Xa ixesha liphuma
Uninzi lwabantu luhlawula unyango lwabo lwempilo. Ingakanani ehlawulayo kuxhomekeke kwisicwangciso sezempilo abayisebenzisayo.
Ingaba umntu uhlala kwi- Medicare , icebo le-Inshurensi yeeNtsholongwane yezeMpilo, i-inshurensi exhaswe ngumqeshi, okanye esinye isicwangciso se-inshurensi yabucala baza kufuneka bahlawule iiprayimari zenyanga ukuze basebenzise icebo. Baya kuhlawula iidraucable kunye ne-copayments kunye ne-coinsurance kwiinkonzo abazifumanayo.
I-Medicaid , nangona kunjalo, isebenza ngokungafaniyo. Ngokuxhomekeke kwimeko, iinkonzo zeMedicaid zinokukhululeka kwiindawo ezithile. Ezinye kodwa akuzona zonke iindawo ziya kufuna iiprimiyam; ezinye ziza kufuna iikopi. Ezinye iindawo zize zazisa iimfuno zomsebenzi ukucacisa ukufaneleka. Isiphakamiso seMedicaid sakutshanje kukuba ukongeza imida yokuphila kwiprogram.
Kungakhathaliseki isicwangciso sezempilo esisetyenzisiweyo, kunokuba kuyingozi ukuba ufunde ukuba, nangona umntu ehlawula isabelo sakhe, iinzuzo zabo zingasuswa emva kwexesha elithile, kungakhathaliseki ukuba yimpilo okanye imfuno. Ukuba isiphakamiso seMedicaid sihamba, siya kulandela umda omde wexesha lokuphila elibekwa ngabashuseli besikhathi esidlulileyo.
Imilinganiselo yoBomi kwi-Intshuwalense yangasese
Ngaphambi koMthetho wokuNakekelwa ongenakunciphisa (ACA) owadlulayo ngo-2010, iinkampani zomshuwalense yabucala babe neyona ndlela yokongeza imida yokuphila kwizicwangciso zabo.
Abagcini bomshuwalense bengekho kuphela abaphuculisi bonyusa izindleko zeepriyamu kubantu ababenemiqathango engaphambili , bayeka ukuhlawula ukunyamekela emva kokuba inani elithile lase dollar lisetyenzisiwe.
Ingaba bekukhona umda wonyaka okanye umda wokuphila (inani lomntu obhalisiwe kwisicwangciso) isetyenziselwa ukuba i-insurer iya kubahlawula phi, abaxhamli bazakunamathela kuzo zonke iindleko ezisele emva kokuba umda ufikelelwe.
Ngombulelo, i-ACA ayizange iphumelele kuphela ngeemeko ezixhasayo kodwa ngeemyinge zonyaka kunye nobomi, ubuncinane xa kuzifumana kwiimfuno zezempilo ezibalulekileyo .
Abasayi kuhlala bengabikho abantu abagulayo ngaphandle kokunakekelwa kwezempilo xa befuna kakhulu.
Imilinganiselo yoBomi kwiMida
I-Medicare yinkqubo yesigqeba esinika inkxaso kubantu abadala kunye / okanye abo banokukhubazeka okufanelekileyo. Icandelo A , enye yezine kwi-Medicare, inikezela ukuhanjiswa kwezibhedlele ezingenasifo esibhedlele , ukuhlala kwexesha elifutshane kwiindawo zokunesiza ezinezakhono , kunye ne- hospice .
Ngelixa abantu abaninzi abanakho ukuhlawula iipriyamu kwiCandelo A , oko akuthethi kukhululekile. Ukuhlaziywa kunye ne-coinsurance kufuneka ihlawulwe kwiinkonzo ezinikezelwa kwixesha ngalinye leenzuzo. Kukho neentsuku zokugcina ixesha lokuphila ukuba ziqwalaselwe.
Icandelo A libandakanya iintsuku ezingama-90 kwisibhedlele nganoma nayiphi na inzuzo. Emva kokuhlawula i-deductible, iintsuku ezingama-60 zokuqala zikhululekile kumxhamli. Ngo-2018, iintsuku ezingama-61 ukuya ku-90 ziza kufuna ukuhlawuliswa kwe-$ 335 ngosuku. Emva kweentsuku ezingama-90, umxhamli uya kuhlawula zonke iindleko eziphuma ephaketheni okanye ngaphandle kokungena kwiindawo zabo zokugcina iintsuku. Mna kunjalo, baya kuhlawula i-$ 670 ngemini nganye ngosuku lokugcina ubomi. Umntu ngamnye unemihla engama-60 eninzi angayisebenzisa ngaphezu kobomi babo.
Iintsuku zokugcina iintsuku zokuhlala zingasetyenziselwa ukuhlala kwisibhedlele esinye okanye kwiindawo ezininzi zokuhlala. Kuxhomekeke kwiimfuno zomntu ngamnye.
Ixesha lokuPhila kweMpilo
I-Medicaid ixhaswa ngemali kunye noorhulumente bombuso kunye noorhulumente kodwa iqhutywa yilizwe.
Nangona urhulumente wesigqeba ubeka imilinganiselo encinci ye-Medicaid coverage, urhulumente ngamnye unokuphakamisa ukutshintshwa kule mi gangatho nge- 1115 i-Medicaid waivers .
