Isicwangciso sezempilo sobhedu luhlobo lwe-inshorensi yempilo ehlawula, ngokuqhelekileyo, iipesenti ezingama-60 zeendleko zokunakekelwa kwempilo (kodwa ke umyinge kubo bonke ababhalisile-ipesenteji yeendleko zakho ezicwangcisiweyo zizahluka ngokuxhomekeke ekubeni udinga unyango oluninzi kunyaka, okanye akuninzi nakakhulu). Ababhalisi bahlawula amanye ama-40 ekhulwini kwiindleko zabo zononophelo zonyango ngendlela yemali yokubhalwa kwemali, i- coinsurance , kunye neengxowa-mali .
Ukumisela ukuba isicwangciso singena kwizinga lobhedu lokubhengezwa sisekelwe kwixabiso le-actuarial, lichazwe apha ngeenkcukacha ezingakumbi . Izicwangciso zebhondi ziyafumaneka kwiinkampani zee-inshorensi zempilo zecandelo ngalinye kunye nelincinci, ngokutshintshiselana okanye ekutshintshisweni.
Ukuqhathanisa iziCwangciso
Ukwenza kube lula ukuthelekisa ukuba uluxabisa kangakanani imali oyisebenzisayo kwiimali-mali ze-inshorensi yezempilo, u- Care Affordable Act ulungelelaniso lwamanqanaba ezicwangciso zezempilo kunye namancinci kwiqela elinesithathu. Ezi ntsimbi zibhedu, isiliva, igolide kunye neplatinum.
Zonke izicwangciso zempilo zecandelo elinikezelweyo zinika ixabiso elifanayo elipheleleyo, nangona ziyakwazi ukuguqulwa ngaphakathi kwe-+ 2 / -2 ye-minimus range (uluhlu luye landa ukuya ku-2 / -4 ngo-2018, kwaye izicwangciso zethusi zine-widimus uluhlu lwe + 5 / -4; oku kwakuyinxalenye yombuso wozinzo lweemarike owenziwa nguHHS ngo-Apreli 2017).
Izicwangciso ze-bronze-tier, ixabiso le-actuarial value lilinganiselwa kuma-60 ekhulwini.
Kodwa ngeloluhlu oluvunyelwe, i-2018 iiplani kunye namaxabiso angama-actuarial of 56% ukuya kuma-65 ekhulwini aya kuqwalaselwa njengezicwangciso zethusi. Nangona iinqununu ze-ACA zetsimbi zenza uncedo ngokwenza kube lula ukwenza ukuthelekiswa okuqhelekileyo phakathi kwezicwangciso, kubalulekile ukubheka ukushicilelwa okulungileyo, njengoko izicwangciso ezimbini zethusi zingaba neendlela ezahlukileyo zokucwangcisa iingeniso kunye namanqanaba okufikelela.
Ixabiso lithetha ntoni
Ubungakanani, okanye ixabiso le-actuarial , likuxelela ukuba yeyiphi ipesenteji yeendleko zonyango ezikhuselekileyo isicwangciso esilindeleke ukuba sihlawulele wonke umntu ophantsi. Oku akuthethi ukuba wena, ngokwakho, uya kuba neefesenti ezingama-60 zeemali zakho zokunakekelwa kwezempilo ezihlawulwe ngesicwangciso sakho sobhedu. Ngokuxhomekeke kwindlela osebenzisa ngayo i-inshorensi yakho yezempilo, unokufumana ngaphezulu okanye ngaphantsi kwama-60 ekhulwini kwiindleko zakho ezihlawulwe.
Umntu ophethe iindleko zokunakekelwa kwempilo ephezulu kuya kubonakala ukuba akhokhe ngaphantsi kwama-40 ekhulwini kwiindleko ezipheleleyo kuba iplani ye-out-of-pocket ephezulu iya kunciphisa inani elihlawulelwa lilungu. Ngakolunye uhlangothi, umntu onendleko eziphantsi kakhulu unokulindela ukuhlawula ngaphezulu kwama-40 ekhulwini kwiindleko eziqhelekileyo, kuba akanako ukuhlangabezana ne-deductible yonyaka. Oku kuchazwe ngcaciso engaphezulu apha .
Iindleko zonyango ezingaphelelanga ezingabandakanywayo aziqwalaselwa xa zichonga ixabiso leprogram yezempilo. Iindleko ze-out-of-network nazo azibalwanga, kwaye akukho neendleko zonyango ezingangeni kwiintlobo zeenzuzo zezempilo ze -ACA.
Oko Uya Kuhlawula
Uya kufuneka uhlawule iiprayimari zenyanga nganye kwisicwangciso sezempilo. Kuya kufuneka uhlawule ukwabelana ngeendleko ezifana nokuncitshiswa, uxanduva lwemali, kunye ne-copays xa usebenzisa i-inshorensi yakho yempilo.
Isicwangciso sebhondi seprayimari zenyanga zivame ukuhlawuleka kunezicwangciso zexabiso eliphakamileyo kuba izicwangciso zethusi zilindele ukuhlawula imali encinci malunga neengcebiso zezempilo. Ufumana oko uhlawulayo.
