I-Medicaid yinkqubo yenhlalakahle yentlalontle ehlinzekela inzuzo ye-inshurensi yezempilo kubantu abaphantsi kwemali e-United States. Ingaba ungummkeli weMedicaid okanye unethemba lokuba ngumnye, ukuqonda indlela i-Medicaid isebenza ngayo yenza kube lula ukufumana unyango lwempilo oluyidingayo. Ukuba awuyena umxhamli weMedicaid, kodwa usebenza ngokunyamekela abafumana iMedicaid, ukuqonda indlela i-Medicaid isebenze ngayo kunokukunceda ufumane izigulane zakho oko zifuna.
Indlela i-Medicaid isebenze ngayo kwiNgcamango yomMkeli
Ulungelelwano lweMilicaid
Ukulungelelaniswa kweMilicaid okungenani kuncike kwimali engenayo. Kwamanye amazwe, abahlali abanemivuzo ye-138% yezinga elihlwempuzekileyo lombuso okanye ngaphantsi baya kufumana iMediicaid. Ukuze ukwazi ukufumana iMedicaid kwamanye amazwe, kufuneka udibanise imilinganiselo eyahlukileyo yokufumana imali kunye nokuba ilungu leqela elijongene nentsholongwane njengomntwana, umfazi okhulelweyo, umntu osekhulile, umntu okhubazekile, umntu oyimpumputhe okanye umzali omncinci umntwana.
Ukongezelela, amanye amazwe afuna ukuba uhlangabezane nezikhokelo zeempahla ukuze ufumane iMedicaid. Umzekelo, nangona unomntu okhulile onomvuzo ophantsi, unokuba ungafaneleki kwiMedicaid ukuba unayo i-$ 100,000 ehleli kwiakhawunti yomhlalaphantsi kuba ixabiso lakho likhulu kakhulu.
Kuqhelekile ukuba amazwe abe neendlela eziliqela umntu angakufanelekela kwiMedicaid. Umzekelo, unokufumana ilungelo lokufumana ingeniso engaphantsi kwe-138% ye-FPL, ngokufumana ingeniso engaphantsi kwe-200% ye-FPL kunye nokukhulelwa, okanye ngokufumana iNgeniso yeNkxaso yoKhuseleko.
Zingaphi iindlela ezifanelekileyo zokufumana iMedicaid kunye neendlela ezifanelekileyo zokufaneleka zihluka ukusuka kummandla ukuya kwimeko.
Inzuzo yeMedicaid
Iintlawulo ozifumanayo xa ufumana iMedicaid zihluka ukusuka kummandla ukuya kutsho kwaye zihluka ukusuka kumntu ukuya kumntu kwilizwe. Imimiselo ye-Federal idinga ukuba iintlawulo ezithile zeziseko zibonelelwe kubaxhamli abathile abasengozini kuwo onke amazwe.
Nangona kunjalo, ngaphaya kwaloo nto, uthi uguquguqukayo ekunqumeni ukuba yiziphi iinzuzo zokubonelela ngamaphi amaqela abantu.
Ngokomzekelo, urhulumente unako ukubonelela bonke abaxhamliweyo abafanelekayo kwiMedicaid phantsi kweendlela ezikhethiweyo ze-Medicaid. Unokubonelela abantu abafanelekayo phantsi kweendlela ezichaziweyo ezahlukeneyo kunye neendlela ezimbalwa zeqela lokuqala.
Ufikelela njani kwiintlawulo zakho zeMedicaid ukuba ungummkeli weMedicaid uhluka ukusuka kwilizwe ukuya kwimeko kunye nakwilizwe ngalinye. Nangona kunjalo, iindlela ezimbalwa ziqhelekileyo.
- Imali-ye-Inkonzo. Ukuba iinzuzo zakho zeMedicaid zithunyelwa ngeendlela zokufumana imali-ngenkonzo, ukhululekile ukutyelela nawuphi na ugqirha, esibhedlele, okanye omnye umniki-mvume oya kumkela iintlawulo zeMedicaid. Umboneleli ngamnye uya kuhlawulwa yiMedicaid ngenkonzo ayenzayo ngexesha ngalinye ufuna ukunyamekela.
