LweMida

Ingqwalasela ye-Medicare Eligibility and Benefits

I-Medicare yinkqubo yesigqeba esinika uncedo lwempilo kubahlali abadala kunye nabantu abaneziphene ezifanelekileyo. Abemi baseMelika bezomthetho abahlangabezana neemfuno zeminyaka yobudala kunye / okanye ukukhubazeka nako nako ukufaneleka. Le nkqubo ihlangabezana neemfuno ezingaphezu kwezigidi ezingama-56 zaseMerika. Ngokuqikelelwa ukuba abantwana abangama-10 000 boomers abaguqulela iminyaka engama-65 ubudala imihla ngemihla ngo-2030, inani labantu baseMedare liyaqhubeka likhula.

Ungenwe ngumthetho nguMongameli uLyndon Johnson ngo-1965, i-Medicare ekuqaleni yayineengxenye ezimbini. Ebhekiselwe kwi-Medicine yasekuqaleni, iNgxenye A kunye neCandelo B ibhekiselele ukunakekelwa kwezibhedlele eziphambili kunye neendleko zonyango ngokulandelanayo. Ukususela ngeli xesha, le nkqubo iye yanda ukuba idibanise "amanqaku" kwaye, ngokunjalo, inzuzo eninzi. Ukuqonda iingxenye ze-Medicare kunye nendlela abasebenzisana ngayo kukunceda ukuba ubhalisele kwi-Medicare ngendlela eya kulungiselela unonophelo olulwamkelayo.

• Uphi unyango kwaye alufihla intliziyo yakho

• Ubhaliso oluvulekileyo kunye nokuBhalisa okuKhethekileyo Masitshintshe iziCwangciso zeMedare

I-Medicare Ingxenye A: IsiBonelelo soBhedlele

Izibhedlele zihlala zibiza. Ngo-2011, isibhedlele esiqhelekileyo sihlala sibiza i-12,600 zama-dollar kubantu abaphakathi kweminyaka engama-65 no-84 ubudala. Ndiyabulela ku-Medicare, urhulumente wahlawula i-11,900 zamaRandi kulabo bahlala.

Icandelo A yi-inshorensi yakho yesibhedlele. Ihlawulela kwiindleko zebhedlele, ukunakekelwa kwezibhedlele, indawo yokunakekela abahlengikazi kuhlala , indawo yokuvuselela ihlala, kunye neenkonzo ezithile zononophelo lwezempilo ekhaya. Musa ukucinga oku kuthetha ukuba yonke into iya kuhlawulwa ngexesha elide. I-Medicare ineemithetho eqinile ekhungela ixesha eliza kugubungela ngayo le nkonzo, ukuba kunjalo.

I-Medicare Ingxenye B: Umgangatho wezeMpilo

Ubuninzi bempilo yononophelo oyifumanayo iya kuba kwisilathiso sokugula, esithetha esibhedlele.

Oku kungabakho kwiofisi yekliniki, ibhubhoratri, isibonelelo se-radiology okanye nayiphi na indawo yeendawo . Nangona inkonzo isinikwe esibhedlele, njengokufumana i-X-ray kwisibhedlele se-radiology esibhedlele, i-Medicare ayifumkeli ukunakekelwa kwezibhedlele ngaphandle kokuba ungeniswe kwisigulana.

Icandelo B ngu-inshorensi yakho yonyango. Iquka iinkonzo ezahlukeneyo zonyango kubandakanya ukutyelelwa koogqirha, ukukhwela kwee- ambulensi , umhlaza kunye nezinye izixhobo zokukhusela, isibonelelo sezinto zesifo sikashukela, izixhobo zonyango ezizinzileyo, iimvavanyo zengqondo, iimvavanyo zelabhoratri, unyango olulinganiselweyo , izitofu , ukutyelela kakuhle , nokunye.

I-Medicare Icandelo C: I-Medicare Benevantage

I-Medicare Benevantage , eyayibizwa ngokuba yi-Medicare + Ukukhethwa, yindlela eya kwi-Original Medicare eyongezwe kwinkqubo ngo-1997. Unokukhetha i-Original Medicare (i-Parts A ne-B) okanye iCandelo C. Urhulumente akakuvumeli ukuba .

Izicwangciso ze-Medicare Benevantage zinikezelwa ngamashishini angasese yomshuwalense asayine iikontraka kunye norhulumente wephondo.

Ezi zicwangciso ziyavuma ukufihla yonke into eyenziwa yi-Original Medicare kodwa ingaba neenkonzo ezongezelelweyo.

Ngo-2016, abantu abangaphezu kwezigidi ezili-18 baseMerika baqulunqa i-Medicare Advantage izicwangciso kwi-Medicare yaseMveli ukuze baqiniseke ukuba banwebelele ukunika inkxaso kwiinkonzo abayidingayo. Izicwangciso ze-Medicare Benevantage ziza ngeendleko ezongeziweyo kubaxhamli abaqhele ukuhlawula iiprayimari zenyanga eziphezulu kunokuba babeya kwi-Medicare yaseMveli.

