I-inshorensi yempilo

Uqwalaselo lweeNtshumo zeNtshurensi yezempilo

Amathuba kukuba, unomshuwalense wezempilo-kuphela malunga neepesenti ezili-11 zamaMerika abaqinisekanga. Kodwa ngaphandle kokuba unamava usebenzisa i-inshurensi yakho yezempilo yonyango oluphambili, ungenakho ukubeka ingqwalasela enkulu kwiinkcukacha zakho. Kwaye ukuba uthe wazithengela i-coverage yakho okanye ukhethe phakathi kwezikhetho ezininzi ezinikezwa ngumqeshi wakho, usenokuba ufumene ukhetho olunzima okanye oludidekayo.

Kungakhathaliseki ukuba uyifumana phi i-inshurensi yakho yempilo, kubalulekile ukuqonda isigama esetyenziswayo ukuchaza imigaqo-nkqubo kunye nokufikelela kunye nokukwazi ukuthelekisa izicwangciso. Ukwazi indlela isicwangciso sakho sisebenza ngayo-ngaphambi kokuba ufune ukuyisebenzisa-kubalulekile; awufuni ukuhlenga iinkcukacha zenkcazelo yakho ngelixa uhleli egumbini lesibhedlele.

Ungaphi Ufuna Uncedo?

Phantse isiqingatha seMerika bafumana i-inshurensi yempilo kumqeshi.

• Ngaba Ngaba wena noMkwenu Wenu Makhe Nahlukanise Izicwangciso Zomshuwalense Wezempilo?

• Xa Umshuwalense wezeMpilo wenqaba ukufihla i-ER

Phantse umntu wesithathu wabantu baseUnited States unamava phantsi kweMedicaid okanye i- Medicare kwaye malunga neepesenti ezi-6 zithengwa kwiimarike nganye-kuquka ukutshintshiselana kunye nokucwangcisa.

Uncedo ekukhetheni isicwangciso, ukubhaliswa, kunye nokusebenzisa i-coverage yakho ihlala ikhona, kungakhathaliseki ukuba uyifumana kuphi. Ukuba umqeshi wakho unika i-inshorensi yempilo, ungabi namahloni ngokubuza imibuzo. Ukuba kukho isebe labasebenzi kwiinkampani zakho, kukukunceda uqonde iingenelo zakho yingxenye yomsebenzi wabo.

Ukuba usebenzela umqeshi omncinci ongenalo iqela elinikezelweyo labasebenzi, banokukukhokelela kwizixhobo ezinokukunceda, kubandakanywa nomthumeli womshuwalense wezempilo, umthengisi oye wanceda umqeshi ukhetha ukukhutshwa, i-inshurensi yezempilo yincinci. utshintshiselwano, okanye inkampani yesithathu yomvuzo / inzuzo eyenziwa ngumqeshi.

Naliphi na ixesha uqinisekisa iingeniso okanye iinkcukacha zamabango, cela iinkcukacha ngokubhaliweyo ukuze wazi ngokuqinisekileyo ukuba ulwazi luchanekile.

Kwimeko yokuthenga i-inshurensi yakho yempilo, abadayisi bafumaneka ukubonelela ngoncedo lwe-intanethi, phezu kwefowuni okanye ngomntu-kwaye akukho ntlawulo kwienkonzo zabo. Abathengi banokukunceda uqhathanise izicwangciso kunye kunye nokutshintshiselana . Ukuba uyazi ukuba ufuna ukusebenzisa intshutshiso yomshuwalense wezempilo, kukho abahamba ngeendlela kunye nabacebisi ababhalisiweyo abanokufumaneka ukukunceda ukuba ubhalise. Ukufumana utshintshi kwimeko yakho, ungaqala kwi-Healthcare.gov kwaye ukhethe urhulumente wakho. Ukuba uhlala kwimeko enokutshintshiselana, uya kuhanjiswa kuloo sayithi.

Inkqubo ye-Inthanethi okanye iMpilo ye-Intshuwalense yezempilo (CHIP), i-agency yakho yombuso inokusinceda uqonde izibonelelo ezikhoyo kuwe, ukuba zifanelekile, kwaye zincede ngenkqubo yokubhalisa. Ungabhalisa kwi-Medicaid okanye kwi-CHIP ngokusebenzisa utshintshi lwempilo yomshuwalense kuwo onke amazwe.

