Imimiselo ihloselwe ukuzinzisa iiMakethe zomshuwalense
Ukukhathazeka malunga nokuzinza kwemarike yempilo yomshuwalense (kokubili kunye nokutshintshiselana) kuye kwadlula ixesha elithile. Abanini-mshishino abanomtshini-mali baye baphuma kwiintengiso okanye lonke iimarike ekupheleni konyaka we-2016, kwaye iiproyeyam zenkxaso-mali zangaphambi kwenkxaso-mali zangaphambili zinyuka ngama-25 ekhulwini ngonyaka we-2017 ( inkxaso-mali ekutshintshiseni yakhula yahlutha yonke ininzi yokunyuka kweprayimenti kubantu abafanelekayo-mali abathengayo ukuthengwa kwintengiso, ngoko kuya kucaceka, iipalamum azange zinyuka ngama-25 ekhulwini kubantu abaninzi abathengisa izicwangciso zabo ngokutshintshiselana).
Ukujongana neenkxalabo zokuzinza kweemarike, iSebe lezeMpilo kunye neenkonzo zoLuntu licebise uhlalutyo lweenguqulelo phakathi kwe-Februwari, iintsuku ezimbalwa emva kokuba uNobhala we-HHS u-Tom Price uqinisekiswe yi-Senate.
Isaziso sokumiswa komgaqo-nkqubo esicetywayo ngokumalunga nokuthengiswa kweemarike kwiimarike zeqela kunye namancinane. Ngokuqhelekileyo, iimarike zeqela elincinci zizinzile. Kodwa iimarike zithile kwezinye iindawo zazingxowankulu ekupheleni kwe-2016, kwaye uHuman watshengeza ngoFebruwari 14 ukuba baya kuphuma ngokupheleleyo kwiimarike zempilo yomshuwalense kwilizwe lonke ekupheleni kuka-2017 ).
Ngo-Apreli 13, i-HHS yagqiba imimiselo yabo yokuzinza imakethe, ngokubanzi njengoko iphakanyisiwe. Abanye abathathi bezityiba baye baqonga imimiselo njengenyathelo elifanelekileyo lokuzinzisa imarike yomshuwalense, kodwa abanye bathi ezinye zeemigaqo emitsha ziya kubangela ukuba enye imarike ihlasele.
Kubalulekile ukuba uqaphele ukuba njengabanini-bhoksi abadala amaxabiso kunye nezicwangciso ze-2018, baqaphele ngokuphindaphindiweyo ukuba ezimbini ezibalulekileyo izinto ezibangela ukuthengiswa kweemarike zinyanzeliso ze-ACA, kunye nokungaqiniseki ngokwemali yokuqhubeka kwezimali zokwabelana ngeendleko .
Akukho nanye yale micimbi ilawulwa yimimiselo yokuzinzisa imarike, kwaye izenzo zeCandelo loLawulo lweTrump zenze igalelo elikhulu ekuthengiseni imakethe kwiindawo zombini.
I-Market Market Stabilization Imithetho njani Ingozi Yomshuwalense Wezempilo?
Abantu abafumana i-inshorensi yabo yempilo evela kumqeshi omkhulu (kwiindawo ezininzi, oko kuthetha ukuba abasebenzi abangama-50 + ), iMedicaid , okanye iMedaretha ayiyi kuba nefuthe ngenguqu oluye lwagqitywa yi-HHS. Olu tshintsho lusebenza ngokubanzi kumakethi athile, apho i-7 ekhulwini labantu base-US, nangona abantu abasebenza kubaqeshi abancinci bangabona iindleko eziphezulu ze-pocket, kwaye mhlawumbi ama-premium aphantsi.
1. Kubantu abazithengayo iinshurensi yabo yezempilo, ukubhaliswa okuvulekileyo ku-2018 kuya kuba mfutshane kunokuba kuneminyaka edlulileyo.
