Iingcebiso ezi-4 zokwenza i-HIV yakho ibe neziyobisi ezininzi

Iindleko eziPhakamileyo zoKhathalelo zifuna iSicwangciso soThengiselo lokuThengwa

Ukubonisa ukunakekelwa kwempilo esemgangathweni kuMerika osemgangathweni unzima ngokwaneleyo ngaphandle kwengxaki eyongeziweyo yesifo esingapheliyo. Ngokuqinisekileyo, kubantu abaphila ne-HIV, imingeni inkulu kunikwa iindleko eziphezulu zeziyobisi ze-HIV, imfuno yokunyanzeliswa ngokuthe ngqo kwonyango , kunye nemfuno yokuqhubeka, unyango lwexesha lonke kunye nokunyamekela.

Cinga, umzekelo, ukuba umyinge, iindleko zomntu ngamnye wokuphila nge-HIV iphezulu ngaphezu kwama-400,000-kwaye oku kubantu abaqala unyango kusasa kwaye baninzi ukuphepha izifo ezinxulumene nesifo esilandelayo (okanye esingaphendulwanga) .

Ngoku kongeza kule indleko ye-HIV yonyango, ephethe iteksi yentengo ephakathi kwama-2,000 ngenyanga, kwaye izithintelo zikhula ngokucacileyo. Ngaphandle kwenkcazo yokusetyenziswa kweziyobisi, amaninzi ala mayeza awahlala engenakulungeleka ngenxa yeendlela "ezinobungozi" ezinokuthi i-insurers ifune iindawo ezivela kwipesenti ezingama-20 ukuya kwi-50 yemali yokuhlawula i-insurance insurance nganye.

Oku kuthetha ukuba umntu onomvuzo "ongezantsi" we-20 weengxowa-mali unokuhlawula ngokukhawuleza phakathi kwe-$ 440 ukuya kwii-480 zeenyanga ngenyanga ukufumana i- Triumeq , umgangatho ongeyena, ipilisi enye. Kwaye oko akunakucingela neendleko zee-deductibles kunye nezinye iindleko ze-pocket ezingabongeza ukuya kumawaka eedola phambi kokuba iinzuzo zakho zikhawuleze.

Nangona kunjalo ukukhathazeka ngamathuba okuba-ikakhulukazi abafumana umvuzo ophakathi, abangenakho ukufumana iintlawulo zentsebenziswano kunye nokufumana izibonelelo ezibonelelwe ngamaqela angeniso-mali angaphantsi-kukho izilungiso.

Abanye banokufuna ukuba ulungelelanise isicwangciso sakho se-inshorensi yangoku, ngelixa abanye bangakuvumela ukuba ufikelele kwiinkqubo zoncedo onokucinga ukuba awufanelekanga.

Kulabo bafuna ukunceda, ziyiendlela ezi-4 ezilula zokunciphisa iindleko eziphezulu zokunyangwa kwe-HIV kunye nokunyamekela.

1. Qala ngokuSichaza ukufaneleka kwakho koNcedo

Iingcamango ezingavumelekanga kukuba iinkqubo zoncedo lwe-HIV zenzelwe ukukunceda kuphela abantu baseMelika abangenayo imali.

Nangona kuyi nyaniso ukuba ezininzi iinkqubo ze-federal kunye neenkqubo ezixhomekeke kummandla zinciphisa ukufikelela kubantu abahlala okanye ngaphantsi komgaqo-nkqubo olwaphulo-mthetho obumiselweyo, akusoloko kunjalo.

Ngenxa yokunyuka kwexabiso le-HIV kunye nokunyamekela, inani elincinci leenzuzo lifumaneka kubantu abafumana imali engama-65,000 okanye iintsapho ezifumana ingeniso engama-$ 80,000 ngonyaka. Oku kungenxa yokuba iinzuzo zinikezelwa abo bahlaziywe ingeniso engaphezulu kwama-200 ukuya kuma-500 ekhulwini kwinqanaba lehlwempu (okanye i-FPL).