Ukuba ufanelekile kwi-Medicare, ungasebenzisa iNkqubo yoNcedo lweNkxaso ye-inshurensi yezeMpilo njengomthombo.

Kukho nabathengi kwilizwe lonke abanceda abaxhamli ababhalise kwiiprogram ze-Medicare Benevantage okanye i-Supplemental coverage ye-Medicare yaseMveli.

Izigqibo, izigqibo, izigqibo

Kwezinye iimeko, izicwangciso zakho zokucwangcisa zingancinci, ngokungathi umqeshi wakho unikezela isicwangciso esinye. Kodwa abaninzi abantu banokukhetha ezimbalwa xa kuziwa ekukhethweni kwinshorensi yabo yempilo. Umqeshi wakho unokunika uluhlu lwezicwangciso ngamanqanaba okubhalela kunye nama-premium ngenyanga. Ukuba uthenga i-inshorensi yakho yempilo, ungakhetha kuyo nayiphina iplani ekhoyo kwiimarike kummandla wakho (okanye ekutshintshiselwano, ngaphandle nangona inkxaso-mali ye-premium itholakala kuphela kwintsebenziswano).

Ukuba ufanelekile ukubhalisa kwi-Medicare, uya kuba nenketho yokukhetha isicwangciso seMediare Benevantage okanye ukunamathela kwiMithi yoLuntu yaseNkcazo kwaye uzimisele ukuba uyongezelela nge- Medigap kunye ne-Part D yokubhalwa kwemithi.

Kuzo zonke iindidi zokufakela ezinye i-Medicaid / CHIP, iinyanga zokubhalisa ezivulekileyo zisebenza. Ixesha lokubhalisa olukhethekileyo, nangona kunjalo, lukhona xa ufumana iziganeko ezithile zokuphila ezifanelekileyo, njengokulahlekelwa ngokukhawuleza kwenkcazo okanye umtshato.

Akukho nto ifanayo-ifanayo-konke xa kuziwa kwinshuwalense yezempilo. Isicwangciso esiza kulungela kuwe sincike kwiimeko ezahlukeneyo:

1. Ngaba unayo na imeko ekhoyo ngaphambili? Oku akusiyo umbandela ngokubhekiselele kokufumaneka kwenkcazo njengoko uMthetho ojongene noNonophelo ongenakunqunyulwa unqatshelwe ukubhala phantsi kwezokwelapha ngo-2014. Kodwa ngokuqinisekileyo kuya kuba yinto ebalulekileyo ngokuchonga isicwangciso, ngenxa yokuba inzuzo, ukukhutshwa ngaphandle kwe-pocket, kuluhlu lwezilwanyana (formulary), kwaye umnxibelelwano wenethiwekhi uhluka kakhulu kwicebo elinye.
   
   Ukuba ilungu elinye losapho lwakho luneemeko zangaphambili okanye lukulindelwe iindleko zonyango ezibalulekileyo kunyaka ozayo, unokufuna ukucinga ukubhalisa intsapho kwizicwangciso ezihlukeneyo, kunye nokukhawulelana okunamandla kulungu lentsapho elindeleke ukuba lifuna unonophelo lwezempilo ngexesha unyaka.

2. Ngaba uthatha naziphi na iziyobisi? Qiniseka ukuba uhlolisise iifomries zezicwangciso zezempilo ozicingayo. Unokufumana ukuba icebo elilodwa lijongene neziyobisi zakho kwinqanaba eliphantsi kweendleko kunomnye okanye ukuba ezinye izicwangciso azifihla iyeza lakho. Izicwangciso zezeMpilo zahlula iziyobisi ezizinzileyo kwiindidi, ngokubanzi zibizwa ngeNqanaba 1, iNqanaba 2, iNqanaba lesi-3 kunye neNqanaba 4.
   
   Iziyobisi kwiNqanaba 1 lixabiso elincinci, ngelixa abo baseMgangatho wesi-4 baninzi izidakamizwa ezikhethekileyo. Izidakamizwa kwiNqanaba 4 ngokubanzi zihlanganiswe ne-coinsurance (uhlawula ipesenti yeendleko) ngokuchasene ne-copay-rate rate rate. Ukunikezelwa kwentengo ephakamileyo kwimithi ekhethekileyo, abanye abantu bafikelela ekudibaniseni i-plan- out-of-pocket yabo ekupheleni konyaka xa befuna izidakamizwa ezibizayo ze-Tier 4. Kodwa, ezinye iindawo zenze imida kwiindleko zogulane kwizonyango ezizodwa.
   
