2027 医疗保险讲座

2027 医疗保险怎么选Choosing Health Coverage for 2027

白卡 · 奥巴马保险 · 红蓝卡，一次讲清楚Medi-Cal · Covered California · Medicare, explained in one sitting

Presented by Team Rise

各位朋友，大家好！欢迎来到今天的讲座，我们是 Team Rise。先谢谢大家抽时间过来。今天这一个多小时，我们只做一件事：把美国的医疗保险，尤其是 2027 年的新规则，用大白话讲清楚。不推销，也不催大家当场做任何决定，大家放松听，听完回家能跟家人讲明白，就是今天最大的收获。

Hello everyone, and welcome. We're Team Rise, and thank you for taking the time to be here. For the next hour or so we'll do just one thing: explain American health insurance, especially the new rules for 2027, in plain language. No selling and no pressure to decide anything today. If you can go home and explain it clearly to your family, that's the best outcome we could ask for.

为什么要专门讲 2027 年？因为明年三张卡的规则同时在变：白卡开始查工作时数，奥巴马保险的补贴「收入悬崖」回来了，红蓝卡的药费封顶和药价也在调整。很多家庭明年交的保费、能不能继续领补贴，都会跟今年不一样。早一点知道，就能早一点准备。

Why a whole talk on 2027? Because all three programs change at once next year. Medi-Cal starts checking work hours, the income “cliff” returns to Covered California subsidies, and Medicare's drug cap and drug prices are shifting. For many families, next year's premiums and subsidy eligibility will look different from this year's. The sooner you know, the sooner you can prepare.

先说明一下今天数字的来源。奥巴马保险的价格，是我们在 Covered California 官方试算工具上，用洛杉矶县 Alhambra 的邮编亲自查出来的 2027 年初步价格；白卡的收入线来自加州卫生服务部 DHCS；红蓝卡 Part A、Part B 的 2027 年数字目前还是预估，联邦政府通常在 11 月中旬公布正式数字。凡是预估或者示例，幻灯片上都会标出来。

A word on where today's numbers come from. The Covered California prices are 2027 preliminary rates we pulled ourselves from the official Shop and Compare tool, using an Alhambra zip code in LA County. Medi-Cal income limits come from the state Department of Health Care Services. Medicare Part A and Part B figures for 2027 are still projections; the federal government usually publishes the official numbers in mid-November. Anything that's a projection or an example is labeled on the slide.

还有一点很重要：今天讲的是一般性的信息，不是针对任何一个家庭的法律、税务或移民建议。涉及身份的问题，请先问移民律师；涉及报税的问题，请问您的税务师。每个家庭的情况不同，最后怎么选，要看您自己的情况。

One more important point: today is general information, not legal, tax or immigration advice for any particular family. For anything involving immigration status, please talk to an immigration attorney first. For tax questions, ask your tax preparer. Every family is different, and the right choice depends on your own situation.

大家手边如果有纸笔，可以先写下三样东西：家里几口人、每个人的年龄、全家一年大概的收入。今天讲的每一张表，都是拿这三个数字去对照的。好，我们开始。

If you have pen and paper, jot down three things: how many people are in your household, each person's age, and your household's rough yearly income. Every chart today is read with those three numbers. All right, let's begin.

讲师提醒Presenter note

开场一定要说明：本讲座是一般教育信息。按 CMS 教育活动的规定，现场不介绍、不比较具体的红蓝卡 C 计划或 D 计划，也不收投保资料；有人想了解具体计划，另约时间单独谈。

Say this at the start: this is a general educational event. Under CMS rules for educational events, do not present or compare specific Medicare Advantage or Part D plans and do not take enrollment information on site. Anyone who wants plan specifics gets a separate appointment.

互动设计Interaction

请大家举手：家里明年有人满 65 岁的？自己买奥巴马保险的？孩子有白卡的？记下大概比例，讲到对应部分时多停一会儿。

Ask for a show of hands: who has someone turning 65 next year? Who buys their own Covered California plan? Whose children have Medi-Cal? Note the rough split and slow down in the parts that matter most to this room.

今天只回答三个问题Three Questions for Today

01

我家该走哪张卡？Which program fits my family?

年龄、身份、收入三个数字，决定您落在白卡、奥巴马保险还是红蓝卡Age, immigration status and income decide whether you land in Medi-Cal, Covered California or Medicare

02

2027 年变了什么？What changes in 2027?

补贴悬崖回来了、白卡查工作时数、药费封顶 $2,400、身份规定收紧The subsidy cliff returns, Medi-Cal checks work hours, drug costs cap at $2,400, status rules tighten

03

怎么选才不吃亏？How do I choose well?

收入估准、等级选对、日期赶上：同样的保障，少花冤枉钱Estimate income carefully, pick the right tier, meet the deadlines: same coverage, less money wasted

今天内容不少，但其实只回答三个问题。第一个：我家该走哪张卡？美国的医疗保险看起来五花八门，其实大多数家庭只会落在三条路上：收入低的走政府的白卡 Medi-Cal；有合法身份、收入中等、没有公司保险的走奥巴马保险；满 65 岁的走红蓝卡 Medicare。决定您走哪条路的，就是三个数字：年龄、身份、收入。

There's a lot today, but it all answers three questions. First: which program fits my family? US health insurance looks complicated, but most families land on one of three paths. Lower-income families use the state's Medi-Cal. People with legal status, middle incomes and no job-based coverage use Covered California. People 65 and over use Medicare. Three numbers decide your path: age, status and income.

第二个问题：2027 年变了什么？简单说四件事。奥巴马保险的补贴恢复了「收入悬崖」，收入超过一条线，联邦补贴就没了；白卡开始要求部分成年人每月证明工作或上学时数；红蓝卡的药费一年自付封顶 $2,400；身份方面，能领补贴、能加入红蓝卡的人群都收窄了。

Second: what changes in 2027? Four things in short. Covered California subsidies bring back the income “cliff”: above a certain line, the federal subsidy disappears. Medi-Cal starts asking some adults to show work or school hours each month. Medicare caps yearly drug costs at $2,400. And fewer immigration statuses now qualify for subsidies or for Medicare.

第三个问题：怎么选才不吃亏？同样的保障，有人一个月交十几块，有人交几百块，差别往往不在运气，而在三件事：收入有没有估准、等级有没有选对、日期有没有赶上。后面我们会用官方工具查出来的真实价格，一笔一笔算给大家看。

Third: how do I choose well? For the same coverage, one family pays a few dollars a month and another pays hundreds. The difference usually isn't luck. It comes down to three things: estimating income correctly, choosing the right tier, and enrolling on time. We'll work through real prices from the official tool, one number at a time.

大家听的时候可以对号入座：家里有老人，重点听第三部分红蓝卡；自己做生意或者提前退休，重点听第二部分；家里有孩子、收入不高，第一部分白卡一定要听。每一部分讲完，我们都会留时间给大家提问。

As you listen, find yourself in the picture. If you have parents at or near 65, focus on Part 3, Medicare. If you're self-employed or retired early, focus on Part 2. If you have children and a modest income, don't miss Part 1 on Medi-Cal. We'll leave time for questions after each part.

节奏提示Pacing

这一页一分钟带过。把三个问题写在白板上，每讲完一部分回头打一个勾，听众会觉得有进度。

Spend about a minute here. Write the three questions on a whiteboard and tick one off after each part so the audience feels the progress.

为什么说 2027 是规则大变的一年Why 2027 Is a Year of Big Changes

奥巴马保险：收入超过 400% 贫困线，补贴归零Covered California: no subsidy above 400% of poverty全州保费平均涨 9.9%（初步）Premiums up 9.9% on average statewide (preliminary)
白卡：工作要求和半年审查登场Medi-Cal: work rules and six-month renewals19–64 岁扩展成人，2027 年 1 月起Expansion adults 19–64, starting January 2027
红蓝卡：药费全年自付封顶 $2,400Medicare: drug costs capped at $2,400 a year15 种谈判药 1 月 1 日起用新价格15 negotiated drugs get new prices on January 1
身份：补贴和红蓝卡资格都收紧Status: subsidy and Medicare eligibility narrow主要只剩公民、绿卡等少数身份符合Mainly citizens, green-card holders and a few others

一只手翻开日历的新一页 / A hand turning a calendar page

Covered California 2027 初步费率（2026/7/21）；DHCS；CMS 2027 Part D 正式参数；H.R.1Covered California 2027 preliminary rates (7/21/2026); DHCS; CMS final 2027 Part D parameters; H.R.1

为什么说 2027 年是规则大变的一年？因为三张卡同时在变，而且每一条都跟大家的钱包有关。我一条一条讲。

Why call 2027 a year of big changes? Because all three programs are changing at once, and every change touches your wallet. Let's take them one at a time.

第一，奥巴马保险。过去几年，联邦有一笔「加强版补贴」，收入再高，基准保费最多也只占收入的 8.5%。这笔加强补贴 2025 年底已经到期，国会到现在也没有延长。所以 2027 年，收入超过联邦贫困线 400% 的家庭，联邦补贴直接归零：一个人是 $63,840，四口之家是 $132,000。同时，Covered California 全州保费平均上涨 9.9%，这是初步数字。

First, Covered California. For several years an “enhanced” federal subsidy meant that, however high your income, the benchmark premium was capped at 8.5% of income. That enhancement expired at the end of 2025 and Congress has not renewed it. So in 2027, households above 400% of the federal poverty level get no federal subsidy at all: $63,840 for one person, $132,000 for a family of four. On top of that, Covered California premiums rise 9.9% on average statewide, a preliminary figure.

第二，白卡。联邦新法要求 19 到 64 岁、通过扩展资格拿白卡的成年人，从 2027 年 1 月起，每个月要能证明 80 小时的工作、社区服务或上学等；加州现有会员从 2027 年 3 月的续保开始，改成每半年审查一次。

Second, Medi-Cal. A new federal law requires expansion adults aged 19 to 64 to show, starting January 2027, 80 hours a month of work, community service, school or similar activity. And in California, current members move to a renewal every six months, starting with March 2027 renewals.

第三，红蓝卡。D 计划药费 2027 年全年自付封顶 $2,400，这个数字已经定案；另外有 15 种经过联邦谈判的药，从 2027 年 1 月 1 日起用新的谈判价，像 Ozempic，还有几种常见的糖尿病和哮喘药都在名单里。

Third, Medicare. Part D out-of-pocket drug costs cap at $2,400 for 2027, and that number is final. Fifteen drugs with federally negotiated prices also switch to the new prices on January 1, 2027, including Ozempic and several common diabetes and asthma medicines.

第四，身份。从 2027 年 1 月 1 日起，奥巴马保险的联邦补贴只给绿卡持有人、古巴/海地入境者和 COFA 身份的人；难民、庇护、TPS，以及工作和学生签证，都不再有补贴。红蓝卡也收紧了：难民、庇护、TPS、人道假释等身份已经不能新加入，已经在用的人预计 2027 年初失去资格，具体日期要等联邦最终规则。已经转成绿卡的不受影响。家里有这类情况的，请尽快咨询移民律师。

Fourth, immigration status. From January 1, 2027, Covered California's federal subsidy goes only to green-card holders, Cuban/Haitian entrants and COFA migrants. Refugees, asylees, TPS holders, and people on work or student visas lose it. Medicare is tightening too: refugees, asylees, TPS holders and parolees can no longer newly enroll, and those already enrolled are expected to lose eligibility in early 2027, with the exact date awaiting a final federal rule. Anyone who has already become a green-card holder is not affected. If this applies to your family, please see an immigration attorney soon.

每一条后面都会细讲。大家先记住一句话：2027 年，去年的经验不一定还管用，一定要重新看一遍。

We'll cover each of these in detail. For now, remember one thing: in 2027, last year's experience may no longer apply, so take a fresh look.

合规提醒Compliance

身份相关内容只讲规则，不判断个案。有人问「我这个身份会不会受影响」，统一请他咨询移民律师。

On immigration status, explain the rules but never judge an individual case. If someone asks whether their status is affected, refer them to an immigration attorney.

先找到您家属于哪一张卡Find Your Family's Path

您家的情况Your situation	多半走哪条路Likely path	今天在哪讲Covered in
65 岁以下，家庭收入 ≤ 贫困线 138%Under 65, income ≤ 138% of poverty单人约 $22,025；四口之家约 $45,540About $22,025 for 1; $45,540 for 4	白卡 Medi-CalMedi-Cal	第一部分Part 1
孩子 0–18 岁，家庭收入 ≤ 266%Children 0–18, income ≤ 266%四口之家约 $87,780About $87,780 for a family of 4	孩子走白卡Children on Medi-Cal	第一部分Part 1
有合法身份、收入高于白卡线、没有公司保险Legal status, above Medi-Cal limits, no job coverage收入越接近 400% 越要算清楚The closer to 400%, the more carefully you should run the numbers	奥巴马保险 Covered CaliforniaCovered California	第二部分Part 2
公司有保险，员工只保自己的月费 ≤ 收入 10.22%Job coverage costing ≤ 10.22% of income for employee-only2027 年「负担得起」的标准The 2027 “affordability” test	一般留在公司团体保险Usually stay on the employer plan	问答环节Q&A
满 65 岁，或领残障金满 24 个月65 and over, or on disability benefits 24 months本人或配偶工作交税满 10 年，A 免保费Part A is premium-free with 10 years of work by you or a spouse	红蓝卡 MedicareMedicare	第三部分Part 3

收入线按 2026 年联邦贫困线（用于 2027 年参保）；白卡 2027 年初会换用新一年的数字。Income limits use the 2026 federal poverty guidelines (used for 2027 coverage); Medi-Cal switches to the new year's figures in early 2027.

Covered California 2027 收入资格表；DHCS ACWDL 26-01；IRS Rev. Proc. 2026-26Covered California 2027 FPL chart; DHCS ACWDL 26-01; IRS Rev. Proc. 2026-26

这一页是今天最实用的一页，是一张「分流图」。请大家把刚才写下的三个数字拿出来：年龄、身份、收入，我们一行一行对。

This is the most practical slide today: a sorting map. Take out the three numbers you wrote down, age, status and income, and let's go row by row.

第一行，65 岁以下、家庭收入不超过联邦贫困线 138% 的成年人，多半可以拿白卡。138% 是多少钱？一个人一年大约 $22,025，四口之家大约 $45,540。这里看的是全家的报税收入。

Row one: adults under 65 with household income at or below 138% of the federal poverty level can usually get Medi-Cal. In dollars, that's about $22,025 a year for one person and about $45,540 for a family of four. It's based on the whole household's taxable income.

第二行特别重要：孩子的门槛比大人高很多，是 266%。四口之家年收入不超过 $87,780，孩子就可以拿白卡。所以很多家庭是「大人买奥巴马保险、孩子用白卡」，一张申请表就能同时办好。

Row two matters a lot: the limit for children is much higher, 266%. If a family of four earns no more than $87,780, the children can have Medi-Cal. That's why many families have the parents on Covered California and the kids on Medi-Cal, all through one application.

第三行，有合法身份、收入超过白卡线、公司又不提供保险的，比如自己做生意、提前退休、做兼职的朋友，就走奥巴马保险，在 Covered California 购买，按收入领补贴。

Row three: people with legal status, income above the Medi-Cal line, and no coverage through work, such as the self-employed, early retirees and part-timers, use Covered California and get subsidies based on income.

第四行，公司有提供保险的，要看公司保险「负担不负担得起」。2027 年的标准是：员工只保自己的那一份月费，不超过家庭收入的 10.22%。达到这个标准，就不能再领奥巴马保险的补贴，一般留在公司保险最划算。最后一行，满 65 岁，或者领社安残障金满 24 个月的，走红蓝卡。

Row four: if your employer offers coverage, the question is whether it's “affordable.” For 2027, that means the employee-only premium is no more than 10.22% of household income. If it meets that test, you can't get a Covered California subsidy, and staying on the employer plan is usually the better deal. The last row: people 65 and over, or on Social Security disability for 24 months, use Medicare.

对完以后，大家应该已经知道今天哪一段跟自己最有关。如果您家几种情况都有，比如爸妈 65 岁、自己 40 岁、孩子 10 岁，那三张卡都要懂，今天正好全听。

By now you should know which part of today matters most to you. If your family has a mix, say parents at 65, you at 40 and a child at 10, you need all three, so you're in the right place today.

互动设计Interaction

请两三位愿意分享的朋友说出「几口人、大概收入」（不用说名字），现场带大家一起对表，找到他落在哪一行。

Invite two or three volunteers to share household size and rough income (no names) and match them to a row together with the room.

第一部分Part 1

白卡 Medi-CalMedi-Cal

政府出钱的医疗保险：符合条件的家庭几乎零自付State-funded health coverage with little or no cost for those who qualify

好，我们进入第一部分：白卡，英文叫 Medi-Cal，是加州版本的联邦 Medicaid。白卡是政府出钱的医疗保险，符合条件的家庭一般不用交保费，看病、住院、拿药，自付也很少，甚至没有。

Let's start Part 1: Medi-Cal, California's version of the federal Medicaid program. It's health coverage paid for by the government. Families who qualify usually pay no premium, and doctor visits, hospital stays and prescriptions cost little or nothing.

很多朋友分不清白卡和奥巴马保险，以为是同一个东西。其实很好记：白卡是政府全包；奥巴马保险是自己出钱买、政府按收入补贴一部分。两者都可以从同一个网站、同一张申请表去申请，系统会自动判断您家每个人走哪一个。

Many people mix up Medi-Cal and Covered California. Here's an easy way to remember it: Medi-Cal is fully paid by the government; Covered California is insurance you buy, with the government paying part of the premium based on income. You can apply for both on the same website with one application, and the system decides which one fits each family member.

这一部分我们讲五件事：谁能拿、包哪些服务、2027 年怎么变严、大家最常见的三个误会，还有怎么申请。

In this part we'll cover five things: who qualifies, what's covered, how the rules get stricter in 2027, three common myths, and how to apply.

白卡主要照顾这几类人：收入不高的 19 到 64 岁成年人、孩子、孕妇，还有收入低的老人和残障人士。很多老人在有红蓝卡的同时，也可以叠加白卡，由白卡帮忙付红蓝卡的保费和自付部分，这个我们在第三部分会再讲。

Medi-Cal mainly serves lower-income adults 19 to 64, children, pregnant people, and lower-income seniors and people with disabilities. Many seniors can have Medi-Cal on top of Medicare, with Medi-Cal helping pay Medicare premiums and cost sharing; we'll come back to that in Part 3.

