Ngaphezulu kweminyaka embalwa edlulileyo, kukho amabali amaninzi kwiindaba ngezibhedlele ezicela izigulana ukuba zihlawule iinqununu zabo phambi kokuba iinkonzo zonyango zibonelelwe. Kutheni oku kwenzekayo, kwaye abathengi kufuneka bazi ntoni ukuze bahambe ngendlela yethu yokunakekelwa kwempilo?
Indlela Eyisebenzisayo Ukuba
Kwixesha elidlulileyo, kwavunywa ukuba izigulane kulindeleke ukuba zihlawule iikopi zabo ngexesha leenkonzo, kodwa iindleko ezibalwe kwi- deductible ziya kukhutshwa emva koko.
Ngoko ukuba isicwangciso sakho sezempilo sine-copay ye-$ 20 yokutyelela iofisi, iofisi yegqirha iya kuqokelela ukuba xa ufika ukuqeshwa. Kodwa ukuba isicwangciso sakho sinezigidi ezi-2,000 ezidityanisiweyo kwaye ungena kuyo ukuhlinzwa, awuyi kuhlawula nto ngexesha lotyando, kodwa uza kufumana ibhilikhi esibhedlele emva kweeveki ezimbalwa.
Okokuqala, baya kuthumela ibango lakho kumshuwalense, apho ireyiti ekuthethwa ngayo iya kubalwa kwaye ixabiso liza kubhalwa. Emva koko i-inshurensi yayiza kuhlawula isabelo sazo, kwaye yazise isibhedlele ngengxenye yesigulana kwilwayo. Ngelo xesha, isibhedlele sizakukuthumela ibhili-mboleko yexabiso lakho kunye naluphi na uqinisekiso lwemali.
Kutheni Izigulane Ziyakhula Ngokukhawuleza?
Usenokufumanisa ukuba isibhedlele sakho sisebenzisa indlela yendabuko yokulinda ukuthumela i-bill yakho kude kube emva kokuba inkqubo yakho igqityiwe kwaye inkampani yakho yomshuwalense iqhube i-bill yakho.
Kodwa ngokuqhelekileyo kuyaqhelekileyo kwizibhedlele ukuba zicele ukuhlawula-inxenye okanye ngokugcwele-ye-deductible phambi kweenkonzo zonyango ezicwangcisiweyo.
Oku kubangelwe kwiinkalo ezahlukeneyo, kuquka ukunyuka kweendleko zonyango kunye nokwandisa iirhafu kunye neendleko zokuphela kwee-pocket. Kodwa ngokubanzi, le ngcinga kukuba izibhedlele azifuni ukunamathela kwiibhidi ezingakhokhelwa.
Bayazi ukuba emva kokuba inkqubo igqityiwe, izigulane ziyakwazi okanye zihlawule igalelo leendleko ezifunekayo. Isibhedlele singathumela izigulane kwiziqokelelo, kodwa ukufumana ukuhlawula phambili kuyindlela efanelekileyo yokuqinisekisa ukuba ibhilikhwe iyahlawulwa.
Yintoni endiyenzayo ukuba ndiyenze ukuba iSibhedlele ifuna ukuhlawula phambili?
Ngokufanelekileyo, oku kuyinto ofuna uxoxe ngayo neofisi yokubhalwa kwebhedlele kakuhle ngaphambi kwenkqubo yakho. Ukufumanisa iiyure ezingama-18 phambi kokuhlinzwa kwakho esibhedlele ukuba ufuna ukuhlawula imali yakho engama-4,000 e-deductible ngokukhawuleza yimeko esicinezelayo, ukuthetha okungenani.
Ukuba uhlela inkqubo yonyango apho i-deductible yakho iya kusebenza khona, buza malunga nemigaqo-nkqubo yesibhedlele kwasekuqaleni. Thetha kunye ne-inshurensi yakho ukuba ubone ukuba ngaba naziphi na iingxoxo zentsebenziswano nezibhedlele ezifuna ukuba ibhajethi ithunyelwe kwi-inshurensi phambi kokuba isiguli sihlawulwe. Ukuba akunjalo, isibhedlele sinokufuna ukuba uhlawule ubuncinane isahlulo se-deductible front.
Ukuba ungathandabuzeki, kulungile ukudibanisa isebe likarhulumente we-inshorensi ukuba ubone ukuba unayo nayiphi na ingcebiso malunga nemithetho nemimiselo kwiphondo ephathelele iinkqubo zokuhlawula ngonyango. Xa uyazi ngakumbi, bhetele uya kuba nakho ukuhamba kwindlela.
