Ukuqonda ukuxhaswa kweNcediso eyanciphisa i-Deductibles, iCopays, kunye ne-Coinsurance
Ukuthenga i-inshurensi yezempilo kuyabiza, kodwa ukuhlawula i- premium yenyanga ayiyena kuphela iindleko ezibandakanyekayo. Kufuneka uhlawule iidraucable , i- copayments , kunye ne- coinsurance rhoqo ngexesha usebenzisa i-inshorensi yakho yempilo.
Ezi mali ezongezelelweyo ze-pocket ziyaziwa njengeendleko zokwabelana ngeendleko. Bangakwazi ukudibanisa ukuya kumawaka eedola ngonyaka.
UMthetho woNonophelo olungabonakaliyo udale inkxaso-mali yokuthenga kunye nokusebenzisa i-inshurensi yempilo ebenokuhlawulekayo kubantu abanemivuzo enokuthobeka.
Kukho iintlobo ezimbini ezahlukeneyo zenkxaso:
- Inkxaso-mali ehlawula iindleko ze-inshorensi yempilo yenyanga yonyaka ukuze ukuthenga i-inshorensi yezempilo ifikeleleke kakhulu. Funda kabanzi malunga nale nto, " Indlela iNcediso yeNkxaso-mali ye-Ntsapho-Ukuqonda iNkcazo yeNtlawulo yeNkcazo ."
- Iinkxaso-mali ezikunceda ukuhlawula iindleko ze-post-like-like-like-deductible, i-copayments kunye ne-coinsurance. Ezi ziyaziwa njengezincediso zenkxaso-mali ezincitshileyo kwaye ziza kumacandelo amabini ahlukeneyo, zombini ezo zidibeneyo kwizicwangciso ezifanelekileyo ukufumana inkxaso-mali ngeendleko.
- Okokuqala kunciphisa ukuphuma kwakho kwe-pocket . Funda kabanzi, " njani Inkxaso-mali yokunciphisa i-Out-Of-Pocket Imisebenzi ephezulu ."
- Okwesibini, isibonelelo esibhekiswe apha, sinciphisa inani olihlawulayo, ukuhlawulwa kunye ne-coinsurance rhoqo xa usebenzisa yakho inshorensi yempilo.
- Inkxaso-mali yokwabelana ngeendleko zifumaneka kuphela xa uthengisa isicwangciso sesilivere, kwaye zifakwe ngokuzenzekelayo kuzo zonke izicwangciso zesilivere ukuba ingeniso yakho ayidluli kuma-250 ekhulwini kwintlupheko. Oku kuyahluke kwiinkxaso ze-premium, ezinokusetyenziswa kwi-bronze, yesiliva, kwigolide, okanye kwizicwangciso ze-plantinum, kwaye oko kungamkelwa okanye kukhatywe ingqiqo yokubhalisa.
Ukuncediswa kweNkxaso-mali yokuNcedisa iIndleko ekunciphiseni njani?
Ukuncitshiswa kweendleko zokunciphisa indleko kunciphisa iindleko zakho ngaphandle kwee-pocket xa usebenzisa yakho inshorensi yempilo. Ngokomzekelo, ukuba isicwangciso sakho sempilo sichaza i-copayment ye-$ 50 rhoqo xa u tyelela ugqirha, inkxaso-mali yokwabelana ngeendleko inganciphisa ukuba ikhoyayili ukuze uhlawule kuphela i-$ 20 xa ubona ugqirha.
Ukuba isicwangciso sakho sezempilo siyakudinga ukuba i-$ 2,000 ichithwe, i-subsidy yokwabelana ngeendleko inganciphisa loo mali.
Kufana nokuphucula ukukhululeka kwinshuwalense yezempilo. Uhlawula i-premium yenyanga nganye oya kuhlawula umgaqo-nkqubo we-inshorensi yempilo , kodwa i-inshorensi yempilo oyifumene ingcono kunomyinge kuba ihlawulela inxalenye enkulu yeendleko zonyango lwakho.
Inkokhelo ihlawula kangakanani?
