Mapulani a California Medicare mu 2021

Zamkati

• Medicare ndi chiyani?
• Gawo A (Kupitilira kuchipatala ndi kuchipatala)
• Gawo B (kuchipatala ndi chithandizo chamankhwala)
• Gawo D (Kuphunzira mankhwala osokoneza bongo)
• Medicare Ubwino
• Ndi mapulani ati a Medicare Advantage omwe amapezeka ku California?
• HMO
• PPO
• SNP
• Omwe amapereka ku California
• Ndani ali woyenera ku Medicare ku California?
• Ndingalembetse liti ku Medicare ku California?
• Nthawi yoyamba kulembetsa
• Nthawi yachisankho yapachaka
• Kulembetsa kwa Medicare Zopindulitsa
• Nthawi yolembetsa
• Nthawi zolembetsa zapadera
• Malangizo polembetsa ku Medicare ku California
• Zida za California Medicare
• Ndondomeko Yaupangiri Wathanzi & Zaumoyo (HICAP)
• Mankhwala
• Kuwunikira kothandizidwa ndi olemba ntchito
• Ndiyenera kuchita chiyani kenako?

Medicare ndi chiyani?

Medicare ndi inshuwaransi yazaumoyo kwa anthu azaka 65 kapena kupitirira. Muthanso kukhala ndi mwayi wopeza Medicare ngati simunakwanitse zaka 65 ndipo mukukhala ndi zilema kapena matenda ena.

Mapulani a Medicare ku California ndi awa:

• choyambirira Medicare: pulogalamu ya inshuwaransi yazaumoyo yoyendetsedwa ndi Centers for Medicare & Medicaid Services (CMS)
• Medicare Ubwino: mapulani omwe amaperekedwa kudzera m'makampani a inshuwaransi omwe amachita mgwirizano ndi CMS
• Mapulani azamankhwala: mapulani a inshuwaransi omwe amalipira mtengo wamankhwala

Gawo A (Kupitilira kuchipatala ndi kuchipatala)

Gawo A limafotokoza chisamaliro chomwe mumalandira mukakhala muzipatala, zipatala zovuta kwambiri, komanso nthawi yochepa m'malo ophunzitsira okalamba. Anthu ambiri samalipira ndalama pamwezi pamalingaliro a Gawo A, koma pamakhala chotsitsa ngati mwalandiridwa kuchipatala.

Gawo B (kuchipatala ndi chithandizo chamankhwala)

Gawo B limakwirira chisamaliro kunja kwa chipatala pazinthu monga:

• maulendo a madotolo
• kuyezetsa matenda
• mayeso a labu
• zida zamankhwala zolimba

Mulipira ndalama zowonjezera zowonjezera pazakudya za Gawo B. Ndalamazo zimayikidwa ndi CMS ndipo zimasintha chaka chilichonse kutengera ndi ndalama zonse zothandizira.

Gawo D (Kuphunzira mankhwala osokoneza bongo)

Aliyense pa Medicare ali woyenera (Gawo D), koma muyenera kulipeza kudzera kwa inshuwaransi payekha. Ndikofunika kufananizira mapulaniwa chifukwa mitengo ndi kuphimba kumasiyanasiyana.

Medicare Ubwino

Mapulani a Medicare Advantage (Gawo C) amaperekedwa kudzera kuma inshuwaransi aumwini omwe amalemba zonse zomwe mungapezeko mu gawo A ndi B, ndipo nthawi zina mankhwala opangira mankhwala, amapangira dongosolo limodzi. Ndi mapulani a Medicare Advantage, mumalipirabe mtengo wa Medicare Part B.

Mapulani a Medicare Advantage ayenera kufotokoza zinthu zomwezi monga Medicare magawo A ndi B, koma ena amakhala ndi zowonjezera (komanso zowonjezera zowonjezera) pazinthu monga:

• mano kapena masomphenya
• Zoyenda panyumba zoyenda
• yobereka chakudya
• mayendedwe kupita ndi kubwera kuchipatala

Ndi mapulani ati a Medicare Advantage omwe amapezeka ku California?

Ku California, mapulani a Medicare Advantage amakhala m'magulu atatu: Mabungwe Okonza Zaumoyo (HMOs), Mabungwe Opereka Operekera (PPOs), ndi Mapulani a Zosowa Zapadera (SNPs).

