Ingqwalasela ye-inshurensi yobisi yee-odrug
Imirhumo yesigqirha yinxalenye ebalulekileyo kwinkqubo yethu yokhathalelo lwempilo. I- Journal ye-American Medical Association (JAMA) yabika ukuba ama-59 ekhulwini aseMelika asebenzisa ubuncinane imithi eyodwa yonyango ngo-2011-2012. Ngoko nangona ungayisebenzisi iyeza elide elide ukunyanga isigulo esingapheliyo, amathuba kukuhle ukuba uya kufuna imithi rhoqo emva kwexeshana.
Kwaye imimiselo abantu abayithathayo iya kuba yabiza, ngezinga eliphambili kakhulu lokunyuka kwamaxabiso (le nto ayilona nto entsha; inqaku leMicimbi yezeMpilo ukusuka ngo-1990 lichaza ukuba iindleko zonyango ziphakathi kweendleko zonyango ezikhulayo ngokunyuka kwezempilo kumakhaya asebekhulile kuma-70s no-80).
I-JAMA yabika ukuba ngo-2013, imali yokusetyenziswa kweziyobisi zonyango e-United States yayingaphezu kweyesibili yezinye iintlanga ezikhungathekileyo, kwaye yabalwa ngamaphesenti angama-17 "kwiinkonzo zonyango jikelele. Ngokwe-2015 Milliman Medical Index, iindleko zemimiselo zenyuka ngama-13,6 ekhulwini ukususela ngo-2014 ukuya ku-2015, eyona nto eyona nto eyona nto ibangela ukunyuka kweendleko zonyango ngexesha lelo xesha.
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Yintoni evumelekileyo njengemali yezoNyango kwiRhafu yakho yeNgeniso?
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Indlela Yokulondoloza Izidakamizwa NgeeNkqubo zoRhulumente
Ngokucacileyo, ukuhlawula izidakamizwa zemithi kuyinxalenye ebalulekileyo yesicwangciso se-inshurensi yempilo. Kodwa ukuhanjiswa kweziyobisi zonyango kuye kwavela kakhulu kwiminyaka embalwa edlulayo. Ukubhengezwa kwamagqabantshintshi bekude kube yinto eqhelekileyo phantsi kwemigaqo-nkqubo ye-inshorensi yempilo yabucala, kodwa kumakethi athile kwiminyaka ye-2000, abanye abathwali baqala ukutshintshwa kwizicwangciso ezingenakufakela imiqathango kuwo onke, okanye ukuba kuphela izidakamizwa eziqhelekileyo. Ekuqaleni kuka-2013, ngokwe-Analysis ye-HealthPocket, kuphela iipesenti ezingama-82 kuphela zezicwangciso ezikhoyo kwiimarike zodwa ezikhusele iziyobisi, kwaye zibandakanya izicwangciso "ngokukhawulelana okufutshane."
Ukuguqulwa kwezeMpilo kunye neMithi yokuLawulwa kwemithi
Xa uMthetho ojongene noNonophelo olungabonakaliyo ubhaliwe, abagwebi babesazi ukuba ukukhutshwa kwezidakamizwa kufuneka ukuba kufakwe kuzo zonke izicwangciso, njengoko iimpembelelo zemali kunye nezokwelapha zokungabikho komrhumo weemfuno zonyango zingabangalisa.
Izidakamizwa zonyango zingenye yeenzuzo zezempilo ze-ACA, oku kuthetha ukuba zihlanganiswe kuzo zonke izicwangciso zezempilo zeqela kunye nezincinci ezincinci ukususela ngo-2014. Izicwangciso zeqela elikhulu (kumazwe amaninzi, oku kuthetha ukuba ubuncinane abasebenzi abangama-51, nangona abambalwa bathi , kubhekiselela abasebenzi abancinci abangama-101) abafunwa ukuba bafumane ii-ACA ezibalulekileyo zeempilo ngaphandle kokunyamekela , kodwa isininzi sezicwangciso zeqela elikhulu sele zifumene izidakamizwa zamachiza phambi kokuba i-ACA iphunyezwe, kwaye yaqhubeka yenza njalo.
