I-inshorensi yexesha elifutshane ifumaneka unyaka wonke, kodwa funda ukushicilelwa okulungileyo
Ngaphandle kobhaliso oluvulekile, ithuba lokuthenga i-individual coverage okanye ukutshintshwa kwiplani enye ukuya kwelinye lilinganiselwe. Uninzi lwabantu ludinga isiganeko esifanelekileyo ukubhalisa, nangona amaNative aseMerika angabhalisa unyaka kwicebo ngokutshintshiselana, kwaye nabani na abafanelekayo kwiMedicaid okanye i-CHIP banako ukubhalisa naliphi na ixesha kunyaka.
Amathuba okubhalisa amancinci kumakethi athile asebenzayo kunye nokucima itshintshiso.
Kodwa kukho ezinye iindidi zokubhengezwa ezifumaneka kuwo wonke umnyaka. Izicwangciso ezingalawulwa yi-ACA zingathengwa naliphi na ixesha, kwaye zihlala zingabizi xabiso xa zithelekiswa ne-ACA ehambelana nokuxhaswa kwezempilo. Kodwa kubalulekile ukuba uqaphele ukushicilelwa okulungileyo xa ucinga isicwangciso esingafanelekanga se-ACA.
Ziziphi iziCwangciso ezingekho kwi-ACA-Compliance?
Izicwangciso ezingavumelekanga ziquka izicwangciso zokugula eziphambili (oko kukuthi, isicwangciso esinika iingeniso ukuba ufumene izifo ezithile), ezinye izicwangciso zokufumana izibonelelo ezingenakuncedo, izongezelelo zengozi (oko kukuthi, izicwangciso ezihlawulela inani elithile xa ukalimele iziganeko zengozi), izicwangciso zamazinyo / zembono (ukukhutshwa kwamazinyo kwezilwanyana kulawulwa yi-ACA, kodwa ukufihla kwamazinyo akudala), kunye ne-inshorensi yempilo yesikhashana.
Uninzi lwezi zikhetho ze-coverage azizange zenzelwe ukukhonza njenge-self-coverage-zaye zenzelwe ukuba zongezeleleke kwisicwangciso se-inshurensi yezempilo yonyango.
Ngoko umntu onomdaka ophezulu unokukhetha ukwanda komngcipheko oza kuwuhlawula xa usenobungozi-kodwa ukuxhaswa kwengozi ngokwakho kuya kuba yinto engafanelekanga ukuba uthengwe njengomntu kuphela.
Inkcazo ye "Ixesha elifutshane" liye latshintsha, kwaye kuya kwenzeka ukuba litshintshe kwakhona
I-inshorensi yangexesha elifutshane yenzelwe ukukhonza njengendlela yokuzimelela yedwa, ngaphandle kwexesha elifutshane nje.
Ngaphambi kowe-2017, i-inshurensi yexesha elifutshane ichazwe ngu-federal government njengomgaqo-nkqubo kunye nexesha elide ukuya kwii-364 iintsuku, nangona ezinye iindawo zithintela kwiinyanga ezintandathu, kwaye ininzi yezicwangciso ezikhoyo kwilizwe lonke zathengiswa kweenyanga ezintandathu.
Kodwa ngo-2017, izicwangciso zexesha elifutshane zifumaneka kuphela kwiinyanga ezilishumi. Oku kubangelwa yimimiselo i- HHS yagqitywa ekupheleni konyaka we-2016, ngokuthotyelwa kokuqala ngo-Apreli 2017 (izicwangciso zexesha elifutshane ezaqala ukusebenza ngaphambi ko-Apreli 2017 zavunyelwa ukuba zigcine kude kube sekupheleni kuka-2017, okanye umhla ogqitywe ngu-insurer).
Nangona kunjalo, imigaqo iyakwazi ukutshintsha kwakhona phantsi kolawulo lweTrump. Ngo-Oktobha 2017, uMongameli uTrump wasayina umyalelo olawulayo olawula ii-arhente ezahlukahlukeneyo ze-federal "ukuba ziqwalasele ukuphakanyiswa kwemimiselo okanye ukuhlaziya izikhokelo, ngokuhambelana nomthetho, ukwandisa ukufumaneka kwe-inshorensi yempilo yesikhashana. Ukulindela kukuba i-arhente iya kuphakamisa imimiselo yokubuyela kwingcaciso yangaphambili ye-inshorensi yangexesha elifutshane, ukuvumela ukuba izicwangciso zibe neminyaka engama-364.