HMO

Ndi HMO, mumasankha dokotala woyang'anira wamkulu yemwe amayang'anira chisamaliro chanu ndikukutumizirani kwa akatswiri pakufunika. Mapulani ambiri amafunikira kuti mupeze chisamaliro kuchokera kwa omwe amapereka ma netiweki a HMO.

Chisamaliro kunja kwa netiweki ya HMO nthawi zambiri sichiphimbidwa pokhapokha ngati chisamaliro chadzidzidzi, chisamaliro chapadera, kapena dialysis yakunja.

Zina mwa mapulani a HMO zimafuna kuti mugule mankhwala osokoneza bongo (Gawo D).

Kupezeka kwa mapulani a HMO ku California kumasiyana malinga ndi dera, ndipo sikupezeka kulikonse.

PPO

Ndi PPO, mutha kupeza chisamaliro kuchokera kumagulu a madotolo ndi malo omwe amapereka ntchito zomwe zikugwirizana ndi pulani yanu.

Muthanso kusamalidwa ndi wothandizira kunja kwa netiweki yanu, koma ndalama zomwe mumagula mthumba nthawi zambiri zimakhala zazikulu.

Ma PPO ambiri samafuna kutumizidwa kuti akawone katswiri.

California ilibe mapulani apadziko lonse a Medicare Advantage PPO, koma zigawo 21 zili ndi mapulani a PPO akomweko.

SNP

SNPs imapezeka kwa anthu omwe amafunikira milingo yayikulu yoyang'anira chisamaliro ndi chisamaliro. Mutha kupeza SNP ngati:

• kukhala ndi matenda osachiritsika, monga matenda ashuga kapena mtima wosalimba
• ali "awiri oyenerera" ku Medicare ndi Medicaid
• mumakhala kumalo osungirako okalamba kapena malo ena ofanana kapena mumakhala kunyumba koma mumalandila chisamaliro chofanana ndi cha munthu wosamalira okalamba

Omwe amapereka ku California

Makampaniwa amapereka mapulani a Medicare Advantage ku California:

• Aetna Medicare
• Dongosolo Laumoyo Waumoyo
• Nyimbo Buluu
• Blue Cross yaku California
• Tsiku Latsopano
• Dongosolo La Central Health Medicare
• Ndondomeko Yaumoyo Wanzeru
• Dziko la Golden
• Health Net Community Solutions, Inc. ndalama zazikulu
• Health Net yaku California
• Humana
• Imperial Health Plan yaku California, Inc.
• Kaiser Permanente
• Sakanizani Mapulani A Zaumoyo
• UnitedHealthcare
• Kusamalira

Sikuti aliyense wonyamula amapereka mapulani kudera lonse, chifukwa chake zisankho zomwe mungapeze zidzasiyana malinga ndi komwe mukukhala.

Ndani ali woyenera ku Medicare ku California?

Anthu aku California akuyenera kulandira mapulani a Medicare ndi Medicare Advantage ngati:

• ndinu nzika ya United States kapena wokhala mwalamulo kwazaka 5 kapena kupitilira apo
• muli ndi zaka 65 kapena kupitirira, ndipo inu kapena mnzanu mumakwaniritsa zofunikira pantchito yothandizidwa ndi Medicare

Anthu ochepera zaka 65 atha kukhala oyenerera ngati:

• muli ndi chilema ndipo mumalandira Inshuwaransi Yolemala ya Social Security Disability (SSDI) kapena Railroad Retirement Board
• muli ndi amyotrophic lateral sclerosis (ALS) kapena matenda am'magazi otsiriza (ESRD)

Ngati mukufunsabe ngati mukuyenereradi, mutha kugwiritsa ntchito chida chothandizira kugwiritsa ntchito intaneti pa Medicare.

Ndingalembetse liti ku Medicare ku California?

Nthawi yoyamba kulembetsa

Nthawi yoyamba kulembetsa (EIP) ndi miyezi 7 yomwe imayamba miyezi itatu musanakwanitse zaka 65 ndipo imatha miyezi itatu mutakwanitsa zaka 65. Mukalembetsa, kufalitsa kwanu kudzayamba koyambirira kwa mwezi womwe mudzakwanitse zaka 65.

Ngati mungachedwetse kulembetsa mpaka mwezi kapena tsiku lanu lobadwa litatha, mutha kukhala ndi mwayi pa inshuwaransi yanu.

Nthawi yachisankho yapachaka

Mutha kulembetsa mapulani a Medicare Advantage pakati Ogasiti 15 ndi Disembala 7 chaka chilichonse. Kuphunzira kumayamba Januware 1.

