Umngxuma we-donut, okanye i-gap coverage, ingenye yeengxenye eziphambili kwi-Medicare Part D izibonelelo zonyango kunye nokukhathazeka kubantu abaninzi abaye bajoyina isicwangciso sezilwanyana seCandelo D. Iindaba ezilungileyo kukuba ngokukhawuleza kwehla kwaye ngowama-2020, uya kuhlawula i-25 ekhulwini kwizilwanyana ozihlawulayo xa udibana ne-deductible yakho (ukuba unayo).
Ukubetha iDonut Hole
Nangona zonke izicwangciso zeziyobisi zonyango kufuneka zichaze ikhefu lokungena kwiincwadi zabo kunye nokukhangisa, kuza nje kukutshatyalaliswa kubhalisi abaninzi xa behamba ngokukhawuleza ekubeni benze iikopi okanye bahlawule iipesenti ezingama-25 zeendleko zeziyobisi ukuhlawula ipesenti enkulu xa befaka umnikelo umgodi.
Nangona kunjalo, akusiyo wonke umntu kwi-Medicare oya kungena kwi-gap-cover and if you qualify for additional help in paying your Costare Part D cost, you will not fall into the hole.
Indlela iDonut Hole isebenza ngayo
Le yimiqathango yesigxina sesigxina seCandelo D efunekayo yi-Medicare ngo-2018:
- Ukuba ujoyina isicwangciso seziyobisi zemithi yesigqirha, kufuneka uhlawule kwi-$ 405 yokuqala yeendleko zeziyobisi, kuxhomekeke kwisicwangciso sakho. Oku kwaziwa ngokuba yi- deductible . Ezinye iiplani azinalo i-deductible.
- Ngethuba lesigaba sokuqala sokubanjiswa (emva kokudityaniswa kwexabiso, emva kokuba udibene, ucinga i- copayment okanye i- coinsurance) , kwaye isicwangciso sakho sezonyango seCandelo D sihlawula isabelo sayo kwisicatshulwa ngasinye sivotyiweyo kuze kube yimalini yakho ehlangeneyo (kubandakanywa ne-deductible). $ 3,750.
- Xa wena kunye neCandelo lesichengululo seCandelo D usichitha ama-$ 3,750 ngamayeza afunyenwe, uya kuba semngxeni we-donut (ekubeni isixa sakho isicwangciso sakho sihlawulelwa kwakhona, awuyi kuchitha le nto kwi-out-of-pocket drug iindleko ngelixesha ufikelela kwindawo yokungena). Ngaphambi kowe-2011, kwafuneka uhlawule iindleko ezipheleleyo zemithi yakho yesigqirha ngexesha lolo mgodi. Nangona kunjalo, ukuqala ngo-2011, isaphulelo saqala ukusebenza kwiindleko zezilakamiza ngelixa kubhalisiwe kubangxoweni. Ngo-2018, awuhlawuli ngaphaya kwama-35 ekhulwini weendleko zegama elibizwa ngokuba yi-brand-name engumgubo wecawa ngexesha lokwimeko yomdaka, kunye ne-44 ekhulwini yeendleko zezilwanyana eziqhelekileyo.
- Ingxowa yomdaka iyaqhubeka ide ixabiso lakho elipheleleyo le-pocket lifike kuma-5,000. Isixa-mali sokuchitha imali esingaphandle kwonyaka sichaza ixabiso lakho lokunciphisa imali, i-copayment kunye ne- coinsurance amount , kwaye iquka isaphulelo somenzi kwimichiza oyifumana ngexesha elithile kwi-gap yokukhawuleza (ngoko nangona uhlawula iipesenti ezingama-35 zeendleko ze-brand -ibiza izidakamizwa ngelixa lombhobho wengubo ngo-2018, iipesenti ezingama-85 zeendleko zeso sithuthi zibalwe kwiindleko zakho ezingaphandle kwe-pocket, kukunceda ukuba uphume emkhombeni we-donut kungekudala).
