I-out-of-pocket enkulu iya kuba ngu-12,6% ephezulu kunokuba ibe ngowama-2014
Ukuba unesicwangciso sezempilo esivumelana noMthetho ononophelo wokuNakekela (ACA), i-out-of-pocket yakho ephezulu i $ 6,850 ngo-2016. Ukuba unabantu abangaphezu kwesinye isicwangciso sakho, inxalenye engaphantsi kweefowuni inokudibanisa ' kudlula i-13,700 zamaRandi, nangona isicwangciso kufuneka sibe ne- pack-out-of-pocket ephezulu ebingenayo i-$ 6,850.
Kubalulekile ukuqonda ukuba i-plan-out-of-pocket yakho isicwangciso esingaphantsi kwezi mali ...
akunakukwazi ukuphakama (ngaphandle kokuba unesicwangciso esiphezulu okanye esikhulu). Ngoko unokuba nomgaqo-nkqubo onama-dollar ayi-1 000 kunye ne-out-of-pocket ye $ 4,000. Oku kungaphakathi kwezikhokelo zemimiselo, kwaye kuyaqhelekileyo, kuxhomekeka kwisicwangciso sensimbi yesicwangciso (izicwangciso zethusi zivame ukuba nezona ziphezulu eziphezulu ze-pocket - kaninzi kwizinga eliphezulu kakhulu - ngelixa igolide neeplatinum zicwangciso unamaqondo angaphantsi kwee-pocket, ngokuqhelekileyo uncinci kunqanaba elivumelekileyo).
Isikhulu esiphezulu se-pocket ngo-2017
NgoFebruwari 2016, iSebe lezeMpilo kunye neNkonzo zoLuntu (HHS) likhuphe iPartimeters Benefit and Payment for 2017 . Kuyo, i-HHS ijongene nemibandela ephakamileyo yemicimbi, kubandakanywa nemida ephezulu.
Ngo-2017, i-HHS ifake i-out-of-pocket ephezulu kwi $ 7,150 ngamnye, kwaye i-14,300 zama-intsapho kwintsapho (ama-maximums ngaphandle kwe-pocket ahlanganisiweyo aya kusadingeka kwizicwangciso zentsapho).
Kwakhona, kuya kubakho izicwangciso ezininzi ezifumanekayo kunye nama-maximally out-of-pocket maximums. Kodwa akukho zicwangciso ezintsha ziyakwazi ukufumana ama-maximums out-pocket ngaphezulu kweli nqanaba.
Ngokombono, ukuphela kwe-pocket ephezulu ngo-2014-kunyaka wokuqala i-ACA-iiplani ezihambelanayo zikhona-yayingamaRandi ayi-6,350, kwaye i-$ 12,700 yintsapho.
Ngo-2017, i-out-of-pocket maximum iya kwanda ngo-12.6% ukususela ngo-2014.
Kutheni i-out-of-pocket inyuse kunyaka ngamnye?
Okubalulekileyo, yindlela yokugcina iiprayimari ukukhangela, kunye nokugcinwa kwemali yonyango. I-HHS isebenzisa i-formula efanisa umyinge we-inshorensi ye-inshorensi yempilo yonyaka ngamnye ye-inshurensi ye-insured-sponsored plans (i-$ 6,076 ngo-2016), kunye nomyinge we-inshorensi ye-inshorensi yezempilo nganye ngonyaka.
Kule meko, sithatha i-6076 - 5365 = 711. Emva koko sithatha i-711 eyahlula ngo-5365 ukubona ukunyuka kweepesenti kwi-premium yokubhalisa ama-premium kwiiplani ezixhaswe ngumqeshi. Sifumana i-0.1325256291, okanye malunga ne-13.25%.
Ngoku sithatha i-out-of-pocket yangaphambili esekelwe ngo-2014 (i-$ 6,350), kwaye yonyusa ngo-13.25%. Siphelela nge $ 7191.
Kodwa kukho umqathango kummiselo ofuna iHHS ukuba ijikeleze kwi-$ 50 esondeleyo, ngoko ke umphumo ujikeleze ukuya kuma-7,150.
Ngokucacileyo, le ngcamango kukuba i-premium ehlawulwa ngumqeshi ikhutshwe malunga ne-13.25% ukususela ngo-2013 ukuya ku-2016, i-maxim-out-of-pocket maximums kufuneka iphandwe ngama-percentage efanayo ukusuka ngo-2014 ukuya ku-2017 (kuba ijikeleze, ukwanda okwenziwe kwimaphumo engaphandle kwe-pocket kuphela malunga ne-12.6% endaweni yoko).