先说一句：白卡是符合条件的人依法享有的权益，符合就可以申请，不用觉得不好意思。但如果家里有人正在办身份，请一定听完后面「误会一」那一页。

One thing up front: Medi-Cal is a benefit you're legally entitled to if you qualify, so there's no reason to feel awkward about applying. But if anyone in your family is in the middle of an immigration case, please listen closely to “Myth 1” a few slides from now.

谁能拿白卡：先看收入Who Qualifies: Income First

家庭人数Household size	成人 19–64 岁Adults 19–64≤ 138%≤ 138%	孕妇Pregnant≤ 213%≤ 213%	儿童 0–18 岁Children 0–18≤ 266%≤ 266%
1 人1	$22,025	$33,995	$42,454
2 人2	$29,864	$46,094	$57,563
3 人3	$37,702	$58,192	$72,672
4 人4	$45,540	$70,290	$87,780

65 岁以上和残障人士：收入 ≤ 138%，2026 年起另看资产65+ and people with disabilities: income ≤ 138%, plus an asset test since 2026

全家全年收入；孕妇收入在 213%–322% 之间可申请 MCAP（免费，另一个项目）。Yearly household income. Pregnant people between 213% and 322% can apply for MCAP (free, a separate program).

2026 年联邦贫困线；DHCS ACWDL 26-01（Health Consumer Alliance 2026 收入表）2026 federal poverty guidelines; DHCS ACWDL 26-01 (Health Consumer Alliance 2026 chart)

这张表就是白卡的收入线。看法很简单：最左边找您家几口人，再往右找您属于哪一类人，那个数字就是全家一年收入的上限。

This table shows the Medi-Cal income limits. Find your household size on the left, then move right to the column that describes you. That number is the yearly household income limit.

成年人 19 到 64 岁，是贫困线的 138%：一个人一年 $22,025，两个人 $29,864，三口之家 $37,702，四口之家 $45,540。换成每个月，一个人大约 $1,836。

For adults 19 to 64, the limit is 138% of poverty: $22,025 a year for one person, $29,864 for two, $37,702 for three and $45,540 for four. Monthly, that's about $1,836 for one person.

孕妇的线高一些，是 213%，四口之家 $70,290。收入再高一些、在 213% 到 322% 之间的孕妇，还有一个叫 MCAP 的项目，由州政府开办，现在不收保费，生产后还能继续保 12 个月，而且不看移民身份。

For pregnant people the limit is higher, 213%, or $70,290 for a family of four. Between 213% and 322% there's another state program called MCAP. It currently has no premium, continues for 12 months after the birth, and doesn't depend on immigration status.

孩子的线最高，266%，四口之家一年 $87,780。举个例子：一家四口年收入 $80,000，大人超过了 $45,540，不能拿白卡；但孩子在 $87,780 以下，可以拿白卡，大人去买奥巴马保险。而且加州的孩子不论移民身份，只要收入符合，都可以拿全幅白卡。

Children have the highest limit, 266%, which is $87,780 for a family of four. For example, a family of four earning $80,000: the parents are above $45,540 and don't qualify, but the children are under $87,780 and do. The parents buy through Covered California. In California, children who meet the income rules get full-scope Medi-Cal regardless of immigration status.

65 岁以上和残障人士，收入线也是 138%，一个人每月大约 $1,836；但从 2026 年起，这一类还要看资产，我们在「误会三」会讲。最后提醒：这张表用的是 2026 年的贫困线，白卡 2027 年初会换成新一年的数字，到时以新表为准。

For people 65 and over or with disabilities, the income limit is also 138%, about $1,836 a month for one person, but since 2026 there's an asset test too, which we'll cover in “Myth 3.” Finally, this table uses the 2026 poverty guidelines. Medi-Cal switches to the new year's figures in early 2027, so check the updated chart then.

白卡包哪些服务What Medi-Cal Covers

看病Doctor visits

门诊、体检，家庭医生看诊、转诊专科Office visits, checkups, primary care and specialist referrals

住院和急诊Hospital & ER

急诊、住院、手术、怀孕生产Emergency care, hospital stays, surgery, childbirth

吃药Prescriptions

处方药统一由 Medi-Cal Rx 支付Prescriptions are paid through Medi-Cal Rx

牙科Dental

Medi-Cal Dental：洗牙、补牙、拔牙等Medi-Cal Dental: cleanings, fillings, extractions and more

眼科Vision

验光、配眼镜，一般每 24 个月一次Eye exams and glasses, usually every 24 months

心理与儿保Mental health & kids

心理健康、戒瘾治疗、疫苗、儿童体检Mental health, addiction treatment, vaccines, child checkups

全幅白卡：一般没有保费，自付为零或极低Full-scope Medi-Cal: usually no premium and $0 or very low copays

DHCSDHCS

白卡包的东西很全，我分六类讲。第一类看病：平时看家庭医生、做体检，需要看专科就由家庭医生转诊。第二类住院和急诊：急诊、住院、手术，包括怀孕生产，都在里面。

Medi-Cal covers a lot, so let's take it in six groups. One, doctor visits: seeing your primary doctor, checkups, and referrals to specialists. Two, hospital and emergency care: ER visits, hospital stays, surgery and childbirth.

第三类吃药：处方药由州政府统一的 Medi-Cal Rx 支付，拿着白卡去药房就可以。有一点要知道：从 2026 年起，21 岁以上的成年人，用来减肥的 GLP-1 类药物白卡不再给付；如果是治疗糖尿病等疾病，仍然可以。

Three, prescriptions: the state pays for them through Medi-Cal Rx, so you just bring your card to the pharmacy. One thing to know: since 2026, Medi-Cal no longer covers GLP-1 drugs for weight loss for adults 21 and over. They're still covered when used for diabetes and certain other conditions.

第四类牙科，叫 Medi-Cal Dental，以前叫 Denti-Cal，洗牙、补牙、拔牙都可以看。第五类眼科：验光、配眼镜，一般每 24 个月一次。第六类是心理健康和戒瘾治疗，还有孩子的疫苗和定期体检。

Four, dental: Medi-Cal Dental, formerly Denti-Cal, covers cleanings, fillings and extractions. Five, vision: eye exams and glasses, generally every 24 months. Six, mental health and addiction treatment, plus vaccines and regular checkups for children.

费用方面，全幅白卡一般不用交保费，看病自付是零或很少，诊所也不能因为您付不起共付额就拒绝看诊。但有两个未来的变化要知道：一是 2028 年 10 月起，收入在贫困线 100% 以上的扩展成人，部分服务可能要付共付额，每次最多 $35，全年不超过家庭收入的 5%；二是没有合法身份的成年人，从 2027 年 7 月 1 日起成人牙科会取消，只保留急诊牙科。

As for cost, full-scope Medi-Cal usually has no premium and $0 or very low copays, and a provider can't turn you away because you can't pay a copay. Two future changes to know about: from October 2028, expansion adults above 100% of poverty may owe small copays on some services, at most $35 each and no more than 5% of household income a year. And for adults without satisfactory immigration status, adult dental ends on July 1, 2027, except emergency dental.

所以，家里有人用白卡、又有牙齿要处理，或者眼镜到期了，可以趁现在安排好，不要拖。

So if someone in your family has Medi-Cal and needs dental work, or is due for new glasses, it makes sense to schedule it now rather than wait.

2027 年白卡：审查越来越严Medi-Cal in 2027: Stricter Checks

工作要求：19–64 岁扩展成人，每月 80 小时Work rule: expansion adults 19–64, 80 hours a month工作、社区服务、工作项目，或至少半工读；月收入 ≥ $580 也算Work, community service, a work program, or at least half-time school; earning ≥ $580/month also counts
续保审查：从一年一次改为半年一次Renewals: from once a year to every six months加州现有会员从 2027 年 3 月的续保开始For current California members, starting with March 2027 renewals
追溯期缩短：只能往回补 1–2 个月的医疗账Retroactive coverage: only 1–2 months back扩展成人 1 个月，其他人 2 个月（原来 3 个月）1 month for expansion adults, 2 for others (was 3)
无身份成年人：2026 年起暂停新的全幅申请Undocumented adults: new full-scope enrollment paused since 2026已在册者按时续保可保留；儿童、孕妇不受影响Current members keep it if they renew on time; children and pregnant people unaffected
豁免：孕妇、13 岁以下孩子的家长、残障或重病者等Exempt: pregnant people, parents of kids 13 and under, people with disabilities or serious illness, and others符合豁免要主动申报，并按时回复通知You must report the exemption and answer notices on time

工作要求与追溯期新规 2027 年 1 月 1 日起适用；细节以 DHCS 寄给您的通知为准。The work rule and new retroactive limits apply from January 1, 2027; follow the notices DHCS mails to you.

H.R.1；DHCS ACWDL 25-30、25-31、26-14；AB 116；2026–27 加州预算H.R.1; DHCS ACWDL 25-30, 25-31, 26-14; AB 116; 2026–27 California budget

这一页是白卡 2027 年最大的变化，跟很多家庭有关，请大家仔细听。

This slide covers Medi-Cal's biggest changes for 2027, and they affect a lot of families, so please listen closely.

第一，工作要求。从 2027 年 1 月 1 日起，19 到 64 岁、通过「扩展资格」拿白卡的成年人，每个月要能证明其中一种：工作 80 小时，或做社区服务 80 小时，或参加工作项目 80 小时，或至少半工读在学校上课；每月收入达到 $580 也算符合。新申请的人看申请前一个月；已经有白卡的人，从 2027 年 3 月以后的续保开始审查。州政府会先自己查工资等记录，查不到才请您在 30 天内补交证明。

First, the work requirement. From January 1, 2027, adults 19 to 64 who get Medi-Cal through the expansion group must show one of these each month: 80 hours of work, 80 hours of community service, 80 hours in a work program, or at least half-time school. Earning $580 or more a month also counts. New applicants are checked for the month before they apply; current members are checked at renewals from March 2027 on. The state first checks wage and other records itself; only if it can't confirm will you get 30 days to send proof.

第二，续保从一年一次变成半年一次。比如您 7 月续保通过，保到 12 月，半年后又要再续一次。最容易出事的就是没看信、没回复，结果白卡被停掉。

Second, renewals move from once a year to every six months. If you renew in July, you're covered through December, and then you renew again. The most common way people lose coverage is simply not opening or answering the mail.

第三，追溯期缩短。以前申请白卡，可以往回补三个月的医疗账；2027 年起，扩展成人只能补 1 个月，其他人 2 个月。所以别等生病了才想到申请，符合条件就早点办。

Third, shorter retroactive coverage. Medi-Cal used to pay medical bills from up to three months before you applied. From 2027, it's one month for expansion adults and two months for everyone else. So don't wait until you're sick; if you qualify, apply early.

第四，没有合法身份的 19 岁以上成年人，从 2026 年 1 月起不能新申请全幅白卡，只能拿急诊和孕期等有限白卡；已经在册的，按时续保就能保留，断保 3 个月内还能回来。2027 年 7 月起，其中 19 到 59 岁的每月要交 $30 保费，以后可能调到最多 $50。儿童和孕妇不受这些影响。

Fourth, adults 19 and over without satisfactory immigration status have not been able to newly enroll in full-scope Medi-Cal since January 2026; new applicants get restricted coverage for emergencies and pregnancy. Current members keep full scope if they renew on time and can return within three months if coverage lapses. From July 2027, those aged 19 to 59 will pay a $30 monthly premium, which may later be set as high as $50. Children and pregnant people are not affected.

最后是豁免：孕妇和产后一年内、带 13 岁以下孩子或照顾残障家人的家长、残障或医疗上很脆弱的人、已经有红蓝卡的人、原住民、完全残障的退伍军人等，都可以豁免工作要求。但豁免不会自动给，要主动申报。白卡寄来的信，一定要打开看、按时回。

Finally, exemptions. People who are pregnant or within a year after birth, parents or caretakers of a child 13 or younger or of a disabled person, people who are disabled or medically frail, people with Medicare, American Indians and Alaska Natives, and veterans with a total disability rating, among others, are exempt from the work rule. But exemptions aren't automatic; you have to report them. Always open and answer Medi-Cal mail on time.

互动设计Interaction

问一问：最近有没有人收到白卡或县政府寄来的信？提醒大家：信封上有 Medi-Cal 或县政府字样的，别当广告丢掉，看不懂可以拍照请家人或专业人士帮忙。

Ask: has anyone recently received mail from Medi-Cal or the county? Remind people not to toss envelopes marked Medi-Cal or county as junk mail, and to ask family or a professional for help if a letter is unclear.

讲师提醒Presenter note

工作要求的联邦细则和诉讼仍在变动，讲座前再看一次 DHCS 的最新说明；不要替听众判断「您一定豁免」。

Federal details and litigation on the work rule are still moving. Check DHCS's latest guidance before the seminar, and never tell an attendee they are definitely exempt.

关于白卡的三个误会Three Myths About Medi-Cal

误会一：白卡跟绿卡无关Myth 1: Medi-Cal never affects a green card

2026/9/18 起新领的白卡可能被考虑，孩子、孕妇也不例外。先问移民律师。Medi-Cal received from 9/18/2026 can be considered, children and pregnancy included. Ask an immigration attorney first.

误会二：看完病要还钱Myth 2: You must pay it all back

一般不用。只有 55 岁后长期护理等费用可能从遗产追回，配偶在世不追。Generally not. Only long-term care after 55 may be recovered from an estate, and never while a spouse is alive.

误会三：存款多就申不到Myth 3: Savings disqualify you

19–64 岁、儿童、孕妇只看收入；65+、残障者 2026 起看资产，单人 $130,000Ages 19–64, kids and pregnancy: income only. 65+ and disabled: asset limit since 2026, $130,000 for one

我们不提供法律或移民建议；涉及身份，请先咨询移民律师。We don't give legal or immigration advice; please consult an immigration attorney on status questions.

联邦公共负担最终规则 91 FR 45324（2026/9/18 生效）；DHCS 遗产追偿；AB 116、ACWDL 25-14Public charge final rule, 91 FR 45324 (effective 9/18/2026); DHCS estate recovery; AB 116, ACWDL 25-14

关于白卡，有三个流传很广的说法，我们一个一个来澄清。

There are three widespread beliefs about Medi-Cal. Let's clear them up one by one.

误会一：「白卡跟绿卡没关系，孩子和孕妇的白卡更是一定安全。」这个说法在 2026 年 9 月 18 日以后已经不对了。联邦新的「公共负担」最终规则在这一天生效：这之后领取的白卡，移民官在审绿卡时可以纳入考虑，而且这次规则没有把孩子和孕妇排除在外。9 月 18 日以前领的非现金福利一般不算，但现金补助和长期住院式护理例外；难民、庇护等身份本来就不适用公共负担。这条规则目前有 20 多个州在打官司，结果还没定。所以只有一句建议：正在办或打算办身份的家庭，做决定之前先问移民律师。

Myth 1: “Medi-Cal has nothing to do with a green card, and children's or pregnancy Medi-Cal is always safe.” Since September 18, 2026, that's no longer true. A new federal public charge rule took effect that day. Medi-Cal received after that date can be considered when an officer reviews a green-card application, and this rule does not carve out children or pregnant women. Non-cash benefits received before September 18 generally don't count, except cash aid and long-term institutional care, and refugees, asylees and some other groups aren't subject to public charge at all. More than 20 states are challenging the rule in court, and the outcome isn't settled. So the advice is simple: if your family has or plans an immigration case, talk to an immigration attorney before deciding anything.

误会二：「白卡看完病，以后要还钱。」一般不用。加州只有一种情况会追讨：55 岁以后用白卡支付的长期护理，比如护理院、居家和社区护理，以及相关的住院和药费，在过世后可能从需要法院认证的遗产里追回；配偶还在世就不追，有困难还可以申请豁免。平时看病、住院、生孩子，都不用还。

Myth 2: “Whatever Medi-Cal pays, you have to pay back.” Generally not. California recovers costs in only one situation: long-term care paid by Medi-Cal after age 55, such as nursing homes and home- and community-based care, plus related hospital and drug costs, which may be recovered after death from an estate that goes through probate. There's no recovery while a spouse is alive, and hardship waivers exist. Ordinary doctor visits, hospital stays and childbirth are never paid back.

误会三：「存款多就申不到白卡。」要分人看。19 到 64 岁的成年人、孩子、孕妇，只看收入，不看存款。但 65 岁以上和残障人士，从 2026 年 1 月 1 日起恢复了资产审查：一个人资产上限 $130,000，夫妻 $195,000，每多一人加 $65,000；自住房一般不算，一辆车和部分退休账户也可以不算。还要注意，加州预算定了 2027 年 7 月 1 日起，上限可能降到一个人 $21,000、夫妻 $31,000。

Myth 3: “If you have savings, you can't get Medi-Cal.” It depends on who you are. Adults 19 to 64, children and pregnant people are judged on income only, not savings. But for people 65 and over or with disabilities, an asset test returned on January 1, 2026: $130,000 for one person, $195,000 for a couple, plus $65,000 for each additional person. Your home is generally exempt, as are one car and some retirement accounts. Also note that the state budget sets a possible cut, starting July 1, 2027, to $21,000 for one person and $31,000 for a couple.

家里有老人在用白卡、又有一些存款的，现在就要开始留意这条线；具体怎么规划，请找律师等专业人士商量。

If an older family member has Medi-Cal and some savings, start watching this limit now, and talk to an attorney or other professional about planning.

合规提醒Compliance

公共负担只讲规则，不预测个案：不说「一定没事」，也不说「一定有影响」，更不能劝人退掉白卡。讲座前再查一次诉讼进展（New York v. DHS）。

On public charge, explain the rule but never predict an individual outcome. Don't say “you'll be fine” or “this will hurt you,” and never advise anyone to drop Medi-Cal. Check the litigation (New York v. DHS) again before the seminar.

