I-asterisks ehamba kunye nokuvinjelwa kwixesha lokuphila kunye neengxowa-mali zonyaka
Omnye wabasebenzisi bokukhusela kuMthetho woNonophelo ongenakunciphisa umyalelo wokuvalwa kwimivuzo yamaxesha onke kunye neenzuzo zokuphila. Ama-maximums amaxesha angenasiphelo amaxesha ayasavunyelwa nonke, nakwiizicwangciso ezininzi. Unyaka - kodwa kungenjalo umda-umyinge wemingcele unokusasebenza kwizicwangciso eziziintloko, kodwa kungenjalo izicwangciso zeqela.
Oko kuthetha ukuba abathengi abasengcupheni yokufumana abafuna unyango lomhlaza kunye nesicwangciso sezempilo esinama-$ 300,000 okufumana inzuzo yexesha lokuphila.
Kwaye abantu abanezifo ezingapheliyo kwaye eziyinkimbinkimbi abangekho engozini yokukhankanywa kwisicwangciso sabo xa iibhilikhwe zabo zonyango zifikelela kwindawo ethile.
Kodwa kukho imibala embalwa ebalulekileyo ukuqonda.
Iimpilo eziyimfuneko
Xa i-ACA ibhaliwe, abagwebi banqume ukuba kukho iintlobo ezilishumi zononophelo ezazibhekwa njengento ebalulekileyo. Bazibiza ngeemfuno eziyimfuneko zezempilo, kwaye zonke izicwangciso zeqela kunye namancinci kunye nomhla osebenzayo kaJanuwari 2014 okanye kamva kufuneka zibandakanye ukuxhaswa kwabo (amazinyo emntwaneni ngenye yeenzuzo zezempilo ezibalulekileyo, kodwa imithetho iyahlukelelana neenkcukacha zezempilo zamazinyo).
Umngcipheko kwixesha lokuphila kunye ne-maximums benefit annu kuphela isebenza kwizibonelelo zempilo ezibalulekileyo. Kuyavunywa, malunga nonyango olufunekayo lwezonyango luwela phantsi kwe-sambuli yezibonelelo zezempilo ezibalulekileyo, kuba ezinye zeendidi zibanzi (umzekelo, ukunakekelwa kwabangaphantsi kwezilwanyana ngenye yezibonelelo zezempilo ezibalulekileyo, kunye nokunyamekelwa ngonyango omnye).
Kodwa njengomzekelo, iinkonzo zamathambo ezindala aziqwalaselwe njengenzuzo ebalulekileyo yezempilo phantsi kwe-ACA. Kuyinto inqabileyo ukufumana isicwangciso sezempilo esibandakanya ukufihla kwamazinyo omdala okufakwe ngaphakathi, kodwa akhona. Nangona kunjalo, izicwangciso ezinjalo zingafaka i-cap kwiingxelo zonyaka kunye nezobomi beenkonzo zamagqirha abadala, ekubeni akuyona enye yeenzuzo zezempilo ezibalulekileyo.
Imiba yenethiwekhi
Ukuvinjelwa kwe-ACA kwimida yokuphila kunye nemigangatho yoncedo yonyaka kusebenza kwiinkonzo zombini kunye nesevisi. Kodwa izicwangciso zezempilo azidingeki ukuba zikhusele ngaphandle kwenethiwekhi. Ukuba ngaba kunjalo, abanako ukunyanzelisa umlinganiselo weli dola kwiirhafu zonyaka okanye zobomi.
Ii-HMO ngokubanzi zigcinwa kuphela ngononophelo olufunyenwe kubaboneleli bee-network, ngaphandle kwimeko yongxamiseko eyenzeka ngaphandle kwendawo yenkonzo yesicwangciso, okanye apho indawo ejongene nexakeka ngokukhawulezileyo ayikho inxalenye yentsebenziswano ye-HMO. Kodwa ngenxa yokunakekelwa kweenkonzo ezingxamisekileyo ngaphandle kwe-Intanethi ye-HMO, isigulane ngokuqhelekileyo iya kuba nexanduva kulo mthetho-mthetho.
