Kutheni kutheni ukubhaliswa kwesicwangciso sempilo kuphelelwe ixesha lokubhalisa elivulekile
Ngaba uzame ukubhalisela i-inshorensi yempilo kuphela ukuba uxelelwe ukuba awuvumelekanga ukuthenga inshorensi yempilo de ube ubhaliso oluvulekile ? Ukuba uya kumthengisi wemoto ukuthenga imoto, umnini-mthengi akafuni ukuthengisa imoto kude kube nguNovemba ozayo. Kodwa iinkampani ze-inshorensi zempilo aziyi kukuvumela ukuba ubhalise kwi-inshurensi yezempilo xa ufuna, nokuba uzama ukuthenga isicwangciso sezempilo kwi- Care Affordable Act , ukuba ungene kwi-inshurensi yezempilo, ungene ngemvume kumqeshi wakho, okanye ungayibhalisa kwi- Medicare .
Izicwangciso zezempilo zinciphisa ukubhaliswa kwithuba lokubhaliswa okuvulekileyo ukwenzela ukuphazamisa ukhetho olubi . Ukhetho olubi lwenzeka xa abantu abagulayo betyikitya inshuwalense yezempilo, kodwa abantu abaphilileyo abanalo. I-skews isixa semngcipheko isicwangciso sempilo esenzekayo xa uqinisekisa umntu, ngoko yonke inkampani yoshishino lomshuwalense lizama ukukhusela.
Ukhetho olubi lusebenza njani
Inkampani yomshuwalense wezempilo inokuphela kuphela ukuba ithatha imali engaphezulu kwiiprayimari ngamnye ngonyaka kunokuba ihlawule amabango . Ukuze kwenzeke oku, kuyadinga amalungu angcono kunamalungu ogulayo.
Nantsi umzekelo olula. Masithi ngalinye ilungu lesicwangciso sezempilo lihlawule i-6,000 $ ngonyaka ngeminshuwalense yezempilo. Kwilungu ngalinye elidinga i-$ 400,000 yomnkantso wokuthutha umongo ngaloo nyaka, kufuneka kubekho amalungu angama-67 ahlawula iiprayimari unyaka wonke ngaphandle kokubakho ibango. (67 X $ 6,000 = $ 402,000.) Inkampani ye-inshorensi yezempilo isebenzisa iiprayimali ezivela kumalungu angama-67 angenayo nayiphi na inkathalo yokuhlawula iindleko zonyango ilungu elinye elidinga unonophelo oluninzi.
Kutheni ukhetho olubi lubi kumntu wonke
Yonke inkqubo iya kubhekana xa bonke abantu abaphilileyo becinga bona, "Kutheni ndimele ndihlawule i-6,000 zamawaka ngonyaka nge-inshorensi yezempilo? Ndiphilile. Ndiza kugcina i-$ 6,000 leyo kwaye ndilinde de ndigule ukuthenga i- inshorensi yempilo. "Emva koko, abantu abagulayo kuphela, abantu abavakalisi abangaphezulu kwama-premiums abo, babhalise kwi-inshurensi yezempilo.
Isicwangciso sempilo asiyi kuthatha imali eyaneleyo kwiiprayimari ukuhlawula onke amabango. Ukuba oko kwenzeka, isicwangciso sezempilo siya kuba neendlela ezimbini: ukuphuma kwishishini okanye ukuphakamisa ama-premium.
Ukuba kuphuma kwishishini, oko kubi kumntu wonke. Sonke sinokukhetha okufutshane okukhoyo xa uthengela i-inshorensi yempilo, kwaye kuya kubakho ukuncintisana. Iinkampani zomshuwalense ezimbalwa ezikhuphisana nezoshishino zithetha ukuba kunokuncinci kancinci kwizicwangciso zezempilo ukubonelela ngeenkonzo ezifanelekileyo zabathengi kunye nefuthe elincinci lokuba bagcine iiprayimari eziphantsi ukuze batye abathengi.
Ukuba iphakamisa ama-premium, oku kubi nakumntu wonke. Sonke kufuneka sihlawule ngaphezulu kwinshuwalense yezempilo. Njengama-premiums ayenyuka, abantu abanempilweni babeya kuba banokuzicingela bona, "Kutheni uhlawula kakhulu loo inshorensi yezempilo? Ndiza kulinda ndide ndigule ndize ndibhalise kwisicwangciso sezempilo. "Oku kuya kubangela ukuba amazinga e-premium aqhube phezulu ukuze kubekho mntu unako ukufumana i-inshurensi yezempilo.
Indlela Abagcini beeNkxaso zeMpilo baVimba ukuKhethwa okuMbi
Abaqinisekisi bezeMpilo abakwazi ukukhusela ngokupheleleyo ukhetho olubi, kodwa banokukwenza ukuba bancinci xa benokungena ngemvume kwi-inshurensi yezempilo ukuya kanye kuphela ngonyaka. Ixesha lokubhalisa elivulekileyo livumela wonke umntu ofuna ukubhalisa kwisicwangciso sonyango ukwenza oko, kodwa uvimba abantu abasempilweni ukuba bacinge, "Ndiya kulinda de ndigule ukuthenga i-inshorensi yempilo." Ngaphandle kokuba bavele nje bafumane abagulayo ngexesha lokubhaliswa ngokuvakalayo kwonyaka, baya kuba bengenalo inhlanhla kwaye bengakwazi ukubhalisela i-inshorensi yezempilo xa begula.
