Indlela isicwangciso sakho sezempilo esibhekiselele ngayo inkathalo eninzi kuxhomekeke kwisicwangciso soyilo
Kuthetha ukuthini xa ukunakekelwa kwezempilo "kungabandakanywa kwi-deductible" okanye "kungekho phantsi kwe-deductible"? Lo ngumbuzo abafundi abathile baye baphendula ngokuhlalutya kwe-Commonwealth Fund ukuhlalutya izicwangciso zezempilo ezithengiswa kumazwe asebenzisa i-Healthcare.gov.
Kulula ukubona indlela oku kungadideka ngayo, kuba "ngaphandle" kuyigama elisetyenziselwa ukuchaza iinkonzo ezingagqitywanga kuzo zonke izicwangciso zezempilo (zithi, umzekelo, unyango olungenasiphelo kwiimeko ezingabalulekanga) .
"Ayikho phantsi kwe-deductible" = uhlawula ngaphantsi
Kodwa xa inkonzo ingekho phantsi kwe-deductible, ithetha ukuba uye wafumana ingcaciso engcono yelo nkonzo. Enye indlela yokuba inkonzo inikwe i-deductible, oko kuthetha ukuba uza kuhlawula ixabiso elipheleleyo ngaphandle kokuba sele udibene ne-deductible yakho yonyaka.
Ukucacisa, "intlawulo epheleleyo" ithetha emva kokuba isaphulelo sokuthengiswa kwenethiwekhi sisetyenziswe. Ngoko ukuba i-payday rhoqo i-$ 250, kodwa inkampani yakho yinshorensi yempilo ixoxise umyinge we-$ 150, "ixabiso elipheleleyo" lithetha ukuba uza kuhlawula i-$ 150.
Ukuqonda konke oku, kubalulekile ukuqonda isigama esetyenziswayo ukuchaza izicwangciso zempilo . I-Copay ayikho into efanayo ne-coinsurance. I-Deductible ayikho into efana ne-out-of-pocket maximum (leyo ingaba iphakamileyo njenge $ 6,850 ngomntu omnye ngo-2016, kwaye ingaphezulu kwe-$ 7,150 ngo-2017 ). Iimali-ntlawulo azibalwanga kwiindleko zakho zangaphandle (nangona kufuneka uzibandakanye xa wenza izibalo ukuthelekisa izicwangciso).
Kwakhona kubalulekile ukuqonda i-Benenable Affordable Care Act, efunyenwe yizicwangciso zezempilo zeqela kunye namancinci kunye nemihla ephumelelayo kaJanuwari 2014 okanye kamva. Ukuba unemivuzo phantsi kweqela elincinane okanye isicwangciso ngasinye esingakhange sizalwe okanye sikhulu , unyango oluwela phantsi kwe-umbrella linye yeenzuzo zezempilo ezibalulekileyo lufakwe kwisicwangciso sakho.
Kodwa "ukugutyungelwa" kuthetha ukuba izicwangciso zakho zezempilo zisebenza. Indlela ezo zibonelelo zisebenza ngayo kuxhomekeke kwisicwangciso sakho soyilo:
- Akunakufuneka uhlawule nayiphi na into (oku kuya kuba yinkathalo yokukhusela).
- Okanye usenokufuneka uhlawule i-copay (umrhumo osisigxina obekwa kuqala kwisicwangciso sakho-mhlawumbi i-$ 25 okanye i-$ 50 okanye i-$ 100, kuxhomekeke kwonyango olubhekiselwe kumbuzo).
- Okanye usenokufuneka uhlawule ixabiso elipheleleyo kunyango (ukuba awuzange uhlangabezane ne-deductible yakho okwamanje).
- Okanye usenokufuneka uhlawule ipesenteji yeendleko (i-coinsurance).
