Ndandisandula ukuva i-rant i-inshurensi yezempilo entsha. Uthe wayesekhokhele ngaphezu kwe-inshorensi yempilo yonyaka we-inshorensi ngenyanga, kodwa i- inshurensi yakhe yezempilo ayengayikhokheli i-ofisi yakhe. Xa wabiza isicwangciso sakhe sempilo ukuba azi ukuba kutheni bengabhataleli, waxelelwa ukuba akazange afumane i-deductible okwamanje.
Wayecinga ukuba iintlawulo zee-premium ezenza inyanga nganye zifanele zithathwe ngokubaluleka kwonyaka wakhe. Ngelishwa, i- inshorensi yezempilo ayisebenzisi ngaloo ndlela; Iiprimiyamu azibalanga kwi-deductible yakho.
Ukuba iipalamende azizibali kwi-Deductible yakho, ngoko ke ziphi na zona?
Iimali-mali ze-inshorensi yezempilo ziyindleko yenkqubo yomshuwalense wezempilo. Yiloo nto uhlawula ngayo inkampani yomshuwalense yempilo ngokuchitshiyelwa isivumelwano somshuwalense ukuba ubeke inxaxheba kwengozi yemali yeendleko zonyango lwenyanga leyo.
Kodwa, nangona uhlawula iimpompo zomshuwalense wezempilo yakho, i-inshorensi yakho yezempilo ayikhokheli i-100% yeendleko zempilo yakho. Ukwabelana ngeendleko zeendleko zonyango lakho kunye ne-inshurensi yakho xa uhlawula iidraucable, i- copayments , kunye ne- coinsurance , kunye kunye nezindleko zokwabelana ngeendleko. Inkampani yakho yinshorensi yemali ihlawula lonke iindleko zakho zokunakekelwa kwezempilo, nje kuphela emva kokuba ulandele imithetho yokunyamekela yezempilo impilo yakho.
Ukwabelana ngeendleko kukuvumela iinkampani ze-inshorensi zempilo ukuba zithengise imigaqo-nkqubo ye-inshorensi yempilo ngeepriyam ezinokuhlawulekayo kuba
- Ukuba unayo "isikhumba emdlalweni", uya kuphepha ukunyamekela awuyidingi ngokwenene. Umzekelo, awuyi kugqirha kuyo yonke into encinane ukuba uhlawule i-copayment ye-$ 50 rhoqo xa ubona ugqirha. Kunoko, uya kuhamba kuphela xa ufuna ngokwenene.
- Umngcipheko wemali u-inshurensi ebhekene nawo uyancitshiswa ngumlinganiselo wokwabelana ngeendleko kufuneka uhlawule. Yonke idola oyihlawulayo kwi-deductible yakho, i-copayments kunye ne-coinsurance xa ufumana unonophelo lwempilo enye yeyona dollar engaphantsi kwenkampani yakho yomshuwalense.
Ngaphandle kokwabelana ngeendleko ezifana nokunciphisa imali, iipresimenti zempilo zomshuwalense ziza kuba ziphezulu kunokuba zikhona ngoku.
Ingozi Yakho Yemali? Yintoni oya kuyenza?
Xa unesiqinisekiso, inkcazo yokwabelana ngeendleko kwi-inshorensi yempilo yakho okanye Isishwankathelo seNzuzo kunye nokuPhakamisa ixelela ukuba uninzi lweendleko zakho zonyango ozihlawulayo kunye nenkokhelo yakho yenkampani yomshuwalense . Kufuneka ukucacise ngokucacileyo ukuba uhlawulelwa kangakanani, ingaba uninzi lwama-copays akho, kwaye ubuninzi bakho bentengo.