三种方式申请白卡Three Ways to Apply

01

在线申请Online

CoveredCA.com 一张表同时判断白卡和奥巴马保险；也可上 BenefitsCal.comCoveredCA.com checks Medi-Cal and Covered California in one form; BenefitsCal.com also works

02

打电话By phone

国语 (800) 300-1533 · 粤语 (800) 339-8938Mandarin (800) 300-1533 · Cantonese (800) 339-8938

03

找人帮忙In person

持证经纪人或认证协助员免费帮忙；也可去本县社会服务办公室Licensed agents or certified enrollers help for free; or visit your county social services office

妈妈带着幼儿看儿科医生 / A mother and toddler with a pediatrician

准备：身份证件、社安号（如有）、住址和收入证明、移民文件；65+ 和残障者另备资产证明。白卡全年都可申请。Bring ID, SSN (if any), proof of address and income, immigration papers; 65+ and disabled applicants also need asset records. Medi-Cal is open all year.

Covered California 客服（周一至周五 8am–6pm）；DHCS 申请页面Covered California service center (Mon–Fri 8am–6pm); DHCS application page

申请白卡有三种方式，选您最方便的就好。

There are three ways to apply for Medi-Cal. Pick whichever is easiest for you.

第一，在网上申请。最推荐的是 CoveredCA.com：只要填一次申请表，系统会同时判断您家每个人是走白卡还是奥巴马保险，像「大人买奥巴马、孩子拿白卡」这样的家庭，一次就办好。另一个官方网站是 BenefitsCal.com，这是县政府的平台，还可以一起申请 CalFresh 食物券等福利。

First, online. We recommend CoveredCA.com: one application checks every family member for both Medi-Cal and Covered California, so a family with parents on Covered California and kids on Medi-Cal gets it all done at once. The other official site is BenefitsCal.com, the county portal, where you can also apply for CalFresh food benefits and other programs.

第二，打电话。Covered California 有中文专线：国语 (800) 300-1533，粤语 (800) 339-8938，周一到周五早上 8 点到下午 6 点。客服可以一步一步带您填表。

Second, by phone. Covered California has Chinese-language lines: Mandarin at (800) 300-1533 and Cantonese at (800) 339-8938, Monday through Friday, 8 a.m. to 6 p.m. A representative can walk you through the application step by step.

第三，找人帮忙。持证经纪人或者认证的协助员可以免费帮您申请，您也可以直接去本县的社会服务办公室现场办理。白卡跟奥巴马保险不一样，一年到头随时都可以申请，不用等开放期。

Third, get help in person. Licensed agents and certified enrollment counselors can help you apply at no cost, or you can go to your county social services office. Unlike Covered California, Medi-Cal is open all year, so there's no need to wait for open enrollment.

申请前请准备好：带照片的身份证件、社安号（有的话）、加州住址证明、收入证明，比如工资单、报税表或社安信，身份或移民文件，还有现在手上的保险卡。65 岁以上或残障的申请人，从 2026 年起还要准备银行、股票、房产等资产证明；2027 年起，19 到 64 岁的扩展成人还要准备工作、上学或豁免的证明。

Before you apply, gather: photo ID, a Social Security number if you have one, proof of California address, proof of income such as pay stubs, a tax return or a Social Security letter, citizenship or immigration documents, and any current insurance card. Since 2026, applicants who are 65+ or disabled also need asset records such as bank, brokerage and property statements. From 2027, expansion adults 19 to 64 should also have proof of work, school or an exemption.

第二部分Part 2

奥巴马保险 Covered CaliforniaCovered California

自己买保险、按收入领补贴：2027 年补贴规则大改Buy your own plan, get help based on income: the subsidy rules change in 2027

好，我们进入第二部分：奥巴马保险，在加州就是 Covered California。

Now Part 2: the Affordable Care Act marketplace, which in California is Covered California.

先讲清楚它和白卡的关系：两者用的是同一张申请表。收入在白卡线以下，系统会把您转到白卡；收入高于白卡线，才进入奥巴马保险。因为孩子的白卡线比大人高很多，所以最常见的情况，是一家人分在两边：大人买奥巴马保险，孩子用白卡。

First, how it relates to Medi-Cal: both use the same application. If your income is under the Medi-Cal line, the system routes you to Medi-Cal; above it, you go to Covered California. Because the children's limit is much higher than the adults', the most common result is a split family: parents on Covered California, kids on Medi-Cal.

这一部分最适合三种朋友：自己做生意的、还没到 65 岁就退休的，以及公司不提供保险的家庭。也是 2027 年变化最大、最容易算错钱的一部分。

This part matters most for three groups: the self-employed, people who retire before 65, and families with no coverage through work. It's also where 2027 brings the biggest changes, and where it's easiest to get the math wrong.

我们会讲七件事：奥巴马保险是什么、哪些人最该看、补贴怎么算、2027 年回来的 400% 悬崖、铜银金白金四个等级怎么挑、只有银级才有的自付减免，以及 2027 年保障有哪些进退。后面还会用官方试算的真实价格做例子。

We'll cover seven things: what Covered California is, who should look closely, how the subsidy works, the 400% cliff returning in 2027, how to choose among Bronze, Silver, Gold and Platinum, the extra savings available only on Silver, and what got better or worse in 2027 benefits. We'll use real prices from the official tool as examples.

顺便提醒：2027 年的续保和比价，从 2026 年 10 月 1 日就已经开始了。已经有奥巴马保险的朋友，今天听完回家就可以上网看看明年的价格。

A quick reminder: renewals and plan comparison for 2027 opened on October 1, 2026. If you already have a Covered California plan, you can go online tonight and look at next year's prices.

奥巴马保险是什么What Is Covered California?

正式名称《平价医疗法》ACA，加州平台叫 Covered CaliforniaIt's the Affordable Care Act; California's marketplace is Covered California
给没有公司保险、自己买保险的个人和家庭For individuals and families buying their own coverage
同一等级福利全州统一，各家只比价格和医生网络Same benefits within a tier statewide; carriers differ on price and doctors
收入合格可领保费补贴；有既往病也不能拒保、加价Income-based premium help; no denial or surcharge for pre-existing conditions

一对夫妻用笔记本电脑比较保险计划 / A couple comparing plans on a laptop

奥巴马保险的正式名称是《平价医疗法》，英文 Affordable Care Act，简称 ACA。在加州，大家是在州政府的官方平台 Covered California 上购买，所以这两个名字说的是同一件事。

The formal name is the Affordable Care Act, or ACA. In California you buy it through the state's official marketplace, Covered California, so the two names refer to the same thing.

它是给谁的？给没有公司保险、需要自己买保险的个人和家庭。要领政府的保费补贴，就必须在这个平台上买；在平台外面直接跟保险公司买，就没有补贴。

Who is it for? Individuals and families who don't have coverage through work and need to buy their own. To get government premium help, you must buy through the marketplace; buying directly from an insurer outside it means no subsidy.

第三个特点很重要：同一个金属等级，全州的福利设计是统一的。比如每家公司的银级 70，免赔额、看医生的共付额都一样，差别只在保费高低、医生和医院网络，以及离家近不近。所以比较的时候，不用逐条看条款，重点看价格，还有您的医生在不在网络里。

The third point is important: within a metal tier, the benefit design is the same statewide. Every carrier's Silver 70 has the same deductible and the same copays for doctor visits. What differs is the premium, the doctor and hospital network, and how convenient it is to where you live. So when you compare, you don't need to read every clause; focus on price and whether your doctors are in the network.

第四，ACA 有几条重要保护：有糖尿病、高血压这类既往病史，保险公司不能拒保，也不能加价；每张保单都必须包含门诊、急诊、住院、孕产、新生儿、儿科、精神健康、处方药、康复、检验和预防保健这十大基本福利；也不能设一年或一辈子的理赔上限。

Fourth, the ACA includes key protections. Insurers can't deny you or charge more because of a pre-existing condition such as diabetes or high blood pressure. Every plan must include ten essential benefits: outpatient care, emergency care, hospital care, maternity, newborn care, pediatric care, mental health, prescription drugs, rehabilitation, and lab and preventive services. And plans can't set yearly or lifetime limits on coverage.

最后提醒一句：联邦层面「没保险的罚款」已经是零，但加州有自己的州个人强制投保规定，没有保险，报加州州税时仍可能被罚。金额每年会变，具体请问您的税务师。

One last reminder: the federal penalty for being uninsured is now zero, but California has its own individual mandate, so going without coverage can still mean a penalty on your state tax return. The amount changes each year, so check with your tax preparer.

这四类人最该看奥巴马保险Four Groups Who Should Look Closely

自雇人士Self-employed

司机、中介、小生意老板：没有公司替您交保费的人Drivers, agents, small-business owners: no employer paying your premium

提前退休的人Early retirees

65 岁之前、还没到红蓝卡的「桥接期」，这是主要选择The main option for the “bridge” years before Medicare at 65

新移民家庭New immigrant families

刚拿绿卡、收入超过白卡线一些的家庭New green-card holders with income just above Medi-Cal limits

兼职和学生Part-timers & students

不是全职、公司或学校没有提供医保的人Not full-time, with no health plan from an employer or school

2027 年起联邦补贴只给公民、绿卡、古巴/海地入境者和 COFA 身份；工作和学生签证可以买，但没有补贴。From 2027, federal subsidies go only to citizens, green-card holders, Cuban/Haitian entrants and COFA migrants; work and student visa holders can buy but get no subsidy.

哪些人最该认真看奥巴马保险？我们平时见得最多的是这四类。

Who should take a close look at Covered California? These are the four groups we see most often.

第一类，自雇人士：开网约车的、做房地产中介的、开小店的老板。没有公司替您交保费，奥巴马保险基本就是主要选择。自雇的朋友收入常常起伏，年初估收入时要特别用心，因为补贴就是按您估的收入发的。

One: the self-employed, such as rideshare drivers, real estate agents and small shop owners. With no employer paying, Covered California is usually your main option. Self-employed income often goes up and down, so take extra care estimating it at the start of the year, because the subsidy is based on that estimate.

第二类，提前退休的人：比如 60、62 岁就退休了，离 65 岁拿红蓝卡还有几年，这段「桥接期」最常用的就是奥巴马保险。退休的朋友收入怎么安排，会直接影响补贴，等一下「400% 悬崖」那一页，会给大家看一个很惊人的真实例子。

Two: early retirees. If you retire at 60 or 62, there are a few years before Medicare at 65, and Covered California is the usual bridge. How a retiree's income is arranged directly affects the subsidy. On the “400% cliff” slide coming up, you'll see a striking real example.

第三类，新移民家庭：刚拿到绿卡，收入又超过白卡线一些的。要提醒大家：从 2027 年 1 月 1 日起，联邦补贴只给公民、绿卡持有人、古巴/海地入境者和 COFA 身份的人；难民、庇护、TPS，以及工作签证和学生签证都不再有补贴，可以买，但要交全价。

Three: new immigrant families, for example new green-card holders with income a bit above the Medi-Cal line. Keep in mind that from January 1, 2027, federal subsidies go only to citizens, green-card holders, Cuban/Haitian entrants and COFA migrants. Refugees, asylees, TPS holders and people on work or student visas no longer qualify for subsidies; they can still buy a plan, but at full price.

第四类，兼职和学生：工作不是全职、公司没有提供保险的人，还有学校没有提供医保的学生。家庭收入不高的，补贴后保费往往很低，有的甚至能找到 $0 保费的计划。

Four: part-time workers without job coverage, and students whose school doesn't provide a health plan. If household income is modest, premiums after the subsidy are often very low, and some people can even find $0-premium plans.

如果您属于其中任何一类，接下来「补贴怎么算」这一页请一定要听。

If you're in any of these groups, the next slide on how the subsidy works is a must.

政府怎么帮您交保费：补贴原理How the Premium Subsidy Works

补贴 = 基准银级保费 − 您该自付的部分Subsidy = benchmark Silver premium − your expected share基准 = 当地第二便宜的银级计划Benchmark = the second-lowest-cost Silver plan where you live
您该自付的 = 收入 × 2.15%–10.22%Your share = income × 2.15%–10.22%收入越低比例越低；贫困线 200% 以下加州另有州补贴Lower income, lower share; California adds a state subsidy up to 200% of poverty
收入超过 400% 贫困线：联邦补贴归零Above 400% of poverty: no federal subsidy单人 $63,840；四口之家 $132,000$63,840 for one person; $132,000 for a family of four
报税时多退少补，多领的要全额还Reconciled at tax time; any excess is repaid in full申请时收入要估准，收入变了马上更新Estimate income carefully and update it when it changes

选银级的低收入家庭，另外还有一份「自付减免」（后面讲）。Lower-income households who choose Silver also get extra cost-sharing help (coming up).

IRS Rev. Proc. 2026-26；Covered California 2027 收入资格表；官方 Shop and Compare 试算（邮编 91801，2026-10-07）IRS Rev. Proc. 2026-26; Covered California 2027 FPL chart; official Shop and Compare quote (zip 91801, 10/7/2026)

补贴怎么算，其实就是一个公式：补贴 = 当地「基准银级计划」的保费，减去政府认为您该自己出的那部分。基准银级，就是您所在地区第二便宜的银级计划。

The subsidy comes down to one formula: subsidy equals the premium of the local benchmark Silver plan minus the amount the government expects you to pay yourself. The benchmark is the second-lowest-cost Silver plan in your area.

您该自己出的部分，是按收入的百分比算的。2027 年这个比例从 2.15% 到 10.22%，收入越低，比例越低；收入在贫困线 300% 到 400% 之间的，比例是 10.22%。加州今年另外拿出 $3 亿做州补贴，收入在贫困线 200% 以下的家庭会再便宜一些：150% 以下，基准银级可以做到 $0；150% 到 200%，自付比例降到 2.8% 到 5.28%。

Your expected share is a percentage of income. For 2027 it ranges from 2.15% to 10.22%: the lower your income, the lower the percentage, and between 300% and 400% of poverty it's 10.22%. California is also putting $300 million into a state subsidy for households up to 200% of poverty. Up to 150%, the benchmark Silver plan can cost $0; from 150% to 200%, your share drops to 2.8%–5.28% of income.

举个真实例子：一家四口，年收入 $100,000，大约是贫困线的 303%。他们该自己出的是 $100,000 × 10.22% ÷ 12，大约每月 $851.67。我们在官方试算工具上查到，这家人每月补贴 $743.45，补贴后最便宜的铜级每月 $457.77。

A real example: a family of four earning $100,000, about 303% of poverty. Their expected share is $100,000 × 10.22% ÷ 12, about $851.67 a month. The official tool showed a subsidy of $743.45 a month, and the cheapest Bronze plan after the subsidy came to $457.77 a month.

第三点就是 2027 年最大的变化：收入超过贫困线 400%，联邦补贴直接归零。一个人是 $63,840，四口之家是 $132,000。超过一块钱也一样归零，这就是大家说的「悬崖」。

The third point is 2027's biggest change: above 400% of poverty, the federal subsidy drops to zero. That's $63,840 for one person and $132,000 for a family of four. Going even one dollar over means zero, which is why people call it a “cliff.”

第四点，补贴是按您申请时估的收入先发的，第二年报税时再用实际收入对账，多退少补。从 2026 税务年度开始，多领的补贴要全额还回去，不再有还款上限。所以收入一定要估准；年中加薪、换工作、收入减少，都要马上去更新。

Fourth, the subsidy is paid in advance based on your estimated income, then reconciled against your actual income when you file taxes: you get back any shortfall and repay any excess. Starting with tax year 2026, excess subsidy must be repaid in full, with no cap. So estimate carefully, and update right away if you get a raise, change jobs or earn less.

节奏提示Pacing

公式写在白板上，用 $100,000 的例子现场算一遍再翻下一页；下一页的悬崖例子会接着用这套算法。

Write the formula on the whiteboard and work through the $100,000 example live before moving on; the cliff example on the next slide builds on it.

400% 悬崖：多赚 $2,000，多交 $7,000The 400% Cliff: Earn $2,000 More, Pay $7,000 More

同一个人：62 岁、单身、提前退休、住洛杉矶县Same person: 62, single, retired early, LA County

年收入 $63,000（约 395%）Income $63,000 (about 395%)

每月补贴 $585.03Subsidy: $585.03/month
最便宜铜级 $259.58/月Cheapest Bronze: $259.58/month
最便宜银级 $365.63/月Cheapest Silver: $365.63/month
铜级一年约 $3,115Bronze for a year: about $3,115

年收入 $65,000（约 407%）Income $65,000 (about 407%)

补贴只剩 $1/月，等于没有Subsidy: $1/month, effectively none
最便宜铜级 $843.61/月Cheapest Bronze: $843.61/month
最便宜银级 $949.66/月Cheapest Silver: $949.66/month
铜级一年约 $10,123Bronze for a year: about $10,123

只多赚 $2,000，同一张铜级保单一年多交约 $7,008Earning $2,000 more costs about $7,008 more a year for the same Bronze plan

Covered California Shop and Compare 官方试算 · 2027 计划年 · 邮编 91801（Alhambra）· 2026-10-07 查询 · 初步费率 · 试算示例Covered California Shop and Compare · plan year 2027 · zip 91801 (Alhambra) · queried 10/7/2026 · preliminary rates · illustrative quote

这一页是今天最值得带回家的一页。我们用官方工具试算了同一个人：62 岁、单身、提前退休、住在洛杉矶县 Alhambra。只改一个数字：年收入。

If you take home one slide today, make it this one. We ran the official tool for the same person: 62, single, retired early, living in Alhambra in LA County. We changed just one number, yearly income.

左边，年收入 $63,000，大约是贫困线的 395%，还在 400% 以内。官方工具显示，他每月可以拿 $585.03 的补贴，最便宜的铜级补贴后每月 $259.58，最便宜的银级 $365.63。

On the left, income of $63,000, about 395% of poverty and still under 400%. The official tool shows a subsidy of $585.03 a month. The cheapest Bronze plan costs $259.58 a month after the subsidy, and the cheapest Silver $365.63.

右边，年收入只多了 $2,000，变成 $65,000，大约 407%，越过了 400% 这条线。官方试算只剩每月约 $1，等于没有补贴。同一张最便宜的铜级，每月变成 $843.61，银级 $949.66。

On the right, income is just $2,000 higher at $65,000, about 407%, past the 400% line. The official estimate shows about $1 a month, which is effectively no subsidy. The same cheapest Bronze plan now costs $843.61 a month, and Silver $949.66.

算一下全年：铜级从一年约 $3,115 变成约 $10,123，多交大约 $7,008。也就是说，多赚了 $2,000，保费却多出 $7,000，等于倒贴 $5,000。这就是「悬崖」的意思。而且年纪越大，保费越贵，悬崖就越陡。

Over a full year, Bronze goes from about $3,115 to about $10,123, roughly $7,008 more. In other words, earning $2,000 more costs $7,000 more in premiums, leaving you about $5,000 worse off. That's what the cliff means. And the older you are, the higher the premium, so the steeper the cliff.