Zonke ezo zikhetho zibala ngathi "zihlanganisiwe." Ezinye izicwangciso zezempilo ziyilo kunye nendlela abayila ngayo ukufihla kwabo (umz., Isicwangciso esingenakudityaniswa, kodwa i-copay ye-$ 5,000 yezibhedlele). Kodwa kungakhathaliseki ukuba isicwangciso sakho senziwe njani, isixa-mali esihlawulelwayo kwiinkonzo ezigqityiweyo kunyaka siya kubala kwi-out-of-pocket yakho ephezulu. Ingaba nayiphi na inhlanganisela ye-copays, i-deductible, kunye ne-coinsurance, kodwa xa udibene ne-exotic year-out-pocket, isicwangciso sakho sezempilo siya kuhlawulela i-100% nayiphina inkonzo ekhuselekileyo yonyaka oseleyo (qaphela ukuba ukuba utshintshele kwisicwangciso esingafaniyo phakathi konyaka-mali, ukuphuma kwakho kwe-pocket ephezulu kuqala ngelo cwangciso).
I-Copays = iindleko eziphantsi ngexesha leenkonzo
Ukuba isicwangciso sakho sezempilo sineenkonzo ezahlukeneyo ezifakwe ngaphandle kodwa zingekho phantsi kwe-deductible, ithetha ukuba uya kuhlawula ngaphantsi kokunyamekela kunokuba ungayenza ukuba inkonzo inokuxhomekeka kwi-deductible.
Ukuba bekuphantsi kwe-deductible, uya kuhlawula ixabiso elipheleleyo lenkonzo, ucinga ukuba awuzange udibane ne-deductible yakho (ukuba sele udibene ne-deductible yakho, uya kuhlawula ipesenteji yeendleko-zemali-mboleko-okanye akukho nantoni na, ukuba ubude udibene ne-out-of-pocket yakho ephezulu).
Kodwa ukuba inkonzo ayikho phantsi kwe-deductible, uya kuba noxanduva lwe-copay esele yaqulunqwa esikhundleni sexabiso elipheleleyo. Qaphela ukuba ezinye iinkonzo - ezifana nokunyamekela, kunye nezicwangciso ezithile, iziyobisi eziqhelekileyo - azixhomekeke kwi-deductible okanye kwi-copay, oku kuthetha ukuba akufanele uhlawule nantoni na loo nkathalo (zonke izicwangciso ezingenalo ukukhusela ukunakekelwa kokukhusela ngaphandle kokwabelana ngeendleko, oko kuthetha ukuba isigulane asihlawuli naliphi na loo nkathalo - ifakwe iiprayimari ezihlawulwa ukuthenga isicwangciso).
Umzekelo ufanele amawaka ayi-1,000
Ngoko masithi isicwangciso sakho sezempilo sinee-$ 35 zama-copays ukuze ubone ugqirha wezonyango oluphambili kodwa kubalwa ukutyelela okhethekileyo kwi-deductible. Unayo i-$ 3,000 echithwayo kunye ne-4,000 e-out-of-pocket. Kwaye inqanaba lezentengiselwano zentengiso kunye nenkampani yakho yinshorensi yempilo ngu-$ 165.
Masithi uye watyelela kathathu kwi-PCP yakho ngexesha lonyaka, kwaye ukutyelela ezimbini kwiingcali. Iindleko zakho ezipheleleyo zokutyelela i-PCP yi-$ 105, kwaye iindleko zakho ezipheleleyo zokutyelela iingcali zifika kwi-$ 330 njengoko uhlawula ixabiso elipheleleyo.
Kule ngongoma, uhlawule i-$ 330 kwi-deductible yakho, kwaye uhlawule i-$ 435 kwi-out-of-pocket yakho ephezulu. ($ 330 kunye ne-105).
Ngoku masithi ngengozi ngaphambi kokuphela konyaka, kwaye siphelo esibhedlele kwiveki. Iindleko zonyango zisetyenziswa kwi-deductible, kwaye isicwangciso sakho sihlawula i-80% emva kokuba uhlawule i-deductible uze udibane ne-out-of-pocket yakho ephezulu.
Ukuba uhlala esibhedlele, kufuneka uhlawule i-$ 2,670 yeerhafu ezihlawulwayo (i-$ 3,000 ngaphantsi kwe-$ 330 eyayivele uhlawule ukutyelela okhethekileyo). Emva koko uza kufuneka uhlawule i-20% yeerhafu eziseleyo ukuba ixabiso elihlawulele umnyaka lifikile kwi-4,000 zamawaka. Ekubeni uhlawule ii-copay ezintathu ze-PCP ezingama-105 zama-dollar, kufuneka uhlawule kuphela i-$ 895 kwiintlawulo ze-coinsurance zokuhlala esibhedlele ukuze ufike kwi-out-of-pocket maximum.