Iinjongo zeNtsholongwane yezeMpilo yimiNxeba yeNgcaciso yoMgaqo
Kukho ukuhlukahluka ngokubanzi malunga nendlela izicwangciso zempilo zijonga ngayo izidakamizwa zonyango. Kukho izicwangciso ezintathu eziqhelekileyo zenzelwe ukuba izicwangciso zisebenzise:
- Iikopi zeemimiselo eziqala ngokukhawuleza. Ngokomzekelo, isicwangciso sinokuhlawula i-$ 10 / $ 25 / $ 50/30% kwiNqanaba 1 / iNqanaba lesi-2 / iNqanaba lesi-3 / i-Tier 4, ngaphandle kokuchithwa okanye enye ukwabelana ngeendleko .
- I- deductible yemithi ehlukileyo kwi-medical deductible, emva koko iifayili zisebenza ngokuxhomekeke kwi-tier tier. Kwi-Benefits yePrayimenti ne-Payment Parameters ngo-2018, i-HHS yaqaphela ukuba izicwangciso ezifanelekileyo ezicetywayo ngo-2018 ziza kubandakanya ukuhluthwa kwezidakamizwa ezahlukileyo kunye nezidakamizwa zezicwangciso zesilivere, "kubonakalisa ukufana kwesi sakhiwo sokwabelana ngeendleko kwii-QHP kule mazinga ukufihla. " Ngamanye amazwi, esi sicwangciso sakhiwo sele sasiqhelekileyo kwiiplani ezithengiswa kwikharityhulam nganye. Ngezicwangciso eziqhelekileyo eziye zaphakanyiswa ngu-HHS ngo-2018, iiplani zesilivere ziza kuba ne-$ 500 yezidakamizwa ezichithwe ngokuchithwa kwemithi, ngaphezu kwe-$ 3,500 yonyango.
- Ukudibanisa unyango / umrhumo ochanekileyo, kunye ne-copays yomrhumo okanye i-coinsurance esebenza kuphela emva kokuba udibene ngokupheleleyo. Izicwangciso ezifanelekileyo ezifanelekileyo ze-HSA azikwazi ukubonelela ngezinye iinkonzo ngaphandle kokunakekelwa kokukhusela phambi kokuncitshiswa, ngoko ke ezo zicwangciso ziya kulandela imiyalelo emva kokuba uhlawule umrhumo wakho wonyaka.
Ezinye iindawo ziye zaphunyezwa izicwangciso malunga nokuba isicwangciso sempilo sinokufuna ukuba amalungu ahlawule izidakamizwa ezizodwa, ngenzame yokugcina imithi efikelelekayo kubantu abaneemeko ezinokuphathwa kuphela ngeziyobisi ezibiza kakhulu.
Kodwa nangona i-state yakho ingenayo, kwaye unyanzelekile ukuhlawula ipesenteji enkulu yeendleko zonyango ebiza kakhulu ngenyanga, yazi ukuba isicwangciso sakho se-inshorensi yempilo siya kuhlawula iipesenti ezili-100 zemali yakho yesigunyaziso xa sele udibene nawe -i-pocket ephezulu ngonyaka. Ukususela kuloo ngongoma, iziyobisi zakho ziya kugqitywa ngokuzeleyo ukwenzela intsalela yonyaka.
Konke malunga neFormularies
I- formulary yoluhlu lwezilwanyana eziza kuzikhupha isicwangciso sakho sezempilo. Kwi-formulary, izicwangciso zempilo zahlula iziyobisi kuma-third party, kunye neziyobisi ezincinci kakhulu zihlala kwiNqanaba 1 kwaye izidakamizwa ezibiza kakhulu ziphantsi kweNqanaba 4, 5, okanye 6, kuxhomekeke kwindlela isicwangciso esilungiselelwe ngayo.
Izidakamizwa ezisemgangathweni zivame ukuba zizodwa iziyobisi , kubandakanywa neenjectables kunye ne- biologics . Ngenxa yale mithi, umthengi uya kufuneka ukuba akhokhe ipesenti yeendleko (oko kukuthi, u- coinsurance kunokuba ikopi ye-copay ), ngaphandle kokuba imimiselo yomgaqo-nkqubo ifake ikhefu kwiindleko zonyango ezizodwa.