Kuya kuthatha ixesha lokuba oku kwenzeke, nangona kunjalo, njengoko i-arhente iya kufuneka ihambe kwinkqubo eqhelekileyo yokuyila imimiselo nokuvumela ixesha lokubeka izimvo zikarhulumente kubo.
Kwaye iza kuthi ziza kuba neyokugqibela ngokutsho kwezinto ezivunyelwe kwimeko nganye. Amaqela ambalwa avimbela izicwangciso zexesha elifutshane, kwaye uya kuqhubeka enza njalo. Kwaye kuthiwa ngaphambili ukucwangcisa iiprogram zexeshana ezingaphelelanga kweenyanga ezintandathu kwithuba elide liyakwazi ukugcina loo mgaqo wendawo ukuba kwaye nini na ukuba urhulumente wenqila abuyele kwincazelo yakhe yangaphambili ye-inshorensi yesikhashana.
Yintoni endiyidingayo ukuyiqonda malunga nexesha elifutshane?
Ngenxa yobuninzi bemingcipheko (echazwe ngezantsi), i-inshurensi yempilo yexesha elifutshane ayibiza kakhulu kune-inshorensi yempilo yonyango.
Yaye nangona i-inshorensi yangexesha elifutshane ayitholakali kuwo onke amazwe, iyafumaneka ukuthenga unyaka-wonke, ngaphandle kwexesha lokubhalisa elivulekileyo, kwiindawo ezininzi.
Kodwa i-inshurensi yangexesha elifutshane ayilawulwa yi-ACA. Ngenxa yoko, kukho izinto eziliqela ekufuneka uziqaphele ukuba ucinga ukuthenga isicwangciso sexesha elifutshane:
- Izicwangciso zexesha elifutshane azidingeki zigubungele iinkonzo ezilishumi zempilo ezibalulekileyo. Izicwangciso ezininzi zexesha elifutshane azigubungele ukunakekelwa kwababelethi, impilo yokuziphatha, okanye ukunakekelwa kokukhusela.
- Izicwangciso zexesha elifutshane zinama- maxum enzuzo , nangenxa yeenkonzo ezithathwa njengezibonelelo zezempilo ezibalulekileyo phantsi kwe-ACA.
- Izicwangciso zangexesha elifutshane zisasebenzisa ukubhala phantsi kwezokwelapha, kwaye azigubungeli izimo ezikhoyo ngaphambili. Isicelo sisazibuza ngembali yezobugqirha ukuze kuqinisekiswe ukufaneleka kwenkcazo. Kwaye nangona uluhlu lwemibuzo yezobugqirha kwisicelo se-inshorensi yexesha elifutshane lifutshane kunoluhlu lwemibuzo eyayisetyenziswe kwi-inshorensi enkulu ye-inshorensi ngaphambi kwe-2014, imigaqo-nkqubo yexesha elifutshane ivela kunye necala lokukhutshwa kuzo zonke imeko ekhoyo.
- Izicwangciso zexesha elifutshane azithathwa njengento encinci yokubhengezwa ngokubalulekileyo, oku kuthetha ukuba abantu abathembele kubo baxhomekeke kwisigwebo se-ACA sokungaqiniseki , ngaphandle kokuba baxolelwe ngaphandle kwesohlwayo (kwaye phawula ukuba isohlwayo siphezulu kakhulu ngoku ngoku ngo-2014 no-2015).
- Ngenxa yokuba bengabonwa njengeyona nto ibalulekileyo yokukhawuleza, ukupheliswa kwesicwangciso sexesha elifutshane akusisiganeko esifanelekileyo . Ngoko ukuba isicwangciso sakho sexesha elifutshane siphelela kwiminyaka emibini kwaye awufaneleki ukuthenga esinye isicwangciso sexesha elifutshane (oko kuya kuba njalo ukuba uphumelele imeko ekhoyo ngaphambili xa ihlanganiswe phantsi kwecebo lokuqala elifutshane) awuyi kuba nethuba lokubhalisa kwiprogram yomshuwalense wezempilo rhoqo ukuya kubhaliso oluvulekile luqala kwakhona.