Ukucacisa, ukufumana ingeniso yemali yonyaka (okanye i-MAGI) ingeyona mali epheleleyo wena kunye neqabane lakho owenza ngaphezu kwexesha lonyaka. Kunoko yinto engenayo ingeniso (AGI) efunyenwe kwingxelo yakho yerhafu yonyaka (umgca 37 ngo-1040, umgca we-21 kwi-1040A, kunye nomgca we-4 kwi-1040EZ) kunye ne-add-backs:

Ngala manani ngesandla, unako ukubala i-MAGI yakho kwaye unqume ukuba ingawa phantsi komgca we-FPL ochazwe yiprogram ethile, i-state okanye inkxaso-mali.

Yandisa ngokuphindaphindiweyo i-MAGI ngokwemimiselo emiselweyo (umzekelo, ngaphantsi kweepesenti ezingama-300 zeFPL) ukuze ubone ukuba ufanelekile.

Inqanaba lentlupheko elisemgangathweni (FPL) , okwangoku, ngumlinganiselo okhutshwe yiSebe lezeMpilo kunye neNkonzo zoLuntu (i-DHHS) yase-United States ukuqinisekisa ukuba umntu okanye umntu ofanelekileyo unokufumana inkxaso yenkqubo yoncedo efana ne- Medicaid . Ngo-2016, i-DHHS ibeka izikhokelo ezilandelayo ze-FPL kubantu kunye nakwiintsapho:

(I-FPL yobabini iAlaska neHawaii iya phezulu.)

Ukusebenzisa ezi zikhokelo, umntu ongu-MAGI ungaphantsi kwama-138 ekhulwini we-FPL uza kufumana iMedicaid ngokusekelwe kwimali engenayo kuphela. Ngokufanayo, uncedo lunokufumaneka kuloo i-MAGI iphantsi kwe-200 ekhulwini okanye ephakamileyo njengama-500 ekhulwini kwi-FPL. Yinto eninzi enokuyenza inzuzo kwimindeni ephezulu engenayo ne-HIV.

Uphakame kangakanani na?

Kwimiqathango yedola eyimfuneko, isibini esisebenza ngokuzimeleyo eMassachusetts sithumela ngokubambisana nemali engenayo yonyaka we-R16 000 kunye ne-inshurensi yempilo yabucala ibe ne-MAGI engama-76,000. E-Massachusetts, ukufikelela kwi-Programme yoNcedo lwe-HIV (i-HDAP) ye-HIV ivulekele kwiibinibini ezine-MAGI ezingaphantsi kwe-500 ekhulwini ze-FPL (okanye i-$ 80,100 ngo-2016). Phakathi kwezi zibalo, esi sibini siya kulungeleka i-HDAP.

Ngokwahlukileyo, isibini esifanayo asiyi kulungeleka eTexas kunokuba umqathango wokufaneleka wemeko usetyenziswa kuma-200 ekhulwini we-FPL (okanye i-$ 32.040 ngo-2016). Nangona kunjalo, inani leeprogram ezixhaswa ngemali ( jonga ngezantsi ) zinokufumaneka kwiibhanki eziphezulu.

2. Thatha indlela yokuCwangcisa iSicwangciso-qhinga xa usebenzisa iSicwangciso seNtshurensi

Ukusebenza apho umgaqo-nkqubo ulungele ukuba wena nentsapho yakho uhlala ufana nokubeka iipuzzli ezifanelekanga. Ukuba ungumntu onentsholongwane kaGawulayo, ngokuqhelekileyo uza kubala i-premium yakho yonyaka kunye ne- year deductible yakho kunye neendleko zakho zokuhlawula umrhumo wonyango wonyaka ukwenzela ukuba uqikelele inkcitho yakho yezempilo. I-equation elula ngokwaneleyo, kuya kubonakala.

Okanye ngaba kunjalo?