I-Medicare Ingxenye D: Umgca woMhlaza weMithi

I-US Census Bureau yabika imimiselo engumyinge oyi-America egcwalisiweyo ye-12.2 ngo-2013. Le nani inyuke kwimigangatho engama-27,8 ngonyaka kunyaka ongaphezu kweminyaka engama-65 ubudala. Kulula ukubona ukuba iindleko zeziyobisi zonyango zingakongeza njani.

Icandelo D yinkcazo yesigxina somthetho esasayinwe kumthetho ngo-2003 phantsi koMongameli uGeorge W. Bush kodwa yaqalisa ukusebenza ngo-2006. Njengoko i-Medicare Benevantage, ezi zicwangciso ziqhutywa ngamashishini ase-inshurensi yabucala kodwa kufuneka zihlangabezane nezikhokelo eziqhelekileyo ezibekwa nguRhulumente wephondo. Isicwangciso ngasinye siya kuba neyeza ezahlukeneyo zonyango kwaye ngamnye umxhamli we-Medicare kufuneka anqume ukuba yiyiphi iplani efanelekileyo ifanelana neemfuno zabo.

Akukho cwangciso cwangcisa onke amayeza.

IziCwangciso zoNcediso lweMida: iMedigap

Kulabo abafuna ukugqithiswa okongezelelweyo, isicwangciso seMedric Supplement Plan, saziwa nangokuthi isicwangciso seMedigap , sinokuthi siyiqwalasele. Ezi zicwangciso aziyiyo inxalenye esemthethweni yeprogram ye-Medicare, nangona i-Centers ye-Medicare kunye neeNkonzo zeMedicaid (CMS) imisa izinto ezizibandakanyayo. Izicwangciso zeMedigap ziyafana kuzo zonke iindawo kunye nemida yaseMassachusetts, eM Minnesota naseWisconsin.

Izicwangciso zeMedigap azikongezi ngokwenene izibonelelo ezongezelelweyo kwi-Medicare. Oko bayenzayo kukunceda ukuhlawula iindleko ezithi uMagare avele etafileni, njengamanani athathekayo, u-coinsurance kunye ne-copayments. Basenokudibanisa ukukhawuleza xa uhamba phesheya. Ezi zicwangciso zinikezwa ngabashurensi bangegunyeni kwaye zingasetyenziselwa kuphela ngokubambisana ne-Original Medicare, kungeyiyo izicwangciso ze-Medicare Benevantage.

Xa Ubhalise kwi-Medicare

Isikhathi sokuBhalisa sokuQala (IEP) se-Medicare siqala emva kweenyanga ezintathu kwaye siphela iinyanga ezintathu emva kokuzalwa kwakho kweminyaka engama-65. Abantu kwi- Intshurensi yokuKhubazeka koLuntu (SSDI) bafanelekile kwi-Medicare ngenyanga ye-25 ye-SSDI kwaye banokubhalisa ngokuzenzekelayo kwinkqubo ngoKhuseleko loLuntu.

• Ukuqonda oko kufunyenwe phantsi kweMedareriya yeSifo sikashukela

• I-Trump ka-2019 I-FY I-Budget Proposition: I-Pros and Cons Cons for Medicare

Abanye abantu banokufumana ithuba lokubhalisa ixesha elizodwa ngokusekelwe kwimbali yabo yengqesho okanye nezinye i-inshorensi yezempilo.

Kukho ixesha lokubhalisa elivulekileyo unyaka ngamnye kubantu abafuna ukutshintshwa kwe-Medicare. Ngaba ufuna ukutshintsha ukusuka kwi-Original Medicare ukuya kwisicwangciso seMedare Benevantage okanye ngokuphambeneyo? Okanye ufuna ukutshintsha kwisicwangciso seMedare yodwa? Eli lixesha lokukwenza. Ixesha lokubhalisa elivulekileyo lwenzeka njalo ngonyaka ukususela ngo-Oktobha 15 ukuya kuDisemba 7.

Akuyena wonke umntu omele atyikitye kuyo yonke inxalenye ye-Medicare, kodwa ukungasayina ngexesha kungabiza indleko kwiimali ezidlulileyo ukuba ukhetha ukubhalisa kamva. Imirhumo yokugqibela yeNgxenye A ingadlulela iminyaka, kodwa iSahlulo B kunye neCandelo D izigwebo ezihlawulelwayo zingapheli nje ngokuba unayo i-Medicare. Kule rekhodi, ukhetha isicwangciso seMediare Benevantage endaweni yeSifo seMveli asiyi kukufumana ukuhlawula iCandelo A ne-Part B.

Ingakanani Imithi Yonyango Iindleko

I-Medicare idla ngokubizwa ngokuba yiyeza eluntwini, kodwa ayikho inkululeko. Nangona ingaba nexabiso elingaphezulu kunezicwangciso ze-inshurensi yabucala, abaninzi baseMerika bazama ukunyamekela ngempilo. Kwabo bahlangabezana neemfuneko ezithile zeempahla kunye neengeniso, kukho iiprogram zokugcina i-Medicare ezinganceda ukugcina iindleko phantsi.

