Ukuba untsha kwi- inshurensi yezempilo , uqonda ukuba kufuneka uhlawule njani kwiindleko zeendleko zakho zonyango, xa kufuneka uhlawule, kwaye ingaba itekiti yakho yezempilo iyakuthatha ngayo inokudideka.
Iinshurensi zempilo ze-inshurensi kunye neentlawulo zentlawulo zombini zintlobo zombini yokwabelana ngeendleko , okubhekiselele kwindlela iindlela zeenkampani zomshuwalense zezempilo ezihlula ngayo iindleko zempilo yakho.
Ngoko, yintoni umehluko phakathi kwe-deductible kunye ne-copayment? Ahluke xa ufanele uhlawule, unjani ukuhlawula, kwaye yintoni esele isisele kwisicwangciso sakho sezempilo ukuhlawula.
Iyintoni i-inshurensi yempilo echithwayo?
I-deductible yinani elimisiweyo ohlawula ngamnye unyaka ngaphambi kokuba i-inshorensi yempilo ikhatywe ngokupheleleyo. Emva kokuba uhlawule imali yakho, isicwangciso sakho sezempilo siqala ukuqokelela isabelo salo sezempilo. Nantsi indlela esebenza ngayo.
Masithi isicwangciso sakho sinemali engama-2,000 e-deductible, kwaye sibala zonke iinkonzo ezingenakukhusela ukuya kutshatyalaliswa kude zidibene. Ufumana umkhuhlane ngoJanuwari uze ubone ugqirha wakho. Ibhilikhi yegqirha i-$ 200 (emva kwesaphulelo sesicwangciso sakho sempilo). Unembopheleleko yebhilikhi yonke kuba awuzange uyihlawule imali enokukhatyulwa kulo nyaka. Emva kokuhlawula i-bill ye-$ 200 ye-bill, unayo i-$ 1,800 ehambayo ukuya kwi-deductible yakho ngonyaka.
Ngo-Matshi, uyawa kwaye uphule ingalo yakho. Umthetho osayilwayo emva kwesaphulelo sakho sezocwangciso zezempilo is $ 3,000.
Uhlawula i-$ 1,800 yebhilikhwe phambi kokuba udibene ne-deductible yakho ye-$ 2,000 ngonyaka. Ngoku, i-inshorensi yakho yezempilo iyakkhahlela kwaye inokukunceda ukuhlawula yonke ibhajethi.
Ngo-Apreli, usususwe ukukhutshwa kwakho. Umthetho-mali u-$ 500. Ekubeni sele sele udibene ne-deductible yakho yonyaka, akufanele uhlawule nayiphi na into echithwayo.
Intsholongwane yakho yempilo ihlawula isabelo sayo esigcwele kule bhili-mali.
Nangona kunjalo, oku akuthethi ukuba i-inshorensi yakho yempilo iya kuhlawula yonke ibhajethi kwaye awuyi kuhlawula nayiphi na into. Nangona ufezekile ukuhlawula i-deductible yakho kunyaka, unokwakhokhelwa i-copayment okanye i- coinsurance , de ube udibene nesicwangciso sakho esiphezulu se-pocket ngonyaka.
Ngaphantsi kwe-ACA, ngowama-2018, zonke izicwangciso ezingenakulinganisekanga, kufuneka zikhuphe iindleko ze-pocket ezingekho ngaphaya kwamaRandi 7,350 kumntu oyedwa kunye ne-14,700 zamawaka kwintsapho. Uninzi lwezicwangciso zezempilo zibhalisa iindleko ze-out-of-pocket kwiindleko ezingezantsi kwezi mida, kodwa azikwazi ukudlula.