Enye inqubo ephazamisa ukhetho olubi lixesha elifutshane lokulinda phakathi kokubhaliswa okuvulekileyo kunye nomhla wokuqala u-inshurensi yezempilo. Ngokomzekelo, ukuba ubhalisela i-inshorensi yempilo ngexesha lokubhalisa okuvulekileyo, i-coverage yakho iqala ngoJanuwari 1. Oku kuthintela abantu ukuba babhalise kwi-inshurensi yempilo endleleni eya kwisibhedlele, benethemba lokuba isicwangciso sabo sempilo esitsha siza kuhamba ngesilwayo kwi-hospital hospital.
Ukongeza, uMthetho woNonophelo ongenakunqwenela unenjongo yokunciphisa ukhetho olubi ngokugunyazwa ukuba wonke umntu unomshuwalense wezempilo okanye ahlawule intlawulo .
Ngaphandle kokubhalisa okuvulekileyo
Kukho okunye okungafaniyo okuvumela abantu ukuba babhalise kwi-inshurensi yezempilo ngaphandle kobhaliso oluvulekile.
- Ixesha lokuqala lokufaneleka.
- Ubhaliso obukhethekileyo .
- Medicaid kunye ne-CHIP.
- BaseMelika baseMelika .
Ixesha lokuqala lokufaneleka liyenzeka xa uqala ukufaneleka kwinshurensi yezempilo emsebenzini, ngokuqhelekileyo inyanga okanye ezimbini emva kokuba uqeshwe. Eli thuba lokufaneleka lokuqala alingahambelani nokubhaliswa okuvulekileyo kuba abantu baqeshwe kulo nyaka. Nangona kunjalo, ixesha lokugqibela lokufaneleka lilinganiselwe; ukuba awusayineli ngexesha lefestile elithile lithuba xa uqala ukufaneleka ukufumana ingxelo, uya kufuneka ulinde kuze kube yithuba elizayo lokubhalisa.
Uza kuba neenyanga eziyisixhenxe zokufumana imvume yokuqala kwi-Medicare xa uphendukela kwiminyaka engama-65. Ukuba awuyi kubhalisa ngexesha lokufumana imvume yokuqala, kungekuphela nje kuya kufuneka ulinde kude kube yonyaka olandelayo wokubhalisa, nazo zihlawulwe ngeeprayimari eziphezulu.
Ixesha elibhaliweyo lokubhalisa libangelwa iziganeko ezithile zobomi ezifana nokutshata okanye ukwahlukanisa, nokuba nosana, ukulahlekelwa yinshurensi yempilo yakho esekelwe kwimisebenzi okanye ukuphuma kwendawo yesevisi yezempilo. Xa ubhaliso olukhethekileyo lubangelwa, unesithuba sefestile, ngokuqhelekileyo iintsuku ezingama-30-60, ukutshintsha isicwangciso sakho sempilo esele okanye ubhalisele isicwangciso esitsha. Ukuba ulahlekelwa yile festile yelithuba, kuya kufuneka ulinde de kube lixesha elizayo lokubhalisa.
Qaphela ukuba imarike nganye ayinalo ixesha lokubhaliselwa okhethekileyo ngaphambi ko-2014, kodwa ngoku linamaxesha athile okubhalisa aqhelekileyo afana nalawo asebenza kwi-inshurensi yempilo. Intengiso nganye ayizange isebenzise ixesha lokubhalisa elikhethekileyo (okanye amaxesha okubhalisa avulekileyo) phambi ko-2014 kuba abantu banokubhalisa nayiphi na ixesha abayifunayo ... kodwa ukurhweba kwakukho kuzo zonke kodwa zimbalwa, ukufaneleka ukufumana ingxelo kwiimarike kuxhomekeke kwimbali yakho yonyango. Abafaki-zincwadi baya kunqanda izicelo ngokupheleleyo (okanye ngaphandle kwemeko ekhoyo ngaphambili) ukuba abantu bazama ukubhalisa okanye ukutshintsha izicwangciso emva kokufumana imeko yonyango.
Ngoku ngoku kuqinisekiswa-kukhutshwa kwintengiso nganye (njengendlela efanelekileyo kubasebenzi abafanelekileyo kwisicwangciso sezempilo somqeshi), enye imarike isebenzisa ukubhaliswa okuvulekileyo kunye nezihlandlo ezizodwa ezibhalisiweyo njenge-inshorensi yempilo exhaswe ngumqeshi.
I-Medicaid, inkqubo yezenhlalakahle ezisekelwe kuluntu ezinikezela ngempilo kubantu abaphantsi kwemali-mboleko, ihluke kunezinye iintlobo ze-inshurensi yezempilo ngenxa yokuba ayinciphisi ukubhaliswa kumaxesha athile alo nyaka. Esikhundleni saloo nto, iyanciphisa ukubhaliswa kubantu abafumana umvuzo onobuchule kunye nezinye iindlela zokufaneleka. Ukuba ufanelekile kwiMediicaid, ungasayina naliphi ixesha lonyaka. Kuyafana ne-CHIP ( iNkqubo ye-Intshuwalense yezeMpilo yeNtwana ).
I-Medicaid ayifumana imali yayo ekuhlawuleni abaxhamli be-Medicaid abaphambili ama-premium. Kunoko, ixhaswa ngemali yerhafu neyezemfundo. Ekubeni abamkeli abaninzi beMedicaid abahlawuli iiprayimari, akukho mngcipheko wokukhetha okubi ngenxa yabantu abaphilileyo abazama ukugcina kwiiprayimari.
> Imithombo:
> I-Cornell Law School. Iziko Lolwazi Lomthetho. 45 CFR 155.420 Iirejista zokuBhalisa ezizodwa.
> Kaiser Family Foundation. Inguqu yeeNtsholongwane yezeMshuwalense yezeMpilo: Ingxaki eqinisekisiwe . Juni 2012.
> Norris, uLouise. Isikhokelo seeNyanga zokuBhalisa eziKhethekileyo kwiMarike yabanye. Fe bruwari 2017.