• Icandelo A: Iipresimesi zenyanga zeNgxenye A zikhululekile kubantu abaye basebenza ngaphezu kwe-40 kwikota (iminyaka eyi-10) yengqesho ehlawulwe irhafu. Abafazi babo , ngamanye amaxesha abafazi babo bokuqala nabahlolokazi, nabo banelungelo lokufumana iiprimiyam. Abo ba sebenze ngaphantsi kwelo baya kuhlawula ikhulu lamadola ngenyanga. Ngo-2016, oku kungama-226 eenyanga ngenyanga kwi-30-39 iikota ukuya kwi-411 yeenyanga ngenyanga ngenkonzo engaphantsi kwama-30. Icandelo elongezelelweyo Iindleko zibandakanya i-$ 1,288 echithwe ngo-2016 kwisibhedlele ngasinye, ukubhalwa kweefayibhedlele kwizibhedlele zihlala ixesha elingaphezu kweentsuku ezingama-60, kunye neemali zesikhokelo seziko loongikazi abanamakhono zihlala ixesha elingaphezulu kweentsuku ezingama-20.
• Icandelo B: Wonke umntu uyahlawula iiprayimari zenyanga nganye kwiNgxenye B, kwaye ngaphezulu oya kuzuza ngaphezulu oya kuhlawula. I-Medicare ibhekisele kwimbuyekezo yakho yerhafu engenayo kwiminyaka emibili edlulileyo ukucacisa indleko zeeprimiyam zakho. Kukho ixesha elilodwa elichithwayo ukuhlawula rhoqo unyaka ngaphambi kokuba izibonelelo zakho zikhawule ($ 166 ngo-2016). Ngaphandle kweemvavanyo zokuvavanya, ukufumana ukutyelela kwi-Medicare ukutyelela kunye nokuvakatyezwa kweentengiso zonyaka zikhululekile ukuba ugqirha wakho uvumelana neshedyuli yohlawula i-Medicare. Kufuneka ulindele ukuhlawula i- 20 yepesenti ye-coinsurance kuyo nayiphi na inkonzo yeNgxenye B oyifumanayo.
• Icandelo C (i-Medicare Benevantage) kunye neCandelo D: Iimali-ntlawulo, ama-deductibles kunye neempayenti ze-Medicare Benevantage kunye neCandelo D zizahluka ngokusekelwe kwinkampani yomshuwalense yabucala enikeza isicwangciso. Nangona kunjalo, ukuba ingeniso yakho ingaphezulu kwexabiso elithile, i-CMS idinga ukuba uhlawule intlawulo eyaziwa njenge-Income-Related Related Adjustment Value (IRMAA) ngaphezu kwee-premium ze-Part D zenyanga. Le ntlawulo iya kudibaniswa ukuba uphuhliso lwe-Medicare Benevantage olubandakanya ukukhutshwa kwezidakamizwa. I-IRMAA ihlawulwa ngqo kurhulumente, kungekhona kwinkampani yomshuwalense yabucala ebamba isicwangciso sakho.

Kuphi Ukufumana Uncedo

I-Medicare yinkqubo eyinkimbinkqubo kunye nemimiselo nemimiselo eguqukayo. Oko kwathiwa, kunokuba nzima ukukwazi ukuqhubeka. Unokufuna ukucela uncedo lwenkqubo yakho yenkxaso-nkonzo yomshuwalense wezempilo xa unemibuzo okanye ixhalaba malunga ne-Medicare. Ezi ziinkqubo zokuvolontiya ezifumana inkxaso-mali evela kurhulumente wephondo ukuba akukhokele. Ngaphandle koko, unokuqesha abacebisi bangebucala ukukuncedisa nayiphi na imiba onokuyenza.

> Imithombo:

> Medicare Benevantage. Iwebhusayithi yakwaHenry J. Kaiser Family Foundation. http://kff.org/medicare/fact-sheet/medicare-advantage/. Ipapashwe ngoJuni 29, 2015.

> Medicare Ukubhalisa iDashboard. Amasebe e-Medicare ne-Medicaid Services website. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMSProgramStatistics/Dashboard.html. Ukuhlaziywa ngoJuni 2016.

> Usetyenziso lweMithi kunye neendleko zeShifting zezempilo. ISS Institute for website ye-Health Informatics. http://www.imshealth.com/en/thought-leadership/ims-institute/reports/use-of-medicines-in-the-us-2013. Epapashwe ngo-Ephreli 2014.

> I-Pfuntner A, i-Wier LM, i-Steiner C. Iindleko zokuhlala kwiibhedlele e-United States, ngo-2011. I-HCUP Inkcazo yeShtatisti # 168. I-Arhente yoPhando lwezeMpilo kunye neMigangatho . http://www.hcup-us.ahrq.gov/reports/statbriefs/sb168-Hospital-Costs-United-States-2011.pdf. Kushicilelwe ngoDisemba 2013.

> Yintoni ye-Medicare Supplement Insurance (Medigap)? KwiWebhare.gov website. https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html.