Ukunciphisa intsapho kwenzelwe ukwenzela ukuba iintsapho ezinkulu zingayi kuhlalwa zihlawule iinchubo zentsholongwane yempilo yelungu ngalinye lentsapho. Kufuneka uqonde indlela osebenza ngayo intsapho echithwayo ukuze uhlahloye isabelomali kwiinkonzo zonyango lwezempilo.
Okokuqala, ukuba ungaqhelekanga kwizinto ezisiseko ze-deductible, funda "I- inshurensi yezeMpilo echithwe-yintoni na kwaye isebenza ngayo " ngaphambi kokuya phambili.
Uya kuluqonda ukuqonda okusemgangathweni kweedroductions ngaphambi kokuba ukwazi ukuqonda indlela osebenza ngayo intsapho.
Indlela iNtsapho Eyayichitha Imisebenzi Yeninzi Intsholongwane yezeMpilo
Uninzi lwentlalo ye-inshorensi yempilo enomdaka kunye neentlawulo zeentsapho. Ngalinye ixesha umntu ngaphakathi kwentsapho ahlawula umntu ngamnye owenyulwayo, loo mali ityala kwakhona kwintsapho echithwayo. Ubungakanani buqala kunoma yimuphi umntu othile ngokukhawuleza xa edibene nomntu ngamnye owenziweyo. Ubungqina buqala kwintsapho yonke, kwanawo malungu entsapho abangazange bahlangabezane neentengo zabo ezidityanisiweyo, ngokukhawuleza xa kudibene nentsapho.
Kukho iindlela ezimbini zempilo yentsholongwane yempilo yomshuwalense iya kuqala ukuhlawula iintlawulo zomntu othile ngaphakathi kwintsapho.
- Ukuba umntu udibana nomntu ngamnye ochithwayo, izibonelelo zezocwangciso zezempilo zikhawuleza ziqale ukuhlawula iindleko zonyango kuloo mntu kuphela , kodwa kungekhona kwamanye amalungu entsapho.
- Ukuba intsapho edibeneyo idibeneyo, izibonelelo zezempilo zikhawulwa kuyo yonke ilungu lentsapho nokuba ingaba zidibene neentlawulo zabo.
Lolu hlobo lwenkqubo yokuxhatshazwa kwintsapho luyaziwa njenge- deductible embedded deductible kuba i-deductibles nganye ibandakanywe ngaphakathi kwaye ibalekele kwintsapho enkulu.
Umzekelo Wendlela Intsapho Eyayicima Imisebenzi
Masithi intsapho yesihlanu ine-deductible ye-$ 500 kunye nentsapho echithwe kwi-$ 1,500:
- EyoMqungu:
Utata uhlawula i-$ 500 kwiindleko ezithintekayo.
Ubawo udibene nomntu wakhe owenziwe.
Intsapho echithwayo ine-$ 500 edityanisiweyo, i-$ 1,000 ukuya ngaphambi kokuba idibene.
Isicwangciso sempilo ngoku sihlawulela ukunakekelwa kwempilo kabawo .
Isicwangciso sezempilo asihlawuli mali kumama nabantwana okwamanje. - EyoMdumba:
Umntwana uhlawula i-$ 500 kwiindleko ezithintekayo.
Umntwana omnye udibene nomntu ngamnye.
Intsapho echithwe ngoku i-$ 1,000 idalwe, i-$ 500 ukuya ngaphambi kokuba idibane.
Isicwangciso sezempilo ngoku sihlawulela ubaba kunye nokunakekelwa kwezempilo komntwana.
Isicwangciso sezempilo asihlawuleli umama, umntwana womntwana okanye umntwana omathathu. - EyoKwindla:
Umama uhlawula i-$ 200 kwiindleko ezithintekayo.
Umama akazange ahlangane nomntu wakhe, kodwa i-$ 300 ukuya.
Intsapho echithwe ngoku i-$ 1,200 idityanisiwe, i-$ 300 ukuya ngaphambi kokuba idibene.
Isicwangciso sezempilo sihlawulela kuphela ubaba kunye nokunakekelwa kwezempilo komntwana.
Isicwangciso sezempilo asiyihlawuleli umama, umntwana womntwana okanye umntwana omathathu. - UTshazimpuzi:
Umntwana omibini uhlawula i-$ 300 kwiindleko ezithintekayo.
Umntwana omabini akazange ahlangane nomntu wakhe, kodwa i-$ 200 ukuya.
