Nantsi into oyifunayo ukuba uyazi ukuba isicwangciso sakho esikhulu siphelile
Xa uMthetho ojongene noNonophelo ongenakunokuthi ungasayinwa ngumthetho ngo-2010, wawudinga ukugqithiswa okukhulu kwemimiselo ye-inshurensi yezempilo yomntu ngamnye neyincinci, ubuninzi beenguqu ezisebenzayo ngo-2014. Kodwa umthetho wawubandakanya ilungiselelo lokugcina umntu ngamnye Izicwangciso zeqela elincinci elisele lisebenza ngamandla ngoMatshi 23, 2010, xa i-ACA yenziwe.
Ezi zicwangciso zithandwa kakhulu (ezingafaniyo kunye nabazukulu) kwaye ziyavunyelwa ukuba zihlale zikhona ngokungapheliyo, nje kuphela ukuba izicwangciso zihlala zingatshintshi kwaye azinciphisi ngokukhawuleza iindleko okanye iindleko zonyuka (inqaku eli libhekisela kwiindleko eziphezulu iinkonzo zeenkonzo zempilo; iiproyamu ezandisiweyo zodwa aziyi kubangela ukuba isicwangciso sezempilo siphulukane nesimo esiphezulu).
Ukucacisa, icebo leqela elincinci elincinci linye elokuba umqeshi sele wayesebenzile ngo-Matshi 23, 2010-abasebenzi abatsalwa banokungeniswa kwizicwangciso ezikhoyo, kodwa abaqeshi abazange bakwazi ukuthenga izicwangciso ezinzulu ukususela ekubeni i-ACA isayinwe nomthetho.
Isicwangciso somntu ngamnye esasithengiweyo sithe sathengwa ngumntu ngamnye ngo-Matshi 23, 2010 - akukho mntu uye wakwazi ukuthenga isicwangciso ngasinye somntu ukususela ngo-Matshi 23, 2010, nangona abatsha kuxhomekeke kwiintsingiselo ezinzulu (ngoko ukuba unesicwangciso somntu ngamnye kwaye unomntwana, unokongeza umntwana kwisicwangciso sakho).
Ukuba isicwangciso sakho sezempilo sizalisekile, unokukhetha ukuyigcina ngonaphakade. Kodwa kuphela ukuba umqhubi womshuwalense wezempilo uyaqhubeka ukunikela. Akukho nibonelelo kwi-ACA efuna ukuba abaqinisekisi bempilo baqhubeke nokunikela isicwangciso esithile, okanye ukuqhubeka nokunikela nayiphi na ingxelo kuyo yonke into, ngenxa yolu hlobo.
Kutheni i-inshurensi yokugqibela yayiza kupheka iiplani ezinokuzala?
Kwimarike nganye ngaphambi ko-2014, i-inshurensi yempilo yayibhalwe phantsi kwezonyango kuwo onke amahlanu . Ngoko abantu abaye bazalwa ngabanye kwizicwangciso kwiindawo ezininzi ngabantu abanempilo njengokuba bezithengiwe izicwangciso zabo. Kodwa njengoko ixesha lihamba, unyango lwezokwelapha "lugugule," kuba iimeko zezempilo ziqala ukuphuhlisa kubemi ababekade bephilile.
Kwaye kuba kungekho mntu uye wakwazi ukuthenga izicwangciso ezinokuqala ukususela ngo-2010, amachibi omngcipheko walezo zicwangciso ziye zancipha ngokukhawuleza ngobukhulu kwiminyaka emithandathu edlulileyo. Abantu banako ukulahla izicwangciso zabo ezininzi kunye nokutshintshela kwenye indawo, kodwa akukho mntu angajoyina iiplani ngaphandle kokuba amalungu atholakalayo athole abaxhomekeke kuye.
Njengoko izicwangciso zezempilo ezinokuzala ziqinisekisa amalungu amancinci, iindleko zabo zolawulo zelungu ngalinye linyuka. Kwabanye abatshutshisi, izicwangciso ezininzi azizuzi nzuzo okanye azinasilungeleleneyo kunye nomsebenzi wazo jikelele. Ngaloo nto, inkampani yomshuwalense inokukhetha ukuphelisa izicwangciso ezinzulu.