Ukubonelelwa ngeendleko eziphezulu zeziyobisi ze-HIV, akuqhelekanga ukufumana ukuhlawula ngaphezulu-okanye ngaphantsi kweendleko zenyanga nyanga nokuba ngaba ufumana i-premium / low low deductible / low low-pay pay policy okanye i-premium / high high deductible / high uhlawule umgaqo-nkqubo.

Oku kungenxa yokuba iziyobisi ze-HIV ziza kufakwa ngokukhawuleza kwi-"specialty" yexabiso eliphezulu xa ithola umgaqo-nkqubo ongezantsi. Kwaye, nangona kungenjalo, i-deductible yakho yonyaka iya kuba yinto ephakamileyo kakhulu kangangokuthi uza kugqiba ukuchitha i-fortune phambi kokuba ufikelele nakuphi na uncedo.

Kodwa akusoloko kunjalo. Nazi ezimbalwa, iingcebiso ezilula zokukhetha umgaqo-nkqubo we-inshorensi efanelekileyo ukuba ungumntu ophila ne-HIV:

3. Yenza Ukusetyenziswa Okugqwesileyo kwezibonelelo ze-ADAP

INkqubo yoNcedo lweMithi yoGawulayo (ADAP) sele ithathelwa ingqalelo kwimithombo yokuqala ye-HIV imishanguzo ye-low-middle-joint Americans. Ukususela ekuqaleni kwayo ngo-1987, ububanzi beprogram buye banda kakhulu, ngamanye amazwe ngoku adibanisa unyango lwempilo, iimvavanyo zebhabhi, uncedo lwe-inshorensi, kunye ne- HIV yokhuseleko lokukhusela kwisibonelelo sexesha.

Njengoko kunye nezinye iinkqubo ezixhaswe ngemali, ukufaneleka kukusekelwe ngokubanzi kwimali engenayo, imiqobo leyo ingahluka ngokubanzi ukusuka kummandla ukuya kwilizwe. Ubungqina bokuhlala kunye namaxwebhu e-HIV afunekayo.

Ngelixa amaninzi amazwe aya kunciphisa ukufaneleka kwabemi base-US kunye nabahlali abathintekayo kuphela, ezinye ezifana neMassachusetts neNew Mexico ziye zandisa uncedo lwe-ADAP kumanye amazwe angagqithwanga kwamanye amazwe, ngokunjalo.

Okwangoku, iintandathu ezintandathu zase-US zikhupha izibonelelo kubantu okanye kwiintsapho eziphathekayo zeempahla zangaphakathi ziwela phantsi komda othile, ukusuka ku-R25 000 ukuya kwiNew York State ukuya ngaphantsi kwamaRandi angama-4 500 eGeorgia.

Izilungelo ezikhoyo zokufumana umvuzo we-ADAP zichazwe ngolu hlobo lulandelayo:

I-ADAP ibhekwa njengomhlawuli wexesha lokugqibela, oko kuthetha ukuba, ngaphandle kokuba ufanelekile kwi-Medicaid okanye kwi-Medicare, uya kufuneka ubhalise kwindlela ethile ye-inshorensi yangasese okanye yomqeshi. (Amanqaku ambalwa anika inkxaso yokuxhaswa kwabasenakho ukuhlawula kunye / okanye abavumelekanga kwiMedicaid.)

Ngaphambi kokuba uzenzele nayiphi na umkhiqizo womshuwalense, qhagamshelana nomnikezeli we-ADAP wombuso ukuba ubone ukuba ufanelekile ukuncedwa. Ngokusekelwe kwiintlobo zeenzuzo okwazi ukufikelela kuzo, unokukhetha ukhenketho lwe-inshorensi olufanelekileyo kwiimfuno zakho.

Ukuba, umzekelo, iindleko zemithi yindleko zakho eziphezulu kwaye awuyikubonela phambili nayiphi na inkcitho enkulu yempilo yonyaka, unakho ukukhetha umkhiqizo we-inshurensi nge-premium yenyanga ephantsi kunye ne-high-deductible-out- enkulu ipokothini. Ngale ndlela, unokufuna kuphela ukuhlawula iimvavanyo zakho zegazi ezimbini kunye neentengiso zonyango, akukho nto enye.