Ngaphambi komgaqo wokuzinza kweemarike, ixesha lokubhalisa elivulekileyo le-2018 lucwangciselwe ukulandela isimiso esifanayo esasetyenziswa kwi-206 no-2017 (Novemba 1 ukuya kuJanuwari 31). Kodwa ngo-2019, isicwangciso saqalisa ukusebenzisa ixesha elibhalisiweyo lokubhalisa, ukuqala ngoNovemba 1 kunye nokuphela kukaDisemba 15. I-HHS iye yakhetha ukutshintshela kwithuba elincinci lokubhalisa elifutshane kunyaka omnye, kwaye uqale ukuyisebenzisa ekupheleni kuka-2017 (ukwenzela ukufikelela ngokukhawuleza ngo-2018), endaweni yokulinda de ukuwa kwe-2018.
Ngako-ke abantu abathengela i-inshurensi yabo yempilo (okt, abayifumani kumqeshi okanye kwiprogram karhulumente efana ne-Medicare okanye iMedicaid) baya kuba nefestile elincinci ukukhetha icebo le-2018. Kuya kuqala ngoNovemba 1, 2017, kwaye iphele ngoDisemba 15, 2017.
Oko kuthetha ukuba akukho tshintsho lolungiso emva kokuqala konyaka, ngoko akusayi kuphinda kube nethuba lokutshintshwa izicwangciso ngoJanuwari ukuba ukutshintsha kwakho kweprayimenti kukuthintele. Kuya kubaluleke kakhulu ukuhlawula ingqalelo kwi-premium kunye nesicwangciso sokutshintsha izaziso ozifumene ngo-Oktobha / Novemba ukusuka kwinkampani yakho yomshuwalense okanye utshintshiselwano, kwaye wenze isicwangciso utshintsho ngaphambi kwe-15 kaDisemba.
Emva koko, cwangcisa utshintsho nobhaliso olutsha luya kwenzeka kuphela ukuba unesiganeko esifanelekileyo .
Oku akuyi kuguqula nantoni malunga neefestile zokubhalisa ezivulekileyo ezikhoyo kwi-inshurensi yempilo okanye i-Medicare.
2. Abantu ababhalisa kwizicwangciso zokutshintshaniswa ngaphandle kobhaliso oluvulekile baya kufuneka banikezele ubungqina besiganeko esifanelekileyo, kwaye ukufaneleka kwezikhathi zokubhalisa ezizodwa kuya kunqandwa kwezinye iimeko.
I-ACA kunye nemimiselo elandelelanayo ivumela abantu abaneentlobo ezahlukeneyo zeziganeko ezifanelekileyo ukuba babhalise kwiinkcazo ngokutshintshiselana (kwaye kwiimeko ezininzi, ngaphandle kweengxoxo kunye ), kungakhathaliseki ukuba yithuba lonyaka.
Oku kunengqiqo, kwaye yindlela i-inshorensi eyaxhaswa ngayo ngumqeshi isebenza ngayo. Ukuba umntu uyeka umsebenzi wakhe kwaye ulahlekelwe ukufikelela kumgaqo-nkqubo we-inshorensi yempilo-mali exhaswe ngumqeshi ngoJuni, akanakulindelwa ukuba alinde de kube nguJanuwari ukuba abe negalelo elitsha. Yaye ukuba umntwana ezalwa ngo-Ephreli, bekungekho into enengqiqo ukunyanzelisa intsapho ukuba ilinde de ubhaliso oluvulekileyo ukuze ufumane umntwana umntwana.
Ngoko isiganeko esifanelekileyo sibangela ixesha lokubhalisa elikhethekileyo (i-SEP), ngexesha apho umenzi wesicelo unemihla engama-60 ukuze abhalisele isicwangciso esitsha. Kodwa kukho ukuphikisana okukhulu malunga nee-SEP. Kukho iinkxalabo ukuba abantu banokuthi "badlale" inkqubo ngokuzenza ngathi banesiganeko esifanelekileyo xa befumene benesifo sokhathalelo lwezokwelapha, kwaye abaqinisekisayo baye bafumanisa ukuba iindleko zamabango aphezulu ziphezulu kubantu ababhalisa ngexesha le-SEP ngokuchasene nabantu ukubhalisa ngexesha lokubhalisa okuvulekileyo.