Iiplani ze-PPO zihlala zikhupha ngaphandle kwe-network ukunakekelwa, kodwa ngokukhawulelana okuphezulu kunye nokugqithiseleyo okungekho kwipokethi yomguli. I-ACA ye-6,850 yekhompyutheni kwiindleko ezingaphandle kwe-pocket ngo-2016 isebenza kuphela ekunakekeleni inethiwekhi; Izigulane ezikhetha ukuphuma ngaphandle kwenethiwekhi okanye ukungazisebenzisi umboneleli ongeyena unxibelelwano zingaphelela ngeendleko eziphezulu ezingaphezulu kwee-pocket. Kwakhona kuya kuba yinto eqhelekileyo kwiiplogram ze-PPO ukuba zibe ne-exposed-out-pocket exlimation kwonyango efunyenwe ngaphandle kwenethiwekhi yomnatha. Kodwa ukuba isicwangciso sibhekiselele ngononophelo lwentlalo yeemfuno zonyango ezibalulekileyo, ayikwazi ukunyanzelisa ixesha lokuphila okanye inzuzo yonyaka.
Qaphela ukuba kubalulekile ukuqonda ukuhlula phakathi kweefowuni zenkxaso kunye neekhonkco zangaphandle; i-cap benefit yinto ephezulu enkampanini yomshuwalense eya kuhlawula, kwaye yinto engasayi kuvunyelwa. I-cap-out-of-pocket cap iyona nto inokuthi isigulane kufuneka ihlawule ngexesha lonyaka owanikwayo, kungakhathaliseki ukuba iphakamileyo ibango layo liphezulu kangakanani; yiloo nto ikhethiweyo kwi-$ 6,850 ngo-2016 ukwenzela ukunakekelwa kwenethiwekhi kwiintlawulo zezempilo ezibalulekileyo (i-cap iya kuba yi-$ 7,150 ngo-2017; phawula ukuba oku kuphezulu kuvunyelwe - izicwangciso zinakho kwaye zinemiqathango engaphantsi kwe-pocket ngaphezu kwalokhu).
Kubekho umda, abanakukwazi ukufikelela kwiidola
Ukuvinjelwa kwe-ACA ngexesha lokuphila kunye nemingcele yonyaka yokufumana iimfuno zezempilo ezibalulekileyo kusebenza kwimida echazwe ngokweedola.
Ngoko izicwangciso zezempilo azikwazi ukuba ne-3,000,000 yenzuzo yexesha lokuphila, umzekelo, okanye i-cap $ 500,000 yenzuzo yonyaka.
Kodwa izicwangciso zempilo zisenako-kwaye zenze-iminye imida malunga nobuninzi babo abaya kuzifaka. Ngokomzekelo, icebo lingaxela ukuba liza kunika uhambo oluphangaleleyo lwamaziko angama-20 ngonyaka, okanye iintsuku ezingama-60 zabongikazi abanezakhono ngonyaka. Nangona ukunyamekelwa kombuzo kuwela phantsi kwesinye sezibonelelo ezifunekayo zezempilo, abathwali banokukhawulela ukukhutshwa. Akunakukwazi ukukwenza ngomlinganiselo ochazwe kwiidola. Ngoko abayi kuba nako ukuthetha ukuba unako ukufumana unyango olungama-2 000 wonyango ngamnye kunyaka, nangona bangatsho ukuba unako ukuvakatyelelwa kwimiba engama-20 kuphela kwinyanga.
Imithombo:
IRejista yeSithili, i-PPACA-HHS Isaziso seNzuzo kunye neParameters Payment for 2017. Fi kelele 5/14/2016.
Yarbrough, Cassandra, MPP; Vujicic, Marko, PhD .; Nasseh, Kamyar, PhD., I-Institute Policy Policy kunye noMbutho wamaDental waseMelika, iiNgcebiso ezininzi zeeNyuncedo zamazinyo ngo-2015 i-Inshurensi yempilo. Ufikelele kwi-1/19/2016.