- Unokuba necebo elifutshane elifutshane elifutshane. Kwaye ngelixa uya kuba nethuba lokuthenga esinye isicwangciso sexesha elifutshane xa kuqala okokugqibela, kubalulekile ukuqonda ukuba uqala ngepolisi entsha, kunokuba uqhubeke nomnye owawunakho ngaphambili. Oku kuthetha ukuba uya kuthotyelwa phantsi kwezokwelapha kwakhona xa ubhalisa kwisicwangciso sesibini, kwaye nayiphina imeko ekhoyo ngaphambili ekhutshwe ngelixa uqinisekisiwe kwisicwangciso sokuqala ayiyi kuhlanganiswa phantsi kwesicwangciso sesibini.
Oku kuthethi, kukho iimeko apho iprogram yesikhashana ifanelekileyo. Yaye inyaniso yokuba inokuthengwa nganoma naluphi na umnyaka ngokuqinisekileyo inenzuzo kubafake izicelo:
- Ukuba ufuna kuphela ukukhutshwa kweenyanga okanye ezimbini, kwaye uyazi ukuba unesigxina esitsha esilungelelene ekupheleni kwelo xesha, isicwangciso sexesha elifutshane sisisisombululo esihle. Isohlwayo se-ACA sokungaqinisekwanga ayifuni kwisithuba esithile esifutshane kwi-coverage kunyaka, ngokungakhathaliseki ukuba zingaphantsi kweenyanga ezintathu ubude (i-gap-months-month is subject to penalty, nangona kunjalo). Ukuba isithuba sakho sokubhengezwa siza kwandisa iinyanga ezintathu okanye ngaphezulu, isicwangciso sexesha elifutshane sisenokuba lukhetho olufanelekileyo (ukucinga ukuba izicwangciso zexesha elifutshane ziphinde zavunyelwa ukuba zibe nexesha elingaphezu kweenyanga ezintathu), kodwa kuya kufuneka kwiindleko zesohlwayo ngaphezu kweendleko zecebo elifutshane.
- Ukuba uxolelwe kwisihlomelo se-ACA ngenxa yokuba akukho zicwangciso zezempilo ezifikelelekayo ekutshintshisweni (ngo-2018, ixabiso elingathengi lichazwe njengecebo elibiza ngaphantsi kwe- 8.05 iphesenti yengeniso yakho yomzi, emva kokuba nayiphina inkxaso isetyenziswe), isicwangciso sexesha elifutshane sinokuba isisombululo esihle sethutyana. Kwiindawo apho i-inshurensi yezempilo iyabiza kakhulu, abantu abangafanelanga ukufumana inkxaso-mali ye-premium bafumana ngezinye iinkqubo ukuba isicwangciso sezempilo esihambelanayo se-ACA sinokusondeza i-chunk ebalulekileyo yengeniso yabo yonyaka. Ukuba unalo meko kwaye awukwazi ukuthenga i-inshorensi yempilo kwaye ungeke ukwazi ukuthenga i-inshorensi yempilo kwaye mhlawumbi iphelela ungenasiswanga (nangona kungenaso isohlwayo, ucinga ukuba akukho zicwangciso zokungatshintshi ezikhoyo eziza kuba zibiza ngaphantsi kwe-8.05% yengeniso yakho ngo-2018), elifutshane -cwangciso isicwangciso esingcono kunokuba singagqithwanga, nangona kunjalo ukuba isisombululo sethutyana.
- Ukuba unempilweni, isicwangciso sogqirha sexesha elifutshane kunye nesimo esele senziwe ngaphambili asiyi kuba yingxaki. Kodwa gcinani engqondweni ukuba ukufaneleka kwakho ukuthenga isicwangciso sesibini sexeshana elifutshane xa kuqala ukuphelelwa ngumsebenzi.
> Imithombo:
> Isebe lezeMisebenzi, iSebe leNondyebo, iSebe lezeMpilo kunye neNkonzo zoLuntu. Izibonelelo ezingekho; Umyinge weMpilo kunye neNyaka; kunye neNkxaso-mali yexesha elifutshane, eliNcinci . Oktobha 2016.
> INkonzo yeNgeniso yangaphakathi. Inkqubo yeNgeniso 2017-36 .
> WhiteHouse.gov. UMyalelo oLawulayo woMongameli oKhuthaza ukhetho lwezeMpilo kunye noKhuphiswano kwi-United States. Oktobha 12, 2017.