那怎么办？第一，收入接近 400% 的家庭，年初估收入时一定要仔细算，退休的朋友尤其要留意，提款、卖股票这类一次性的收入，都可能把全年收入一下子推过线。第二，怎么合法安排收入，请和您的税务师一起规划，我们不提供税务建议。第三，收入一有变化，马上到 Covered California 更新，免得报税时要全额补还。

So what can you do? First, if you're near 400%, estimate your income carefully at the start of the year. Retirees especially should watch one-time income such as account withdrawals or stock sales, which can push the year's total over the line. Second, plan how to arrange your income legally with your tax preparer; we don't give tax advice. Third, update Covered California as soon as your income changes so you aren't hit with full repayment at tax time.

互动设计Interaction

请大家心算：自己家离 400% 还差多少？一个人 $63,840，两个人 $86,560，四口之家 $132,000。差不到几千块的，会后可以单独聊。

Ask everyone to work out how far they are from 400%: $63,840 for one, $86,560 for two, $132,000 for four. Anyone within a few thousand dollars can talk with us one-on-one afterward.

铜银金白金：四个等级怎么挑Bronze to Platinum: Picking a Tier

铜级 BronzeBronze60%月费最低，看病自付多Lowest premium, highest costs when you get care

银级 SilverSilver70%平衡点；唯一有「自付减免」The middle; the only tier with extra cost-sharing help

金级 GoldGold80%月费较高，免赔额 $0Higher premium, $0 deductible

白金 PlatinumPlatinum90%月费最高，自付最少Highest premium, lowest costs when you get care

2027 个人自付上限：铜 / 银 70 $11,650 · 金 $9,600 · 白金 $5,5002027 individual out-of-pocket max: Bronze / Silver 70 $11,650 · Gold $9,600 · Platinum $5,500

百分比是保险平均承担的医疗费比例（联邦 ACA 标准），不是每次看病的报销比例。Percentages are the average share of medical costs the plan pays (federal ACA standard), not what each visit reimburses.

Covered California 2027 官方福利设计表；官方试算（三口之家 $80,000，邮编 91801，2026-10-07）Covered California 2027 benefit design table; official quote (family of 3, $80,000, zip 91801, 10/7/2026)

奥巴马保险分四个金属等级：铜、银、金、白金。下面的 60%、70%、80%、90%，是保险公司「平均」承担的医疗费比例，不是您每次看病能报销多少。等级越高，月费越贵，但看病时自己掏的越少。

Covered California has four metal tiers: Bronze, Silver, Gold and Platinum. The 60%, 70%, 80% and 90% are the average share of medical costs the plan pays, not what you get back on each visit. The higher the tier, the higher the monthly premium, but the less you pay when you get care.

看一组真实报价：一家三口，40 岁、39 岁和一个 10 岁的孩子，年收入 $80,000，补贴后每个等级最便宜的是：铜级每月 $346.05，银级 $468.04，金级 $616.25，白金 $710.23，都是 L.A. Care 的 HMO 计划。

Here are real quotes for a family of three, ages 40, 39 and 10, earning $80,000. After the subsidy, the cheapest plan in each tier is: Bronze $346.05 a month, Silver $468.04, Gold $616.25 and Platinum $710.23, all L.A. Care HMO plans.

月费差得不算太多，但看病时差很多：铜级医疗免赔额 $5,800，银级 70 是 $4,700，金级和白金的免赔额都是 $0。全年自付上限，铜级和银级 70 一个人 $11,650，金级 $9,600，白金 $5,500；家庭是个人的两倍。

The premiums aren't far apart, but costs when you get care are. The Bronze medical deductible is $5,800 and Silver 70's is $4,700, while Gold and Platinum have a $0 deductible. The yearly out-of-pocket maximum is $11,650 per person for Bronze and Silver 70, $9,600 for Gold and $5,500 for Platinum; family amounts are double.

怎么挑？身体好、很少看病、主要防大病的，铜级最省月费；从 2026 年起，铜级计划也可以搭配健康储蓄账户 HSA。经常看医生、长期吃药，或者明年打算生孩子、做手术的，金级或白金往往更划算。银级在中间，而且是唯一能领「自付减免」的等级，收入不高的朋友一定要先看银级。

How to choose? If you're healthy, rarely see a doctor and mainly want protection against a big illness, Bronze saves the most on premiums, and since 2026 Bronze plans can be paired with a Health Savings Account. If you see doctors often, take ongoing medication, or expect a baby or surgery next year, Gold or Platinum often comes out ahead. Silver sits in the middle and is the only tier with extra cost-sharing help, so lower-income households should look at Silver first.

一个简单的方法：把去年全家看病、拿药花了多少写下来，加上一年的保费，看哪个等级「保费 + 预计自付」加起来最低，那就是最适合您的。

A simple method: write down what your family spent on care and prescriptions last year, add a year of premiums, and see which tier gives the lowest total of premiums plus expected out-of-pocket costs. That's usually your best fit.

Silver 94 / 87 / 73：省钱暗器Silver 94 / 87 / 73: The Hidden Savings

Silver 94Silver 94

单人 ≤ $23,940（100%–150%）
免赔额 $200
上限 $3,000Up to $23,940 for one (100%–150%)
$200 deductible
$3,000 max

Silver 87Silver 87

单人 $23,941–$31,920（150%–200%）
免赔额 $1,100
上限 $4,000$23,941–$31,920 for one (150%–200%)
$1,100 deductible
$4,000 max

Silver 73Silver 73

单人 $31,921–$39,900（200%–250%）
免赔额 $4,700
上限 $9,600$31,921–$39,900 for one (200%–250%)
$4,700 deductible
$9,600 max

只有选银级才有，系统按收入自动匹配；金额为个人，家庭为两倍。Only on Silver plans, matched automatically by income; amounts are per person, double for a family.

Covered California 2027 官方福利设计表与收入资格表；官方试算（三口之家 $50,000，邮编 91801，2026-10-07）Covered California 2027 benefit design table and FPL chart; official quote (family of 3, $50,000, zip 91801, 10/7/2026)

这一页是收入不高的家庭最容易错过的好处，官方叫「费用分担减免」。意思是：收入在一定范围内，只要选银级，系统就会自动把普通的银级 70 升级成银级 73、87 或 94。月费还是银级的价钱，看病时的自付却接近金级，甚至白金。

This is the benefit lower-income families most often miss. It's officially called cost-sharing reductions. If your income falls in certain ranges and you choose Silver, the system automatically upgrades a regular Silver 70 to Silver 73, 87 or 94. You pay a Silver premium, but your costs when you get care look more like Gold or even Platinum.

三档怎么分？收入在贫困线 100% 到 150%，一个人一年 $23,940 以下，是银级 94：医疗免赔额只有 $200，全年自付上限 $3,000。150% 到 200%，一个人 $23,941 到 $31,920，是银级 87：免赔额 $1,100，上限 $4,000。200% 到 250%，一个人 $31,921 到 $39,900，是银级 73：免赔额 $4,700，上限 $9,600。

How the levels work: from 100% to 150% of poverty, up to $23,940 a year for one person, you get Silver 94, with just a $200 medical deductible and a $3,000 yearly out-of-pocket max. From 150% to 200%, $23,941 to $31,920 for one person, it's Silver 87: a $1,100 deductible and a $4,000 max. From 200% to 250%, $31,921 to $39,900 for one person, it's Silver 73: a $4,700 deductible and a $9,600 max.

看一个真实例子：一家三口年收入 $50,000，孩子拿白卡，两个大人在 Covered California 投保。官方工具显示每月补贴 $826.91，最便宜的铜级是 $0，而最便宜的银级 87 每月只要 $13.56。

A real example: a family of three earning $50,000, with the child on Medi-Cal and the two parents on Covered California. The official tool shows a subsidy of $826.91 a month. The cheapest Bronze plan is $0, and the cheapest Silver 87 is only $13.56 a month.

很多人会直接选 $0 的铜级，但请算一笔账：铜级医疗免赔额 $5,800，两个人全年自付上限可能到 $23,300；银级 87 免赔额 $1,100，两个人上限 $8,000。每个月多付 $13.56，一年大约 $163，就把最坏情况下的自付少了一万五千多。

Many people would grab the $0 Bronze plan, but run the numbers. Bronze has a $5,800 medical deductible and, for two people, a yearly out-of-pocket max of up to $23,300. Silver 87 has a $1,100 deductible and an $8,000 max for two. Paying $13.56 more a month, about $163 a year, cuts the worst-case out-of-pocket by more than $15,000.

再提醒两点：第一，这个减免只有银级才有，选铜、金、白金都没有。第二，收入在贫困线 150% 以下的朋友，还有加州州补贴，有机会找到 $0 保费的银级计划。

Two more reminders. First, this help comes only with Silver; Bronze, Gold and Platinum don't get it. Second, if your income is under 150% of poverty, California's state subsidy may also give you a $0-premium Silver plan.

互动设计Interaction

现场问：「$0 的铜级和 $13.56 的银级 87，您选哪个？」先让大家举手，再公布一年最多可能差一万五的答案，印象最深。

Ask the room: “$0 Bronze or $13.56 Silver 87, which would you pick?” Take a show of hands first, then reveal the $15,000 worst-case difference; it sticks.

2027 年的保障：有进有退2027 Benefits: Some Better, Some Worse

计划（个人）Plan (individual)	免赔额 2026Deductible 2026	免赔额 2027Deductible 2027	自付上限 2026OOP max 2026	自付上限 2027OOP max 2027
铜级 Bronze 60Bronze 60	$5,800	$5,800	$9,800	$11,650
银级 Silver 70Silver 70	$5,200	$4,700	$9,800	$11,650
银级 Silver 73Silver 73	$5,200	$4,700	$8,100	$9,600
银级 Silver 87Silver 87	$1,400	$1,100	$3,350	$4,000
银级 Silver 94Silver 94	$0	$200	$1,400	$3,000
金级 Gold 80Gold 80	$0	$0	$9,200	$9,600
白金 Platinum 90Platinum 90	$0	$0	$5,000	$5,500

保费：全州平均涨 9.9%（初步），IEHP 平均涨幅最小 5.6%Premiums: up 9.9% on average statewide (preliminary); IEHP has the smallest average increase, 5.6%

医疗免赔额；家庭金额为个人的两倍。Medical deductibles; family amounts are double.

Covered California 2027 官方福利设计表（2026 年 9 月）；2027 初步费率（2026/7/21）Covered California 2027 Patient-Centered Benefit Designs (Sept 2026); 2027 preliminary rates (7/21/2026)

2027 年的保障，有好消息也有坏消息。先说好消息：银级 70 和银级 73 的医疗免赔额，从 $5,200 降到 $4,700；银级 87 从 $1,400 降到 $1,100。也就是说，看病时保险会更早开始帮您付钱。

2027 brings good news and bad news. The good news first: the medical deductible for Silver 70 and Silver 73 drops from $5,200 to $4,700, and Silver 87 drops from $1,400 to $1,100. In other words, your plan starts paying sooner.

坏消息是全年自付上限普遍上调：铜级和银级 70 从 $9,800 涨到 $11,650；银级 73 从 $8,100 到 $9,600。银级 94 变化最大：免赔额从 $0 变成 $200，自付上限从 $1,400 涨到 $3,000。金级和白金也小幅上调。背后的原因是联邦把 2027 年法定的自付上限调到了个人 $12,000、家庭 $24,000。

The bad news is that yearly out-of-pocket maximums go up across the board. Bronze and Silver 70 rise from $9,800 to $11,650, and Silver 73 from $8,100 to $9,600. Silver 94 changes the most: its deductible goes from $0 to $200 and its maximum from $1,400 to $3,000. Gold and Platinum rise slightly too. The reason is that the federal government raised the 2027 legal cap on out-of-pocket costs to $12,000 for an individual and $24,000 for a family.

保费方面，Covered California 2027 年全州平均上涨 9.9%，这是初步数字，最终以 1 月 1 日生效的费率为准。各家公司涨幅不同，IEHP 的平均涨幅最小，是 5.6%。

On premiums, Covered California rates rise 9.9% on average statewide for 2027. That's a preliminary figure; the final rates take effect January 1. Increases vary by carrier, and IEHP has the smallest average increase at 5.6%.

也有值得安慰的地方：Covered California 估计，如果大家愿意换到同一等级里最便宜的计划，平均保费反而会降 0.2%；全州大约 60% 的会员保费不会上涨。所以最吃亏的做法，就是不比价、直接自动续保。

There is some comfort: Covered California estimates that people who switch to the lowest-cost plan in their tier would see premiums fall 0.2% on average, and about 60% of enrollees will see no premium increase. So the costliest move is to auto-renew without comparing.

怎么办？从 2026 年 10 月 1 日起已经可以续保和比价。拿到续保通知先别急着签，把三个等级的月费和自付上限排在一起看，再结合自己的收入和看病习惯做决定。

What to do? Renewals and comparison shopping have been open since October 1, 2026. When your renewal notice arrives, don't rush. Line up the premiums and out-of-pocket maximums for three tiers side by side, then decide based on your income and how much care you use.

讲师提醒Presenter note

9.9% 和 5.6% 都是初步的平均数，个人实际涨幅因地区、年龄和计划不同；不要说成「您的保费会涨 9.9%」。

Both 9.9% and 5.6% are preliminary averages; individual changes vary by region, age and plan. Don't tell anyone “your premium will go up 9.9%.”

真实报价：收入不同差多少Real quotes: same family, two incomes

同一个四口之家（40、40、10、8 岁），洛杉矶县 AlhambraThe same family of four (ages 40, 40, 10 and 8) in Alhambra, LA County

例一：年收入 $100,000Example 1: $100,000 a year

约 303% 贫困线，在 400% 以内About 303% FPL, under the 400% line
政府补贴 $743.45/月Subsidy: $743.45/mo
最便宜铜级，补贴后 $457.77/月Cheapest Bronze after subsidy: $457.77/mo
四个人都在补贴方案里All four people are on the subsidized plan

例二：年收入 $200,000Example 2: $200,000 a year

约 606% 贫困线，超过 400% 悬崖About 606% FPL, past the 400% cliff
官方试算补贴只剩 $4/月The official tool shows $4/mo
最便宜铜级 $1,197.22/月Cheapest Bronze: $1,197.22/mo
同一张保单，一年多付约 $8,873Same plan, about $8,873 more a year

差价几乎全是补贴：每月 $739.45，一年约 $8,873The gap is almost all subsidy: $739.45 a month, about $8,873 a year

试算 · 示例：2027 年初步费率，实际保费因邮编、年龄、收入而异Example quotes on preliminary 2027 rates; actual premiums vary by zip code, age and income

Covered California Shop and Compare 官方试算，邮编 91801，2027 计划年，2026-10-07 查询；400% 贫困线（四口）$132,000Covered California Shop and Compare, zip 91801, plan year 2027, run 2026-10-07; 400% FPL for a family of four = $132,000

各位朋友，前面讲了补贴怎么算、400% 悬崖是什么意思。这一页我们不讲理论，直接看真实的数字。这是我们在 Covered California 官方的 Shop and Compare 比价工具上，用 2027 年的初步费率跑出来的：一家四口，夫妻都是 40 岁，两个孩子 10 岁和 8 岁，住在洛杉矶县 Alhambra。两边只有一个地方不一样，就是家庭年收入。

Friends, we've talked about how the subsidy works and what the 400% cliff means. On this slide, no theory, just real numbers. We ran these on Covered California's official Shop and Compare tool with preliminary 2027 rates: a family of four, both parents 40, kids 10 and 8, living in Alhambra in LA County. Only one thing differs between the two sides: household income.

左边年收入十万。四口之家的联邦贫困线是 $33,000，十万大约是 303%，还在 400% 以内。官方工具显示每月补贴 $743.45，补贴之后，最便宜的铜级计划每个月 $457.77。按 2027 年的规则，这个收入的家庭每月要自己负担收入的 10.22%，大约 $852；基准银级计划超出这部分的钱，就由补贴来付。另外，孩子的白卡收入线是 266%，这家已经超过了，所以孩子不走白卡，四个人一起放在补贴方案里。

On the left, $100,000 a year. The poverty line for a family of four is $33,000, so $100,000 is about 303%, still under 400%. The official tool shows a subsidy of $743.45 a month, and after it the cheapest Bronze plan is $457.77 a month. Under 2027 rules, a family at this income is expected to pay 10.22% of income, about $852 a month, toward the benchmark Silver plan; the subsidy pays the rest. The children's Medi-Cal line is 266%, and this family is above it, so the kids aren't on Medi-Cal. All four are on the subsidized plan.

右边年收入二十万，大约是贫困线的 606%，远远超过 400%。四口之家的悬崖在 $132,000。官方试算每月只剩大约 $4，等于没有。同样是最便宜的那个铜级计划，每个月要 $1,197.22。

On the right, $200,000 a year, about 606% of the poverty line and far past 400%. For a family of four the cliff is at $132,000. The official tool shows only about $4 a month, which is effectively nothing. The same cheapest Bronze plan costs $1,197.22 a month.

两边一比，每个月差 $739.45，正好就是两边补贴的差额。乘以十二个月，一年差大约 $8,873。请注意，保单是同一张，医生网络一样，福利一样，差的只是补贴。

Put them side by side and the monthly gap is $739.45, exactly the difference in subsidy. Times twelve, that's about $8,873 a year. Notice it's the same plan, the same doctors and the same benefits. The only difference is the subsidy.

这告诉我们两件事。第一，收入在 400% 附近的家庭，申请时报的收入要估得准，多一点少一点，结果可能差很多。第二，收入高的家庭在奥巴马保险里基本拿不到补贴了，买之前值得把公司团保等其他选择一起比一比。今天的数字只是示例，您家的情况要用自己的邮编、年龄和收入重新算一次。

Two takeaways. First, if your income is near 400%, estimate it carefully when you apply, because a small difference can change the result a lot. Second, higher-income families get essentially no subsidy on Covered California now, so it's worth comparing other options, such as employer coverage, before you buy. These are examples only. Your family needs its own quote with your zip code, ages and income.

讲师提醒Presenter note

$4 只说「官方试算只剩每月约 $4，等于没有」，不要解释它从哪里来；400% 以上没有联邦补贴。

For the $4, say only that the official tool shows about $4 a month, which is effectively nothing. Don't explain where it comes from; there is no federal credit above 400%.