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Izidakamizwa Zesizukulwana: Ngaba ndingayigcina kwiWalmart kunye nezinye izitolo ezinkulu zebhokisi?
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Intshurensi yezeMpilo: Izidakamizwa zeGeneric Zikunceda Ukugcina Imali kwimigqaliselo
Kwizikhokelo ezisungulwe yi-HHS kunye nabalawuli belizwe, abaqinisekisi bempilo bakhululekile ukuhlakulela iifomries zabo kunye nokuzilungelelanisa njengoko zifunekayo ngokuhamba kwesikhathi.
Ngaphantsi kwe-ACA, ifom ye-formulary kufuneka ikhuphe ngaphezulu
- ubuncinane isilwanyana esinye kwi-US Pharmacopeia kunye neklasi
- inani elifanayo leziyobisi kwicandelo ngalinye kunye neklasi njengeplani yesithenjwa esikhethwe nguRhulumente
- Izicwangciso zezempilo ziyafuneka ukuba zibe nekomiti yezokhemisi kunye neyeza (P & T) ezijongene nokuqinisekisa ukuba ifomula iphelele ngokwaneleyo.
Ngoko nangona zonke iindidi eziqhelekileyo zonyango zifihliwe, oko akuthethi ukuba iyeza elithile liza kuhlanganiswa yilo cwangciso, okanye nakwephi na izicwangciso kwindawo ethile. Kukho inkqubo yokubhenela ekhoyo , nangona kunjalo, ukuba wena kunye nogqirha wakho kukholelwa ukuba kubalulekile ukuba usebenzise isilwanyana esingekho kwifom ye-formulary yakho yezempilo.
IiMedare kunye neMithi yobisi
Ngokungafani nezicwangciso ze-inshorensi zempilo yabucala, iMicroreare yaMandulo (ii-Medicare Parts A kunye no-B) ayifuni izigulane zonyango. Ngo-2003, iCongress yadlulisela i-HR1, uMthetho weMithi yeDrama yeDrama, iPhuculo loPhuculo loMasipala ka-2003. Umthetho wadala inkqubo entsha- i-Medicare Part D-ukukunceda ukugubungela iindleko zemithi yesigxina kwi-Medicare ababhalisile.
Ukuze kufumaneke imiyalelo yemigqaliselo, ii-Medicare ababhalisile kufuneka babe ne-private coverage. Kukho iindlela ezimbalwa zokufumana ukukhutshwa kweemviwo xa ufanelekile kwi-Medicare:
- I- Medicare ye-Medicine Ingxenye yeDiskr eDiskr eDayibrari , engasetyenziselwa kwi-tandem ne-Original Medicare
- Isicwangciso soNcedo lweMedareji esibandakanya iCandelo D ukusetyenziswa kwezigulane (izigulane ze-Medicare Benevantage zibizwa ngokuba yi-MAPD)
- Inkcazo eyongezelelweyo evela kumqeshi okanye kumqeshi womlingane
I-Medicare Ingxenye D ine " umgodi wenkxaso " ngexesha ababhalisile babeqala uxanduva lwee-100 zeepesenti zabo zeziyobisi. UMthetho woNonophelo ongenakunqwenela wawubandakanya ilungiselelo lokuvala umgodi wecala; le nkqubo iya kuphunyezwa ngokukhawuleza, kwaye umgodi wenkomo uya kulahla ngo-2020.
Ukuxilongwa kweMicrosoft
Kulo lonke urhulumente, i-Medicaid iquka iziyobisi zonyango. Ukuba ubhalise kwiMedicaid (kubandakanywa nabantu ababesanda kulungeleka ngenxa yenyusa ye-ACA ye-Medicaid ), imimiselo yakho iya kugqitywa ngokugcwele okanye ngeekhompyutheni ezithobekileyo.