   Ukuba ubhalisa kwi-Medicare, ungasebenzisa ithuluzi lokufumana isicwangciso se-Medicare xa uqala ukubhalisa kwaye unyaka ngamnye ngexesha lokubhalisa okuvulekileyo. Kuya kukuvumela ukuba ufake imimiselo yakho kwaye kukuncede ukuba ubone ukuba yeyiphi iplani yesigqirha iya kusebenza kakuhle.

• I-inshorensi yempilo kunye neemeko eziPhambi kwexesha: ACA, HIPAA, & Trump Admin

• Yintoni eyenzekayo xa ufuna ii-Medicare kunye neMedicaid

1. Ngaba okwangoku ufumana unyango lwangonyango ukusuka kwidokotela okanye esibhedlele? Unxibelelwano lwezonxibelelwano ziyahluka ukusuka kwiphathi enye ukuya kwelinye, ngoko ke uqhathanisa uludwe lweenkonzo malunga nezicwangciso ezahlukeneyo ozicingayo. Ukuba umboneleli wakho akakho kwinethiwekhi, usenokukwazi ukusebenzisa loo mnikezeli kodwa ngeendleko eziphezulu ezingaphandle kwe-pocket okanye unako ukufumana ingxelo ngaphandle kwenethiwekhi nonke.
   
   Kwezinye iimeko, kuya kufuneka unqume ukuba ngaba ukugcina umniki-nkonzo wakho wangoku ufanele ukuhlawula iiprimiyamu zempilo ze-inshorensi eziphezulu. Ukuba awunalo ulwalamano olumiselwe ngokuthe ngqo kunye nogqirha othile, unokufumanisa ukuba ukukhetha isicwangciso esinomnxeba mncinci kunokubangela iiprayimari eziphantsi.

2. Ngaba ulindele nawuphi na unyango olubi kakhulu kunyaka ozayo? Ukuba uyazi ukuba unobungqina obuzayo, umzekelo, okanye uceba ukuba nomntwana, kuya kuba nengqiqo ukuhlawula iiprayimari eziphezulu kworhwebo kwisicwangciso esiphantsi komda we-pocket. Gcina ukhumbule ukuba unokufumana ixabiso elingcono kwisicwangciso kunye nomlinganiselo osezantsi we-post-pocket, kungakhathaliseki ukuba isicwangciso sakho sifuna ukuba uhlawule iinkonzo ngamnye ngaphambi kokudibana nomda wokuphuma kwipokethi.
   
   Ngokomzekelo, ukuba uyazi ukuba uya kudingwa ukuguqulwa kwamadolo, isicwangciso esinomlinganiselo we-3,000 we-pocket esingaphezulu kwe-3,000 sinokubaluleka kangcono kunesicwangciso esinomlinganiselo we-$ 5,000 ongaphandle kwesikhokelo. Nangona isicwangciso esilandelayo sinikeza ii-copays ukutyelela ugqirha, isicwangciso sangaphambili sibonisa ukuba ugqirha wakho uvakatye kwi-deductible.
   
   Ekugqibeleni kuya kuba yinto engcono yokuhlawula iindleko ezipheleleyo zohambo lwakho loogqirha ukuba uyazi ukuba zonke iinkcitho zakho zokunakekelwa kwempilo kwiinkonzo ezikhuselekileyo ziya kupheliswa xa ushaya i-$ 3,000 ngonyaka. Ukuhlawula i-copay-endaweni yeendleko ezipheleleyo-ukutyelelwa kogqirha kunenzuzo kwixesha elifutshane. Kodwa kubantu abaya kufuna unonophelo olunzulu lwezonyango, i-cap ngokupheleleyo kwi-out-of-pocket spending ingaba yinto ebalulekileyo.

3. Ngaba uhamba ezininzi? Unokufuna ukuqwalasela i-PPO kunye nenethiwekhi ebanzi kunye ne-solid-of-network coverage. Oku kuya kuba kubi ngaphezu kwe-HMO encinci-intanethi, kodwa uguquko olunikezwayo ngokukuvumela ukuba usebenzise ababoneleli kwiindawo ezininzi kunokufanelekile. Ukuba ubhalisa kwi-Medicare, izicwangciso zakho zokuhamba ziza kwenza i-Original Medicare-kunye ne-postage-coverage-ulunge olungcono kuneMediare Advantage, ekubeni i-Medicare Advantage inomncedisi womncinci.