Indlela isicwangciso ngasinye esikwenza ngayo ukuhlawula isabelo sakho seendleko zonyango lwempilo ziyahluka. Ngokomzekelo, isicwangciso esinye sebhedu sinokuba ne-$ 6,000 ephakamileyo ehlawulwayo kunye ne-10% ye-coinsurance ephantsi. Isicwangciso sobhedu esinomncinci sinokuba ne-4,000 engama-dollar engaphantsi kunye kunye ne-$ 45 yee-coonurance zokuvakasha (ii-ACA) ezihambelanayo kunye nezicwangciso zeqela elincinci zineemida eziphezulu kwiindleko zokuphuma kweefowuni ezisebenzayo kungakhathaliseki ukuba Inqanaba lesinyithi; akukho zicwangciso ezinokuthi zibe nemingcele yomntu ngamnye ngaphandle kwee-pocket-kuquka i-deductible, ikopi ye-copay kunye ne-coinsurance-engaphezulu kwama-7,150 ngo-2017, okanye i-$ 7,350 ngo-2018).
Izizathu zokukhetha iSicwangciso seBronze
Xa ukhetha isicwangciso sezempilo, ukuba into ebaluleke kakhulu kuwe i-premium yenyanga ephantsi, isicwangciso sezempilo sobhedu sinokuzikhethela. Ukuba awukulindelanga ukusebenzisa i-inshurensi yakho yempilo okanye ukuba ukwabelana ngeendleko eziphezulu kwi-plan yebhedu akukhathaleli, isicwangciso sezempilo sobhedu sinokulingana nesilwayo.
Ukuba uneminyaka engaphantsi kwe-30 kwaye awufaneleki ukufumana inkxaso-mali ye-premium, unokufumanisa ukuba isicwangciso esiyingozi sinika i-premium yenyanga ephantsi, kunye nexabiso elincinane le-actuarial value (izicwangciso ezinobungozi ezingenayo iinjongo zokujoliswa kwexabiso kwiindlela zetsimbi izicwangciso zenzayo; kufuneka ukuba zifumane ixabiso elingaphantsi kweepesenti ezingama-60, nangona kufuneka zidibanise ukutyelela okubaluleka kwamathathu ngonyaka kwaye zihambelane nemida ephakamileyo efanayo kwiindleko ezingaphandle kwezinye iiplani).
Ukuba uneminyaka engaphezu kwengu-30 ubudala, awuyi kukwazi ukuthenga isicwangciso esiyingozi kwi-inshurensi yezempilo ngaphandle kokuba unesiqinisekiso sokuxolelwa kwe- inshorensi yezempilo. Kwaye iiprojimenti zenkxaso-mali ayinakusetyenziswa kwiiplani eziyingozi, ezenza kube lukhetho olufanelekileyo kubantu abaninzi abafanelekile ukufumana inkxaso-mali ye-premium.
Izizathu zokungakhethi iSicwangciso seBronze
Ungakhethi isicwangciso sezempilo sebheron ukuba ufuna isicwangciso esihlawulela uninzi lweendleko zakho zonyango. Ukuba ulindele ukusebenzisa i-inshurensi yakho yezempilo, okanye awukwazi ukufumana ii-copays eziphezulu, i-coinsurance, kunye ne-deductibles, isicwangciso sobhedu sinokuba sisinalo.
Ukuba unako ukufumana inkxaso -mali yokwabelana ngeendleko ngenxa yokuba ingeniso yakho ingama-250 ekhulwini lomgangatho wentlupheko we-federal okanye ngaphantsi, unokufumana kuphela inkxaso-mali yokwabelana ngeendleko xa ukhetha icebo le-silver-tier. Awuyi kufumana inkxaso-mali yokwabelana ngeendleko ozilungeleyo ukuba ukhetha icebo lobhedu.
Ukwabelana ngeendleko zokwabelana ngeendleko kwenza u-deductible yakho, i-copays, kunye ne-coinsurance ephantsi ukuze uhlawule ngaphantsi xa usebenzisa i-inshorensi yakho yempilo. Enyanisweni, inkxaso-mali yokwabelana ngeendleko iya kwandisa ixabiso lesicwangciso sakho sezempilo ngaphandle kokuphakamisa iipresimari zenyanga. Kunjengokufumana ukuphuculwa kwehhala kwixabiso. Ngeke ufumane ukuphuculwa kokukhululeka xa ukhetha icebo lobhedu.
> Imithombo:
> American Academy of Actuaries. Ixabiso leNkcazo yeeNtsholongwane zeeNtshumo zeMpilo. Epreli 1, 2013.
> Isebe Lempilo Neenkonzo Zoluntu. Ukukhuselwa komonde kunye noMthetho ononophelo loNonophelo, iMakethe yozinzo . Epreli 2017.
> I-Register Register. Isiqinisekiso soMonde kunye noMthetho ononophelo ojongene noThathaka, iSaziso seNzuzo kunye neParameters Payment for 2017. Matshi 8, 2016.
> 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.