Umda we-out-of-pocket usebenza kuzo zonke iinkonzo zokunakekelwa kwenethiwekhi ezithathwa njengenzuzo yempilo ebalulekileyo . Iquka iimali ezibhalisa ukuhlawula i-deductible, i-copays kunye ne-coinsurance; xa ixabiso elidibeneyo lifikelela kwisicwangciso esiphezulu sophotho, ilungu aliyi kuhlawulwa nayiphi na into kulo lonke unyaka (kwi-inethiwekhi, ukunakekelwa kweemfuno ezinonyango olubhekiselwe kuncedo lwezempilo), kungakhathaliseki ukuba mhlawumbi kwakufuneka i-copay okanye i-coinsurance.
Yiyiphi i-inshurensi yempilo yesikhokhelo?
I-copayment yintlawulo echanekileyo oyihlawulayo xa ufumana uhlobo oluthile lwenkonzo yonakekelo yezempilo.
Nantsi indlela esebenza ngayo.
Masithi impilo yakho yinshurensi idinga ikhoyayari ye-$ 30 rhoqo xa ubona ugqirha wakho wokunyamekela , i-$ 50 rhoqo xa ubona ugqirha wezodwa, kunye ne-$ 20 ngeli xesha ugcwalisa umyalelo wendalo .
Ukuba ubona i-PCP yakho ngoMeyi 1, uhlawula ugqirha we-$ 30 ngaloo mini. Isicwangciso sakho sezempilo sithatha yonke ibhajethi yokutyelela. Xa ubuyela kwi-PCP yakho ngoMeyi 5, kufuneka uhlawule enye ikhoyayari ye-$ 30. Isicwangciso sakho sezempilo sihlawula lonke le ntlawulo, kwakhona.
I-PCP yakho ithumela kwizodwa. Xa ubona ingcali ngoMeyi 12, uhlawula i-copayment ye-$ 50 kwingcali. I-inshorensi yakho yempilo ihlawula intsalela yebhili yeengcali.
Imali oyihlawulayo kwii-copayments ngokuqhelekileyo ayiyi kubalwa ekuhlangabezaneni ne-deductible yakho, kodwa ibalwa ngokumalunga neendleko zakho zokuphela kwee-pocket zonyaka (sibonga kwi-Obamacare, i- total-out-of-pocket-total pocket year). Ngoko ukuba unayo imali engama-2,000 e-deductible ngokwongeziweyo kwii-copays ezahlukahlukeneyo ukufumana ugqirha wakho oyintloko okanye ugqirha ozalisiweyo, kufuneka uhlangabezane ne-deductible yakho yonyango ngaphandle kwezo zikhutshwe yi-copays.
Yiyiphi efanayo?
Inani elichithwayo kunye neengxowa-mali zentlawulo zizonke zizonke, nto leyo ithetha ukuba ayitshintshi ngokusekelwe kwindleko yokunakekelwa kweenkonzo zempilo. Oku kuhambelani nolunye uhlobo lokwabelana ngeendleko, u-coinsurance, apho unetyala lepesenti yebhilikhwe kunokuba uhlawule umlinganiselo.
Uyazi xa ubhalisela i-inshurensi yezempilo ukuba ubuninzi bakho buza kuba yintoni kunyaka; ayitshintshi ngokusekelwe kukuphi uhlobo lweenkonzo ofumanayo okanye ezibiza ngeenkonzo. Ukuba unayo imali engama-$ 1,000, uya kuhlawula i-$ 1,000 echithwayo ukuba ngaba u-hospital hospital ubiza i-$ 2,000 okanye i-$ 200,000. Kodwa ezinye iiplani zinomdaka ohlukeneyo osebenzayo kwiidakamizwa zonyango, ngaphezu kwe-deductible kwezinye iinkonzo zonyango. Kwaye i- Medicare Part A ine-deductible esebenza kwixesha elixhamlayo kunokuba unyaka wekhalenda. Kodwa kusekho isisombululo esinqunyiwe, esetyenzisiweyo esisebenzayo kungakhathaliseki ukuba zininzi iindleko zonyango.