U-Humana ophelisa izicwangciso ezinamabakala angama-11
U-Humana unikela ngomshuwalense wezempilo ngamnye kumazwe angama-22. Umphathiswa owamemezela ngoDisemba ukuba baya kuphelisa izicwangciso zezempilo ezizimeleyo kwiindawo ezili-11 ngo-2016: I-Alabama, iArizona, iColorado, iFlorida, i-Georgia, i-Mississippi, i-Ohio, i-Oklahoma, iSouth Carolina, iTennessee kunye ne-Wisconsin (izicwangciso zeqela elincinci ezincinci azichaphazeli kweli nqanaba).
Isicwangciso sokuphela siya kuqalwa ngo-Matshi 1, kwaye siya kusebenza ngolu hlobo lwenkqubo yokuvuselela umhla - ngoko ukuba isicwangciso sakho sokuzalwa se-Humana sinomhla wokuhlaziywa ngo-Agasti 1, unokugcina isicwangciso sakho ngasekupheleni kukaJulayi.
Isicwangciso sam esiphezulu siphela ... ndifuna ntoni?
Ukuze kugqitywe izicwangciso zezempilo ezinzulu, umphathiswa kufuneka azise i-insureds ubuncinane engama-90 athi ngaphambi komhla wokuphela-ngoko kuya kuba nexesha lokucwangcisa phambili. Kwaye umphathi wakho makakuxelele ukuba unokhetho ngokubhekiselele kwisicwangciso sakho. Umphathiswa wakho unokunikezela ekutshintsheni kwenye yezicwangciso zeC ACA-ezifanelekileyo, kodwa uya kukwazi ukuthenga kuyo nayiphi na iiplani ezinikezelwa nayiphi na inkonzo yomshuwarensi yempilo kwindawo yakho.
Ukuba isicwangciso sakho esikhulu siphelile, kubalulekile ukuqonda indlela amaxesha abhalisiweyo abhalisiweyo abenza ngayo. Ukulahlekelwa kwenkcazo yeso siganeko esifanelekileyo esibangela ixesha lokubhalisa elikhethekileyo .
Ixesha lakho lokubhalisa elikhethekileyo liza kuqala iintsuku ezingama-60 phambi komhla isicwangciso sakho siphela, kwaye siya kuqhubeka iintsuku ezingama-60 emva koko. Kwaye ixesha lokubhalisa elikhethekileyo lisebenza kokubili kunye nokucinywa.
Ngokomzekelo, ukuba isicwangciso sakho sicwangcisiwe ukuphela ngoJulayi 31, uya kufumana isaziso malunga nokupheliswa kokuqala ngoMeyi, kwaye ixesha lakho lokubhalisa elilodwa liya kuqhutywa ukususela ngoJuni ukuya kuSeptemba. Ukuba ubhalisa kwisicwangciso esitsha kwiintsuku ezingama-60 phambi kokulahlekelwa kwenkcazo, isicwangciso sakho esitsha siya kusebenza okokuqala kwinyanga emva kwesiqhelo sakho sokupheliswa. Ngoko ukuba isicwangciso sakho siphela ngoJulayi 31, ungabhalisa kwisicwangciso esitsha ngoJuni okanye ngoJulayi - ngokukhawuleza ngoJulayi 31 - kwaye isicwangciso sakho esitsha siya kusebenza ngo-Agasti 1, kungekho sithuba esiphephayo.
Ukuba ubhalisa kwisicwangciso esitsha ngexesha leentsuku ezingama-60 emva kokuba isicwangciso sakho esidala siphela, uya kuba negalelo lokubhengezwa ubuncinane kwenyanga, kuba akukho malungiselelo avumela ukuba izicwangciso zibuyelelwe emva kwimeko (oko kukuthi, ukuba ubhalisa NgoJulayi 1, isicwangciso sakho esitsha asiyi kusebenza ngo-Agasti 1).
I-ACA iquka isohlwayo serhafu yokungaqinisekisiwe, kodwa akukho sihlwayo sesithuba esincinane kwi-coverage ngexesha lonyaka, ngokungakhathaliseki ukuba singaphantsi kweenyanga ezintathu. Ngoko ukuba awuqinisekanga enye okanye ezimbini iinyanga ngelixa ulindele isicwangciso sakho esitsha sokuqalisa ukusebenza, awuyi kuhlawulwa yi-IRS, ucinga ukuba ungoko-mali kulo lonke unyaka. Kodwa ungekho yinshuwalense yonyango ngelo xesha, kwaye kufuneka uhlawule zakho iibhilikhwe zonyango ukuba ingavela imeko engxamisekileyo.
Isicwangciso esitsha siya kuhluke njani kwisicwangciso sam esiphezulu?
