Indlela yoNcediso kwi-Out-Of-Pocket Maximum Works yakho

Inkxaso-mali yokwabelana ngeendleko ifakiwe kwiiplani zesilivere ukuba ufanelekile

Ukuthenga i-inshurensi yezempilo kuyabiza, kwaye ukuhlawula i- premium yenyanga akuyindleko kuphela echaphazelekayo yinshuwalense yezempilo. Kufuneka uhlawule iidrucable , i- copayments , kunye ne- coinsurance xa usebenzisa yakho inshorensi yempilo. Lezi zindleko ezongezelelweyo ze-pocket, ezaziwa ngokuba yabiza iindleko, zingongeza ukuya kumawaka eedola ngonyaka.

Umthetho ononophelo loNonophelo weMpilo udale inkxaso-mali ye-inshorensi yokwenza imali kunye nokusebenzisa i-inshurensi yempilo ebenokuhlawulekayo kubantu abanemali ephantsi kwaye ethobekileyo.

Kukho iintlobo ezimbini:

1. Iinkxaso-mali ezinciphisa iipresimesi zakho zenyanga zenyanga zemali zonyango ukwenzela ukuba uthenge i-inshorensi yezempilo ifikeleleke kakhulu. Funda kabanzi malunga nale nto, " njani Inkonzo Yenkxaso-mali Yomshuwalense weMpilo-Ukuqonda iNgxowa-mali yeNtlawulo yeNkcazo ."
   
2. Iinkxaso-mali ezikunceda ukuhlawula iindleko ze-post-like-like-like-deductible, i-copayments kunye ne-coinsurance. Ezi ziyaziwa njengeenkxaso-mali zokwabelana ngeendleko, okanye ukunciphisa iindleko. Ziza kwiindawo ezimbini, nangona zombini iindawo zizenzeke ngokuzenzekelayo kwizicwangciso zesilivere ezibhalisiweyo ezifanelekileyo:
   
   • Icandelo elinye liyancipha inani olihlawulayo imali echithwayo, iikopi kunye ne-coinsurance rhoqo xa usebenzisa yakho inshorensi yempilo. Funda kabanzi malunga nale ncediso, " Yeka indlela iNkxaso-mali Yenkxaso-mali Yomshuwalense Wezempilo ."
   • Icandelo lesibini linciphisa i-out-of-pocket yakho ephezulu ukuze uhlawule ngaphantsi xa iindleko zakho zonyango ziphezulu.

Iyini i-Out-Of-Pocket Maximum?

Umlinganiselo ophezulu-ngaphandle , okanye umda wokuphuma kwipokethi, ngowona mqathango ophezulu kunabo bonke oza kufuneka uhlawule kwiindleko zokwabelana ngeendleko ezifana ne-deductible yakho, ikopi kunye ne-coinsurance ngonyaka ngamnye.

Emva kokuba uhlawule ngokwaneleyo kwi-deductible, ikopi kunye ne-coinsurance ukuba ufinyelele kwi-out-of-pocket ephezulu, yakho yinshuwalense yezempilo ihlawula zonke iindleko zonyango zakho zonyango kulo lonke unyaka.

Ukuba awusebenzisi i-inshurensi yakho yezempilo kakhulu, iindleko zakho zokwabelana ngeendleko aziyi kufinyelela kumda we-pocket.

Nangona kunjalo, ukuba unesifo esiyingozi esingapheliyo okanye unesifo esisodwa esiyingozi okanye ukulimala, unokuhlawula ngokukhawuleza ngokwaneleyo kwi-coinsurance kunye neendleko ezithintekayo ukufikelela kwi-out-of-pocket.

Ngokomzekelo, ukuba uwela kwelo nqanaba kwaye udibanise i-hip ngelixa unqumla umthi, isabelo sakho segumbi loxinzelelo, ukunyanga nokunyuka kwezibhedlele kungadlulela i-$ 10,000 ukuba umgaqo-nkqubo wakho womshuwalense awunakho umda we-inshorensi.

Nangona kunjalo, ukuba umgaqo-nkqubo wakho womshuwalense wempilo unomda ongaphandle kwe-$ 6,000, uyeka ukuhlawula xa uhlawule i-$ 6,000 kwiimali zakho zonyango. Emva koko, i-inshorensi yakho yemali ihlawula iipesenti eziyi-100 zempilo yakho yeebhilidi zonyango lonke unyaka. Uya kuhlawula i-$ 6000 kunokuba u-$ 10,000. Ukuba ufuna uncedo olungakumbi emva konyaka, isicwangciso sakho sezempilo siya kuhlawula iindleko zonke.