Ubungakanani Kangakanani Owe?
Buza isibhedlele ukuba sikunike uqikelelo lwento oza kuhlawulwa ngayo, ugcine engqondweni ukuba iingxoxo zeendleko zonyango ziphantsi kakhulu kuneendleko zokuthengisa. Ngokomzekelo, masithi ukutsalwa kwakho yi-$ 5,000, uhlela i-MRI, kwaye awukahlawulanga nantoni na ekuhlawulweni kwakho kwonyaka. Iindleko eziqhelekileyo ze-MRI zingaphezu kwama-2,600 zamaRandi, nangona zihluka ngokubanzi kwisibhedlele esinye kwesinye. Yaye nawuphi na umlinganiselo wesibhedlele ihlawuliswa ukuba iphezulu kakhulu kunezinga elithethathethwano apho u-inshurensi wakho enelo bhedlele. Isibhedlele sinokuhlawula i-$ 2,000, kodwa umyinge we-insurer uthetha u-$ 1,295, umzekelo.
Kuloo meko, imali oya kufuneka uyihlawule ekuhlawulweni kwakho iya kuba yi-$ 1,295 ayi-$ 2,000 .
Oku akuyiyo ingxaki ukuba unayo inkqubo ephindaphindiweyo yindleko kunexabiso lakho. Ukuba uzimisele ukuguqulwa kwamadolo, yeyiphi imitha engama-50,000, kwaye i-deductible yakho i-$ 5,000, uza kufuneka uhlawule ngokupheleleyo. Isibhedlele sinokukucela ukuba ukhokhe konke okanye inxalenye yaso ngaphambili, okanye banokukuhlawula imali emva kokuba bangenise ibango lakho kumshuwalense, kodwa akukho nto ihamba ngayo ukuba uya kufuneka uhlawule i-$ 5,000 epheleleyo.
Ngomzekelo wangaphambili malunga neMRI, ke ke, imali efunekayo ukuyihlawula ayiqinisekanga de ukuba i-insurer yakho iqhube ibango. Ukuba isibhedlele ikucela ukuba uhlawule isabelo sakho esicatshulwa kusengaphambili kwaye akucaci ngokucacileyo malunga nokuba uza kuhlawulwa kangakanani, qi niqiniseke ukuba uxoxisana nale meko kunye nomshuwalense wakho ngaphambi kokunika nayiphi imali esibhedlele. Ngenye indlela, uya kufuna ukuqinisekisa ukuba uhlawula imali leyo i -EOB yakho yomshuwalense ekugqibeleni ithi uyayifumana , kunokuba isixa esibhedlele esibhedlele.
Ngaba kukho iSicwangciso soNgeniso?
Izibhedlele ziqhubeka zisebenza kunye neebhanki zokuseka izicwangciso zokuhlawula izigulana ezizifunayo, ngokuhlala zingenamdla kunye nokufumaneka okungaxhomekeke kwimbali yengxelo yemboleko. Ukuba isibhedlele ikucela ukuba uyihlawule imali enokutshatyalaliswa kwangaphambili kwenkqubo yonyango kwaye akukho ndlela enokwenjenjalo yokwenza njalo, babuze malunga nokuhlelwa kwesicwangciso sokuhlawula.
Isibhedlele sifuna ukuba unakekele unyameko kwaye ulunge, kodwa nabo abafuni ukunyanzelwa ngetyala elibi ukuba awukwazi ukuhlawula isabelo sakho sebhili. Isicwangciso sokuhlawula esivumela izigulane zolule i-bill yayo kwiinyanga eziliqela okanye nokuba iminyaka ikhethwayo kwisigulane esingenazinyameko okanye isibhedlele esingahlawulwa nonke. Ukuba awukwazi ukuhlawula imali abayicelayo, bonisa imali enokuyihlawula ngayo, kwaye ubuze ukuba bayakuvumela ukuba uhlalutye iintlawulo zezinye.
Buza ukuba kukho umphathi wecala okanye unontlalontle esibhedlele onokunceda izigulane ekuhambeni kwenkqubo yokuhlawula kunye nentlawulo. Akukufaneki ukuba uzibonise nje wedwa, kwaye kungahle kwenzeke ukuba iimfuno zokubhalwa kwebhedlele zikwazi ukuguquguquka kunokuba zivele kuqala.
