuwaransi wamba. Amaphatikizapo zinthu zingapo za Medicare: Gawo A kufotokozera anthu kuchipatala, Gawo B kufalitsa chithandizo chamankhwala akunja, ndi gawo D la chithandizo cha mankhwala.

Sikuti mayiko onse amapereka Medicare SNPs. Kuyambira mu 2016, mayiko 38 kuphatikiza Washington, DC, ndi Puerto Rico adapereka ma D-SNPs.

SNP imagawika m'magulu atatu kutengera mtundu wa anthu omwe amayenera kulandira.

• Ndondomeko Zofunikira Zapadera Zoyenera (D-SNPs). Mapulaniwa ndi a anthu omwe ali oyenera kulandira Medicare komanso pulogalamu ya Medicaid ya boma lawo.
• Mapulani a Zosowa Zapadera (C-SNPs). Mapulani awa a Advantage adapangidwira anthu omwe ali ndi matenda osachiritsika monga kulephera kwa mtima, khansa, matenda am'mapeto am'magazi, kudalira mankhwala osokoneza bongo ndi mowa, HIV, ndi zina zambiri.
• Mapulani Apadera a Institutional (I-SNPs). Mapulani awa a Advantage adapangidwira anthu omwe amafunika kukhala m'malo kapena malo osamalira anthu kwanthawi yayitali kuposa masiku 90.

Ndani ali woyenera ku Medicare Dual Eligible SNPs?

Kuti muganiziridwe za SNP iliyonse, muyenera kulembetsa ku Medicare gawo A ndi B (choyambirira Medicare), chomwe chimafotokoza za chipatala ndi ntchito zina zamankhwala.

Pali ma D-SNP osiyanasiyana omwe alipo. Ena ndi mapulogalamu a Health Maintenance Organisations (HMO), ndipo ena atha kukhala mapulogalamu a Preferred Provider Organisations (PPO). Zolingazi zimasiyana malinga ndi kampani ya inshuwaransi yomwe mwasankha komanso dera lomwe mukukhala. Pulogalamu iliyonse itha kukhala ndi mtengo wosiyanasiyana.

Mutha kuyimbira 800-MEDICARE kuti mumve zambiri kapena kufunsa mafunso okhudza D-SNPs ndi maubwino ena a Medicare.

Kuyenerera kwa Medicare

Mukuyenera kulandira Medicare ali ndi zaka 65 kapena kupitilira apo. Muli ndi miyezi itatu isanathe komanso itatha mwezi womwe mumakwanitsa zaka 65 kuti mulembetse kuti mupeze chithandizo choyamba cha Medicare.

Muyeneranso kulandira Medicare, ngakhale mutakhala ndi zaka zingati, ngati muli ndi vuto loyenerera kapena olumala, monga matenda a impso kapena amyotrophic lateral sclerosis, kapena mwakhala muli pa Social Security Disability Insurance kwa miyezi 24 kapena kupitilira apo.

Ngati mukuyenerera, mutha kulembetsa mu D-SNP panthawi yoyenera kulembetsa ku Medicare, bola ngati ma D-SNP aperekedwa mdera lanu.

• Kulembetsa koyamba. Nthawi imeneyi imayamba miyezi itatu musanabadwe zaka 65 ndipo imafikira mpaka miyezi itatu mutakwanitsa zaka 65.
• Kulembetsa kwa Medicare Advantage. Izi zikuchokera pa Januware 1 mpaka Marichi 31. Munthawi imeneyi, mutha kulembetsa kapena kusintha dongosolo lanu la Medicare Advantage. Mutha ku ayi sinthani kuchokera ku Medicare yoyambirira kupita ku dongosolo la Advantage panthawiyi; mutha kuchita izi pokhapokha mukamalembetsa.
• Kulembetsa General Medicare. Nthawi imeneyi imachokera pa Januware 1 mpaka Marichi 31. Ngati simunalembetse Medicare yoyambirira munthawi yoyamba kulembetsa, mutha kulembetsa nthawi imeneyi.
• Tsegulani olembetsa. Uku ndi kuyambira Okutobala 15 mpaka Disembala 7. Aliyense amene akuyenerera kukhala ndi Medicare atha kulembetsa panthawiyi ngati sanatero. Mutha kusintha kuchokera ku Medicare yoyambirira kupita ku pulani ya Advantage, ndipo mutha kusintha kapena kusiya dongosolo lanu la Advantage, Part D, kapena Medigap panthawiyi.
• Nthawi zolembetsa zapadera. Izi zimapezeka chaka chonse ndipo zimachokera pakusintha kwanu, monga kuyenerera kwatsopano kwa Medicare kapena Medicaid, kusuntha, kusintha kwazachipatala chanu, kapena kusiya dongosolo lanu.