Ngaphambi kuka-2014, izicwangciso zempilo zazingadingeki ukuba zifake umda wokuphela kwee-pocket. Zininzi izicwangciso ezenzileyo, nangona kwakukho ukuhluka ngokubanzi malunga nokuphakama kwemida ukusuka kwelinye icebo ukuya kwelinye. Kwaye ezinye iiplani azizange zithinte ngaphandle kwe-pocket exposure.

Akusekho icala ngenxa ye-ACA. Ngaphandle kwezicwangciso ezinkulu kunye nezikhulu , zonke izicwangciso kufuneka zikhuphe iindleko ezingekho ngaphaya kwamaRandi ayi-6,850 umntu ngamnye ngo-2016 (umda wentsapho uphakamileyo kabini kunomlinganiselo ngamnye), nangona uya kukhula kwakhona ngo-2017 (iimfuno ze-ACA azifaki kwi-Medicare; abantu abane-original Medicare coverage abanalo umda kwiindleko zabo zangaphandle, oko kutheni amaninzi abafundi ababhalise kwi-Medicare banokubhengezwa ngokungekho, ngokubhalisa kwi-Medicare Benevantage endaweni I-Medicare yasekuqaleni, okanye ngokuthenga isicwangciso seMedigap).

Yintoni engabandakanywa kwi-Out-Of-Pocket Maximum?

Ubuninzi besikhombiso-ngaphandle-mali abubandakanyi ii-premiums zakho zenyanga zenyanga. Akwabandakanyi iindleko zezinto ezingagqunywanga ngumshuwalense wezempilo okanye azifumaneki eziyimfuneko zezempilo. Ngokomzekelo, ukuba i-inshorensi yakho yezempilo ayifuni iinkonzo zokwenza umsebenzi, iindleko zakho ze-acupuncture aziyi kubalwa ngokubhekiselele kwi-out-of-pocket yakho ephezulu. Akubandakanyi inxalenye ebhalisiweyo-inkokhelo yenkathalo onayo evela kumniki-nkonzo wezempilo ongekho ngaphandle . Funda kabanzi kwi " Yintoni ongayibala kwi-Out-of-Pocket Limit? "

Ubuninzi Kangakanani I-Out-Of-Pocket Elikhulu Ngaphambi Kwenkxaso?

Zonke iinshorensi zempilo yomshuwalense wezempilo ngamnye kunye neentsapho ezithengiweyo kwi-inshorensi ye-Care Affordable ye-Care Act kufuneka ibe nomda wokuphuma ngaphandle.

Urhulumente wesigqeba ulawula ukuphakama kwalo mda, kunye nemali evumelekileyo iguquka unyaka ngamnye.

Ngo-2016, ubuninzi be-out-of-pocket abukwazi ukuba ngaphezu kwe-$ 6,850 nganye okanye i-$ 13,700 kwintsapho. Umgaqo-nkqubo we-inshorensi yempilo unokwenza umlinganiselo ongaphantsi kwee-pocket ngaphantsi koko.

Ingxowa-mali yeNtsholongwane yezeMpilo ingakanani ukunciphisa i-Out-Of-Pocket Maximum?

Ingakanani incediso ekunciphiseni umda wakho wokuphuma ngaphandle kwexhomekeke kwingeniso yakho. Ukufumana ingeniso yakho ngakumbi kumgangatho wentlupheko we-federal (FPL), ukunyuka kwakho kwe-po-pocket kuyancitshiswa. I-FPL iguquka unyaka ngamnye kwaye iyahluka ngokuxhomekeka kubukhulu bentsapho nalapho uhlala khona (iAlaska neHawaii i-FPLs eyahlukileyo).

I-FPL isetyenziselwa ukucacisa inkxaso-mali yakho ye-2016 i-$ 11,770 yomntu ngamnye, i-$ 15,930 yebini elithile, kunye ne-20,090 yeenkunzi zentsapho. Unokufumana i-FPL ngeminye iminyaka kunye nobukhulu bentsapho apha.

Ekubeni i-FPL kunye nomda wenkxaso-mali kwi-out-of-pocket lilonke utshintsho ngamnye ngonyaka, ixabiso le dollar lakho lokunciphisa liya kutshintsha unyaka ngamnye.