Ngokuxhomekeka kwiimeko zakho zemali, kufuneka ucele kwakhona malunga neprogram yokunyamekela izibhedlele, nokuba ngaba unokubhala isahlulo seendleko zakho ngokusekelwe kwingeniso yakho.
Ngaba Izibhedlele Zinganakwa Ukunyamekelwa NgokweSakhono Sokuhlawula?
Ngamanye amaxesha ukungaqondi kakuhle malunga nezibophelelo zezibhedlele ngokubonelela ngononophelo nangakhathaliseki ukuba umguli uyakwazi ukuhlawula. Ukususela ngo-1986, uMthetho wezoNyango oPhezulu oPhezulu kunye neMisebenzi (EMTALA) ufune zonke izibhedlele ezamkela i-Medicare (ezizo zonke izibhedlele zase-US) ukubonelela ngeenkonzo zokuhlola nokuzinzisa kuzo zonke izigulane ezifika kwigumbi elingxamisekileyo, kubandakanywa nabasetyhini abakhutheleyo abasebenzi, kungakhathaliseki ukuba imeko ye-inshorensi yesigulane okanye ukukwazi ukuhlawula ukunyamekela.
Igumbi loxinzelelo kufuneka likhusele zonke izigulane ukujonga ukuba ingxaki yintoni, kunye nokubonelela ngeenkonzo zokuzinzisa-abakwazi ukuvumela isigulane siphuluke ekufeni ngenxa yokungahambi kwemali. Kodwa akudingeki banikeze nantoni na ngaphandle kokuzinza ukuba abaqinisekanga ukuba isiguli siya kukwazi ukuhlawula, kwaye i-EMTALA ayinakwandisa kunoma yimuphi unonophelo ngaphandle kweenkonzo eziphuculweyo.
Ngoko inkqubo yezocwangciso ngaphambi kokuba ilungiselelwe unyango ayiyi kuthotyelwa kuyo nayiphi na imigaqo efuna izibhedlele ukubonelela ngononophelo nangakhathaliseki ukuba umguli uyakwazi ukuhlawula.
Ukwandiswa kweziThathaka Ukubeka izigulane kunye nezibhedlele kwindawo eNgqineko
Inqanaba elingenakunyuswa liye lahla kakhulu ngenxa yokuba uMthetho woNonophelo ongenakunqunyiwe waphunyezwa. Ngokwe-US Census data , ama-14.5 ekhulwini labantu base-US abazange baqinisekiswe ngo-2013, kwaye oko kwawa kweepesenti ezingama-8.6 ngo-2016. Nangona okuqinisekileyo into enhle, abanye balabo bantu abasandul indleko.
I-ACA ibeka umlinganiselo wokuba iindleko eziphezulu kwi-intanethi zingabikho , kodwa umda ngokwawo uphakamileyo. Ngo-2018, izicwangciso zempilo zingaba neendleko zokuphuma ngaphandle kwee-7,350 ezizimele kunye ne-14,700 zamawaka kwintsapho. Kwaye ngo-2019, i-HHS inqwenele ukwandisa loo makhonkco angaphezulu kuma-7,900 kunye ne-$ 15,800, ngokulandelanayo. Izicwangciso ezininzi zempilo zinemiqathango engaphandle kwee-pocket ziphantsi kwezi mali, kodwa iinqununu ezicwangcisiweyo kwiimveliso zorhwebo nganye zihlala ziphindwa ngamawaka eedola ( ukunciphisa ixabiso lokunciphisa ixabiso lokunciphisa aba bantu abakulungeleyo, xa nje bekhetha isilivere cwangciso kwintsebenziswano).
Izicwangciso ezixhaswe ngumqeshi kufuneka zigcine i-ACA's cap kwi-out-of-pocket cost, kodwa zivame ukuba nezindleko kunye nezindleko ezingaphandle kwee-market. Ngo-2017, umyinge owenzelwe abantu abanomshuwalense wezempilo oxhaswe ngumqeshi wawuyi-$ 1,221, kodwa leyo yayiquka inhlanhla i-19 yabasebenzi abangenayo i-deductible nonke. Xa sibheka kuphela ama-81 ekhulwini labasebenzi abavotyiweyo, abanokudityaniswa kwemitha engama-1,500.