Ukongezelela, isicwangciso sakho sempilo semida esingaphandle kwe-pocket kufanele sichazwe ngokucacileyo kumgaqo-nkqubo okanye iSishwankathelo seNzuzo kunye nokuPhucula. Ngomnyaka we-2018, umda ongaphandle kwe-pocket awukwazi ukudlulela iRandi 7,350 kumntu oyedwa okanye i-14,700 zamawaka kwintsapho, ngaphandle kokuba unesicwangciso sezempilo esinqununu okanye esikhulu. Le miqathango ephezulu kwiindleko ezingaphandle kwee-pocket iya kunyuka ngo-2019 kwi-7,900 ekhethiweyo ye-$ 7,900 ngamnye kunye ne-15,800 zamawaka kwintsapho. Ngaliphi na unyaka, izicwangciso ezininzi ziyafumaneka ngeemimiselo ezingaphandle kwee-pocket phantsi kwee-maxum eziphezulu, kodwa azikwazi ukudlula umda we-federal.
Umda wokukhutshwa ngaphandle kwe-pocket ukhusela ekulahlekelweni kwezimali ezingenamkhawulo xa kukho iindleko zonyango zempilo eziphezulu. Emva kokuba uhlawule ngokwaneleyo kwii-deductibles, i-copays, kunye ne-coinsurance ukuba ufikelele kwi-out-of-pocket yakho ephakamileyo ngonyaka, isicwangciso sakho sezempilo siqala ukukhupha i-100% yeendleko ze-in-network yakho, unyango oluyimfuneko kuluntu lonke kunyaka. Awunayo ukuhlawula nayiphi na imali eyabelana ngeendleko ngaloo nyaka. Nangona kunjalo, ufanele uhlawule iipresimenti zakho zenyanga okanye umgaqo-nkqubo we-inshorensi yempilo iya kukhutshwa .
Ngoko ke, yintoni encinci ongayenza yona, kwaye yintoni eyona nto unako ukuyenza? Unomvuzo omncinci xa ungadingi naluphi unyango lwempilo unyaka wonke.
Kule meko, awuyi kuba neendleko zokwabelana ngeendleko. Yonke into oza kuba neentlawulo zakho zenyanga zenyanga. Thatha indleko yakho yenyanga yenyanga ye-premium uze uyiphindise ngeenyanga ezili-12 ukufumana imali yakho yonyaka yentsholongwane ye-inshorensi.
Uya kuba neyona nto ininzi ukuba unenkokeli zempilo ephakamileyo ngokwenene kuba ufuna ukunyamekela rhoqo okanye unesicaka sokunyamekela ngokwenene, njengokuba udinga ukuhlinzwa. Kule meko, uninzi oza kuba negalelo lokubelana ngeendleko ngumgaqo-nkqubo ophezulu ongaphandle kwipokethi. Yongeza i-out-of-pocket yakho ephezulu kwiindleko zeeprayimari zakho zonyaka, kwaye oko kufuneka kuchaze umda ophezulu kwinto onokukuhlawulwa ngayo ngeendleko zonyango zempilo zonyaka.
Qaphela, nangona kunjalo. Azikho zonke iindleko zonyango ezixutywayo. Ngokomzekelo, ezinye iintlobo ze-inshorensi yezempilo aziyi kuhlawula umxhesho ngaphandle kokuba uyifumana kwi -network- provider (kwaye ukuba isicwangciso sakho sezempilo sibandakanya ukunakekelwa kwe-network-out-of-de- ukunikezelwa kweenkonzo kwi-out-of-network services). Uninzi lwabaqinisekisi bempilo aluyi kuhlawula iinkonzo ezingenasidingo. Ezinye izicwangciso zezempilo aziyi kuhlawula iintlobo ezithile zokunyamekela ngaphandle kokuba ufumene ngaphambi kokugunyaziswa kwayo.
Ngubani ohlawula i-Premium kwiNtsholongwane Yomshuwalense Wezempilo?
I-premium yindleko yokuthenga i-inshurensi, kungakhathaliseki ukuba usebenzisa isicwangciso okanye cha. Kodwa kwiimeko ezininzi, abantu abaqinisekisiwe ngumgaqo-nkqubo akumele bahlawule iiprimiyam ezipheleleyo ngokwabo. Phantse isiqingatha seMerika bafumana i-inshurensi yempilo ngecebo elixhaswe ngumsebenzi, nokuba ngumqeshwa, okanye njengomlingane okanye oxhomekeke kumqeshwa.