Kulembetsa kwa Medicare Zopindulitsa

Ngati muli kale pa pulani ya Medicare Advantage ndipo mukufuna kusintha njira ina ya Medicare Advantage kapena kupita ku Medicare yoyambirira, mutha kuchita izi Januware 1 ndi Marichi 31 chaka chilichonse.

Nthawi yolembetsa

Kulembetsa kwathunthu kuli pakati Januware 1 ndi Marichi 31 chaka chilichonse. Ngati muli ndi Medicare Part A ndipo mukufuna kulembetsa Gawo B, dongosolo la Medicare Advantage, kapena gawo la Gawo D mutha kutero panthawiyi. Kuphunzira ndikothandiza Julayi 1.

Nthawi zolembetsa zapadera

Nthawi zolembetsa zapadera zimakulolani kuti mulembetse kunja kwa nthawi yolembetsa mwapadera. Mwachitsanzo, nthawi yapadera yolembetsa imakupatsani mwayi wolembetsa dongosolo latsopano lopanda chilango ngati mungataye inshuwaransi yothandizidwa ndi olemba anzawo ntchito ndipo muyenera kulembetsa Gawo B, kapena mutuluke m'dera lomwe mukugwiritsa ntchito pano.

Malangizo polembetsa ku Medicare ku California

Madongosolo a Medicare ndi Medicare Advantage ku California atha kukhala osokoneza, choncho musanalembe ndikofunikira kuwunika zomwe mwasankha ndikuyerekeza zinthu monga:

• ndalama
• Kuphunzira
• opereka ndi malo muukonde wa pulani
• Mavoti a nyenyezi a CMS pamalingaliro a Gawo C ndi Gawo D

Ngati mukufuna thandizo kuti mudziwe mapulani omwe angakwaniritse zosowa zanu kapena muli ndi mafunso pazomwe mungapeze, pali zinthu zambiri zokuthandizani.

Zida za California Medicare

Ndondomeko Yaupangiri Wathanzi & Zaumoyo (HICAP)

California Department of Aging imapereka uphungu kwa Medicare kudzera mu HICAP. Amapereka:

• zambiri za kulembetsa kwa Medicare
• Mafotokozedwe a Gawo A, B, ndi C, ndi momwe mungadziwire zomwe mukufuna
• mayankho pamafunso okhudzana ndi gawo la D pankakhala mankhwala, mtengo wake, ndikuyenera kwawo

HICAP ndi yachinsinsi komanso yaulere kwa aliyense amene akuyenera kulandira Medicare kapena kuti akhale woyenera. Mutha kusaka ntchito zakomweko za HICAP ndi County kapena kuyimbira 800-434-0222.

Mankhwala

Lumikizanani ndi Medicare mwachindunji kuti muthandizidwe ndi kulembetsa kapena kukonzekera mafunso poyimbira 800-MEDICARE (800-633-4227) kapena pitani ku Medicare.gov. Muthanso kuyitanitsa ofesi ya CMS ku San Francisco ku 415-744-3501.

Kuwunikira kothandizidwa ndi olemba ntchito

Ngati muli ndi nkhawa kapena mukufuna thandizo ku Medicare California yomwe idagulidwa kudzera kwa olemba anzawo ntchito, lemberani ku California department of Managed Health Care pa 888-466-2219 kapena imelo [email protected].

Ndiyenera kuchita chiyani kenako?

Mukakonzeka kusaina ku Medicare ku California:

• Dziwani zomwe mukufuna ndikusanthula mapulani omwe alipo, zosankha, ndi mtengo
• Lumikizanani ndi HICAP kapena Medicare ngati muli ndi mafunso okhudzana ndi kuyenerera kapena kufalitsa
• pezani nthawi yolembetsa yotsatira iyamba

Nkhaniyi idasinthidwa pa Okutobala 5, 2020 kuti iwonetse zambiri za 2021 Medicare.

Zomwe zili patsamba lino zimatha kukuthandizani posankha nokha za inshuwaransi, koma cholinga chake si kupereka upangiri wokhudzana ndi kugula kapena kugwiritsa ntchito inshuwaransi kapena zinthu zilizonse za inshuwaransi. Healthline Media siyigulitsa bizinesi ya inshuwaransi mwanjira iliyonse ndipo siyololedwa kukhala kampani ya inshuwaransi kapena opanga madera aliwonse aku U.S. Healthline Media sivomereza kapena kuvomereza aliyense wachitatu yemwe angachite bizinesi ya inshuwaransi.