Kodwa ngaphesheya kweengqekembe, abaxhasi babathengi baye babonisa ukuba bambalwa abantu abafanelekileyo be-SEP babhalisela ukubhalwa kwenkxaso, kwaye kufuneka ukuba ubungqina bomcimbi obangelwayo bungabangela ukuba abhalise abaphilileyo bakwazi ukuphelisa inkqubo. Oku kwabonakala kwinqanaba elithile emva kokungqinelwa kwe-SEP yokufaneleka ukufaneleka ukuba i-HealthCare.gov isebenze ngo-2016.
Phakathi kwabafaki-sicelo abaneminyaka yobudala engama-55 ukuya ku-64, i-73 ekhulwini yabonisa ubungqina bendawo efanelekileyo. Kodwa phakathi kwabafaki-sicelo abaneminyaka eli-18-24, ama-55 kuphela ekhulwini afaka ubungqina bendawo efanelekileyo. Oku kubangela i-pool yama-insureds aneminyaka ephakamileyo yobudala, ehambelana neendleko zonyango lwezempilo.
Ulawulo lwe-Obama HHS lucebise inkqubo yovavanyo, eqala ngohlobo lwango-2017, apho iipesenti ezingama-50 zabasebenzi be-HealthCare.gov (ngokukhethiweyo okukhethiweyo) kuya kufuneka banikeze ubungqina besiganeko esifanelekileyo phambi kokuba isicelo sabo sigqitywe.
Kodwa umgaqo omtsha weHHS utshintshela ukuba kuma-100 ekhulwini. Ukususela ngoJuni ka-2017, yonke i-HealthCare.gov ababhalisa abangabhalwanga ngaphandle kobhaliso oluvulekile kuya kufuneka banikeze ubungqina bendawo efanelekileyo phambi kokuba isicelo sabo singacutshungulwa.
Ukongezelela, imithetho emitsha inciphisa ukufikelela kwi-SEP kwezinye iimeko:
- Umtshato uya kuthathwa nje ngokuba ngumcimbi ofanelekileyo ukuba ubuncinane elinye iqabane liye lalinokubaluleka okungundoqo (okanye lihlala ngaphandle kwe-US okanye kwintsimi yase-US ngaphambi komtshato).
- Xa umntu sele ebhalisile kwisicwangciso sele enomntwana okanye esamkela umntwana, umzali unqunyelwe ukuba wongeze umntwana kwisicwangciso esele sikhona, okanye ubhalise umntwana wedwa kwiplani ekhona (ukuba, ngenxa yesizathu esithile, umntwana akakwazi kwongezwa kwisicwangciso, umzali angabhalisa kwesinye isicwangciso kwinqanaba lezinyithi , kunye nomntwana). Umntu ongaqinisekanga kwaye unomntwana okanye wamkela umntwana usenelungelo lokubhalisa, kunye nomntwana, nakuphi na icebo elikhoyo. Kodwa umntu osuke unako ukunika ingxelo akavunyelwe ukusebenzisa ukongezwa komntu oxhomekeke kuye njengethuba lokutshintshela i-coverage yakhe ekhoyo kwisicwangciso esitsha.
- Abantu abalahlekelwa ngumsebenzi wokungabikho kwentlawulo ye-premium ngexesha elithile kunyaka baya kufuneka bahlawule iiprayimari zabo ezidlulileyo-ngaphambi kokuba bakwazi ukubhalisa-ngexesha le-SEP okanye ukubhaliswa okuvakalayo ngokuvakalayo-kwisicwangciso esivela kwi-insurer efanayo (okanye elinye i-insurer phantsi kwenkampani efanayo yomzali). Ngokuqhelekileyo baya kubakhokhela iiprayimari ezingadlulanga ngaphezu kweenyanga ezintathu zokubhengezwa, kuba azingekho kwi-hook yeprayimesi xa isicwangciso siphelile ngenxa yokungabikho kwentlawulo ye-premium. Ukuba abantu abakule meko babhalisa kwakhona, umgcini-mali uyavunyelwa ukusebenzisa iintlawulo zabo ze-premium kwi-balance balance.