Intsapho echithwe kwi-$ 1,500 ngoku idibene nayo.
Isicwangciso sezempilo siqala ukuhlawula inzuzo kuwo onke amalungu entsapho.
Ekubeni intsapho idibene nentsapho yayo ichithwe, isicwangciso sezempilo saqala ukuhlawula inzuzo kuwo onke amalungu entsapho, nangona abathathu kubo bebengakabonisi ukuxhomekeka kwabo ngabanye.
Unokwenyulwa njani Intsapho Ukugcina Imali Ngaphandle Kwezinto Ezizihlawulelwayo?
Uninzi lwemigaqo-nkqubo ye-inshorensi yempilo inokutshatyalaliswa kwintsapho ephakathi kwamaxesha amabini anesine. Ngaphandle kokuba intsapho ibancinci, intsapho echithwayo iyancipha ngaphezu kwesixa-mali sazo zonke iinqununu.
Ngokomzekelo, masithi unamalungu amahlanu entsapho, u-deductible ngamnye we-$ 1,000 kunye nentsapho echithwe kwi-$ 2,000, amaxesha amabini amaxabiso athathwe ngumntu ngamnye. Ukuba kwakungekho nentsapho echithwayo kwaye ilungu ngalinye lentsapho kufuneka lihlangabezane nomntu ngamnye owenyulwa phambi kokuba isicwangciso sezempilo siqale ukuhlawula inzuzo kuye, intsapho yakho yesihlanu iya kuhlawula i-$ 5,000 ngaphambi kokuba ikhefu lezempilo likhishwe kuyo yonke ilungu lentsapho.
Nangona kunjalo, ekubeni iingeniso zengqesho zikhawulwa kuyo yonke intsapho xa intsapho echithwe kwi-$ 2,000 idibeneyo, intsapho iyasindisa ukuya kwii-3,000 zamaxabiso kwiindleko ezichithwayo.
Yintoni engabandakanyiyo kwiDeductible?
Izinto ezingagciniweyo yinshuwalense yakho yezempilo ayinakubalwa malunga nokuchithwa kwakho nangona uhlawula ngaphandle kwepokothini lakho. Ngokomzekelo, i-liposuction ayisoloko ihlanganiswa yinshuwalense yezempilo. Ukuba uhlawula i-$ 1,500 ye-liposuction, i-$ 1,500 ayiyi kukhankanywa kumntu ngamnye okanye kwintsapho echithwayo ngenxa yokuba ayiyiyo inzuzo ye-plan yakho yezempilo.
Iinkonzo zokunakekelwa kokukhusela azidingi ukuxhomekeka , ukuhlawulwa kwemali okanye ukuthengiswa kwemali e-United States ngenxa yoMthetho wokuNakekelwa ongenakuncedo . Oku kuthetha ukuba i-inshorensi yakho yezempilo iya kuhlawula izinto ezifana nomzimba wakho wenyama, ukutshiza umkhuhlane , kunye ne-mammogram nangona ungazange uhlangabezane ne-deductible yakho okwamanje.
IiCopay ukutyelela i-ofisi kunye nemigqaliselo ngokuqhelekileyo ayinakubalwa kwi-deductible yakho, kodwa iindawo ezithile zingatshintsha ngesicwangciso. Funda kabanzi apha: Ngaba i-Copays Bala kwi-Intshurensi yakho yezempilo?
IziCwangciso zeMpilo eziPhakamileyo eziDeductible ZiyiNgqikithi, kodwa imithetho emitsha iyasebenza
Ukuba unesicwangciso sezempilo esicatshulwa phezulu, usapho lwakho olususwe lunokusebenza ngokuhlukileyo. Uninzi lweHHHPs lusetyenziswa ngokubanzi ngokuchithwa kwenkqubo echazwe ngasentla. Unokufunda okungakumbi malunga nale nto " Indlela iNtsapho Eyayichitha Imisebenzi kwi-HDHP ."
Qaphela ukuba isicwangciso sakho asinakuba yi-HDHP nje ngokuba i-deductible yakho ibonakala ikhulu kakhulu. I-HDHP luhlobo olukhethekileyo lwesicwangciso sezempilo, kungekhona nje ixesha elichazayo. Ngenxa yokuba iiHHHP zihlala zihambelana nama- Accounts Savings Health Benefits, zineemfuno ezikhethekileyo ezibahlula kwizicwangciso zezempilo ezingekho phantsi kwe-HDHP.