Inkxaso-mali yokunciphisa ixabiso-mali ayinakho ukuhlawula imali . Kunoko, iyakusindisa imali ngokunciphisa iindleko zokwabelana ngeendleko. Ingakanani imali oyisindisayo kuxhomekeke kwingeniso yakho kunye nokuba ungakanani usebenzise i-inshorensi yakho yempilo.
Abampofu wena, xa ulwabelana ngeendleko kuncitshiswa. Isixa salolu ncitshiseko sisekelwe ekuqhathaniseni umvuzo wakho kwinqanaba lehlwempu . Inqanaba lobuhlwempu lombuso liguquka rhoqo ngonyaka, kwaye lusekelwe kwintlawulo yakho kunye nosapho lwakho.
Ngaphandle kwenkxaso-mali yokwabelana ngeendleko , inkampani yakho ye-inshorensi yempilo iya kuhlawula malunga neepesenti ezingama-70 zeendleko zonyango zonke ezikhuselekileyo kuzo zonke iirejista (khumbula, kufuneka ukhethe icebo lesilivere ukufumana inkxaso-mali, kunye nezicwangciso zesilivere eziqhelekileyo zihlawula malunga Iipesenti ezingama-70 zeendleko zeendleko zazo zonke izibhengezo zabo.
Ngenkxaso-mali yokwabelana ngeendleko, inkampani yakho yinshorensi yempilo iya kuhlawula:
- Iipesenti ezingama-94 zeendleko (oko kukuthi, bhetele kunecebo leplatinum) ukuba ingeniso yakho ingama-100 ekhulwini ukuya kuma-150 ekhulwini kwi-FPL.
- Kubantu abanomvuzo we-2017 ukusuka kwi-$ 11,880 ukuya kuma-17,820.
- Izibini ezineengeniso ye-2017 ukusuka kwi-16,020 ukuya kwi-24,030 yezigidi.
(phawula ukuba umgca ongaphantsi kweengeniso ezifanelekileyo ukufumana inkxaso-mali ngee-139 pesenti yeFPL kumazwe awandise iMedicaid , ekubeni abantu balawo mazwe banelungelo lokufumana iMedicaid ngenzuzo engenayo ukuya kuma-138 ekhulwini kwinqanaba lehlwempu).
- Iipesenti ezingama-87 zeendleko eziqhelekileyo (oko kukuthi, bhetele kunecebo legolide, phantse njengecebo leplatinum) ukuba ingeniso yakho ingama-150 ekhulwini ukuya kwi-200 ekhulwini ye-FPL
- Kubantu abanomvuzo we-2017 ukusuka kwi-$ 17,820 ukuya kwi-$ 23,760.
- Izibini ezifumana imali engama-2017 ukusuka kwi-$ 24,030 ukuya kwi-32,040 yezigidi.
- Iipesenti ezingama-73 zeendleko (oko kukuthi, bhetele kunecebo eliqhelekileyo lesilivere) ukuba ingeniso yakho ingama-200 ukuya kuma-250 ekhulwini kwi-FPL
- Kubantu abanomvuzo we-2017 ukusuka kwi-$ 23,760 ukuya kuma-29,700.
- Izibini ezifumana imali engama-2017 ukusuka kwi-$ 32,040 ukuya kwi-40,050.
Inkampani yakho yinshorensi yezempilo ingabangela ukunciphisa ixabiso lentengo nangona ifuna ukuba nje isicwangciso sezempilo sihlawule ipesenti efanelekileyo yeendleko zonyango jikelele. Ngokomzekelo, unokwenza isigqibo sokunciphisa ixabiso lakho elichithwe kakhulu, kodwa ushiye iikopi zakho ezingaguqukanga. Okanye, akunakukwazi ukunciphisa i-deductible yakho, kodwa ukuphelisa i-copayments yakho kunye nokunciphisa i-coinsurance yakho.