3. Ukuqala ngo-2018, kuya kubakho ngaphezulu kwepesenti yeendleko ezifunekayo izicwangciso zezempilo. Oku kunokubangela iiprayimari ezincinci, kodwa i-deductibles ephezulu kunye ne-copays. Kwakhona kunokubhekisela kwenkxaso-mali yamancinci emncinci.
Ngaphantsi kwe-ACA, zonke izicwangciso zezempilo zeqela kunye namancinane kufuneka zifake kwizinga lesine zetsimbi: ubhedu, isilivere, igolide, okanye i-platinum (izicwangciso ezinobungozi nazo ziyafumaneka kwabanye ababhalisile). Inqanaba lesitrato sesicwangciso sinqunywe yixabiso le-actuarial (AV), okuyiyona niselo yepesenti yeendleko zonyango eziza kuhlawula isicwangciso sempilo, esilinganiselwe kuwo wonke umhlaba. Izicwangciso zebhonze zi-AV ezingama-60 eepesenti, iiplani zesilivere zinama-70 eepesenti ze-AV, iiplani zegolide zine-AV ye-80 ekhulwini, kwaye iiplatinum zicwangciso zine-AV ezingama-90 ekhulwini.
Kodwa kuya kuba nzima kumakhampani e-inshorensi yempilo ukuyila izicwangciso ezithintela loo manani ngqo (pre-ACA, kwakungekho mfuneko ye-AV efanelekileyo, ngoko ke i-insurers ayifanele ixhalabele ngokushaya i-AV target target). Ngoko izicwangciso zempilo zivunyelwe ukusebenzisa uhla lwe-AV kunokuba ipesenti. Okwangoku, uluhlu luyi +/- 2. Ngoko isicwangciso sesilivere sinokufumana i-AV esukela kuma-68 ukuya kuma-72 ekhulwini (izicwangciso zethusi zineenkcukacha ze-minimus, ngoku kusekwe kwi--2 / + 5).
Ngaphansi kwemigaqo emitsha ye-HHS, ukuqala ngo-2018, uluhlu oluvumelekileyo luyi -4 / + 2, oko kuthetha ukuba isicwangciso sesilivere sinokuthi sibe ne-AV naphi na kwi-66 ukuya kuma-72 ekhulwini (kwizicwangciso zethusi, ububanzi obuvunyelwe -4 / +5).
Ngoko ke izicwangciso eziya kuphuhlisa u-2018, iinkampani zomshuwalense zivunyelwe ukwandisa iindleko ze-pocket (i- deductibles , i- copays , i- coinsurance ), kuba ayiyi kubakhokelela ixabiso elipheleleyo leendleko eziqhelekileyo. Oko kuthetha ukuba i-premium iyakuncipha, kodwa inani abantu kufuneka lihlawule xa lifuna ukunakekelwa kwezempilo liya kwanda (phawula ukuba ukuhla kwe-premium kuhambelana noko bangayi kuba khona kulo tshintsho; iiprayimari jikelele ziya kuvuka ngo-2018, mhlawumbi ngokukhawuleza ngenxa yeminye imakethe engaqinisekiyo ekhona, kubandakanywa ukungabikho kokucacileyo malunga nokuba inkxaso-mali yokwabelana ngeendleko iya kuqhubeka ixhaswa ngemali).