Uyazi kwakhona xa ubhalisela i-inshurensi yezempilo ukuba imfuno zakho zeemfuno zekhowudi yezempilo ziphi, kuba ziyimali echanekileyo. Xa ubona ingcali, ukuba isicwangciso sakho sempilo sidinga i-copay ye-$ 50 ukuze ubone i-specialist, uza kuhlawulwa i-$ 50 ingaba i-bill yezonyango i-$ 100 okanye i-$ 1000 (ngokungapheli nje ukuba ingcali inethiwekhi yakho yesicwangciso sezempilo, kwaye uzalisekisa nawuphi na ukugunyazwa okanye iimfuno zokudlulisela i-plan yakho yezempilo).
I-kopayment kunye ne-deductible nayo iyafana noko, ngenxa yoMthetho woNonophelo olungabonakaliyo , eUnited States iinkonzo ezithile zokunakekelwa kwezempilo ezikhuselekileyo azixhomekeke kwiipayipi okanye isicwangciso sakho sezempilo sinqunyulwa (ngaphandle kokuba unesicwangciso esiphezulu). Ukuba ubona ugqirha ekutyelelekeni kwonyango lwezempilo, nokuba awuzange uhlawule i-dime ngokubhekiselele kwi-deductible yakho yonyaka, awuyi kuhlawula nayiphi na into ekudityanisiweyo kweso sihlandlo. Ngeke uhlawule i-copayment kweso sihlandlo, mhlawumbi (phawula ukuba ezinye iinkonzo ezinokuthi zinikezelwe ngexesha lokutyelela ukukhusela aziyi kubanjelwa ngokugcwele, kuba izigunyaziso zokunakekelwa kokukhusela zifuna kuphela ukuba ezinye iinkonzo zokunyamekela zokukhusela zizaliswe ngokupheleleyo. Hlola kunye ne-inshurensi phambi kokuba uhlele uhambo lokunyamekela ukhuseleko ukuqinisekisa ukuba uyayiqonda into efihliweyo kunye nento engekho).
Yintoni eyahlukileyo?
I-deductible ngokuqhelekileyo inani elifunekayo lokuhlawula kunye nokuba kufuneka uhlawule kaninzi kangakanani. Izidumbu ezininzi zikhulu kakhulu kunama-copays, kodwa kufuneka uhlawule kanye kuphela ngonyaka (ngaphandle kokuba uhlala kwi- Medicare , kwimeko apho i-deductible isebenza kwithuba ngalinye inzuzo endaweni yokulandela unyaka wekhalenda). Emva kokuba udibene ne-deductible yakho yonyaka, akumele uhlawule kwakhona unyaka ozayo.
Kodwa iikopi ziqhubekayo. Uqhubeka uhlawula iikhowyithi rhoqo xa ufumana inkonzo yononophelo yezempilo efuna yona kungakhathaliseki ukuba yiyiphi iikopi oye wakhokhela kunyaka. Indlela kuphela yokuyeka ukuhlawulwa kwemali yesikhokhelo kukuba ufikelele kwisicwangciso sakho sempilo esiphezulu se-pocket ngonyaka. Ukufikelela kwi- out-of-pocket maximum kuyinto engavamile kubantu abaninzi, kwaye kwenzeka kuphela xa unemali ephezulu yonyango lwempilo kunyaka.
Indlela Abasebenzisana Ngayo
Funda indlela i-deductible yakho kunye ne-copay yokusebenzisana ngayo " Ngaba i-Copays Count kuya kwi-Intshurensi yeMpilo yakho ichithwe? " Kunye " Yiyiphi inqaku elibhekiselele kwi- inshurensi yakho yezempilo? "
> Imithombo:
> I-Register Register, iSebe lezeMpilo kunye neNkonzo zoLuntu. Ukhuseleko lomonde kunye noMthetho woNonophelo ojongene noThathaka; Isaziso seNzuzo yeeNzuzo kunye neParameters yokuhlawula i-2018; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi. Disemba 22, 2016.