Ngokwe-survey ye-2017 yeKaiser Family Foundation, abaqeshi bahlawula umyinge wama-70 ekhulwini wee-premium zeentsapho ezipheleleyo zabasebenzi abanomshuwalense wezempilo oxhaswe ngemisebenzi. Enyanisweni, kunokuxelwa ukuba iminikelo yeprayimm yomqeshi iyingxenye yembuyekezo yomqeshwa, eyinyaniso. Kodwa iingcali zengqungquthela yokuba abaqeshwa baya kufumana yonke loo mali ngemali eyongezelelweyo xa i-inshorensi yempilo exhaswe ngumqeshi iza kupheliswa, ngenxa yokuba i-inshorensi yezempilo iyinxalenye yentlawulo yomvuzo yomqeshi.
Phakathi kwabantu abathengisa i-inshurensi yabo yempilo kwimarike nganye, izicwangciso ziyafumaneka ngokusebenzisa ii- ACA zokutshintshana kunye nokutshintshiselana . Kubantu abathengayo ukugqithiswa ngokubambisana, ama- 84 ekhulwini afumana iikhredithi zerhafu ye-premium (inkxaso-mboleko) ngo-2017 ukuhlawula i-premiums zabo. Phakathi kwabantu abakwiindawo ezixhomekeke ngokugcwele kwi-HealthCare.gov, i-premium yangaphambili ye-premium inkxaso i-$ 476 / inyanga ngo-2017, ngelixa umyinge we-premium-subsidy premium yayingama-153 / ngenyanga. Ngokucacileyo, inkxaso-mali ye-premium igubungela uninzi lwama-premium kubuninzi babhalise.
Kodwa abantu abazithengayo ngokwabo ngaphandle kweengxowa-mali bahlawula iiprayimari ezipheleleyo ngokwabo, njengabantu abathengayo ukufumana ingxelo ngeengxoxo kodwa inzuzo yabo ingaphezulu kwama-400 ekhulwini lentlupheko (kubhekiselele, loo nto inqunywe yi-$ 98,400 intsapho ye-fou r ye-2018).
Funda nzulu
- Yiyiphi Inqaku Elibhekiselele kwiNtshuwalense Yempilo Yakho?
- Unonophelo lwezeMpilo Ufumana ngaphandle kokuhlawula i-Deductible yakho
- Indlela yokubala Iintlawulo zakho zeNkxaso-mali
- Yintoni ongayibala kwi-Out-Of-Pocket Limit yakho?
- Deductible vs Copayment-Yintoni eyahlukileyo?
> Imithombo:
> Amasebe e-Medicare kunye neenkonzo zeMedicaid, 2017 I-Snapshot enobhaliso eyenziweyo . Juni 12, 2017.
> Amasebe e-Medicare neeNkonzo zeMedicaid, i-2017 Indawo yokuThengisa ukuBhaliswa kwexesha lokuBhaliswa kweeFayile.
> IRejista yeSithili, uMkhuseli weMonde kunye noMthetho wokuNakekelwa koNonophelo ongenakunciphisa Isaziso se-HHS yeSiza kunye neParameters yokuhlawula i-2019 (umgaqo ohlongozwayo). Novemba 2, 2017.
IRejista yeSigqeba, isiKhuseli soMonde kunye noMthetho wokuNakekelwa ngeNtengo. Isaziso seNzuzo yeeNzuzo kunye neParameters yokuhlawula i-2018; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi. Disemba 22, 2016.
> I-Kaiser Family Foundation, iNgcaciso yoMshuwalense wezeMpilo yoBonke abantu. 2016.
> Kaiser Family Foundation, 2017 Uphando lwezeMpilo lwaBasebenzi. NgoSeptemba 19, 2017.