Nantsi indlela iimathematika eza kukhangela ngayo xa zonke zithe zenziwa kwaye zenziwe:
- I $ 330 + $ 2,670 = $ 3,000 edibeneyo
- I $ 105 (i-copays) + i-$ 895 (i-coinsurance) = enye i-$ 1,000 kwiintlawulo zonyaka
- $ 3,000 + $ 1,000 (ichithwe kunye nazo zonke ezinye iindleko ze-pocket) = $ 4,000
- I-4,000 ye-$ i-out-of-pocket ephezulu kwisicwangciso sakho, oko kuthetha ukuba nayiphi na inkonzo ekhutshwe ngayo yonke loo nyaka iya kugqitywa ngokupheleleyo ngecebo lakho le-inshurensi yezempilo, ekucingeni ukuba uhlale nesicwangciso esifanayo kulo lonke unyaka.
Ukuba isicwangciso sakho sezempilo sasihambise ukutyelela kwe-PCP kwi-deductible, ubuya kubahlawula ixabiso elipheleleyo kwabo nabo (masithi US $ 115 ngamnye). Kwimeko enjalo, ubuya kufika kuma-675 kwiintlawulo ezisebenzayo kwi-deductible ngaphambi kokuhlala esibhedlele (ii-$ 345 zokutyelela i-PCP, kunye ne-$ 330 ukutyelela ootitshala). Uzobe usuphelile nge-$ 4,000 efanayo kwiindleko eziphuma ngaphandle kwebhedlele.
Kodwa ukuba ingozi yayingeke kwenzeke kwaye awuzange uphele esibhedlele, iindleko zakho zonyaka ziza kuba ziphakamileyo kwisicwangciso kunye nohambo lwe-PCP phantsi kwe-deductible (i-$ 675, endaweni ye-$ 435). Ukuba ugqiba ukudibanisa ukuphuma kwakho kwe-pocket ephezulu kunyaka, akuyi kuba yindlela enye okanye enye. Kodwa ukuba awuphelelanga ukudibanisa ukuphuma kwakho kwe-pocket ephezulu, uya kuhlawula ngaphantsi xa ucwangcise ineenkonzo ezingekho phantsi kwe-deductible.
Isishwankathelo
Musa ukwethuka xa ufumanisa ukuba iinkonzo azixhomekeke kwi-deductible. Ngethuba nje xa zigqityiwe isicwangciso sakho, oku kuthetha ukuba uza kuhlawula encinane kwezo nkonzo kunokuba ungathanda ukuba zingaphantsi kwe-deductible.
Ukuba unesi sifo esingapheliyo, esibi kakhulu esidinga unyango olunzulu, kunethuba elihle lokuba uya kudibana ne-out-of-pocket yakho ephezulu kunyaka kungakhathaliseki ukuba uyilo loyilo, kwaye uya kufumana ukuba isicwangciso kunye nenqanaba elingaphantsi kwe-pocket liza kunenzuzo kuwe, nangona kunjalo liya kuza ne-premium ephezulu.
Kodwa ukuba unempilweni kwaye ungagqiba ukudibana neeplani zakho eziphuma ngaphandle kwe-pocket-okanye nokuba i-deductible - ukuba neenzuzo ezingekho phantsi kwe-deductible kuthetha ukuba inkampani yakho yomshuwalense wezempilo iya kuqala ukuhlawula isahlulo lokunyamekela kwakho kungekudala kunokuba ngaba zonke iinkonzo zingaphantsi kwe-deductible (kuba oko kuya kuthetha ukuba uya kufuneka uhlawule intlawulo epheleleyo kuze kufikelelwe i-deductible-engayi kwenzeka nonke kunyaka owenziwe).
Oko kwathiwa, iinkonzo ezininzi ezingabandakanywa kwi-deductible, eziphakamileyo ziyakuthi zibe ziphezulu.