Ukuze uzuze kwi-subsidy eyanciphisa ukukhutshwa kwe-out-of-pocket yakho, kufuneka ubhalise kwisicwangciso sesilivere ngokutshintshiselana. Kucinga ukuba ukhetha isicwangciso sesilivere, nge-2016 inkxaso, ukuba ingeniso yakho:

• Iipesenti eziyi-100-200 zeFPL,
  • Umda wakho wokuphuma kwipokethi awuyi kuba ngaphezu kwe-$ 2,250.
  • Umda wakho ongaphandle kwesikhokelo awuyi kuba ngaphezu kwama-4,500 kwiintsapho.
• 200-250 ipesenti zeFPL,
  • Umda wakho wokuphuma kwipokethi awuyi kuba ngaphezu kwe-$ 5,450.
  • Umda wakho ongaphandle kwesikhokelo awuyi kuba ngaphezulu kweedola ezili-10,900 kwintsapho.

Ngomhla we-2017, umda ongaphandle kwesikhokelo kubafakizicelo abanomvuzo phakathi kwe-100 no-200 ekhulwini le-FPL uya kwanda kancane, ukuya kuma-2,350 ayi-$, ngelixa umda wokuphuma kwipokethi kubantu abanomvuzo phakathi kwama-200 ukuya kuma-250 e-FPL uya kunyuka $ 5,700 (kumabini omabini, umlinganiselo wentsapho ophezulu unomlinganiselo ngamnye kabini).

Ukuncitshiswa okhethekileyo kuyafumaneka kumaNdiya aseMerika aseMelika aneemali ezingaphantsi kwama-300 ekhulwini kwi-FPL. Kwimeko yabo, i-insurer yempilo iya kuphelisa bonke ukwabelana ngeendleko kwiyiphi na inzuzo yezempilo.

Ukuba Ingumxhaso, Ngaba Ufumana Imali?

I-sub-pocket-max-subsidy ayiyikukunika imali. Endaweni yoko, inokusindisa imali kuba uhlawula ngaphantsi ngaphambi kokuba ufikelele kwi-out-of-pocket yakho ephezulu.

Ukuba ufikelele ekuncinciweyo kwe-po-pocket ephezulu kwaye uqhubeke nokusebenzisa iinkonzo zonyango lwempilo, inkampani yakho yomshuwalense yempilo iya kugqiba ukuhlawula enye inkathalo yakho kunokuba ungayifumana inkxaso. Kwimeko apho, urhulumente wephondo uza kubuyiselwa inkampani yakho yomshuwalense ngemali eyongezelelweyo eyichithwe ngenxa yakho yenkxaso.

Ngubani ovumelekile kwi-Out-Of-Pocket ephezulu ye-inshurensi yezempilo?

Ukufanelekela le mali:

• Imali engenayo kufuneka ibe ngama-100-250 ekhulwini we-FPL.
• Kufuneka ufumane i-inshorensi yakho yezempilo ngokusebenzisa utshintsho lomshuwalense wezempilo .
• Kumele ukhethe isicwangciso sezempilo sesilivere (ngokungafani nenkxaso-mali ye-premium, ebalwa ngokusekelwe kwizicwangciso ze-silver-tier, kodwa ekhoyo ukuba isetyenziswe kuzo zonke izicwangciso zezinga lesinyithi)
• Ukuba utshatile, isimo sakho sokufakela irhafu kufuneka sitshatile ukudibanisa ngokubambisana. Isimo sokutshata ngokufakela ngokwahlukileyo siya kukungafaneleka. (Kunokhetho olukhethekileyo ukuba awukwazi ukufakela ngokubambisana ngenxa yeemeko zokusetyenziswa kakubi ekhaya.)
• Kufuneka uhlale eMelika ngokusemthethweni.
• Awukwazi ukuvalelwa.
• Akufanele uvumeleke ukufumana ingxelo evela kumqeshi wakho onokuthathwa njengexabiso elifanelekileyo kwaye unika ixabiso elincinci .

Ungayifaka njani le Ncediso?

Awunakuyenza nantoni na eyongezelelweyo ukuze uthole inkxaso-mali yokwabelana ngeendleko. Ukuba ufanelekile kuyo ngokusekelwe kwingeniso yakho, iya kufakwa ngokuzenzekelayo kwizicwangciso zesilivere ezifumaneka kuwe ngokutshintshiselana.