Okwangoku, i-Indiana neKentucky ziye zavunywa yi-federal government ukuba zibandakanye iimfuno zomsebenzi zokufaneleka kweMedicaid. Ingcamango kukuba "abanamandla" kufuneka bakhuthazwe ukuba basebenze. Ukwenza oko kuya kukwandisa iimeko zokuba ziya kufumana izicwangciso ezixhaswe ngumqashi, endaweni yokuthembela kwi-Medicaid. Abanye abathathu bathi, kuquka iArizona kunye neMaine, banomsebenzi wokulinda umsebenzi.
Ngoku, ezi zihlanu ziphakamisa iimfuno zokuphila kwimivuzo.
Abantwana, abafazi abakhulelweyo kunye nabantu abakhubazekileyo baya kukhululeka kwimida yokufikelela. Enyanisweni, kubonakala ngathi "abanamandla" baseMerika bajoliswe yilo lizwe xa lifika kwimida yokuphila.
I-Arizona kunye neMaine baye badibanisa imida yabo yokuphila kwimimiselo yomsebenzi. Iwashi iqalisa ukukhawuleza xa abantu bengagqibeli iimfuno zomsebenzi kuloo rhulumente. I-Kansas, i-Utah, ne-Wisconsin ziphinda ziphishekele imida yokuphila kwabantwana abangenamntwana nokuba ingahlangabezananga neemfuno zomsebenzi. Ingqalelo, abaninzi abantu abangenabantwana abangenawo abantwana bafumana imvume yokuphucula inkqubo.
| Lumente | Izidingo zomsebenzi | Ubude |
| EArizona | Ewe | 5 iminyaka |
| Kansas | Hayi | 36 iinyanga |
| Maine | Ewe | 36 iinyanga |
| Utah | Hayi | 5 iminyaka |
| Wisconsin | Hayi | Kwiinyanga ezingama-48 |
* I-Maine ijolise ukukhawulela ukufikelela kwiinyanga ezintathu kuphela kwiinyanga ezingama-36.
Ukukhathazeka kuye kwaphakanyiswa malunga nezi ziphakamiso.
Okokuqala nangaphambili, akubona bonke abaqeshi abaphantsi-mali ababonelela ngempilo. Nangona umntu edibana neemfuno zomsebenzi, abanakho ukufikelela kwezinye iindlela zokunakekelwa kwempilo. Imida yokuphila iza kubagweba abantu ngokusekelwe kwimigaqo yabo yomqeshi, into engekho ngaphakathi kwabo.
Abanye bathi i-Medicaid ijoliswe ukuba ibe ngumnatha wokhuseleko, kungekhona inkqubo yenhlalakahle. Abantu abagulayo kunye neengxaki banokuthi bathathe inzuzo yabo yomshuwalense xa beyifuna kakhulu. Iba ngumba wokuziphatha.
ILizwi
Ngo-2010, i-ACA yamisa abaqinisekisi bamashishini abafihliweyo ukuba bangabikho kwimida yokuphila kwimimiselo ebalulekileyo yezempilo, nangona baqhubeka bebeka imingcele kwezinye iinkonzo. I-Medicare igqiba ukuba zininzi iintsuku zesibhedlele eziza kubandakanya. Ngoku iMedicaid inokuphakamisa imida yokuphila, nayo. Iintetho ezihlanu zithumele ii-1115 zaivers ukuba zicele utshintsho kwiiprogram zeMedicaid. Enoba ihambelana neemfuno zomsebenzi okanye ukwandiswa kweMedicaid, abantu banokuhlangabezana nokunciphisa ukufikelela kwiinkonzo zempilo.
> Imithombo:
> Mayelana ne-ACA: Imingcele yeNzuzo. ISebe lezeMpilo laseMelika kunye neeNkonzo zoLuntu. https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/index.html. Ukuhlaziywa kweJanuwari 31, 2017.
> Imigaqo yokugqibela yeZicwangciso eziMkhulu, i-Preexisting Status Exclusions, i-Lifetime kunye neMingcele yeNyaka, iziNgcaciso, umGaqo-mboleko, iziKhalazo, kunye noKhuselo lweMonde phantsi koMthetho wokuNakekelwa onokuThengiswa. Imithetho yokugqibela. INkonzo yeNgeniso yangaphakathi, iSebe leNondyebo; Ulawulo lwezoKhuseleko lwaBasebenzi, iSebe lezeMisebenzi; Amasebe e-Medicare & Services Medicaid, iSebe lezeMpilo kunye neNkonzo zoLuntu. 2015 uNgo-18; 80 (222): 72191-294. https://www.gpo.gov/fdsys/pkg/FR-2015-11-18/pdf/2015-29294.pdf.
> Haefner M. 5 Izizwe Zifuna Ukunyanzela Ukunyanzela Imilinganiselo yoBomi beMidantiid Lifetime: 6 Izinto zokuzi. Ukuhlolwa kweSibhedlele saseBecker. https: //www.beckershospitalreview.com/payer-issues/5-intetho-seek--vever-to-impose-lifetime-medicaid-coverage-limits-3-things-to-know.html. Ukuhlaziywa ngoFebruwari 7, 2018.
> Ukunakekelwa kweZibhedlele zeZibhedlele. Medicare.gov. https://www.medicare.gov/coverage/hospital-care-inpatient.html.
> Musumeci M, Rudowitz R, Hinton E, Antonisse L, iHolo C. Icandelo 1115 Ukubonakaliswa kweMedicaid Ukubonakalisa iiWaiver: I-Current Landscape ye-Approved and Waiting Waivers. I-Henry J. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/section-1115- imemiselo- imbonakalo -iyoyiyo-imbonakalo- Ipapashwe ngoFebruwari 1, 2018.