互动设计Interaction

先遮住右边，请大家猜「收入翻倍，保费会贵多少」，再揭晓一年约 $8,873。

Cover the right side and ask the room to guess how much more a family pays when income doubles, then reveal about $8,873 a year.

HMO 还是 PPOHMO or PPO?

HMO：便宜，但要守规矩HMO: cheaper, with rules

要指定一位家庭医生（PCP）You pick a primary care doctor (PCP)
看专科要家庭医生转诊Specialists need a PCP referral
网络外的医生通常不给付Out-of-network care usually isn't covered
保费便宜，适合预算紧的家庭Lower premiums, good for tight budgets

PPO：灵活，但要多付钱PPO: flexible, at a price

不用指定家庭医生No PCP to designate
网络内的专科可以直接预约Book in-network specialists directly
网络外多半也能看，但自付高很多Out-of-network is often allowed, at much higher cost
保费明显更贵Noticeably higher premiums

同一家公司的银级 87：HMO $210.94，PPO $729.19/月Same carrier, Silver 87: HMO $210.94 vs PPO $729.19/mo

试算 · 示例：三口之家年收入 $5 万（孩子走白卡、两位大人投保），2027 初步费率，补贴后月费Example: family of three at $50,000 (child on Medi-Cal, two adults enrolled), preliminary 2027 rates, after subsidy

Covered California Shop and Compare 官方试算，邮编 91801，2026-10-07 查询Covered California Shop and Compare, zip 91801, run 2026-10-07

各位朋友，选计划的时候，除了铜银金白金，还有一个大问题：要 HMO 还是 PPO？这两个是保险公司的「网络」形式，决定的是您怎么看医生、能看哪些医生。

Friends, besides Bronze, Silver, Gold and Platinum, there's another big choice: HMO or PPO. These are network types. They decide how you see doctors and which doctors you can see.

HMO 可以想成「单位指定医院」。您要先指定一位家庭医生，英文叫 PCP；要看专科，得先让家庭医生转诊，他就像一个守门人。网络外的医生，除了急诊，通常不给付。好处是保费便宜。像 Kaiser 就是典型的 HMO，医生和医院都在自己的体系里。

Think of an HMO as a designated clinic system. You first choose a primary care doctor, or PCP. To see a specialist, your PCP refers you, like a gatekeeper. Doctors outside the network usually aren't covered, except in emergencies. The upside is a lower premium. Kaiser is a classic HMO, with its own doctors and hospitals under one roof.

PPO 就是「自由就医」。不用指定家庭医生，网络里的专科可以直接约；多数 PPO 网络外也能看，只是自付会高很多，要看计划条款。代价就是保费贵。

A PPO is more like open access. No PCP to designate, and you can book in-network specialists directly. Most PPOs also let you go out of network, but you pay much more, depending on the plan. The trade-off is a higher premium.

贵多少？看真实报价。一个年收入五万的三口之家，同样是银级 87，同一家公司：HMO 补贴后每月 $210.94，PPO 要 $729.19，每月差 $518.25，一年差 $6,219。另一家公司的 HMO 是 $182.43，PPO 是 $451.73，一年也差三千多。金属等级和福利档位一样，这个差价买的就是「自由」。

How much more? Real quotes: a family of three at $50,000, Silver 87, same carrier. The HMO is $210.94 a month after subsidy and the PPO is $729.19. That's $518.25 a month, or $6,219 a year. Another carrier's HMO is $182.43 versus $451.73 for its PPO, still more than $3,000 a year apart. Same metal tier, same benefit level. The difference buys you freedom of choice.

怎么选？如果您有固定看的家庭医生、预算又紧，HMO 很合适；如果您经常要看专科、想直接约名医、或者常在外地，PPO 更顺手。不管选哪个，投保前都先做一件事：查一下您现在的医生在不在这个计划的网络里。

How to choose? If you have a regular doctor and a tight budget, an HMO fits well. If you often need specialists, want to book them directly, or travel a lot, a PPO is easier. Either way, do one thing before you enroll: check whether your current doctors are in that plan's network.

互动设计Interaction

请大家举手：现在的保险是 HMO 的请举手，PPO 的请举手，不知道的请举手。最后一组通常最多，顺势讲下一页的保险卡和网络查询。

Ask for hands: who's on an HMO, who's on a PPO, and who doesn't know. The last group is usually the biggest, which sets up checking your card and network.

南加州 2027 有哪些保险公司Southern California carriers in 2027

地区Area	2027 年可选的保险公司Covered California carriers for 2027	地区平均涨幅Avg. rate change
洛杉矶县东北区LA County, northeast	L.A. Care · Kaiser · Anthem · Blue Shield · Health Net	+8.5%
洛杉矶县西南区LA County, southwest	L.A. Care · Kaiser · Molina · Anthem · Blue Shield · Health Net	+9.3%
橙县Orange County	Kaiser · CalOptima（新加入）· Anthem · Blue Shield · Health NetKaiser · CalOptima (new) · Anthem · Blue Shield · Health Net	+10.4%
内陆帝国Inland Empire圣伯纳迪诺、河滨San Bernardino, Riverside	IEHP · Kaiser · Molina · Anthem · Blue Shield · Health Net	+9.8%

全州平均 +9.9%；IEHP 公司平均 +5.6%，涨得最少Statewide average +9.9%; IEHP's average is +5.6%, the lowest

Molina 退出洛杉矶东北区和橙县；同一金属等级福利统一，选公司看价格、医生网络和离家远近Molina leaves LA northeast and Orange County. Benefits are standard within a metal tier, so choose on price, doctors and location

Covered California 2027 初步费率（2026-07-21）及分县费率表（2026-10-01）Covered California 2027 preliminary rates (2026-07-21) and county rate sheet (2026-10-01)

各位朋友，这一页是南加州 2027 年在 Covered California 里可以选的保险公司。洛杉矶县分成两个定价区，东北区和西南区，名单和涨幅都不太一样；再加上橙县和内陆帝国，也就是圣伯纳迪诺和河滨两县。

Friends, this slide shows the Covered California carriers in Southern California for 2027. LA County is split into two pricing regions, northeast and southwest, with slightly different carriers and increases. Then there's Orange County and the Inland Empire, meaning San Bernardino and Riverside counties.

几个变化要特别留意。第一，Molina 退出洛杉矶东北区和橙县，如果您现在是 Molina 的会员、住在这两个地方，续约时会被转到别的计划，一定要看清续约通知，最好自己重新挑一次。第二，橙县多了一家新公司 CalOptima。第三，在这几个地区，Anthem 卖的是 HMO；想要 PPO 的话，主要看 Blue Shield 和 Health Net。

A few changes to note. First, Molina is leaving LA northeast and Orange County. If you're a Molina member there, you'll be moved to another plan at renewal, so read your notice carefully and ideally choose for yourself. Second, Orange County gains a new carrier, CalOptima. Third, in these areas Anthem sells HMOs; if you want a PPO, look mainly at Blue Shield and Health Net.

涨价方面，全州平均是 9.9%，这是初步数字。南加州各区在 8.5% 到 10.4% 之间。按保险公司算，内陆帝国的 IEHP 平均只涨 5.6%，是全州最低的。不过平均归平均，每个人的涨幅还要看您原来选的是哪家、哪个计划。

On prices, the statewide average increase is 9.9%, a preliminary figure. Southern California regions range from 8.5% to 10.4%. By carrier, IEHP in the Inland Empire averages only 5.6%, the lowest in the state. But an average is just an average. Your own change depends on your carrier and plan.

最后记住一个原则：在 Covered California，同一个金属等级的福利是统一的，比如银级 70 的免赔额和自付上限，每家都一样。所以选公司的时候，看三样东西就好：价格、您的医生在不在网络里、还有医院诊所离家方不方便。

Finally, one principle: on Covered California, benefits are standardized within each metal tier. A Silver 70 plan has the same deductible and out-of-pocket maximum at every carrier. So when choosing a company, look at three things: price, whether your doctors are in network, and how convenient the hospitals and clinics are.

节奏提示Pacing

不用逐格念公司名，先问「谁住橙县、谁住内陆帝国」，只讲台下有人住的那一行。

Don't read every name. Ask who lives in Orange County or the Inland Empire and cover only the rows that apply to the room.

看懂账单：四个名词Reading a bill: four terms

自付额 DeductibleDeductible

保险开始赔之前，您要先自己付的钱。What you pay yourself before the plan starts paying.

共付额 CopayCopay

每次看病固定的小额，例如家庭医生 $35、专科 $85。A flat amount per visit, such as $35 for your PCP or $85 for a specialist.

共保 CoinsuranceCoinsurance

付满自付额后按比例分摊，例如保险 80%、您 20%。After the deductible, you split costs by percentage, such as 80% plan, 20% you.

自付上限 OOP MaxOut-of-pocket max

一年最多自己付到这里，之后保险付 100%。The most you pay in a year; after that, the plan pays 100%.

一台 $25,000 的手术，上限 $2,500：您最多付 $2,500A $25,000 operation with a $2,500 cap: you pay at most $2,500

示意算例：自付额 $250、共保 80/20、自付上限 $2,500。2027 真实上限：铜级、银级 70 单人 $11,650Illustration: $250 deductible, 80/20, $2,500 cap. Real 2027 caps: Bronze and Silver 70, $11,650 per person

Covered California 2027 标准福利表（2026 年 9 月）Covered California 2027 Patient-Centered Benefit Designs (Sept 2026)

各位朋友，很多人拿到医疗账单一头雾水，其实只要看懂四个名词就够了。我送大家一句口诀：先垫底、再分摊、有封顶。

Friends, many people are confused by medical bills, but you only need four terms. Here's a phrase to remember: you pay first, then you share, and then there's a cap.

「先垫底」是自付额：保险开始赔之前，您先自己付的那笔钱。「再分摊」是共保：付满自付额以后，剩下的费用按比例分，比如保险付 80%、您付 20%。平常看门诊付的固定小钱叫共付额，比如一张银级 73 的会员卡上写着：家庭医生 $35、专科 $85、急诊 $350。「有封顶」就是自付上限：一年之内，网络内、承保范围内的费用，您自己最多付到这个数，到顶以后保险付百分之百。注意，每月交的保费不算在里面。

Paying first is the deductible, what you pay before the plan starts paying. Sharing is coinsurance: after the deductible, costs are split, say 80% by the plan and 20% by you. The flat amount you pay for a routine visit is the copay. One Silver 73 member card, for example, lists $35 for the family doctor, $85 for a specialist and $350 for the ER. The cap is the out-of-pocket maximum: within a year, for covered in-network care, you never pay more than this, and after that the plan pays everything. Your monthly premiums don't count toward it.

看一个示意的例子。自付额 $250，共保 80/20，自付上限 $2,500。平常年份看病花了 $2,000：您先付 $250，剩下 $1,750 再付 20%，也就是 $350，一共 $600。

Here's an illustration: a $250 deductible, 80/20 coinsurance and a $2,500 cap. In an ordinary year you have $2,000 of care. You pay the first $250, then 20% of the remaining $1,750, which is $350, for $600 in total.

再看出事的那一年：一台 $25,000 的手术。没有封顶的话，您要付 $250 加上剩下 $24,750 的 20%，也就是 $4,950，合计 $5,200。但是有封顶，您最多只付 $2,500，其余 $22,500 保险公司全付。这就是自付上限的价值：它不管小病，管的是「最坏的那一年」。

Now the bad year: a $25,000 operation. Without a cap you'd pay $250 plus 20% of the remaining $24,750, which is $4,950, for $5,200 in total. With the cap you pay at most $2,500, and the plan pays the other $22,500. That's what the cap is for. It isn't about small bills. It protects you in your worst year.

回到 2027 年的真实计划：铜级和银级 70，单人自付上限是 $11,650，家庭是两倍；金级 $9,600，白金级 $5,500；低收入可以拿到的银级 87 是 $4,000，银级 94 是 $3,000。比较计划的时候，别只看月费，把自付上限也写在旁边，您才知道最坏的一年要准备多少钱。

Back to real 2027 plans: Bronze and Silver 70 have a $11,650 out-of-pocket maximum per person, double for a family. Gold is $9,600 and Platinum $5,500. The lower-income Silver 87 is $4,000 and Silver 94 is $3,000. When you compare plans, don't look only at the premium. Write the out-of-pocket maximum next to it, so you know what your worst year could cost.

节奏提示Pacing

$25,000 手术这一例要讲慢，在白板上把 $250 + $4,950 = $5,200 写出来，再划掉改成 $2,500。

Slow down on the $25,000 example. Write $250 + $4,950 = $5,200 on the board, then cross it out and write $2,500.

2027 参保：记住这几个日期2027 enrollment: key dates

2026 年 10 月 1 日Oct 1, 2026续约开放：老参保人可以比较明年的计划Renewals open: current members can compare next year's plans 11 月 1 日Nov 1公开参保开始：新人可以加入Open enrollment starts: new people can sign up 12 月 31 日Dec 31最晚这天办好，1 月 1 日生效Enroll by this date for a Jan 1 start 2027 年 1 月 31 日Jan 31, 2027本轮最后一天，2 月 1 日生效Last day of this round, Feb 1 start 人生大事后 60 天内Within 60 days of a life event特殊投保：结婚、生子、失去保险、搬家、拿到绿卡Special enrollment: marriage, a birth, losing coverage, moving, a new green card 全年Year-round白卡 Medi-Cal 随时都可以申请Medi-Cal applications are accepted any time

错过 1 月 31 日又没有特殊事件，就要等下一年度的开放期Miss Jan 31 without a qualifying event and you wait for next year's open enrollment

Covered California 2027 开放投保公告；Federal Changes Guide（2026-06-19）Covered California 2027 open enrollment; Federal Changes Guide (2026-06-19)

各位朋友，奥巴马保险不是随时都能买的，所以这几个日期请拿手机拍下来。第一个，2026 年 10 月 1 日，续约已经开放。已经有 Covered California 的朋友，现在就可以上去看明年的价格，比较一下要不要换。

Friends, you can't buy Covered California coverage any time you like, so please take a photo of these dates. First, October 1, 2026: renewals are already open. If you're already on Covered California, you can look at next year's prices now and decide whether to switch.

第二个，11 月 1 日，公开参保正式开始，新人可以加入。第三个，12 月 31 日，想要 1 月 1 日就生效，最晚这一天要办好。第四个，2027 年 1 月 31 日，这一轮的最后一天，在 1 月份办的，2 月 1 日生效。去年大家可能听说联邦想把开放期缩短到 12 月底，这条规定已经被法院撤销了，加州 2027 年照样到 1 月 31 日。

Second, November 1: open enrollment begins and new people can sign up. Third, December 31: enroll by this day for coverage starting January 1. Fourth, January 31, 2027, the last day of this round; if you enroll in January, coverage starts February 1. You may have heard the federal government wanted to end open enrollment on December 31. A court vacated that rule, so California still runs to January 31 for 2027.

错过了怎么办？如果没有特殊事件，就只能等下一年。但是人生里有些大事会打开一个特殊投保期：结婚、离婚、生孩子，失去原来的保险，比如失业，搬家，或者刚拿到工卡、绿卡。一般是事件发生后 60 天内申请，次月 1 日生效。

What if you miss it? Without a special event, you wait until next year. But some life events open a special enrollment period: marriage, divorce, a new baby, losing other coverage such as through a job loss, moving, or newly receiving a work permit or green card. You generally apply within 60 days of the event, and coverage starts the first of the next month.

这里要提醒一点：以前收入在 150% 贫困线以下的人，一年里每个月都可以加入，这个特别通道从 2025 年 9 月起已经取消了。所以低收入的朋友也要按开放期来办。

One reminder: people under 150% of the poverty line used to be able to join in any month of the year. That special pathway ended in September 2025, so lower-income families also need to use open enrollment.

最后，白卡 Medi-Cal 不受开放期限制，全年都可以申请。如果收入掉下来、可能符合白卡，不用等，随时可以去 CoveredCA.com 或 BenefitsCal.com 申请。

Finally, Medi-Cal has no enrollment season. You can apply any time of year. If your income drops and you might qualify, don't wait. Apply on CoveredCA.com or BenefitsCal.com whenever you need to.

互动设计Interaction

停 10 秒请大家拍照；可以问「今年家里有没有结婚、生小孩、搬家的」，顺势讲特殊投保期。

Pause ten seconds for photos. Ask whether anyone's family had a wedding, a baby or a move this year to lead into special enrollment.

三个最常见的坑，别再踩了Three common mistakes to avoid

01

收入估错Guessing income wrong

补贴按您估的收入先发，报税时多退少补；估低了，多领的要全额还回去。The subsidy is paid on your estimate and settled at tax time. Underestimate, and the excess must be repaid in full.

02

生活变了没更新Not reporting changes

结婚、搬家、生孩子、收入变了，30 天内报给 Covered California。Marriage, a move, a baby or an income change: report it to Covered California within 30 days.

03

每年自动续约，从不比价Auto-renewing without shopping

价格和公司年年在变，开放期带着新账单比一圈。Prices and carriers change every year. Compare during open enrollment with your new bill in hand.

全州平均涨 9.9%；换到同等级最便宜的计划，平均反而 −0.2%（初步数字）The statewide average rises 9.9%; switching to the cheapest plan in the same tier averages −0.2% (preliminary)

Covered California 2027 初步费率公告（2026-07-21）；H.R.1 §71305（2026 报税年度起取消补贴追回上限）Covered California 2027 rates (2026-07-21); H.R.1 §71305 (no repayment cap from tax year 2026)

各位朋友，最后讲三个最常见的坑，很多家庭每年都在踩。第一个坑，收入估错。补贴是按照您申请时估计的全年收入先发给保险公司的，第二年报税时再用实际收入对账，多退少补。

Friends, let's finish this part with three mistakes many families make every year. The first is guessing your income wrong. The subsidy is paid to your insurer based on the income you estimate when you apply. When you file taxes the next year, it's reconciled against your actual income, and you either get money back or owe it.