- Xa imali yakho yokusetyenziswa kweziyobisi ifinyelela kuma-5,000 ayi-5,000, i-gap yokukhawulela iphelile kwaye isicwangciso sakho seziyobisi sihlawula ezininzi zeendleko zamachiza akho efunyenweyo kwisithuba esisele sonyaka. Uya kuba noxanduva lwenkokhelo encinci (i-$ 3.35 okanye i-8.35 yezigidi, kuxhomekeke ekubeni ingaba le nkunkuma iyigama / igama elikhethiweyo okanye igama elingumntu ongekhethiweyo) okanye i-coinsurance (iipesenti ezi-5 zeendleko), nokuba yiyiphi into enhle. Eli nqanaba, xa uhlawula isahlulo esincinci seendleko zakho zonyango, uyaziwa njenge- coverage .
Iindleko ezikhankanywe ngasentla ziquka kuphela iindleko zemithi yonyango. Abafaki i-premium yenyanga oya kuhlawula isicwangciso seziyobisi.
Ubungakanani buyahlukahluka ngokuxhomekeka kwisiCwangciso sakho
Kubalulekile ukuqonda ukuba isicwangciso sakho sezonyango sesigqirha seCandelo D singasahluka kwisicwangciso soMgangatho oqhelekileyo kuphela ukuba isicwangciso sinikeza inzuzo engcono. Ngokomzekelo, isicwangciso sakho sinokuphelisa okanye sinciphise umrhumo we-deductible. Kwaye isicwangciso sakho sinokuhlawula i- generic okanye ikhethwayo yegama lomhlaza kwigama le-gap.
Ukuguqulwa kwezeMpilo kunye ne-Medicare Part D
Icandelo 3301 loMthetho woNonophelo ongenakunqwenelekayo , osayinwe ngomthetho ngoMatshi 23, 2010, wenza utshintsho kwi-Medicare Part D ukunciphisa iindleko zakho ngaphandle kwefowuni xa ufinyelela kwingxowuni ye-donut, kuquka:
- Ngo-2010, ukuba unayo iindleko kwi-gap cover, ufanele ufumene isaphulelo samaRandi ezingama-250 kwi-Medicare.
- Ukususela ngowama-2011, ukuba ufikelele kwingxowa yecala, wanikwa isaphulelo sama-50 epesenti kwiindleko ezipheleleyo zamachiza ogama lomgama ngelixa ekhoyo.
- I-Medicare yaqalisa ukuphasiswa kwizaphulelo ezongezelelweyo kwiindleko zombini igama lomenzi kunye neziyobisi eziqhelekileyo, ukususela ngo-2012 ukuya phambili. Ukususela ngo-2018, uhlawula iipesenti ezingama-35 zeendleko zamachiza ogama lomngcipheko ngelixa ekungxenyeni, kunye ne-44 ekhulwini yeendleko zezilwanyana zamachiza.
Ngama-2020, kunokuba uhlawule iipesenti ezili-100 zeendleko zemithi yakho yesigunyaziso, uxanduva lwakho luya kuba ngama-25 ekhulwini, nokuba ingaba ligama legama okanye i-generic.
I-Medicare Part D Examples
Ukuze uqonde kangangoko ukuba izidakamizwa ezininzi zingakubiza njani kwi-Medicare D, nantsi imizekelo:
UCharley Smith
UCharley Smith uthatha imithi emithathu ukunyanga uxinzelelo lwegazi eliphezulu kunye ne-cholesterol ephezulu. La mayeza aya kumrhola malunga ne-$ 1,200 ngo-2018. UCharley utshintshela kwisiCwangciso sezonyango sesigqirha sesigqirha se-Medicine esine-premium ephantsi kwaye unikezela ngenzuzo ye-Medicare yezibonelelo zonyango, kubandakanywa i-deductible kwaye akukho nkunkuma yokusetyenziswa kwezidakamizwa kwimingxuma.
Yiyo leyo imithi yakhe yonyango iya kubiza kwisicwangciso esiyikhethile:
- UCharley uya kuhlawula i-deductible ye- $ 405 .
- Uya kuhlawula ipesenti ezingama-25 (i-coinsurance) yeendleko zee-795 zeeyeza zakhe (i-$ 1200- $ 405 = $ 795). Indleko yakhe eyongeziweyo yokuphuma ngaphandle kwelo xesha liza kuba ngu-$ 199 . (I-$ 795 x 25 yeepesenti = $ 199).