Nangona kunjalo, ngo-2016 , izicwangciso zezempilo ezingenakulinganisekanga kufuneka zisebenzise i-ACA-imilinganiselo ye-ACA-efanelekileyo yamalungu eprogram yezempilo yentsapho, nangona i-HDHP kunye nentsapho epheleleyo echithwayo. Ngo-2018, i-out-of-pocket ephezulu ivumelekile i-$ 7,350 enye, kunye ne-14,700 zamawaka kwintsapho. Ngoko intsapho iHDHP ingaba nenani elipheleleyo leentsapho ezichithwe kwi-7,000 yeeRhafu ngokomzekelo, kodwa ayikwazi ukuhlawula i-$ 10,000 yenani, kuba loo nto inokufuna ilungu lentsapho ukuba lihlawule i-R10 000 ngaphambi kokufumana izibonelelo phantsi kwesi cwangciso, kwaye akusayi kuvunyelwa .
Ngo-2019, i-HHS inqwenele ukukhupha iindleko eziphuma ngaphandle kwee-7,900 zamaRandi. Imithetho eyanciphisa iindleko zelungu lomntu ukuba lingabi ngaphezu kwelo mali liya kuqhubeka nokufaka isicelo.
Ngaba iMithetho iya kuguqulwa phantsi kweRiphablikhi yeNkonzo yokuNakekelwa kweMpilo?
Abameli beRiphablikki bachitha ixesha elininzi le-2017 basebenza kwimigudu yokuphinda nokutshintsha i-ACA. Le migudu ayiphumelelanga, ngaphandle kwe-BOP yentlawulo yerhafu eya kutshabalalisa igunya lika-ACA ngamnye ukusuka ngo-2019 .
Iimali eziye zaziswa ngo-2017 ngokuqhelekileyo azizange zibize nayiphi na utshintsho kumgaqo obandakanya ukuba i-maxim-out-of-pocket edibeneyo kwizicwangciso zentsapho. Kananjalo ngokuqhelekileyo abayi kuguqula umda we-out-of-pocket apho i-ACA ibeka kwizicwangciso zezempilo.
Nangona kunjalo, kubalulekile ukuqaphela ukuba i-ACA's cap on out-of-pocket cost only applies kwiinkonzo ezibhekwa njengezibonelelo zezempilo ezibalulekileyo . Iziphakamiso zezohlengahlengiso zezempilo ze-GOP zifake ngokubanzi ugxininiso ekunikezeni lichaza ukukwazi ukuhlaziya iinjongo zezempilo ezibalulekileyo. Ukuba ibhilikhwe enjengaleyo yayingasungulwa, inokubangela izicwangciso ze-inshorensi kwezinye iindawo ezingabandakanyekanga izinto ezifunekayo ukuba zifakwe phantsi kwe-ACA (ukunakekelwa kokubeleka, okanye ukunakekelwa kwempilo yengqondo, umzekelo).
Ukuba oko kwenzeka, izicwangciso zezempilo zingaba zizinzileyo, kwaye iintsapho zinokufuneka zizalise ngokupheleleyo iindleko zonyango oluthatyathwa phantsi kwezicwangciso ze-ACA. Kuloo meko, iindleko ezingaphandle kwezinto ezifunyenwe kwizinto ezingagqitywanga yilo cwangciso aziyi kubala kwisicwangciso esinqunyiwe okanye esingaphandle kwipokethi. Kunoko, babeza kubangela iindleko eziphezulu kakhulu ezingaphandle kwee-pocket zamalungu adinga iinkonzo ezingasayi kuhlanganiswa ngenxa yemithetho engaphantsi emininzi malunga neenzuzo zezempilo ezibalulekileyo.
> Imithombo:
> I-Register Register (Isebe Lempilo Neenkonzo Zoluntu), > Umonde > Ukhuseleko kunye noMthetho woNonophelo ojongene noNcedo; Isaziso seNzuzo yeeNzuzo kunye neParameters yokuhlawula i-2018; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi. Disemba 22, 2016.
> I-Register Register (Isebe Lempilo Neenkonzo Zoluntu). Ukhuseleko lomonde kunye noMthetho woNonophelo ojongene noThathaka; Isaziso se-HHS yeSiza kunye neParameters yokuhlawula i-2019. Novemba 2, 2017.
> I-HealthCare.gov, iiNkonzo zezeMpilo zoKhuselo.
> Kaiser Family Foundation. Isishwankathelo soMthetho wezeMpilo waseMelika, ngoMeyi 2017.