以前少估了，还有还款上限保护；从 2026 报税年度开始，这个上限没有了，多领的补贴要全额还。举个例子，刚才那个年收入十万的四口之家，每月补贴 $743，一年将近 $8,900。如果实际收入冲过了 $132,000 的悬崖，这一整年的联邦补贴都可能要还回去。所以收入有变化，比如年终奖、卖了股票，要及时去更新。具体报税问题，请咨询您的税务师。

There used to be a cap on how much you'd have to repay. Starting with tax year 2026, that cap is gone, and any excess must be repaid in full. Take the $100,000 family of four from earlier: a $743 monthly subsidy is almost $8,900 a year. If their actual income crosses the $132,000 cliff, they may have to repay that whole year's federal subsidy. So if your income changes, say a bonus or a stock sale, update it promptly. For tax questions, please talk to your tax professional.

第二个坑，生活变了没更新。结婚、搬家、生孩子、收入变了，都要在 30 天内报给 Covered California。这些变化可能让您的补贴变多或变少，甚至让孩子变成白卡资格，越早报越不容易出问题。

The second mistake is not reporting life changes. Marriage, a move, a new baby or an income change should be reported to Covered California within 30 days. These changes can raise or lower your subsidy, or even make your children eligible for Medi-Cal. The sooner you report, the fewer surprises.

第三个坑，每年自动续约，从不比价。2027 年全州平均涨 9.9%，但 Covered California 自己算过：如果换到同一等级里最便宜的计划，平均保费反而是 −0.2%。再加上今年有公司退出、有新公司加入，加州州补贴也扩大到 200% 贫困线，所以续约通知来了，别直接放着，带着账单去比一圈。

The third is auto-renewing every year without comparing. Rates rise 9.9% on average statewide in 2027, but Covered California's own figures show that switching to the cheapest plan in the same tier averages −0.2%. Add carriers leaving and joining this year, and a state subsidy now reaching 200% of the poverty line, and it's worth comparing. When your renewal notice arrives, don't just let it roll over. Take your bill and shop around.

合规提醒Compliance

讲到报税对账只讲规则，不给个人税务建议；一律请对方咨询税务师。

Explain the reconciliation rule only; give no personal tax advice and refer people to a tax professional.

第三部分Part 3

红蓝卡 MedicareMedicare

满 65 岁的联邦医疗保险：A、B、C、D 怎么搭配Federal health insurance at 65: how Parts A, B, C and D fit together

各位朋友，接下来进入第三部分，红蓝卡 Medicare。这一部分跟在座很多朋友的父母有关，也跟快满 65 岁的朋友自己有关。

Friends, now we move to Part 3, Medicare. It matters for many of your parents, and for anyone here approaching 65.

我们会按这个顺序讲：红蓝卡是什么、谁有资格；A 和 B 管什么、要自付多少；A、B 留下的缺口有哪两条路可以补；C 计划和 D 药品计划；65 岁还在上班怎么办；最后是几个一定不能错过的日期。

We'll go in this order: what Medicare is and who qualifies; what Parts A and B cover and what you pay; the two ways to fill the gaps A and B leave; Part C and Part D drug plans; what to do if you're still working at 65; and the dates you must not miss.

先说明一下：这一部分是教育讲座。按照联邦的规定，今天我们只讲规则和概念，不介绍任何具体的 C 计划或药品计划，也不在现场办理投保。

First, a note: this part is an educational session. Under federal rules, today we cover rules and concepts only. We won't present any specific Medicare Advantage or drug plan, and we won't take enrollments here.

2027 年红蓝卡的部分费用要到 11 月中旬才由联邦正式公布，所以等一下凡是写着「预估」的数字，都是官方的预测，最后以公布的为准。

Some 2027 Medicare costs won't be officially published until mid-November, so any number marked "projected" is an official forecast. The published figures will be final.

合规提醒Compliance

红蓝卡部分按教育活动处理：不讲具体计划名称、保费或福利，不发投保表、不现场收申请，不预约个别销售会面。

Treat the Medicare section as an educational event: no specific plan names, premiums or benefits, no enrollment forms or applications, and no booking individual sales appointments on site.

红蓝卡：满 65 岁的联邦医疗保险Medicare: federal coverage at 65

A 管住院 + B 管门诊，合起来叫「原始红蓝卡」Part A (hospital) + Part B (medical) = Original Medicare
C 计划（私人公司承包）、D 药品保险，按需要选Part C (run by private insurers) and Part D (drugs) are optional choices
联邦政府办的，65 岁前后要自己注册Run by the federal government; you usually need to sign up around 65
低收入老人可以同时有白卡，帮付保费和自付Lower-income seniors can add Medi-Cal to help with premiums and costs

一对老年夫妇和医生交谈 / A senior couple talking with their doctor

符合条件的低收入老人，白卡还可以帮付 Part B 月费（「省钱计划」MSP）For eligible lower-income seniors, Medi-Cal's Medicare Savings Programs can pay the Part B premium

DHCS ACWDL 25-14、25-27DHCS ACWDL 25-14 and 25-27

各位朋友，红蓝卡，英文叫 Medicare，是联邦政府给 65 岁以上的人，还有部分残障人士办的医疗保险。为什么叫红蓝卡？因为那张卡上有红色和蓝色两条。

Friends, Medicare is the federal health insurance program for people 65 and older, and for some people with disabilities. In Chinese we call it the "red-and-blue card" because the card has a red stripe and a blue stripe.

很多人以为有了红蓝卡就什么都管了，其实不是。它分成四个部分：A 管住院，B 管门诊，A 加 B 合起来叫「原始红蓝卡」。C 计划是私人保险公司替联邦承包的另一种拿红蓝卡的方式；D 是药品保险。C 和 D 要不要、怎么搭配，是您自己来选。

Many people think Medicare covers everything. It doesn't. It has four parts: Part A covers hospital care and Part B covers doctor and outpatient care. Together they're called Original Medicare. Part C is another way to get your Medicare benefits through a private insurer, and Part D covers prescription drugs. Whether you add C or D, and how, is your choice.

第二个常见误会是「到了 65 岁自动就有」。已经在领社安退休金的人，通常会自动加入 A；其他人要在 65 岁前后自己去社安局申请。错过了时间可能要终身多交罚金，后面我们专门讲日期。

A second misunderstanding is that you get it automatically at 65. If you're already collecting Social Security retirement, you're usually enrolled in Part A automatically. Everyone else needs to apply through Social Security around age 65. Missing the window can mean a penalty for life, so we'll cover dates later.

第三点很重要：收入低的老人，可以红蓝卡加白卡一起用，俗称 Medi-Medi。白卡会帮您付红蓝卡的保费和自付。还有一种叫「省钱计划」，比如收入在贫困线以下、单人每月大约 $1,350 以内的，可以帮付 A、B 的保费和自付；收入再高一点的，也可能帮付 Part B 月费。

Third, and important: lower-income seniors can have Medicare and Medi-Cal together, often called Medi-Medi. Medi-Cal then helps pay Medicare premiums and cost sharing. There are also Medicare Savings Programs. For example, a single person with income under the poverty line, about $1,350 a month, can get help with Part A and B premiums and cost sharing, and people with somewhat higher income may still get the Part B premium paid.

不过要注意，65 岁以上申请白卡，2026 年起又开始看资产了：单人 $130,000，夫妻 $195,000，自住房一般不算。按照目前的州预算，2027 年 7 月 1 日起还可能降到单人 $21,000、夫妻 $31,000。家里有长辈想申请的，最好早一点了解。

One caution: for people 65 and older, Medi-Cal has looked at assets again since 2026: $130,000 for one person and $195,000 for a couple, and your home generally doesn't count. Under the current state budget, the limit may drop to $21,000 and $31,000 starting July 1, 2027. If an older relative may apply, look into it early.

哪些人有资格领红蓝卡Who qualifies for Medicare

年满 65 岁Age 6565 岁65本人或配偶交税满 40 个季度，A 免保费You or your spouse paid in 40 quarters: Part A is premium-free

领伤残社安金On SSDI24 个月24 months领 SSDI 满 24 个月，第 25 个月起有Coverage starts in month 25 of SSDI

特定疾病Certain conditionsALS · ESRD渐冻症不用等 24 个月；末期肾病一般透析第 4 个月起ALS: no 24-month wait. Kidney failure: usually from the 4th month of dialysis

绿卡付费加入Green card buy-in5 年5 years65 岁以上、连续在美住满 5 年65+ with 5 continuous years of US residence

2027 年起：只有公民、绿卡、古巴/海地入境者、COFA 身份可以享有红蓝卡From 2027, only citizens, green card holders, Cuban/Haitian entrants and COFA migrants can have Medicare

H.R.1 §71201；2026 Medicare Trustees Report 表 V.E1（Part A 保费为预估）H.R.1 §71201; 2026 Medicare Trustees Report table V.E1 (Part A premiums projected)

各位朋友，哪些人可以拿红蓝卡？最常见的是年满 65 岁。如果您本人或者配偶在美国工作交税满 40 个季度，大约十年，Part A 就不用交保费。

Friends, who can get Medicare? Most commonly, people aged 65. If you or your spouse worked and paid US taxes for 40 quarters, about ten years, Part A has no premium.

不到 65 岁也有两种情况。第一，领伤残社安金 SSDI 满 24 个月，从第 25 个月开始就有红蓝卡。第二，特定疾病：渐冻症 ALS 的朋友，一开始领 SSDI 就有，不用等 24 个月；末期肾病需要洗肾的，一般从透析的第 4 个月开始。

There are two cases under 65. First, after 24 months on Social Security disability (SSDI), Medicare begins in month 25. Second, certain conditions: people with ALS get Medicare as soon as SSDI starts, with no 24-month wait, and people with kidney failure on dialysis generally qualify from the fourth month of dialysis.

如果工龄不满十年怎么办？绿卡持有人年满 65 岁、而且连续在美国住满 5 年，可以自己付费买。2027 年 Part A 的保费预估是：交税 30 到 39 个季度的每月 $330，不到 30 个季度的每月 $600。付费买 A 的人，必须同时买 B。

What if you worked fewer than ten years? Green card holders who are 65 and have lived in the US continuously for 5 years can buy in. The projected 2027 Part A premium is $330 a month with 30 to 39 quarters of work, or $600 with fewer than 30. If you buy Part A, you must also take Part B.

2027 年有一个重要的变化。根据 2025 年通过的联邦法律，红蓝卡只给四类人：美国公民、绿卡持有人、古巴和海地入境者、以及按自由联系条约 COFA 居住的人。难民、政治庇护、TPS、人道假释这些身份，就算交税满十年，也不能再享有。新申请从 2025 年 7 月起就不行了；已经在红蓝卡上的人，按联邦提案，可能在 2027 年初被终止，最终日期还要等规则定案。

There's a major change in 2027. Under a federal law passed in 2025, Medicare is limited to four groups: US citizens, green card holders, Cuban and Haitian entrants, and COFA migrants. Refugees, asylees, TPS holders and humanitarian parolees no longer qualify, even with ten years of work. New applications stopped in July 2025, and people already enrolled may lose coverage in early 2027 under a federal proposal. The final date depends on the final rule.

这条规定不影响社安退休金本身。如果您家里有长辈是难民或庇护身份、已经有资格转绿卡，拿到绿卡就属于可以享有的一类。身份的问题情况各不相同，请一定先咨询移民律师，我们不提供法律建议。

This rule doesn't affect Social Security benefits themselves. If an older relative has refugee or asylee status and qualifies for a green card, getting it puts them back in an eligible group. Every immigration case is different, so please talk to an immigration attorney first. We don't give legal advice.

合规提醒Compliance

只讲规则，不判断个人身份；遇到具体身份问题，一律请对方咨询移民律师。

Explain the rule only and don't assess anyone's status; refer specific cases to an immigration attorney.

原始红蓝卡：A 管住院，B 管门诊Original Medicare: A and B

Part A 住院保险Part A: hospital

住院、专业护理院、临终关怀Hospital stays, skilled nursing, hospice
交税满 40 个季度免保费No premium with 40 quarters of work
每个福利期免赔额 $1,788Deductible per benefit period: $1,788
第 61–90 天每天 $447Days 61–90: $447 a day

Part B 门诊保险Part B: medical

看医生、化验、门诊手术、医疗设备Doctors, tests, outpatient surgery, equipment
标准月保费 $209.50Standard premium: $209.50/mo
全年免赔额 $292Annual deductible: $292
之后自付 20%，没有上限Then you pay 20%, with no cap

2027 年数字均为预估，以 CMS 11 月公布为准（2026 年：B 月费 $202.90，A 免赔额 $1,736）All 2027 figures are projections; CMS publishes official numbers in November (2026: Part B $202.90, Part A deductible $1,736)

2026 Medicare Trustees Report 表 V.E1、V.E2（预估）2026 Medicare Trustees Report tables V.E1 and V.E2 (projections)

各位朋友，这一页看「原始红蓝卡」的两个部分。先声明，2027 年的数字都是联邦精算报告的预估，正式数字 11 月中旬公布。

Friends, this slide covers the two parts of Original Medicare. All 2027 numbers here are projections from the federal Trustees Report; official figures come out in mid-November.

Part A 管住院，包括住院、出院后的专业护理院、还有临终关怀。交税满 40 个季度的，A 不用交保费。但是不交保费不等于住院全免：每次住院有一个免赔额，2027 年预估 $1,788，而且是每个「福利期」都要付一次，不是一年一次。住满 60 天以后，第 61 到 90 天每天自付 $447；再往后用的是一辈子只有 60 天的「终身储备日」，每天 $894。专业护理院第 21 到 100 天，每天 $223.50。

Part A covers hospital care: inpatient stays, skilled nursing after a hospital stay, and hospice. With 40 quarters of work, there's no Part A premium. But no premium doesn't mean free hospital care. Each stay has a deductible, projected at $1,788 for 2027, and you pay it once per benefit period, not once a year. After 60 days, days 61 to 90 cost $447 a day. Beyond that you draw on 60 lifetime reserve days at $894 a day. In a skilled nursing facility, days 21 to 100 cost $223.50 a day.

Part B 管门诊：看医生、化验、X 光、门诊手术，还有轮椅、拐杖这类医疗设备。B 是要交月费的，2027 年标准月费预估 $209.50，已经领社安金的直接从退休金里扣，没领的会收到账单。全年免赔额预估 $292。

Part B covers medical and outpatient care: doctor visits, lab tests, X-rays, outpatient surgery, and equipment like wheelchairs and walkers. Part B has a monthly premium, projected at $209.50 for 2027. If you collect Social Security it's deducted automatically; otherwise you get a bill. The projected annual deductible is $292.

收入高的朋友，B 和 D 的保费还要另外加收，叫 IRMAA。2027 年看的是您 2025 年的报税收入，具体分档 11 月公布；作为参考，2026 年是单身超过 $109,000、夫妻合报超过 $218,000 开始加收。退休后收入大降的，可以向社安局申请重新评估。

Higher-income people pay an extra charge on Parts B and D, called IRMAA. For 2027 it's based on your 2025 tax return income, with the brackets published in November. For reference, in 2026 it began above $109,000 for single filers and $218,000 for joint filers. If your income fell sharply after retiring, you can ask Social Security to reassess.

最关键的一句请记住：付完免赔额以后，B 的费用您要自付 20%，而且没有上限。比如一年门诊治疗花了 $50,000，20% 就是 $10,000，花得再多也没有封顶。这个缺口怎么补，就是下一页要讲的。

The key sentence to remember: after the deductible, you pay 20% of Part B costs, with no cap. If outpatient treatment costs $50,000 in a year, your 20% is $10,000, and there's no ceiling however high it goes. How to fill that gap is the next slide.

A/B 有缺口：两条路补齐Two ways to fill the A/B gap

Medigap 补充险Medigap (Medicare Supplement)

联邦标准化计划，用字母 A–N 区分Federally standardized plans, lettered A to N
补 B 的 20% 和住院自付（看计划）Covers the 20% and hospital costs, by plan
接受红蓝卡的医生，全国都能看See any doctor nationwide who takes Medicare
药品要另外买 D 计划Drugs need a separate Part D plan

Medicare Advantage（C 计划）Medicare Advantage (Part C)

私人公司替联邦承包 A/B，多数含 DA private plan replaces A/B, most include D
要在网络里看医生，出网贵Use the plan's network; out of network costs more
有年度自付上限Has a yearly out-of-pocket limit
各计划福利不同，要看说明书Benefits differ by plan; read the details

两条路只能二选一，不能同时要You choose one path, not both

Medigap 最好的时机：加入 B 后 6 个月内保证承保，不看健康Best time for Medigap: the 6 months after Part B starts, guaranteed issue, no health questions

CMS 2027 Medigap 高免赔额与 K/L 上限公告；加州 SB 407（生日规则）CMS 2027 Medigap high-deductible and K/L limits; California SB 407 (birthday rule)

各位朋友，上一页说了，原始红蓝卡留了一个缺口：B 的 20% 没有上限，住院还有免赔额。补这个缺口有两条路，而且只能二选一。

Friends, as we saw, Original Medicare leaves a gap: the 20% on Part B has no cap, and hospital stays have deductibles. There are two ways to fill it, and you pick one or the other.

第一条路，Medigap 补充险。您保留原始红蓝卡，再加一份补充险，专门补 A、B 留下的自付。它是联邦标准化的，用字母 A 到 N 区分，同一个字母在每家公司福利都一样，差的只是价格。比如 G 计划，除了 B 的免赔额，基本都补；N 计划便宜一些，但看门诊、急诊有少量共付。还有一种高免赔额的 G，2027 年的免赔额是 $3,050。它的好处是，只要医生接受红蓝卡，全国都能看；但药品要另外买一份 D 计划。

The first path is Medigap. You keep Original Medicare and add a supplement that pays the costs A and B leave behind. Plans are federally standardized and lettered A to N, and the same letter has the same benefits at every company; only the price differs. Plan G, for example, covers nearly everything except the Part B deductible. Plan N costs less but has small copays for office and ER visits. There's also a high-deductible Plan G, with a $3,050 deductible in 2027. The advantage: you can see any doctor in the country who accepts Medicare. But you need a separate Part D plan for drugs.

买 Medigap 时机非常重要。从 65 岁加入 B 的那个月起 6 个月内，保险公司必须接受您，不看健康、不能加价。过了这段时间，可能要回答健康问题。加州还有一个「生日规则」：每年从生日起至少 60 天，可以换成福利相同或更少的 Medigap，不看健康状况。

Timing matters a lot with Medigap. For 6 months starting the month your Part B begins at 65, insurers must accept you with no health questions and no extra charge. After that, you may have to answer health questions. California also has a birthday rule: every year, for at least 60 days starting on your birthday, you can switch to a Medigap plan with the same or fewer benefits without health questions.