Ukufaneleka kwakho kwezibonelelo zenkxaso-mali kunye neenkxaso-mali zokwabelana ngeendleko ziya kubalwa ngotshintsho xa ufaka ulwazi lwakho lomntu kwinkqubo yabo. Hlalani nikulungele ukunikezela ngolwazi nge-inshurensi yempilo malunga neholo lakho, ubungakanani bentsapho kunye nomqeshi ukuba unomsebenzi. Fumana utshintsho lwe-inshurensi yezempilo.

Ngaphandle kweemeko ezizodwa , unokuthenga kuphela iinshurensi yezempilo ngokusebenzisa utshintshi lwempilo yomshuwalense ngexesha lokubhalisa ngonyaka. Vula ukubhalisa ukuba ufumane i-inshorensi yempilo ngo-2017 ukususela ngoNovemba 1, 2016 ukuya kuJanuwari 31, 2017 (oku kusebenza kwinshuwalense yezempilo ozithengayo yona, ngokuchasene nokufumana ingxelo evela kumqeshi).

Ukuba ufumana isibonelelo esiphezulu senkxaso-mali ye-pocket, qi ni sekise ukuba uxelele utshintshi lwakho lwempilo yomshuwalense ukuba ingeniso yakho inguqu kunyaka. Ukuba ingeniso yakho iyancipha, unakho uvumelekile ukuba uhlawule isibonelelo sakho ukuze kuphuculwe ukukhutshwa kwakho kwepote.

Indlela uMgaqo-mali we-Out-Of-Pocket Mithetho kunye neeMali eziTshintshiwe

Umthetho woNonophelo ojongene noNgcono ongokoqobo uchazwe ukuba umda wokuphuma kwipokotho uyancitshiswa

• 2/3 kubantu abaneemali ezivela kwi-100-200 yeepesenti zeFPL.
• 1/2 kubantu abanemali evela kwi-200-300 yepesenti yeFPL.
• 1/3 kubantu abanemali esuka kwi-300-400 yepesenti yeFPL.

Nangona kunjalo, akuyiyo indlela ekuphelile ngayo ukusebenza. ISebe lezeMpilo kunye neNkonzo zoLuntu lizimisele ukuba lingenakwenzeka ukukhupha i-po-pocket ephezulu kunokuba abantu banokwenza amaphesenti angama-250 eFPL ngaphandle kokuphulwa kwamanye amanqaku omthetho okanye kubangela ukwanda kwe-deductible kwabanye abancedayo. . Ngoko, kumgaqo wokugqibela uvula indlela i-subsidy isebenza ngayo, i-HHS yatshintshile loo manani ukunciphisa i-out-of-pocket maximum malunga:

• 2/3 kubantu abaneemali ezivela kwi-100-200 yeepesenti zeFPL
• 1/5 kubantu abanemali esuka kwi-200-250 ekhulwini yeFPL
• Akukho ncitshiswa kubantu abanemali engaphezulu kwama-250 ekhulwini kwi-FPL.

I-HHS ingenza utshintsho kule mali ngamnye ngonyaka xa ipapasha "iSaziso seNzuzo kunye neParameters Payment" kulo nyaka ozayo.

_Imithombo:

_{ISebe lezeMpilo kunye neeNkonzo zoLuntu, iSaziso seNzuzo kunye neParameters yokuhlawula i-2016, ifumaneke ngoJuni 6, 2016.}

_{ISebe lezeMpilo kunye neeNkonzo zoLuntu, iSaziso seNzuzo kunye neParameters yokuhlawulela ngo-2017. Kufikelele ngoJuni 6, 2016.}

_{Isaziso seNzuzo kunye neParameters yeNtlawulo ka-2014, iSebe lezeMpilo kunye neNkonzo zoLuntu, http://www.gpo.gov/fdsys/pkg/FR-2013-03-11/html/2013-04902.htm. Ufikelele kuSeptemba 10, 2013.}

_{Ukubaluleka kwangoku kunye neNkxaso-mali yokuNciphisa iNkcitho, iSebe lezeMpilo kunye neNkonzo zoLuntu, http://www.cms.gov/CCIIO/Resources/Files/Downloads/Av-csr-bulletin.pdf}

_{Ukukhuselwa komonde kunye noMthetho woKhathalelo ongenakunyanzeliswayo , icandelo 1402 (c). Kufikelele ngoSeptemba 9, 2013.}

_{UJost, uTimoti, "Ukuphunyezwa kweMpilo yeNguqulelo: I-Benefits and Payment Parameters Final Rule" eyafumaneka kwi-HealthAffairs.org, Septemba 9, 2013.}