- Unakekelo oluLawulayo. Ukuba iingeniso zakho zeMedicaid zithunyelwa ngononophelo olulawulwayo njenge- HMO , unokufumana unyameko kuphela kubaboneleli kwinkonzo yomncedisi wokunakekelwa. Ukongezelela, unokwenza ufumane imvume phambi kokuba ufumane iintlobo ezithile zokunyamekela, okanye unokuthunyelwa kwirejista yakho yokunakekela . Ngokuqhelekileyo, iinkqubo ze-Medicaid ziza kubambisana neenkampani zomshuwalense yabucala ukubonelela ngeenkonzo zokunyamekela. Kule meko, iinkonzo zakho zeMedicaid zinganikwa okanye zilawulwe yinkampani yenkampani yomshuwalense yabucala, njengeBlue Cross, i-UnitedHealthcare, i-Humana, okanye abanye abaqinisekisi bempilo yabucala.
Kwezinye iimeko, unganakho ukukhetha malunga nokuba ufumana isicwangciso sokunyamekela okanye isicwangciso-mali senkonzo xa ubhalisa kwi-Medicaid. Kwezinye iimeko, unako ukukhetha phakathi kwabo xa ubhalisa. Okanye, unokubonelelwa ngenkqubo ye-hybrid apho inkontileka yakho yombuso kunye nenkonzo yokunyamekela elawulwayo ukubonelela ngenzuzo yeMedicaid yakho, kodwa iimbalwa ezimbalwa zeMedicaid zinzuzo zinikezelwa ngemali-ngenkonzo. Umzekelo, mhlawumbi unyango lwezempilo, ukunakekelwa kwezibhedlele, ukunakekelwa kokukhusela , ibrabhu kunye ne-x-ray zibonelelwa ngekontileka yokunyamekela, kodwa iinkonzo zokuthuthwa kwezonyango zinokubonelelwa ngenkonzo-ntlawulo.
Naluphi na indlela i-Medicaid isebenzisa ngayo ukubonelela inzuzo kuwe, phantse abo bonke abanikela ngokwenkonzo yakho yononophelo lwempilo ngamagqirha, abahlengikazi, iikliniki, nezibhedlele kuluntu. Kungenzeka ukuba uya kuba uncedo lwakho kwisibhedlele esifanayo okanye kwiqela elinye loogqirha abathile bakho abamelwane baseMedicaid abasebenzisayo, nangona mhlawumbi uya kuhlawula encinci kule nkonzo kunokuba abamelwane bakho bakhokha.
Kwimimandla ethile, unokwithengela ukufumana ugqirha oza kwamkela izigulane ezintsha zeMedicaid. Kweminye imimandla, akukho mngeni ukufumana umboneleli.
Ngokungafani ne-inshorensi yempilo yabucala, abaninzi abaxhamli beMedicaid bafumana iMedicaid ngaphandle kokuhlawula iiprayimari zenyanga. Ngokufanayo, iinkonzo ezininzi zononophelo zempilo zinikezelwa kubaxhamli be-Medicare ngaphandle kokuhlawula i- deductible , i- copay okanye i-coinsurance yenkonzo. Nangona kunjalo, ezinye iinjongo zihlola iindlela zokuhlawula iindleko zokwabelana ngeendleko zezinye iinkonzo. Umzekelo, urhulumente unokunika iinkonzo zegumbi lexakeka ngokukhawuleza xa kunokwenzeka, kodwa unokuhlawula i-copay ye-$ 25 ukuba ukutyelelwa kwe-ER kukho into eyayinokunyamekelwa kwiofisi yakho yegqirha, endaweni yoko.
Ukufaka isicelo seMedicaid
Unokufaka isicelo seMedicaid okanye ngeendlela ezimbini ezahlukeneyo.
- Faka isicelo ngokuqhagamshelana ne-ofisi ye-Medicaid yeprogram yeprogram ngqo. Fumana ulwazi loqhagamshelwano lwenkqubo yakho ye-Medicaid kwiprogram ye-Medicaid.gov yeeNkcukacha zeeNkcukacha zeSizwe.