4. Yintoni ukunyamezela kwakho engozini? Ngaba ukhetha ukuchitha ngaphezulu kuma-premium rhoqo ngenyanga kwizorhwebo zeendleko ezingaphantsi kwee-pocket? Ngaba unayo i- copay kwiofisi yegqirha-ngokuchasene nokuhlawula yonke into enokunyamekela ukuba udibane neeprayimari eziphezulu ezidityanisiweyo ? Ingaba unayo imali yokugcina imali engasetyenziselwa ukuhlawula iindleko zakho zokunakekelwa kwempilo xa ukhetha isicwangciso kunye nesaphulelo esiphezulu?
   
   Le mibuzo ingenayo impendulo engalunganga okanye engafanelekanga, kodwa ukuqonda indlela ozivakalelwa ngayo ngokuyinxalenye ebalulekileyo yokukhetha isicwangciso sempilo esiza kukunika ixabiso elifanelekileyo. Iipresimenti zenyanga ziya kufuneka zihlawulwe kungakhathaliseki ukuba usebenzisa i-dollar yezigidi zempilo okanye akukho nhlobo. Kodwa ngaphaya kweeprayimari, imali oya kuhlawula kuyo unyaka kuxhomekeke kuhlobo lokubhengezwa kwakho kwaye unonyango olunjani olufunekayo.
   
   Zonke izicwangciso ezingenakulinganiswa nazo zihlanganisa ezinye iintlobo zokunakekelwa kokukhusela ngaphandle kwenxaxheba-ndleko-kuthetha ukuba akukho kopay kwaye akudingeki uhlawule imali enokukhatyelwa kuzo ezo nkonzo. Kodwa ngaphaya koko, ukuhanjiswa kwezinye iindidi zokunyamekela kungahluka ngokubanzi kwisicwangciso esinye. Ukuba ukhetha icebo ngeeprayimari eziphantsi, qaphela ukuba iindleko zakho ziyakuthi ziphakame ukuba kwaye xa ufuna uncedo lwezokwelapha.

5. Ngaba ufuna ukukwazi ukufaka isandla kwiAkhawunti yokuThengisa impilo (HSA)? Ukuba kunjalo, kuya kufuneka uqiniseke ukuba ubhalisa kwiSicwangciso seMpilo esiPhezulu esiPhezulu (HDHP) esiyi-HSA. Ezi zicwangciso zibandakanya ukunakekelwa kokukhusela ngaphambi kokutsalwa, kodwa akukho nto. Izicwangciso ezifanelekileyo ze-HSA zineemfuneko ezincinci ezidityanisiweyo kunye nemida kwiindleko eziphezulu ezingaphandle kweefowuni.
   
   Wena okanye umqeshi wakho unokuxhaswa i-HSA yakho kwaye akukho "ukuyisebenzisa okanye ukuyilahleka" ilungiselelo. Ungasebenzisa imali ukuhlawula iindleko zonyango kunye neerhafu ezingaphambi kweerhafu, kodwa usenokushiya imali kwi-HSA uze uyivumele ikhule. Kuya kuqhubeka ukusukela kunyaka omnye ukuya olandelayo kwaye unokuhlala kusetyenziswa-irhafu-ukuhlawula iindleko zonyango ezifanelekileyo nangona ungasenaso isicwangciso sezempilo esiqeqeshelwa yi-HSA.

ILizwi

I-inshurensi yezempilo iyimfuneko kodwa inokukhungathekisa kwaye inzima. Kungakhathaliseki ukuba unesicwangciso sogunyaziso sikarhulumente, isibonelelo esinikezwa ngumqeshi wakho, okanye umgaqo owalithengele wona, ukuqonda okucacileyo kwindlela inshuwalense yezempilo eyosebenza ngayo. Xa uyazi ngakumbi, kuya kuba lula kuwe ukuba uthelekise iindlela zokukhetha kunye nokwazi ukuba ufumene ixabiso elifanelekileyo kwi-inshorensi yakho yezempilo. Yaye uqiniseke ukuba uncedo luhlala lukhona xa unemibuzo.

> Imithombo:

> I-Gallup, i-US Uninsured Rate kwi-11 Ipesenti, ephantsi kunemihla emithathu,

> I-Kaiser Family Foundation, iNgcaciso yoMshuwalense wezeMpilo yoBonke abantu, ngo-2014.