Kwakhona kuthetha ukuba inkxaso-mali ye-premium ingaba yincinci encinci kunokuba yayingenalo tshintsho, kuba ixhomekeke kwiindleko zesicwangciso sesilivere esiphantsi-indleko (isicwangciso sokulinganisela) kwindawo nganye. Ukuba isicwangciso sesilivere esiphantsi kweendleko eziphantsi kwesibini sinomdla we-AV wama-66 ekhulwini, kuya kuba nexabiso elingaphantsi kunezinye iiplani zesilivere kunye ne-AV yama-68 ekhulwini okanye ngaphezulu. Kwaye isicwangciso-mali esisezantsi esicwangcisiweyo sichaza kwiinkxaso ezincinci.
4. Abatshutshisi bavunyelwe ukusebenzisa ii-premiums ezintsha kwiimali ezidlulileyo.
Ngaphantsi kwemithetho yangaphambili, ukuba isicwangciso sagqitywa ngokungahlawulwanga kweprayimari, umntu angakwazi ukubhalisa kwisicwangciso esifanayo ngexesha lokubhalisa okuvulekileyo, okanye ngexesha lokubhalisa okhethekileyo, kungekho miphumo embi. Ukuhlawulwa kweeNkulumbuso kuya kuqalisa ngaphezu komhla omtsha wokusebenza, kwaye inkampani yomshuwalense ayivumelekanga ukuba ifune umntu ukuba akhokhe iiprayimari zabo ezidlulileyo kwi-plan yangaphambili.
Imimiselo emitsha inika iinkampani ze-inshorensi ngakumbi ukuba ziqokelele iipriyamu ezidlulileyo-ukuba umntu ukhetha ukubhalisa kwisicwangciso esivela kwi-inshurensi efanayo eyaye yaphela phambi kokungabikho kwentlawulo yee-premiums (okanye i-insurer eyingxenye yeqela elilawulwayo, nkampani okanye umzali). Iintlawulo ezihlawulwe kwisicwangciso esitsha zingasetyenziswa kwiiprayimari ezidlulileyo ezidlulileyo kwiinyanga ezili-12 ezidlulileyo, kwaye i-insurers avunyelwe ukuba angayisebenzisi umgaqo-nkqubo omtsha kude kubekho iiprayimari ezidlulileyo-mali eziye zahlawulwa.
Iiproyamu zomntu ezidlulileyo ziza kubakho kuphela kwiinyanga ezi-ezintathu zokubhengezwa, kuba iiprimiyam ezidlulileyo zingaphumeleki emva kokuba isicwangciso siphelile ngenxa yokungahlawulwa kweeprimiyam.
Abantu banokujikeleza olu tshintsho ngokubhalisa kwisicwangciso esivela kwi-insurer ehlukile, kodwa kwezinye iindawo, kukho enye inshurensi yokubonelela ngezicwangciso ekutshintshisweni. Kuloo nto, nabani na ogqitywayo ngenxa yokungahlawulwanga kweprayimenti banokuxhomekeka ekuhlawuleleni iiproyamu emva kokuvunyelwa ukuba babhalise kwisicwangciso esitsha.
> Imithombo:
> ACAsignups.net. Umyinge ongabonakaliyo weeNkcazo zeeMali zeMatriki, ngo-2017. Kugqitywe ngo-Oktobha 27, 2016.
> Isebe lezeMpilo kunye neNkonzo zoLuntu, isiKhuseli soMonde kunye noMthetho woNonophelo ojongene noThathaka; Uzinzo lweMarike . NgoFebruwari 15, 2017.
> Isebe lezeMpilo kunye neNkonzo zoLuntu, isiKhuseli soMonde kunye noMthetho woNonophelo ojongene noThathaka; Uzinzo lweMarike, uMthetho wokugqibela. Ngo-Apreli 13, 2017.
> Humana. Humana > Iyaqhubeka Ukwakha Isicwangciso Esiqinisekisiweyo Emva kokupheliswa kweMibutho nge-Aetna; Unika izikhokelo zezezimali ze-2017; Izisa iziCwangciso zokuSetyenziswa koLuntu. NgoFebruwari 14, 2017.
> Kaiser Family Foundation. Ubungqina bomshuwalense wezeMpilo woBonke abantu, 2015.