Nangona kunjalo i-Federal Reserve yabika ngo-2017 ukuba i-44 ekhulwini yabaphenduli kwi-Survey ye-Economics yasekhaya kunye noKwenziwa kweNqumo ayinakukwazi ukuza ne-$ 400 ukukhawuleza ibhajethi engalindelekanga, okanye bekufuneka kuthengise into ukuze ihlawule iindleko. Oko kubonisa i-conundrum xa abantu benomsebenzi ongenakulindeleka kodwa uyimfuneko yonyango kunye nokuchithwa okuphezulu.
Ikwazisa kwakhona i-conundrum yezibhedlele-ezenziwa kwelinye icala kunye nokubonelela ngononophelo lwempilo kubahlali bendawo, kodwa kwakhona kufuneka ukuba ivelise imali eyaneleyo yokuhlala. Ukufuna ukuhlawulwa kwangaphambili kweyona nxalenye ye-deductible yindlela enye yezibhedlele ukuphepha iimeko apho izigulana ziphela zingakwazi ukuhlawula iibhili.
Cinga nge-HSA Ukuba Unako ukufikelela kwi-HDHP
Ukuba umqeshi wakho unikeza isicwangciso sezempilo esixhomekeke kwi-HSA (HDHP) , okanye ukuba uthengisa i-inshurensi yakho yempilo kwimarike nganye, cinga ukubhalisa kwi-HDHP. Akulona lungile kumntu wonke, kodwa ukuba uhlanganiswe yi-HDHP, unokufaka isandla semali yentlawulo yangaphambili yentlawulo kwi-HSA, kwaye kuya kuba khona ukuba kwaye xa uyifunayo.
Ngo-2018, unako ukufaka isandla kwi $ 6,900 ukuya kwi-HSA ukuba unobungozi bentsapho phantsi kwe-HDHP, uze ufike kuma-3,450 ayi-3,450 ukuba unayo i-auto-cover kuphela phantsi kwe-HDHP. Nangona unokuba negalelo elilodwa kuphela ngenyanga, liya kudibanisa ngaphezu kwexesha, kwaye akukho "ukuyisebenzisa okanye ukulahlekelwa" ukubonelela-imali ihlala kwi-akhawunti yakho de ukuba ngaba kwaye xa ufuna ukuyihoxisa. Unokwakha umkhonto kwi-HSA ngelixa unika ingxelo phantsi kwe-HDHP, kwaye uyigxotha ngomhla ozayo ukuze uhlawule iindleko zonyango kwixesha elizayo, nangona ungenayo inqaku le-HDHP kwangoko.
Ngoko i-takeaway iphuzu apha ukuba ukuba unokufikelela kwisicwangciso esifanelekileyo se-HSA, ukubhalisa kuyo kunye nokwenza igalelo kwi-HSA kuza kwenza kube lula ukujongana nesimo esizayo esizayo apho isibhedlele sikucela ngokukhawuleza ukuba ukhokhe i-chunk enkulu lwemali phambi kokuba ufumane unyango.
Ukuba umqeshi wakho unikela kunye ne-FSA, leyo yinto enhle, kodwa khumbula ukuba imali engasetyenziswayo kwi-HSA yakho iya kuhlala kwi-akhawunti ukususela kunyaka omnye kuya kwesinye-akunjalo nangemali ye-FSA .
> Imithombo:
> IBhodi yabaPhathi be-Federal Reserve System. Upapasho ndaba zekhampani. Imibiko yeBhodi yeBhodi yokuThengisa iNgcaciso kwi-Economic Well-Being yaseMelika. NgoMeyi 19, 2017.
> I-Register Register. Ukhuseleko lomonde kunye noMthetho woNonophelo ojongene noThathaka; Isaziso seNzuzo yeeNzuzo kunye neParameters yokuhlawula i-2018; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi. Disemba 22, 2016.
> I-Register Register. Umthetho ophakanyisiweyo: UMthetho woKhuseleko weMonde kunye noMthetho wokuNakekelwa onoxanduva; Isaziso se-HHS yeSiza kunye neParameters yokuhlawula i-2019. Novemba 2, 2017.
> Kaiser Family Foundation. IiNzuzo zezeMpilo zabaSebenzi, uphando loNyaka lwe-2017. NgoSeptemba 19, 2017.
> I-United States Census Bureau. Umshuwalense wezeMpilo eMelika: 2016 . NgoSeptemba 12, 2017.