第二条路，Medicare Advantage，也就是 C 计划。由私人保险公司替联邦承包您的 A 和 B，多数连 D 药品一起包。它要在网络里看医生，出网会贵；它有一个年度自付上限，帮您把 20% 的风险封住。每个计划的保费、网络、额外福利都不一样，要看那个计划的说明书。

The second path is Medicare Advantage, or Part C. A private insurer provides your A and B benefits, and most plans include drug coverage too. You use the plan's network, and going outside it costs more. It has a yearly out-of-pocket limit that caps your 20% risk. Premiums, networks and extra benefits differ by plan, so read that plan's documents.

怎么选，没有标准答案，看三件事：您习惯看的医生、每月预算、还有常不常出远门。今天是教育讲座，我们不推荐任何具体计划；想比较具体计划，可以上 Medicare.gov 的计划查询工具，或者另外约时间个别咨询。

There's no single right answer. Think about three things: the doctors you want to keep, your monthly budget, and how often you travel. This is an educational session, so we won't recommend any specific plan. To compare plans, use the plan finder on Medicare.gov, or set up a separate one-on-one consultation.

合规提醒Compliance

两条路都要讲优缺点，不偏向任何一边；不提任何 C 计划的名称、保费或附加福利。

Give pros and cons for both paths without favoring either; mention no Medicare Advantage plan names, premiums or extra benefits.

C 计划：私人公司承包的红蓝卡Part C: Medicare through a private plan

私人公司替联邦承包 A/B，多数连 D 药保一起包A private insurer provides A and B, usually with D included
Part B 月费照常要交You still pay your Part B premium
要在网络里看医生；搬到别的县可能要换计划Use the network; moving counties may mean a new plan
年度自付上限：2027 网络内法定最高 $9,8502027 legal maximum for in-network out-of-pocket: $9,850
不少服务要先申请「事先授权」Many services need prior authorization

$9,850 是法律允许的最高上限，各计划可以更低；附加福利、保费和网络各计划不同$9,850 is the legal ceiling; plans may set lower limits. Extra benefits, premiums and networks vary by plan

CMS CY2027 Part C 福利审查标准（经二手报道）；CMS-0057-F 事先授权规则CMS CY2027 Part C benefit review standards (secondary report); CMS-0057-F prior authorization rule

各位朋友，这一页把 C 计划再讲细一点。C 计划的本质，是私人保险公司替联邦政府承包您的红蓝卡：您的 A 和 B 福利改由这家公司来提供，大多数 C 计划还把 D 药品保险一起包在里面。

Friends, let's look more closely at Part C. At its core, a private insurer delivers your Medicare benefits on the government's behalf. Your A and B benefits come through that company, and most Part C plans include Part D drug coverage as well.

第一个要知道的：参加 C 计划，Part B 的月费还是照常要交，2027 年预估 $209.50。C 计划自己的保费有高有低，有的很低，但 B 的这一笔不会因此消失。

First: if you join a Part C plan, you still pay the Part B premium, projected at $209.50 for 2027. Part C plans have their own premiums, some quite low, but the Part B premium doesn't go away.

第二，C 计划有网络，跟奥巴马保险的 HMO、PPO 很像。出网看门诊，费用会高很多，HMO 型的甚至不给付。它通常按服务地区来卖，所以搬到另一个县，可能就得换计划。还有，不少检查和治疗要先申请「事先授权」，就是保险公司先审核同意才给付。按联邦规定，加急申请要在 72 小时内、一般申请要在 7 天内给答复，拒绝要说明理由。

Second, Part C plans have networks, much like Covered California HMOs and PPOs. Out-of-network visits cost much more, and HMO-type plans may not pay at all. Plans are sold by service area, so moving to another county may mean changing plans. Also, many tests and treatments require prior authorization, meaning the insurer must approve them first. Under federal rules, urgent requests must be decided within 72 hours and standard ones within 7 days, with reasons given for any denial.

第三，C 计划有一个原始红蓝卡没有的东西：年度自付上限。2027 年法律允许的网络内最高上限是 $9,850，很多计划会定得更低。也就是说，最坏的一年，网络内的医疗自付有个底。注意这个上限不包括药费。

Third, Part C has something Original Medicare doesn't: a yearly out-of-pocket limit. For 2027 the legal maximum for in-network care is $9,850, and many plans set it lower. So in your worst year, in-network medical costs have a ceiling. Note that this limit doesn't include drug costs.

很多 C 计划还会附带牙科、视力这类额外福利，但每个计划给的都不一样，要以该计划的福利说明为准。C 计划买了以后，每年 10 月 15 日到 12 月 7 日可以换，已经在 C 计划的人 1 月到 3 月还能再换一次，下一页的日期里会讲。今天是教育讲座，我们不讨论任何具体计划。

Many Part C plans also include extras such as dental or vision, but these vary from plan to plan, so go by that plan's benefit documents. Once you're in a Part C plan, you can switch each year between October 15 and December 7, and people already in Part C get one more chance from January to March. We'll cover those dates shortly. As this is an educational session, we won't discuss any specific plan.

合规提醒Compliance

不说「$0 保费」「送牙科眼镜」这类具体卖点；只讲一般规则，具体计划请对方另约时间或查 Medicare.gov。

Avoid selling points like "$0 premium" or "free dental and glasses"; explain general rules only and direct plan questions to a separate appointment or Medicare.gov.

D 计划：2027 年变化最大Part D: the biggest changes in 2027

全年药费自付上限Annual drug out-of-pocket cap$2,400封顶后当年 $0
（已定）Then $0 for the year
(final)

免赔额最高Maximum deductible$700有的计划更低
（已定）Some plans less
(final)

胰岛素每月最多Insulin, per month$35不用先付免赔额No deductible first

推荐的成人疫苗Recommended adult vaccines$0如带状疱疹疫苗Such as shingles

2027 年 1 月 1 日起，再有 15 种谈判药降价，累计 25 种From Jan 1, 2027, 15 more negotiated drugs get lower prices, 25 in all

谈判价是红蓝卡付给药厂的价格；您实际自付多少，仍看所选计划的设计Negotiated prices are what Medicare pays drugmakers; your copay still depends on your plan

CMS 2027 Rate Announcement 表 V-2；CMS 2027 谈判药价公告；2026-07-28 Part D 公告CMS 2027 Rate Announcement table V-2; CMS 2027 negotiated price fact sheet; July 28, 2026 Part D announcement

各位朋友，D 计划管的是门诊吃的处方药。它可以单独买，配原始红蓝卡或 Medigap 用；也可以包在 C 计划里面。这一页的数字都是联邦已经定案的 2027 年数字。

Friends, Part D covers prescription drugs. You can buy it on its own alongside Original Medicare or Medigap, or get it inside a Part C plan. The figures on this slide are final for 2027.

最重要的是 $2,400。一年当中，您自己付的药费一旦累计到 $2,400，当年剩下的时间药费自付就是零。2026 年是 $2,100，2027 年调到 $2,400。免赔额最高 $700，有的计划更低；付完免赔额以后，一般自付 25%，一直到 $2,400 封顶。胰岛素每个月最多 $35，不用先付免赔额；推荐的成人疫苗，像带状疱疹疫苗，$0。如果一下子付 $2,400 压力大，所有 D 计划都可以申请按月分摊，不收利息、不收手续费。

The most important number is $2,400. Once what you pay for drugs in a year reaches $2,400, you pay nothing more for covered drugs for the rest of the year. It was $2,100 in 2026. The deductible is at most $700, and some plans charge less. After the deductible you generally pay 25% until you reach the $2,400 cap. Insulin is at most $35 a month with no deductible, and recommended adult vaccines such as shingles are $0. If paying $2,400 at once is hard, every Part D plan lets you spread costs across the year with no interest or fees.

第二个好消息是谈判药。从 2027 年 1 月 1 日起，又有 15 种药换成联邦谈判后的价格，加上 2026 年那 10 种，一共 25 种。举几个例子，30 天的价格：糖尿病常用的 Ozempic 从 $959 降到 $274；Janumet 从 $526 降到 $80；哮喘和慢阻肺用的 Breo Ellipta 从 $397 降到 $67。要说清楚，这是红蓝卡付给药厂的价格，您到药房实际付多少，还要看您计划的共付设计。

The second piece of good news is negotiated drugs. Starting January 1, 2027, 15 more drugs move to federally negotiated prices, joining the 10 from 2026 for 25 in total. Some 30-day examples: Ozempic, often used for diabetes, drops from $959 to $274; Janumet from $526 to $80; Breo Ellipta, for asthma and COPD, from $397 to $67. To be clear, these are prices Medicare pays the drugmaker. What you pay at the pharmacy still depends on your plan's copay design.

也有要小心的地方。联邦这两年用来稳住单独药保保费的一个示范项目，2026 年底结束，所以 2027 年有些单独 D 计划的保费可能涨得比较多。另外，65 岁时如果连续 63 天以上没有合格的药品保险，以后加入 D 要终身多交罚金：每晚一个月加 1%，按 2027 年基数 $41.33 算，晚一年大约每月多 $5。

There are also things to watch. A federal demonstration that held down stand-alone drug plan premiums ends after 2026, so some stand-alone Part D premiums may rise more in 2027. Also, if you go 63 days or more without qualifying drug coverage after you become eligible, you'll pay a lifelong late penalty when you join Part D: 1% for each month late, based on the 2027 base of $41.33, or about $5 more a month for a year's delay.

所以 D 计划有一个习惯一定要养成：每年 10 月 15 日到 12 月 7 日，拿着自己的药单重新比较一次，因为每个计划的药品清单和价格年年都在变。收入低的朋友还可以申请「额外补助」Extra Help，有白卡的人自动符合，2027 年仿制药每次最多 $5.80。

So build one habit: every year between October 15 and December 7, compare plans again with your own drug list, because each plan's covered drugs and prices change every year. Lower-income people can apply for Extra Help, and anyone on Medi-Cal qualifies automatically; in 2027 generics cost at most $5.80 each.

65 岁还在工作？先问三件事Working at 65? Ask three questions

01

公司规模够大吗？Is the employer big enough?

在职团保、公司 ≥20 人，可延后 B 不罚；不到 20 人要按时加入 A/B。Active job coverage at 20+ employees: delay B with no penalty. Under 20: enroll in A and B on time.

02

还在往 HSA 存钱吗？Still funding an HSA?

加入任何一部分红蓝卡（包括只有 A）就不能再存；A 最多追溯 6 个月。Any part of Medicare, even A alone, ends contributions. Part A can be backdated up to 6 months.

03

公司保险到底好不好？Is the job's plan actually good?

员工自付很高的计划，有时红蓝卡组合更划算。If you pay most of the cost, a Medicare combination may cost less.

65 岁仍在工作的人在办公室 / A 65-year-old still at work in an office

延后的人要留好雇主的「可信保险」证明；离职或团保结束后 8 个月内加入 BIf you delay, keep proof of creditable coverage; enroll in B within 8 months after the job or coverage ends

Medicare.gov「Working past 65」「Avoid penalties」；SSA EN-05-10012Medicare.gov "Working past 65" and "Avoid penalties"; SSA EN-05-10012

各位朋友，现在很多人 65 岁还在上班，这时候红蓝卡要不要马上加入？先问自己三件事。

Friends, many people are still working at 65. Should you sign up for Medicare right away? Ask yourself three questions.

第一，公司规模够大吗？ 如果是您本人或配偶在职的公司团保，而且公司有 20 人或以上，团保是第一付款人，您可以先不加入 B，以后再加，不会被罚。但如果公司不到 20 人，红蓝卡就变成第一付款人，您不加入 B 的话，团保可能大部分都不赔。所以小公司的朋友，到了 65 岁请按时加入 A 和 B。

First, is the employer big enough? If the group coverage comes from your own or your spouse's current job and the employer has 20 or more employees, the group plan pays first. You can hold off on Part B and join later without a penalty. But if the employer has fewer than 20 employees, Medicare pays first, and if you skip Part B the group plan may refuse most claims. So if you work for a small company, please enroll in A and B on time at 65.

第二，还在往 HSA 健康储蓄账户存钱吗？ 一旦加入红蓝卡的任何一部分，包括只有免费的 A，就不能再往 HSA 存钱。还有一个细节：65 岁以后才申请的话，A 最多可以往前追溯 6 个月，所以最好在申请前 6 个月就停止存入。已经在领社安金的人会自动有 A，也要注意。税务上的细节请咨询您的税务师。

Second, are you still contributing to an HSA? Once you're enrolled in any part of Medicare, even premium-free Part A alone, you can't contribute to an HSA. One more detail: if you apply after 65, Part A can be backdated up to 6 months, so it's best to stop contributions 6 months before you apply. If you collect Social Security, you get Part A automatically, so keep that in mind too. For tax details, please talk to your tax professional.

第三，公司保险到底好不好？ 有的公司计划员工要自己付大部分保费，免赔额也高。这种情况下，算一算红蓝卡加补充险或其他组合，有时候反而更划算。不要默认「有公司保险就一定更好」。

Third, is your employer plan actually good? Some plans make employees pay most of the premium and carry a high deductible. In that case, Medicare plus a supplement or another combination can sometimes cost less. Don't assume employer coverage is always better.

选择延后的朋友，请记住两件事：一是向雇主拿好「可信保险」的证明，药品保险也一样，以后加入时用得上。二是工作结束或团保结束，以先到的为准，8 个月内要加入 B。特别提醒：离职后的 COBRA 和退休人员团保，都不算在职团保，不能拿来延后。

If you delay, remember two things. First, get written proof of creditable coverage from your employer, including for drugs; you'll need it when you enroll. Second, enroll in Part B within 8 months after your job or your group coverage ends, whichever comes first. Note that COBRA and retiree coverage do not count as coverage from current work, so they can't be used to delay.

红蓝卡的几个关键日期Key Medicare dates

满 65 岁前后 7 个月7 months around 65初次加入期：生日月的前 3 个月、当月、后 3 个月Initial enrollment: 3 months before, your birthday month, 3 months after 每年 1/1–3/31Jan 1–Mar 31 each year一般加入期：错过初次加入、又没有特殊加入期的人补办General enrollment, if you missed your first window without a special one 离职或团保结束后 8 个月8 months after work or coverage ends特殊加入期：在职团保延后的人加入 B 不罚Special enrollment: join B with no penalty after delaying 加入 B 起 6 个月6 months from Part B startMedigap 开放期：保证承保，不看健康Medigap open enrollment: guaranteed, no health questions 每年 10/15–12/7Oct 15–Dec 7 each year年度选择期：换 C 计划或 D 计划，1 月 1 日生效Annual enrollment: change Part C or D, effective Jan 1 每年 1/1–3/31Jan 1–Mar 31 each yearC 计划开放期：已在 C 计划的人可以再换一次Medicare Advantage open enrollment: one change if already in Part C

错过时间加入 B：每晚 12 个月，月费终身多 10%（按 2027 预估约多 $20.95/月）Late for Part B: 10% more for each 12 months late, usually for life (about $20.95/mo on the 2027 projection)

Medicare.gov；CMS 2027 MA/Part D 公告；2026 Trustees Report（预估）Medicare.gov; CMS 2027 MA/Part D announcement; 2026 Trustees Report (projection)

各位朋友，红蓝卡最怕的不是选错计划，而是错过时间，因为有些罚金是终身的。这一页的日期，请大家拍下来，家里有快 65 岁的长辈，也转给他们看。

Friends, with Medicare the biggest risk isn't picking the wrong plan. It's missing a deadline, because some penalties last for life. Please take a photo of these dates and share them with any relatives turning 65.

第一个是初次加入期，一共 7 个月：65 岁生日那个月的前 3 个月、当月、再加后 3 个月。大部分人应该在这段时间办好。错过了，又没有特殊情况，就只能等每年 1 月 1 日到 3 月 31 日的一般加入期去补办，而且可能已经产生罚金。

First is the initial enrollment period, seven months in all: the three months before your 65th birthday month, the birthday month itself, and the three months after. Most people should sign up then. If you miss it and have no special situation, you have to use the general enrollment period from January 1 to March 31, and a penalty may already apply.

第二个是特殊加入期，就是上一页讲的：在职团保延后的人，工作或团保结束后 8 个月内加入 B，不罚。第三个是 Medigap 开放期：加入 B 起 6 个月内，保险公司不能看健康拒保或加价。

Second, the special enrollment period from the last slide: if you delayed because of coverage from current work, join Part B within 8 months after the job or coverage ends, with no penalty. Third, the Medigap open enrollment period: for 6 months from the start of your Part B, insurers can't turn you down or charge more because of your health.

每年都有的是这两个：10 月 15 日到 12 月 7 日是年度选择期，可以换 C 计划、换 D 计划，或者回到原始红蓝卡，1 月 1 日生效。1 月 1 日到 3 月 31 日是 C 计划开放期，只限已经在 C 计划的人，可以再换一次。请注意，这跟奥巴马保险的 11 月 1 日到 1 月 31 日是两套时间，不要搞混。

Two dates come every year. October 15 to December 7 is the annual enrollment period: you can change your Part C or Part D plan, or return to Original Medicare, effective January 1. January 1 to March 31 is the Medicare Advantage open enrollment period, only for people already in Part C, who get one more change. Note this is a different calendar from Covered California's November 1 to January 31, so don't mix them up.

最后说罚金。没有特殊加入期却晚加入 B，每晚 12 个月，月费多 10%，通常是终身的。按 2027 年预估的 $209.50 算，晚一年每个月就多 $20.95，一辈子都要付。所以宁可早点问清楚，也不要拖。

Finally, penalties. Join Part B late without a special enrollment period and your premium goes up 10% for each full 12 months you waited, usually for life. On the projected 2027 premium of $209.50, one year late means $20.95 more every month for the rest of your life. It's far better to ask early than to wait.

互动设计Interaction

请大家想一想：家里谁在未来一年满 65 岁？把生日月写在讲义上，往前数 3 个月就是该开始办的时间。

Ask: who in your family turns 65 within the next year? Write down the birthday month and count back three months to find when to start.

最常被问的五个问题Five questions we hear most

Q1

没有身份能参保吗？Can I get coverage without legal status?

Covered California 要合法身份，补贴 2027 起只给绿卡等少数身份；场外有不带补贴的私人保险。Covered California requires lawful presence, and from 2027 subsidies go to green card holders and a few others. Unsubsidized private plans exist outside it.