Ngakolunye uhlangothi, ukuba uneminye imiqathango ekhoyo okanye ukhangele iindleko zonyango eziphezulu zonyaka, unokufuna umgaqo-nkqubo onika ixabiso elincinci okanye elingaphandle. Kule meko, i-ADAP inokukhupha ngokukhawuleza indleko ephezulu yonyango kwaye mhlawumbi, ngamanye amaxesha, kunika ukufikelela kumayeza asetyenziswa ukuphatha izifo ezinxulumene ne-HIV.

Ingezantsi yile: sebenze nommeleli wakho we-ADAP kwaye umnike iinkcukacha ezininzi malunga neenzuzo zakho zomgaqo-nkqubo kunye neyeza langoku kunyango. Ngaloo ndlela, unokwenza isigqibo esipheleleyo esichazela ibhajethi yakho kunye nezidingo zonyango lwezempilo.

4. Thatha inzuzo epheleleyo yoNcedo lweMithi yoMenzi

Xa kuziwa ekunciphiseni iindleko zokuphuma ngaphandle kwee-HIV, sithatha ukugxininisa phantse kwiiprogram / zephondo kwaye sikhohlwe ukuba uncedo lufumaneka ngokulula kuwo wonke umenzi omkhulu wezilwanyana ze-HIV. Ezi ziqhelekileyo zinikezelwa ngoncedo lwentlawulo-ntlawulo yenkxaso-mali okanye iiprogram zokuncedisa isigulane ngokupheleleyo (PAPs).

Inkokhelo yokuhlawula i-HIV (inkokhelo yentlawulo-mali) iyafumaneka kubantu ngabanye abaqinisekisiwe kunye nokunikezela ukugcinwa kuyo yonke indawo ukusuka kwi-$ 200 ngenyanga ukuya kuncediso olungenamkhawulo emva kokuhlawulwa kwentlawulo ye-$ 5 yokuqala (njengamachiza e-Edurant, Intelence, ne-Prezista).

Inkqubo yesicelo ilula, kwaye ngokuqhelekileyo akukho zithintelo ezisekelwe kwingeniso. Oku kunokuba yinzuzo enkulu kulabo bathengisa i-inshorensi entsha, bavumela ukuba bakhethe iimveliso zendleko ephantsi apho ixabiso labo lokuhlawula iilesi okanye ixabiso lokuthengisa liwela phantsi kwe-annual annually / benefit monthly.

Makhe sithi, umzekelo, ukuba ungowesigxina i-Triumeq, apho umenzi unikeza inzuzo yonyaka-ntlawulo ye-6,000 ngonyaka. Ukuba i-Triumeq ifakwe kwisigxina seziyobisi esidinga ukuhlawula i-co-intlawulo, ngokuqhelekileyo loo nzuzo iphelele ngokwaneleyo ukufihla zonke iindleko zokuhlawula iikhowudi.

Kodwa, ngakolunye uhlangothi, unokwenza ntoni ukuba i-Triumeq iwele ngaphakathi kwinqanaba elidinga iipesenti ezingama-20, iipesenti ezingama-30 okanye i-50% ye-coinsurance? Kwimeko enjalo, unokukwazi ukufumana umgaqo-nkqubo ophantsi kwe-pocket ephezulu. Ngoko ungasebenzisa uncedo lwentlawulo ngokukhawuleza uhlawule zonke iindleko zonyango kude kube yile xesha ufikelela kwisikhululo sakho sonyaka, emva koko zonke iindleko-iziyobisi, ii-X-rays, ukutyelela ugqirha-zifunyenwe ipesenti ezili-100 ngu-insurer yakho.