Kwakhona kubalulekile ukukhumbula ukuba ipesenteji yeendleko ezigqitywe ngumgaqo-nkqubo we-inshorensi yempilo ibhekiselele kumyinge jikelele kubantu bonke-kungekhona kubhengezo lomntu othile. Ukuba uhlala unempilo kulo lonke unyaka kwaye ungeneli elincinci kwiindleko zonyango, uza kuhlawula isabelo esikhulu seendleko zakho ngaphezu komntu ogula kakhulu kwaye ubangele iindleko eziphezulu ngaphezu kweyona nto ephezulu ye-pocket kwisicwangciso .
Ezinye iindleko zonyango zempilo azifaki ukunciphisa iindleko zakho. Iindleko zakho zokuphuma ngaphandle kwezinto ezingagqithwanga ngumgaqo-nkqubo we-inshorensi yempilo okanye ayiyona inzuzo yempilo ebalulekileyo ayiyi kuncitshiswa. Inxalenye ekhokhwayo-mboleko yokunakekelwa kwakho ekuphumeni kwenethiwekhi ayiyi kuncitshiswa, ngokunjalo unamathele nabanikezeli bee-network ukufumana uninzi kuncediso lwakho.
Ngubani ofanelekayo kwiNkxaso-mali ye-Intshuwalense yeMpilo?
Ukuze uvumeleke ukuxhaswa kwe-mali-mali ephantsi, kufuneka:
- Thenga i-inshorensi yakho yezempilo ngokusebenzisa utshintsho lwempilo yomshuwalense wezempilo .
- Khetha isicwangciso sezempilo sesiliva .
- Unemivuzo evela kwi-100% ukuya kuma-250 ekhulwini we-FPL (ama-139 ekhulwini ukuya kuma-250 ekhulwini kumazwe awandise iMedicaid).
- Hlala eUnited States ngokusemthethweni.
- A nga valelwa.
- Unesimo sokufakela irhafu somtshato esityathwe ngokubambisana ukuba utshatile.
Indlela yokufaka isicelo kwiNkxaso-mali yokuXhaswa kweNdleko
Faka isicelo senkxaso-mali yokunciphisa izindleko nge-inshorensi yoshishino lomshuwalense wezempilo xa uthenga i-inshurensi yezempilo. Unokufaka isicelo se-subsidy yentlawulo yerhafu kunye ne-sub-pocket-maximal subsidy. Yilungele ukunika ulwazi lokutshintshiselana ngemali yakho engenayo, ubungakanani bentsapho kunye nomqeshi ukuba unomsebenzi. Ukuba unako ukufumana inkxaso-mali yokwabelana ngeendleko, uhlaselo oluphuculweyo luyakhiwa kuzo zonke izicwangciso zesilivere ezifumaneka kuwe ngokutshintshiselana.
Ngaphandle kweemeko ezizodwa, ungabhalisa kwi-inshurensi yezempilo ngokusebenzisa utshintshi lwe-inshurensi yezempilo ngexesha lokubhalisa okuvulekileyo . Ubhaliso oluvulekileyo lwe-2017 lubaleka ngoNovemba 1, 2016 ukuya kuJanuwari 31, 2017. Ishedyuli efanayo iya kusetyenziswa ngo-2018, kodwa ngokuqala ngo-2019, ukubhaliswa okuvulekile kuya kuphela ngoDisemba.
Ukuba ubhalisa kwisicwangciso sesilivere kwaye ufumane inkxaso-mali kodwa ingeniso yakho inguqu kunyaka, vumela u-inshurensi yempilo yomshuwalense uyazi. Ukuba ingeniso yakho yehla, unokufanelekile ukuba ukwabelana ngeendleko kunciphise ngakumbi.
> Imithombo:
> Isebe lezeMpilo kunye neeNkonzo zeHumanana, ixabiso lokuhlaziya kunye ne-Cost-Sharing Reductions Bulletin ,
> Isebe Lempilo Neenkonzo Zoluntu, iSaziso seNzuzo kunye neParameters Payment for 2017.
> UJost, uTimoti, "Ukuphunyezwa kweMpilo yeNguqulelo: Iimpawu zeNzuzo kunye neNtlawulo yeParameters Final Rule" eyafumaneka kwi-HealthAffairs.org,
> Umyalelo woKhuseleko kunye noMthetho woKhathalelo ongenakunciphisa , icandelo 1402 (c).