Kuyenerera kwa Medicaid

Kuyenerera kwa Medicaid kumakhazikitsidwa pazinthu zingapo, kuphatikiza zomwe mumapeza, thanzi lanu, komanso ngati mukuyenera kulandira Supplemental Security Income. Kuti mudziwe ngati muli ndi ufulu wopeza chithandizo cha Medicaid mdera lanu ndikulandila chitsimikiziro chakuyenereradi kwanu, funsani ofesi ya Medicaid yaboma lanu.

Kodi mungalembetse bwanji mu SNP Yoyenera?

Nthawi zina, mutha kulembetsa ku Medicare magawo A ndi B mukadzakwanitsa zaka 65. Koma simudzangolembetsedwa mu D-SNP chifukwa ndi mtundu wa Medicare Advantage (Part C) Plan.

Mutha kugula mapulani a Medicare Advantage, kuphatikiza ma D-SNPs, munthawi yolembetsa kuvomerezedwa ndi Medicare: nthawi yolembetsa ya Medicare Advantage kuyambira Januware 1 mpaka Marichi 31, kulembetsa kuyambira pa Okutobala 15 mpaka Disembala 7, kapena munthawi yolembetsa ngati muli ndi sinthani momwe mulili.

Kulembetsa dongosolo lililonse la Medicare Advantage, kuphatikiza ma D-SNPs, tsatirani izi:

• Sankhani dongosolo m'dera lanu (onani chida chopeza mapulani a Medicare cha mapulani mu ZIP code yanu).
• Kuti mulembetse pa intaneti kapena mupemphe fomu yamapepala kuti mulembetse ndi makalata, pitani patsamba la kampani ya inshuwaransi pa pulani yomwe mwasankha.
• Imbani 800-MEDICARE (800-633-4227) ngati mukufuna thandizo.

• khadi yanu ya Medicare
• tsiku lenileni lomwe mudayambitsa Medicare magawo A ndi / kapena B.
• umboni wokhudzidwa kwa Medicaid (khadi yanu ya Medicaid kapena kalata yovomerezeka)

Kodi SNP Yoyenerera Pawiri imaphimba chiyani?

D-SNPs ndi mapulani a Medicare Advantage, chifukwa chake amalipira ntchito zofananira ndi mapulani ena a Medicare Advantage. Izi zikuphatikiza:

• $ 0 malipiro apamwezi
• ntchito zothandizira
• Gawo la Medicare D.
• mankhwala ena ogulitsa ndi mankhwala
• mayendedwe azachipatala
• zamalonda
• masomphenya ndi maubwino akumva
• kulimbitsa thupi komanso umembala wa masewera olimbitsa thupi

Ndi mapulani ambiri a Medicare Advantage, mumalipira gawo limodzi la mapulani anu mthumba. Ndi D-SNP, Medicare ndi Medicaid amalipira ndalama zambiri kapena zonse.

Medicare imalipira gawo lina lazachipatala choyamba, kenako Medicaid imalipira ndalama zomwe zingatsalire. Medicaid imadziwika kuti ndi "njira yomaliza" yolipirira ndalama zomwe sizinapikidwe kapena pang'ono ndi Medicare.

Ngakhale malamulo aboma amakhazikitsa ndalama zolipirira Medicaid, boma lirilonse limakhala ndi malire pazoyenera ndi kulipira kwa Medicaid. Konzekerani kufalitsa kumasiyana malinga ndi boma, koma pali mapulani ena omwe akuphatikiza ma Medicare ndi Medicaid.

Kodi SNP Yoyenerera Yapawiri imakhala yotani?

Nthawi zambiri, ndi Special Needs Plan (SNP), mumalipira gawo lofanana ndi lomwe mungalipire pansi pa dongosolo lililonse la Medicare Advantage. Ndalama, zolipiritsa, ndalama zochotseredwa, ndi zochotseredwa zimatha kusiyanasiyana kutengera dongosolo lomwe mungasankhe. Ndi D-SNP, ndalama zanu ndizotsika chifukwa thanzi lanu, kulumala, kapena zachuma zakuthandizani kuti mupeze thandizo lina kuchokera ku maboma aboma ndi maboma.

Mitengo yodziwika ya D-SNPs mu 2020

Kutenga

• Ngati muli ndi zosowa zambiri zathanzi kapena zolemala ndipo ndalama zomwe mumapeza ndizochepa, mutha kulandira thandizo la feduro ndi boma.
• Mapulani Apadera Ofunika (D-SNPs) ndi mtundu wa dongosolo la Medicare Advantage lomwe limakhudza kuchipatala kwanu, chithandizo chamankhwala akunja, ndi malangizo; Mtengo wa mapulaniwo umaphimbidwa ndi ndalama zaboma ndi boma.
• Ngati mukuyenera kulandira Medicare ndi pulogalamu ya Medicaid ya boma lanu, mutha kukhala ndi mwayi wopeza chithandizo chamankhwala chotsika kapena chotsika pansi pa D-SNP.