Uhlawulo lwezoNyango kwi-Medicare, Medicaid, kunye neTricare

Ukuqonda izicwangciso ze-inshorensi yezempilo kunye nabahlawuli bentlawulo kwenza abasebenzi basebefesini bezobugqirha baxhumane ngokufanelekileyo nezigulane malunga neengcebiso zeeinshorensi zempilo baze baxoxe ngeenkcukacha zegulane ze-akhawunti kunye nabameli be-inshorensi. Ukuba unomdla wokuba ngumbhali wonyango, nantsi isifundo kwi-Medicare, Medicaid, Tricare, kunye nabanye abahlawuli.

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Ukuqonda i-Medicare

Kubalulekile ukuqonda iimfuno zokuhlawula i-Medicare ezingaba nzima kakhulu. Cinga ngokuya kwiimviwo kunye namathuba. Ababoneleli kufuneka baqinisekise ukuba abo bajongene nokulungiselela nokuhambisa amabango kwi-Medicare bayazi izikhokelo ezifanelekileyo zokungeniswa.

Kukho iingxenye ezine ezisisiseko zeProgram yeMedare:

1. I-Medicare Icandelo A: I- Medicare Ingxenye A yinxalenye ye-Medicare ukuba abaninzi abantu abanakho ukuhlawula i-inshurensi yesibhedlele. I-Medicare Icandelo A libizwa ngokuba yi-inshurensi yesibhedlele kuba inceda ukuhlawula ukunyamekela isigulane esifumene nesilwanyana esibhedlele esibhedlele, isibhedlele esifikeleleko esibalulekileyo, indawo yokunakekelwa kwabanobuchule (SNF), ukunakekelwa kwezibhedlele kunye nokunakekelwa kwempilo ekhaya.
2. I-Medicare Ingxenye B: I- Medicare Ingxenye B yinxalenye ye-Medicare ebizwa ngokuba yi-inshurensi yonyango. Icandelo B libandakanya iinkonzo ezininzi ezingakhange zigqitywe yiCandelo A, njengoTygician Visits, Treatments Outpatient, Ukunyamekela okuKhuselekileyo, iiNkonzo zonyango, iiNkonzo zeMibulance, njl njl.
3. I-Medicare Icandelo C: I- Medicare Ingxenye C yaziwa nangokuthi yi-Medicare + Ukhetho kodwa ibizwa ngokuba yi-Medicare Advantage Plans. Iiprogram ye-Advantage Plans ivumela abaxhamli be-Medicare ukuba babhalise kwi-inshurensi yezempilo yabucala okanye icebo lokunyamekela. Kukho iintlobo ezahlukeneyo zezicwangciso zokukhetha kwiinkonzo zonikezelo eziqhelekileyo zihlanganiswe phantsi kweMveli yeMveli.
4. I-Medicare Ingxenye D: Le nxalenye yeprogram ye-Medicare yiNzuzo yoLwazi lweMithi. Ukukhuselwa kwezidakamizwa kufumaneka kuphela kwi-Plans Advantage Plans.

Kaninzi

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Ukuqonda iMedicaid

I-Medicaid ihlala ihlawula umvuzo wokugqibela . Oku kuthetha nje ukuba iMedicaid ihlawula ixesha lokugqibela apho ezinye iinjongo ze-inshorensi zempilo zikhoyo. Abafumanayo kufuneka bahlale bexhaswa yiMedicaid nayiphi na inkcazelo ye-inshurensi yezempilo.

Ababoneleli banembopheleleko yokwazisa iMedicaid ye-inshurensi yenkampani yangaphandle abayifumanayo kunye nokwazisa iMedicaid nayiphi na iintlawulo zentlalo abafumanayo egameni lommkeli.

I-Medicaid ilawulwa nguburhulumente, ngoko ke, i-state nganye inemfuno zayo zokuhlawula. Abahlawuli kufuneka baqhagamshelane nenkqubo yeMedicaid kwilizwe labo ukuze bafumane ulwazi oluthile lokuhlawula.

Kaninzi

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Ukuqonda ukulingana

I-TRICARE, inxalenye yeNkqubo yezeMpilo ye-Military, yinkqubo yokhathalelo lwempilo yamaqela asebenzayo, asele umhlala-phantsi kunye no-Guard / Reserve kunye neentsapho zabo. Kukho imimandla emine eyahlukileyo enika iinkonzo kubaxhamli be-TRICARE:

• Mantla
• Mazantsi
• Bucala ngasekunene
• Ngaphesheya

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Ukuqonda abanye abahlawulayo

Ukuba nolwazi olusisiseko lwaluhlobo ngalunye lwe-inshorensi luyakunciphisa ubunzima bokufaka izicelo zamabango kunye nokuqokelela iintlawulo. Kukho iintlobo ezimbini ezibalulekileyo ze-inshorensi yezempilo:

• Inkonzo Yomshuwalense-mali : Iinjongo ze-insenance ye-indemnity yenza iintlawulo kwi-ofisi yezobugcisa ngokusekelwe kumzekelo-ntlawulo-wenkonzo.
• IziCwangciso zoNonophelo : Ukulawula izicwangciso zokunyamekela zifuna ukulawula iindleko zempilo yabasebenzi ngamalungu ayo ngokucwangcisa nokucwangcisa ngononophelo lwamayeza, iingcali kunye nezibhedlele. Kukho iintlobo ezine zolawulo lokunyamekela:
  • Imibutho yezoMpilo (ii-HMO)
  • Imibutho yabanikezeli abathandayo (ii-PPOs)
  • Imibutho yeeNkonzo eziPhambili (i-EPOs)
  • Izicwangciso ze-Point-of-Service (POS)