- Ekubeni uCharley akazange afinyelele umyinge we-3 750 wemali yokuqala, akayi kungena kwindawo yokungena.
Ixabiso lika-Charley ye-Medicare Part D liza kuba yi-$ 405 (i-deductible) + i-$ 199 (ipesenti zayo ezingama-25 zesigidi-mali) = $ 604 (kunye neprayimari zayo zenyanga ze-Medicare Part D) .
UMary Jones
UMary Jones uthatha imithi emithathu ukunyanga uhlobo lwakhe lwesifo sikashukela, uxinzelelo lwegazi oluphezulu kunye ne-cholesterol ephezulu-zonke izibizo-magama. La mayeza aya kumhlawula malunga ne-$ 4,500 ngo-2018. UMary wajoyina isicwangciso seziyobisi semithi yesigqirha esibonelela nge-Medicare inzuzo , kuquka ne-deductible kwaye akukho nkonzo yokugulisa imithi kwi-hole.
Yile nto imithi yakhe yokugulisa imirhumo iya kubiza kwisicwangciso awayikhethile:
- UMariya uya kuhlawula i-deductible ye- $ 405 .
- Emva koko uza kuhlawula iipesenti ezingama-25 zeendleko zamachiza akhe kwiirhafu ezilandelayo zeerandi ezingama-3,345. Iindleko ezongeziweyo zokungena kwipokota ngeli xesha lokuqala eliza kubakho i-$ 836 (ukususela kuma-3,345 amaxesha ama-25 ekhulwini = $ 836.25).
- Ekubeni uMariya wafikelela kuma-3,750 ayi-$ 750 kwimali yokusetyenziswa kweziyobisi (i-$ 405 + $ 3,345 = $ 3,750), uya kufaka umgodi wecala. Ngaphambi ko-2011, uMariya uza kuba noxanduva lweepesenti ezili-100 zeendleko zakhe ngeli nqanaba. Nangona kunjalo, ekubeni onke amayeza kaMariya anika amagama e-brand, uya kuhlawula kuphela malunga ne-35% yeendleko zeziyobisi ngelixa lombhobho. Udinga ukuqokelela enye i-$ 1,250 kwiindleko zeziyobisi ngaphambi kokuba aphume emkhombeni womdaka, kodwa zombini iindleko zakhe (iipesenti ezingama-35 zeendleko zezilakamizo) kunye ne-50% yexabiso elikhuphayo elinikezelwa ngumenzi weziyobisi liya kubala ukufikelela kwi-$ 1,250. Nangona oko kuya kuthatha i-$ 1,470 kwiindleko zeziyobisi ezipheleleyo (i-$ 1,250 ezahlula ngamaphesenti angama-85), uMary uza kufuneka akhokhe imali engama-$ 515 ngaphandle kwepokothini yakhe ngelixa ekungxenyeni kwintsimbi (iipesenti ezingama-35 ze $ 1,470).
Ixabiso likaMariya elilinganiselwayo elidlulileyo lonyaka we-Medicare Part D icebo liza kuba yi-$ 405 (i-deductible) + i-$ 836 (isabelo sakhe sepesenti ezingama-25 kwisigxina sakhe semithi phambi kwe-hole hole) + $ 515 (oko kufuneka ukuhlawula ngexesha lokungena umda) = $ 1,756 (kunye neeprimishina zenyanga zenyanga ze-Medicare Part D plan).
> Imithombo:
> Medicare.gov. Iindleko kwiGap Coverage.
> Medicare.gov. Uninzi lweMali yokuThengisa iMichiza ezayo ngowe-2020.
> Medicare.gov. Gcina kwiiNdleko zeMithi.
> Medicare.gov. Ukukhutshwa konyaka kwiSicwangciso soMilo.
> U. KwiNdlu yabameli. Isiqinisekiso soMonde kunye noMthetho woNonophelo ojongene noThathaka, iSigaba 3301 . Yenziwe ngoMatshi 23, 2010.