Q2

孩子能单独上白卡吗？Can my kids get Medi-Cal on their own?

可以。孩子的收入线是 266% 贫困线，比大人高得多，大人超标不影响孩子。Yes. The children's line is 266% FPL, far above the adult line, so parents over the limit don't affect the kids.

Q3

有公司保险还买奥巴马吗？I have job coverage. Should I buy Covered California?

本人那一份不超过收入 10.22% 就拿不到补贴，通常公司保险更划算。If your own share costs no more than 10.22% of income, you get no subsidy, so the job plan usually wins.

Q4

C 计划买了还能换吗？Can I change my Part C plan?

每年 10/15–12/7 可换；1–3 月可再换一次；搬家等事件也能换。Yes, each Oct 15–Dec 7, once more from Jan to Mar, and after events like moving.

Q5

错过开放期怎么办？What if I missed open enrollment?

看有没有结婚、生子、搬家等特殊事件，60 天内可办；白卡全年都能申请。A life event such as marriage, a birth or a move gives you 60 days. Medi-Cal takes applications year-round.

H.R.1 §71301；Rev. Proc. 2026-26（10.22%）；Covered California 2027 FPL 表H.R.1 §71301; Rev. Proc. 2026-26 (10.22%); Covered California 2027 FPL chart

各位朋友，这五个问题是我们每次讲座后被问得最多的，我一个一个回答。第一，没有身份能参保吗？ 在 Covered California 里买保险，需要合法身份。而且从 2027 年 1 月 1 日起，补贴只给绿卡持有人、古巴和海地入境者、COFA 身份这几类，难民、庇护、TPS、工作和学生签证都不再有补贴。市场外还有不带补贴的私人保险可以买。另外，19 岁以下的孩子，不论身份，都可以申请全额白卡。涉及身份的问题，请先咨询移民律师。

Friends, these are the five questions we hear most after every seminar. First, can you get coverage without legal status? Buying through Covered California requires lawful presence. And from January 1, 2027, subsidies go only to green card holders, Cuban and Haitian entrants and COFA migrants; refugees, asylees, TPS holders and people on work or student visas no longer get them. Outside the exchange you can still buy private plans without a subsidy. Children under 19 can get full Medi-Cal regardless of status. For any status question, please talk to an immigration attorney first.

第二，孩子能单独上白卡吗？ 可以。孩子的白卡收入线是 266% 贫困线，四口之家大约 $87,780，比大人的 138% 高得多。所以常见的情况是：大人买奥巴马保险，孩子走白卡，一张申请表一起办。

Second, can children get Medi-Cal on their own? Yes. The children's line is 266% of the poverty line, about $87,780 for a family of four, far above the adult line of 138%. A common setup is parents on Covered California and kids on Medi-Cal, all through one application.

第三，有公司保险还要买奥巴马吗？ 关键看「负担得起」的标准：2027 年，公司保险员工本人那一份的保费不超过家庭收入的 10.22%，就算负担得起，您本人就拿不到补贴。这种情况通常公司保险更划算。家属那一份是按家庭档的保费来算的，如果特别贵，家属可能另外有补贴资格，值得算一下。

Third, if you have job coverage, should you buy Covered California? It comes down to affordability. In 2027, if your own employee-only premium is no more than 10.22% of household income, it's considered affordable and you can't get a subsidy. Usually the job plan is the better deal. For family members, the test uses the cost of family coverage, so if that's very expensive they may qualify for help. It's worth checking.

第四，C 计划买了还能换吗？ 能。每年 10 月 15 日到 12 月 7 日可以换；已经在 C 计划的人，1 月 1 日到 3 月 31 日还可以再换一次；搬家等特殊情况也会给您换的机会。

Fourth, can you change a Part C plan? Yes. You can switch every year from October 15 to December 7. People already in Part C get one more change from January 1 to March 31, and events like moving also give you a chance to switch.

第五，错过开放期怎么办？ 先看这一年有没有结婚、生孩子、搬家、失去保险、拿到绿卡这些特殊事件，有的话 60 天内可以办。没有的话就等下一轮开放期。不过白卡没有开放期，全年都能申请。

Fifth, what if you missed open enrollment? First check whether you had a qualifying event this year, such as marriage, a new baby, a move, losing coverage or getting a green card. If so, you have 60 days to enroll. If not, you wait for the next open enrollment. Medi-Cal, though, has no season and accepts applications all year.

节奏提示Pacing

这一页可以改成开放问答：先请台下提问，被问到哪一题就讲哪一题，剩下的快速带过。

Run this as open Q&A: take questions from the floor, answer the matching card, and move quickly through the rest.

Team Rise 能帮您做什么How Team Rise can help

免费帮您看：白卡、奥巴马保险、红蓝卡，哪条路适合您家A free look at Medi-Cal, Covered California and Medicare for your family
一张表看全家：每个人走哪张卡、大约多少钱One page for the whole family: who goes where, roughly what it costs
每年开放期前提醒您，重新比较一次A reminder before each open enrollment to compare again
通过持证经纪人投保，保费与自己直接投保相同Enrolling through a licensed agent costs the same as enrolling directly

顾问在一家人的餐桌旁讲解 / An advisor talking with a family at their dining table

本讲座为一般信息，不构成法律、税务或移民建议；数字为 2027 年官方、初步或预估数字，以官方公布为准General information only, not legal, tax or immigration advice. Figures are 2027 official, preliminary or projected numbers; official publications govern

各位朋友，今天讲了很多数字和规则，大家不用全部记住。最后我说一下 Team Rise 可以帮您做些什么，要不要找我们，完全由您决定。

Friends, we've covered a lot of numbers and rules today, and you don't need to remember them all. To close, here's what Team Rise can help with. Whether you reach out is entirely up to you.

第一，免费帮您看方向。您家里有几口人、几岁、收入大概多少、有没有公司保险、有没有快 65 岁的长辈，我们帮您看看白卡、奥巴马保险、红蓝卡，各自适合走哪一条路。符合白卡条件的，我们也可以协助申请，白卡本身不收任何费用。

First, a free look at your options. Tell us how many people are in your household, their ages, your rough income, whether you have job coverage, and whether anyone is close to 65. We'll look at which of Medi-Cal, Covered California and Medicare fits each person. If someone qualifies for Medi-Cal, we can help with the application, and Medi-Cal itself costs nothing to apply for.

第二，一张表看全家。很多家庭是三种卡混在一起：孩子白卡、大人奥巴马、父母红蓝卡。我们帮您整理成一张表，谁走哪张卡、大约多少钱、什么时候要续约，一目了然。第三，每年开放期前提醒您，因为价格、公司和规则年年在变，今天讲的 2027 年变化就是例子。

Second, one page for the whole family. Many households mix all three: kids on Medi-Cal, parents on Covered California, grandparents on Medicare. We'll put it on one page so you can see who has what, roughly what it costs and when each renewal is due. Third, a reminder before each open enrollment, because prices, carriers and rules change every year, as today's 2027 changes show.

大家常问：找经纪人要不要另外付钱？通过持证经纪人投保，保费和您自己直接投保是一样的。我们能做的是帮您看清选项、把数字算明白，至于补贴多少、能不能获批，最终以政府和保险公司的审核为准，我们不能替您保证结果。

People often ask whether using an agent costs extra. Enrolling through a licensed agent, your premium is the same as enrolling on your own. What we can do is help you see your options and work through the numbers. Subsidy amounts and approvals are decided by the government and the insurers, so we can't guarantee any outcome for you.

最后提醒一下，今天的内容是一般信息，不构成法律、税务或移民建议；2027 年的数字有正式的、初步的和预估的，以官方公布为准。关于红蓝卡的具体计划，按联邦规定今天不在现场讨论，如果需要，可以另外约时间。谢谢各位！

One last reminder: today's content is general information, not legal, tax or immigration advice. The 2027 figures include official, preliminary and projected numbers, and official publications govern. Under federal rules we don't discuss specific Medicare plans here today; if you'd like to, we can set up a separate time. Thank you all!

合规提醒Compliance

不催促、不承诺补贴或结果；红蓝卡计划咨询须另约，并按规定先签「预约范围」（Scope of Appointment）、只谈客户勾选的产品。

No pressure and no promises about subsidies or outcomes. Medicare plan consultations need a separate appointment with a signed Scope of Appointment, and covers only the products the client checks.

项目Program	2027 年的变化What changes in 2027
奥巴马保险Covered California	收入超过贫困线 400%（单人 $63,840、四口之家 $132,000）补贴归零；全州保费平均涨 9.9%（初步）No subsidy above 400% of poverty ($63,840 single, $132,000 for four); premiums up 9.9% statewide on average (preliminary)
白卡Medi-Cal	19–64 岁扩展成人 1 月起有工作要求；续保改为半年审查Work rules for expansion adults 19–64 from January; renewals every six months
红蓝卡Medicare	药费全年自付封顶 $2,400；15 种谈判药 1 月 1 日起用新价格Drug costs capped at $2,400 a year; 15 negotiated drugs take new prices January 1
身份Status	补贴和红蓝卡主要只剩公民、绿卡、古巴/海地入境者和 COFA 身份符合Subsidies and Medicare narrow mainly to citizens, green-card holders, Cuban/Haitian entrants and COFA residents

您家的情况Your situation	多半走哪条路Most likely path
65 岁以下，收入 ≤ 贫困线 138%（单人约 $22,025，四口之家约 $45,540）Under 65, income ≤ 138% of poverty (about $22,025 single, $45,540 for four)	白卡Medi-Cal
孩子 0–18 岁，收入 ≤ 266%（四口之家约 $87,780）Children 0–18, income ≤ 266% (about $87,780 for four)	孩子走白卡Children on Medi-Cal
有合法身份、高于白卡线、没有公司保险Legal status, above Medi-Cal limits, no job coverage	奥巴马保险Covered California
公司保险员工只保自己的月费 ≤ 家庭收入 10.22%Employee-only job coverage costs ≤ 10.22% of household income	一般留在公司团保Usually stay on the job plan
满 65 岁，或领社安残障金满 24 个月65+, or on Social Security disability for 24 months	红蓝卡Medicare

	$63,000（约 395%）$63,000 (about 395%)	$65,000（约 407%）$65,000 (about 407%)
补贴Subsidy	$585.03	约 $1，等于没有About $1, effectively none
最便宜铜级Cheapest Bronze	$259.58	$843.61
最便宜银级Cheapest Silver	$365.63	$949.66
铜级一年Bronze, full year	≈ $3,115	≈ $10,123

四口之家（40、40、10、8 岁）Family of four (40, 40, 10, 8)	年收入 $100,000$100,000 income	年收入 $200,000$200,000 income
占贫困线Share of poverty line	约 303%About 303%	约 606%About 606%
每月补贴Monthly subsidy	$743.45	约 $4，等于没有About $4, effectively none
最便宜铜级（月）Cheapest Bronze (monthly)	$457.77	$1,197.22

计划（个人）Plan (individual)	免赔额 2026 → 2027Deductible 2026 → 2027	自付上限 2026 → 2027OOP max 2026 → 2027
铜级 60Bronze 60	$5,800 → $5,800	$9,800 → $11,650
银级 70Silver 70	$5,200 → $4,700	$9,800 → $11,650
银级 73Silver 73	$5,200 → $4,700	$8,100 → $9,600
银级 87Silver 87	$1,400 → $1,100	$3,350 → $4,000
银级 94Silver 94	$0 → $200	$1,400 → $3,000
金级 80Gold 80	$0 → $0	$9,200 → $9,600
白金 90Platinum 90	$0 → $0	$5,000 → $5,500

等级Tier	保险平均承担Plan pays on avg.	医疗免赔额Deductible	个人自付上限Individual OOP max	示例月费Example premium
铜级Bronze	60%	$5,800	$11,650	$346.05
银级 70Silver 70	70%	$4,700	$11,650	$468.04
金级Gold	80%	$0	$9,600	$616.25
白金Platinum	90%	$0	$5,500	$710.23

计划Plan	单人年收入Single income	免赔额Deductible	自付上限OOP max
Silver 94	≤ $23,940 (100%–150%)	$200	$3,000
Silver 87	$23,941–$31,920 (150%–200%)	$1,100	$4,000
Silver 73	$31,921–$39,900 (200%–250%)	$4,700	$9,600

日期Date	发生什么What happens
2026 年 10 月 1 日Oct 1, 2026	续约开放，可以比较明年的计划Renewals open; compare next year's plans
11 月 1 日Nov 1	公开参保开始，新人可以加入Open enrollment begins for new members
12 月 31 日Dec 31	最晚这天办好，1 月 1 日生效Enroll by now for January 1 coverage
2027 年 1 月 31 日Jan 31, 2027	本轮最后一天，2 月 1 日生效Last day; coverage starts February 1
人生大事后 60 天内Within 60 days of a life event	特殊投保：结婚、生子、失去保险、搬家、拿到绿卡Special enrollment: marriage, a birth, lost coverage, a move, a green card
全年All year	白卡随时可以申请Medi-Cal applications any time

项目Item	2027 预估2027 projected
A 住院免赔额（每个福利期）Part A deductible (per benefit period)	$1,788
A 第 61–90 天（每天）Part A days 61–90 (per day)	$447
B 标准月保费Part B standard premium	$209.50
B 全年免赔额Part B annual deductible	$292

时间When	是什么What it is
满 65 岁前后 7 个月7 months around turning 65	初次加入期：生日月前 3 个月、当月、后 3 个月Initial enrollment: 3 months before the birthday month, that month, 3 months after
每年 1/1–3/31Jan 1–Mar 31	一般加入期：错过初次加入的人补办General enrollment for those who missed initial enrollment
离职或团保结束后 8 个月8 months after work or coverage ends	特殊加入期：加入 B 不罚Special enrollment: join Part B without penalty
加入 B 起 6 个月6 months from Part B start	Medigap 开放期：保证承保Medigap open enrollment: guaranteed acceptance
每年 10/15–12/7Oct 15–Dec 7	年度选择期：换 C 或 D 计划，1 月 1 日生效Annual election period: change Part C or D, effective January 1
每年 1/1–3/31Jan 1–Mar 31	C 计划开放期：已在 C 计划的人可再换一次Medicare Advantage open enrollment: current members can switch once

The 2027 Health Coverage Seminar

2027 医疗保险怎么选Choosing Health Coverage for 2027

今天只回答三个问题Three Questions for Today

我家该走哪张卡？Which program fits my family?

2027 年变了什么？What changes in 2027?

怎么选才不吃亏？How do I choose well?

为什么说 2027 是规则大变的一年Why 2027 Is a Year of Big Changes

先找到您家属于哪一张卡Find Your Family's Path

白卡 Medi-CalMedi-Cal

谁能拿白卡：先看收入Who Qualifies: Income First

白卡包哪些服务What Medi-Cal Covers

看病Doctor visits

住院和急诊Hospital & ER

吃药Prescriptions

牙科Dental

眼科Vision

心理与儿保Mental health & kids

2027 年白卡：审查越来越严Medi-Cal in 2027: Stricter Checks

关于白卡的三个误会Three Myths About Medi-Cal

误会一：白卡跟绿卡无关Myth 1: Medi-Cal never affects a green card

误会二：看完病要还钱Myth 2: You must pay it all back

误会三：存款多就申不到Myth 3: Savings disqualify you

三种方式申请白卡Three Ways to Apply

在线申请Online

打电话By phone

找人帮忙In person

奥巴马保险 Covered CaliforniaCovered California

奥巴马保险是什么What Is Covered California?

这四类人最该看奥巴马保险Four Groups Who Should Look Closely

自雇人士Self-employed

提前退休的人Early retirees

新移民家庭New immigrant families

兼职和学生Part-timers & students

政府怎么帮您交保费：补贴原理How the Premium Subsidy Works

400% 悬崖：多赚 $2,000，多交 $7,000The 400% Cliff: Earn $2,000 More, Pay $7,000 More

年收入 $63,000（约 395%）Income $63,000 (about 395%)

年收入 $65,000（约 407%）Income $65,000 (about 407%)

铜银金白金：四个等级怎么挑Bronze to Platinum: Picking a Tier

Silver 94 / 87 / 73：省钱暗器Silver 94 / 87 / 73: The Hidden Savings

Silver 94Silver 94

Silver 87Silver 87

Silver 73Silver 73

2027 年的保障：有进有退2027 Benefits: Some Better, Some Worse

真实报价：收入不同差多少Real quotes: same family, two incomes

例一：年收入 $100,000Example 1: $100,000 a year

例二：年收入 $200,000Example 2: $200,000 a year

HMO 还是 PPOHMO or PPO?

HMO：便宜，但要守规矩HMO: cheaper, with rules

PPO：灵活，但要多付钱PPO: flexible, at a price

南加州 2027 有哪些保险公司Southern California carriers in 2027

看懂账单：四个名词Reading a bill: four terms

自付额 DeductibleDeductible

共付额 CopayCopay

共保 CoinsuranceCoinsurance

自付上限 OOP MaxOut-of-pocket max

2027 参保：记住这几个日期2027 enrollment: key dates

三个最常见的坑，别再踩了Three common mistakes to avoid

收入估错Guessing income wrong

生活变了没更新Not reporting changes

每年自动续约，从不比价Auto-renewing without shopping

红蓝卡 MedicareMedicare

红蓝卡：满 65 岁的联邦医疗保险Medicare: federal coverage at 65

哪些人有资格领红蓝卡Who qualifies for Medicare

原始红蓝卡：A 管住院，B 管门诊Original Medicare: A and B

Part A 住院保险Part A: hospital

Part B 门诊保险Part B: medical

A/B 有缺口：两条路补齐Two ways to fill the A/B gap

Medigap 补充险Medigap (Medicare Supplement)

Medicare Advantage（C 计划）Medicare Advantage (Part C)

C 计划：私人公司承包的红蓝卡Part C: Medicare through a private plan

D 计划：2027 年变化最大Part D: the biggest changes in 2027

65 岁还在工作？先问三件事Working at 65? Ask three questions

公司规模够大吗？Is the employer big enough?

还在往 HSA 存钱吗？Still funding an HSA?

公司保险到底好不好？Is the job's plan actually good?

红蓝卡的几个关键日期Key Medicare dates

最常被问的五个问题Five questions we hear most

没有身份能参保吗？Can I get coverage without legal status?

孩子能单独上白卡吗？Can my kids get Medi-Cal on their own?