Izicwangciso ezinokuzalwa kufuneka zihambisane nemibandela embalwa ye-ACA, ngoko icebo lakho elitsha liza kuba neendlela ezikhuselekileyo zokukhusela abathengi. Kwaye ukuba unelungelo lokufumana inkxaso-mali ye-premium, kungase kube kubi kakhulu. Ngakolunye uhlangothi, ukuba awufanelanga ukufumana inkxaso-mali ye-premium, isicwangciso sakho esitsha singagcina sabiza ngaphezu kwesicwangciso sakho esikhulu.
Izicwangciso zezempilo eziziinkozo zodwa azikwazi ukufumana ama-maxum (nangona ahlala enama-maximums annual benefit). Kwakhona kufuneka bavumele abantwana abaselula ukuba bahlale kwisicwangciso sezempilo somzali kude kube ngama-26 ubudala, kwaye kufuneka bachithe ubuncinane ama-premium ama-80% kwiinkonzo zonyango.
Kodwa iiplani ezingenayo iifom zezingcali zezempilo ze-ACA, kwaye azidingeki ukuba zijonge imeko ekhoyo ngaphambili. Ngoko ukuba isicwangciso sakho singabandakanyi imibandela ekhoyo ngaphambili okanye sikuhlawulise i-premium ephakamileyo ngokusekelwe kwimbali yakho yezobugqirha xa uthenge isicwangciso, ezo nxalenye zesicwangciso akuzange zitshintshe ngenxa ye-ACA.
Ukuba utshintshana kwisicwangciso esitsha - mhlawumbi ngokutshintshiselana okanye utshintshiselwano-uya kufumanisa ukuba intsha yokubambisana inokuba neentlobo ezininzi zezibonelelo, kubandakanya izinto ezifana nokunakekelwa kwababelethi, iziyobisi zonyango kunye nokunakekelwa kwempilo yengqondo. Kwaye kuya kuqinisekiswa-kungakhathaliseki ukuba imbali yakho yonyango.
Iiplani ezininzi zazingenakufaneleka kwiimali zerhafu ze-premium ze-ACA (inkxaso-mboleko), ngoko ke ama-insureds ahlawula iindleko ezipheleleyo zolawulo lwabo phantsi kwecebo elikhulu. Ukuba isicwangciso esiphezulu siphelile, unokufumanisa ukuba unelungelo lokufumana inkxaso-mali ye-premium ukuba umvuzo wakho wekhaya awukho ngaphezu kwe-400% kwinqanaba lehlwempu, okwangoku i-47,080 i-$ 37,080 enye, kunye ne-97,000 zamawaka kwiintsapho ezine ( Izikhokelo zezinga lobuhlwempu ngo-2015 ziya kuqhubeka zisetyenziselwa ukuxhaswa kwemvume yokuxhasa uncedo kuze kufike ixesha lokubhalisa ngo-2017 ngokuqala kokuwa kwe-2016, nangona ukufaneleka kwamanqaku eMedicaid / CHIP ngoku kusekelwe kwizikhokelo zentlupheko ye-2016).
Ndifanele ndifumane phi isicwangciso sam isisombululo?
Ngexesha lokubhalisa okhethekileyo, ungathengisa ekutshintshiseni, okanye ungaya ngqo kwi-inshurensi yezempilo kwaye uthenge isicwangciso. Kodwa ukuba unelungelo lokufumana inkxaso-mali ye-premium - okanye ukuba kukho nayiphi na amathuba okufumana ingeniso yakho yokunciphisa kamva ngonyaka kwaye wenze ukuba uvumeleke kule nqanaba - qi niseka ukuba uthengise isicwangciso sakho sokutshintshana ekutshintshisweni. Iinkxaso-mali ze-Premium azifumaneki ngaphandle kokutshintshiselana, kwaye akukwazi ukufunwa kamva kwirejista yakho yerhafu ukuba uthenge isicwangciso sakho sezempilo ngaphandle kokutshintshiselwa.
Ukuba isicwangciso sakho esikhulu siphelile kwaye awuqinisekanga ngolu hlobo olukhethekileyo lokuyifaka indawo, khangela uncedo. Abathengisi kunye nabahamba ngeendlela zihlala kuzo zonke iindawo, kwaye intlawulo yesicwangciso sakho iya kuba yinto efanayo nokuba uncedayo kwinkqubo yokukhetha kunye nenkqubo yokubhalisa.