Enye inketho iiprogram zokuncedisa isigulane se-HIV (PAPs) . Ii-PAP zenzelwe ukubonelela ngemithi yamahhala kubantu abangaqinisekanga abangafanelekanga kwiMediicaid, Medicare, okanye ADAP. Ulungeleliso luvame ukukhawulelwa kumntu okanye kwiintsapho ezafumana ingeniso yeminyaka engama-500 ngaphantsi kwe-FPL (nangona kungenakwenziwa ngaphandle kwimeko yecala le-Medicare Part D okanye abantu abangaphantsi koxanduva lwabo lokunakekelwa kwempilo luye lwaba lukhuni).

Ii-PAP zihlala zikwazi ukuphilisa abantu abahlala kwilizwe ezifana neTexas, apho i-Medicaid ne-ADAP incitshiswa kuphela kubahlali abafumana ngaphantsi (okt, iipesenti ezingama-200 ngaphantsi kweFPL). Namhlanje, ezininzi zePAP zifumaneka kulabo abahlala kwi-500 engaphantsi kwe-FPL, ngaphandle kwemimiselo esekelwe kwixabiso elifanelekileyo.

Ukongezelela koko, ukuba utshintsho kwiimeko zokulungelelanisa zikarhulumente ngokukhawuleza akufanelekanga kwi-ADAP, usenokukwazi ukufumana uncedo lwe-PAP nangona ungena ngaphandle kwemingcele engenisiweyo. Ngokubanzi, ii-PAP zilula kakhulu ukuhlangabezana nazo xa kufakwa isikhalazo xa kuthelekiswa namaofisi karhulumente, kwaye iyakwazi ukukukhokelela kwezinye iinkqubo ezingezona urhulumente ezinikezela ngoncedo oluthile lwe-HIV.

Nenye yokugqibela yokucinga

Nangona ukufikelela kukubalulekileyo kwimpumelelo yonyango, ungalokothi uvumele intengo yedwa ulawule ukhetho lwonyango. Ngelixa unako ukugcina i-dollar embalwa ngephambi kwepilisi enye (umzekelo, i-Atripla) yamacandelo eziyobisi ngamanye (uSustiva + Truvada), utshintsho olunjalo alufanele lwenzeke ngaphandle kokubonisana ngqo kunye nogqirha wakho wokunyanga.

Oku kuyinyani ngokukodwa xa ugqiba ukutshintsha kwi-regimen apho nayiphi na isicatshulwa sezilwanyana ehlukileyo kwizinto okhoyo ngoku. Ukungatshintshwa kwenguqu yonyango kunokunyusa umngcipheko wokuchaswa kweziyobisi ngaphambi kokuqala , okwenzeni ukuhluleka kwexesha lokuqala .

Umgca weyona nto: kungcono ukuhlolisisa ngokupheleleyo zonke iindlela zokuncediswa ngaphambi kokuqwalasela nayiphi na utshintsho lweyeza elinokuthi lonakalise impilo yakho. Ukufumana ulwazi oluthe vetshe, qha ga mshelana ne-Non-for-profit Partnership ye-Assurance Assistance (PPA), edibanisa izigulane kwiinkonzo zoncedo mahhala, okanye i-HarbourPath, iqela elingenzi inzuzo eliseCharlotte, North , abantu abangaqinisekanga.

> Imithombo:

> Farnham, P .; Gopalappa, C .; Isihlengo, S ..; okqhubekayo. "Ukuhlaziywa kweNdleko yoBomi beNkxaso kunye neNqanaba loBomi be-HIV-Abantu abachaphazelekayo kwi-United States: Ixesha elifutshane kunye nokuxilongwa kwangaphambili kunye nokungena kwiNkathalo." I-Journal ye-Immune Deficiency Syndromes. Oktobha 2003; 64: 183-189.

> Kaiser Family Foundation (KFF). "Umyinge we-Single Premium kubasebenzi ababhalisiweyo kwiNtshurensi yezeMpilo yase-Employee-2015." Oakland, California; fi kelele ngoDisemba 8, 2016.

> KFF. "Umyinge weeNyanga zeNyanga zeeNyanga ngamnye kwiMarike yedwa." 2013; fi kelele ngoDisemba 8, 2016.