Nangona kunjalo, kubantu abanobuchule -abafanelekile kwiMedicaid kunye ne-Medicare , iMedicaid yayeka ukugaya izidakamizwa zonyango ngo-2006, xa i-Medicare Part D yaphunyezwa. Abaxhamli abafanelekayo abafumana emibini bayayifumana imimiselo yabo kwi-Medicare Part D (kunokuba i-Medicaid), kodwa iNkqubo yoNcedo yoNgezelelweyo ihlawula iiprayimari kunye nenxalenye enkulu yokwabelana ngeendleko kwisicwangciso somyalelo.
IziCwangciso zeNgcaciso zeeDrug kunye neeSicwangciso eziManyeneyo
Ukuba unesicwangciso esikhulu okanye esikhulu esingazifumanisi iziyobisi zonyango, okanye ukuba awuqinisekanga, kukho iindidi ze-inshorensi yezilwanyana zonyango kunye nezicwangciso zokuphuhlisa. Ziyakwazi ukubonelelwa ngeenkampani zomshuwalense, ama-pharmacy, abenzi beziyobisi, okanye imibutho yokubambisana / yobulungu njenge-AARP.
Ukuba ucinga ngolu hlobo lwesicwangciso, funda ukuprintwa kakuhle kakuhle. Yazi ukuba kunye nesicwangciso sokuphuhlisa, ngokuqhelekileyo uya kuhlawula imali eninzi kwiindleko ezibiza kakhulu, ke gcina ukhumbule ukuba izinto zokuthengisa zithi "ukufikelela kuma-60 ekhulwini," akuthethi ukuba uya kufumana Iipesenti ezingama-60 kwiindleko zaso nasiphi na isilingo onokuyidingayo.
Izicwangciso zonyango ezizimeleyo azibaluleki njengento encinci ye-coverage phantsi kwe-ACA, ngoko ke ukuba awuqinisekanga kwaye unemishanguzo yomshuwalense okanye isicwangciso sokuphuhlisa, uya kuhlala usesikweni se-ACA somyalelo wesigwebo somntu ngamnye, ucinga ukuba nga xolelwa.
Inqaku esuka
Imirhumo iyabiza, kwaye ukufumana ngokwaneleyo ukukhutshwa kungenza umehluko phakathi kokukwazi ukuhlawula amayeza akho ngokubhekiselele ekusebenzeni ngaphandle.
Ukuba unzima ukuhlawula imimiselo yakho, kukho iinkqubo zonyango zoncedo ezinganceda. Ukuba udidekile malunga neenzuzo zakho okanye ukhetho olufumanekayo kuwe, fikela kwiqela le-HR yomqeshi wakho, okanye kumthengisi okanye umqhubi wendlela onokukunceda uqhathanise izicwangciso ezahlukeneyo. Nceda ungacingi ukuba ufanele uzibonise zonke; Uncedo lufumaneka kwindawo yakho.
> Imithombo:
> Congress.gov. UMthetho weMithi yokuLawulwa kweziDakamizwa, ukuPhucula, kunye noLungiselelo lweModyuli ka-2003. I-Congress ye-108 (2003-2004).
> Isebe lezeMpilo kunye neNkonzo zoLuntu, uMkhuseli weMonde kunye noMthetho woNonophelo ojongene noThutho, iSaziso seHSS soNcedo kunye neParameters yokuhlawulwa ngo-2018 . 9/6/2016.
> UGirod, uChristopher S., Weltz, Scott A., Hart, uSusan K., i-Index yezigidi ze-2015, ngoMeyi 19, 2015.
> Kantor, Elizabeth D., MPH; Rhem, Colin D., PhD, MPH; Haas, Jennifer S., MD, MSc; Chan, Andrew T., MD, MPH; Giovannucci, Edward L., MD, ScD. Iintlobo zeendlela zokusetyenziswa kwezidakamizwa phakathi kwabantu abadala e-United States Ukususela ngo-1999-2012. I-Journal ye-American Medical Association , ngoNovemba 3, 2015, Vol Vol 314, No. 17.
> Kesselheim, Aaron S., MD, JD, MPH; Avorn, Jerry MD; Sarpatwari, Ameet, JD, PhD. Iindleko eziPhakamileyo zeMithi yokuLawulwa kweMithi eMelika. Umbhalo we-American Medical Association , Agasti 23/30, 2016, Vol 316, No. 8.