- Faka isicelo ngokugcwalisa isicelo se-inshorensi yempilo kwi- Career Affordable Care Act . Ukuba kubonakala ngathi uya kufaneleka kwi-Medicaid, utshintshiswano luya kucwangcisa isicelo sakho seMedicaid okanye uthumele isicelo sakho kwiprogram ye-Medicaid yelizwe. Kule meko, uya kunikwa imiyalelo engakumbi malunga noko kufuneka uyenze ukugqiba isicelo sakho seMedicaid. Fumana utshintshiselwano lwempilo yomshuwalense welizwe ngokusebenzisa lo mthengi we-Marketplace kwi-Healthcare.gov.
Indlela i-Medicaid isebenze ngayo kwi-Persal Perspective
I-Medicaid yinkqubo edibeneyo yombuso kunye nombuso. Urhulumente wephondo ubeka imimiselo enika isakhelo esibanzi jikelele ukuba zonke iinkqubo zeMedicaid zimele zilandele. I-state nganye idiza kwaye iqhuba inkqubo yayo yeMedicaid ngaphakathi kwesi sikhokelo semimiselo yomthetho.
Ekubeni imimiselo yomgaqo-nkqubo ivumela ukulungelelaniswa koyilo, iiprogram zeMedicaid ziyahluka ukusuka kwilizwe ukuya kwilizwe. Umzekelo, ukuba umntu ofumana iMedicaid kwelinye ilizwe wayefanele ahambe, akanakho ukuhlangabezana neendlela zokufaneleka kwiimeko zakhe ezintsha. Ukuba wadibana ne-Medicaid yokulungelelaniswa kwimeko efanelekileyo kwimeko yakhe entsha, iinjongo zeMedicaid ezifunyenwe apho zingachasana nalabo awamkela kwimeko yakhe yangaphambili.
Uxhaswa ngemali
I-Medicaid ihlawulwa ngemali evela kubini karhulumente kunye noorhulumente ngamnye karhulumente. Urhulumente wephondo unika i-50-83% yeemali ezifunekayo kwiimveli zeMedicaid. Amazwe anika intsalela yemali.
Abahlali abahlali abahlali basesigxina, ngokusekelwe kwingeniso yemali nganye, isezantsi ipesenti yemali enikezelwa nguRhulumente wephondo. Zonke ezinye iimali zivela kwilizwe lakho. Uyakwazi ukubona ukuba yeyiphi ipesenti yeprogram ye-Medicaid yeprogram yelizwe evela kwi-federal government apha.
Enye into ephawulekayo kumgaqo we-50-83% wokuxhasa ngemali ye-Medicaid kukunyuswa kweMedicaid eyenziwe nguMthetho woNonophelo ongenakunqwenelekayo. Urhulumente wephondo unama-90-100% weendleko zokubonelela iMedicaid kulabo bafumana iMedicaid kuphela ngenxa yokwanda kwe-ACA's Medicaid.
I-Medicaid kunye noMthetho woKhathalelo ongenakuncedo
Ababhali be-ACA ekuqaleni babenjongo yokuba zonke iindawo zibonelele nge-Medicaid coverage kubahlali abanemivuzo ye-138% ye-FPL okanye ngaphantsi. Nangona kunjalo, isigqibo seNkundla ePhakamileyo senze ukuba ukwandiswa kweMedicaid. Ezinye iindawo ziye zakhetha ukwandisa iMedicaid njengenjongo eyayijoliswe ngaphambili ngabalobi be-ACA; Amanye amazwe akhethe ukuba angakwandisi iMedicaid. Kwimihlaba engazange ikhulise iMedicaid, kunzima ukufumana iMedicaid kunye nepesenti enkulu yabemi abafumana umvuzo ophantsi abahlala bengagqunywanga kunokuba baye bakhetha ukwandisa iMedicaid.
Funda ngakumbi malunga neMedicaid
I-Medicaid i-labyrinth eyinkimbinkimbi, eguqukayo njalo apho oorhulumente baseburhulumenteni kunye nabasemagunyeni badibanisa noorhulumente basekhaya, amashishini abucala-nzuzo-nzuzo, abangenanto kunye nabangasese. I-Medicare neMedicaid kunye inika iingenelo zempilo kubantu abangaphezu kwezigidi ezili-100.