Ngalolu hlobo, kunokwenzeka ukuba ama-maximum angaphandle kwee-pocket anganqumla ukusuka kunyaka omnye ukuya kutsho, ukuba ngaba iipresom ezixhaswe ngumqeshi ziyeke. Ngo-2017 kuya kuba ngumnyaka wesine kuphela wokuba nemida yokugunyazwa kuma-maximums-out-pocket (phambi kuka-2014, abo bango-inshorensi babekhululekile ukubeka ama-maximum abo abaphuma ngaphandle. Kwaye nangona ama-maximi angaphandle kwee-pocket enyukile kunyaka ngamnye, akukho mgaqo othi baya kuqhubeka ukwenza njalo ngonyaka.
Kuthetha ukuthini ukuphuma kwe-pocket ephezulu?
Isicwangciso esiphezulu se-pocket (ekwabizwa ngokuba sisithuba esiphezulu se-pocket) sisonke isixa esiza kugula isigulane kunyaka owenzelwe ukufumana unyango lwe -intanethi njengoluhlu lwezempilo oluyimfuneko.
Ukuba ufumana unonophelo ngaphandle kwenethiwekhi yakho yechungechunge , i-out-of-pocket maximum ingaphezulu, okanye ingenakulinganiswa.
Ngethuba nje uhlala kwi-network kwaye ufumane unonophelo olufakwe phantsi kwesicwangciso sakho sezempilo, iindleko zakho zonyaka ziya kufakwa ngaphandle kwe $ 6,850 ngo-2016. Oku kuquka ukudibanisa yakho
- i-deductible (inani olihlawulayo phambi kweenzuzo ezininzi ukukhahlela)
- i-copays (inani elincinci olihlawulayo ukubona ugqirha, gcwalisa umyalelo wecawa, tyelela uchwepheshe, uye kwigumbi lexakeka, njl.), kwaye
- i-coinsurance (ipesenteji yebango elihlawulayo emva kokuba uhlawule imali yakho, kodwa ngaphambi kokuba udibene ne-out-of-pocket maximum).
Azikho zonke izicwangciso ezibandakanya zonke ezo zintathu zendawo yokuchitha. Umzekelo, isiCwangciso seMpilo esiPhezulu esiPhezulu esiPhezulu seHSA esiqhelekileyo asiyi kuqukwa neefayili, kodwa siya kuba ne-deductible kwaye sinakho okanye singenayo i-coinsurance (kwezinye iimeko, i-deductible kwi-HDHP yiyona epheleleyo ye-pocket, ngelixa ezinye i-HDHP ziya kuba ne-deductible plus coinsurance ukwenzela ukuba kufinyelele kwi-out-of-pocket maximum).
Xa usufikelele kwi-out-of-pocket ephezulu kunyaka, isicwangciso sakho sezempilo siya kuhlawula i-100% yakho kwinethiwekhi, iindleko ezifihliweyo zisele kwonyaka. Kodwa ukuba utshintshe izicwangciso zeminyaka eminyaka (ngenxa yesiganeko esifanelekileyo esibangela ixesha lokubhalisa okhethekileyo ), iindleko zakho zokuphuma ngaphandle ziza kuqala ngecebo elitsha. Kwaye nangona ugcina isicwangciso esifanayo ngonyaka emva konyaka, iindleko zakho zokuphuma ngaphandle ziza kuqalwa ekuqaleni konyaka ngamnye.
Imfuneko ye-ACA yokuba izicwangciso zezempilo zikhupha iindleko ze-pocket zisebenza kwizicwangciso zomntu ngamnye kunye neqela, kubandakanywa izicwangciso zeqela elikhulu. Kodwa izicwangciso ezininzi zikhululekile, njengokuba zikhulu kunye nezicwangciso zeqela elincinci. Izicwangciso zeqela elikhulu azidingeki ukuba zibandakanye iingenelo zezempilo ze-ACA ezibalulekileyo , kodwa kwindlela abazenza ngayo, abanakufuna ukuba ilungu lihlawule ngaphezulu kwiindleko ezingaphandle kwexesha elidlulileyo kunyaka osebenzayo kulo nyaka.