Ukuba uzama ukukhetha isicwangciso sakho sezempilo okanye uqhathanise izicwangciso ze-inshurensi zempilo e-United States, kufuneka uqonde inkqubo yecingo. UMthetho woNonophelo ongenakunqununu ubeka umgangatho wendlela amaziko ezempilo axatywayo ngayo. Ukususela ngo-2014, zonke izicwangciso zezempilo zeqela kunye nezincinci zincinci ziye zafuneka zifake kwiindidi ezine: i-bronze, isilivere, igolide okanye i-platinum (kukho enye iiplani ezicwangcisiweyo ezithengiswa kwimarike nganye ).
Isondlo sesinyithi sikuxelela ixabiso le- actuarial yesicwangciso sezempilo. Yindlela elula yokuthelekisa ukubaluleka kwesicwangciso esisinye sezempilo ukuze ukwazi ukuphi na isicwangciso sikunika inkoliso ye-buck yakho. Zonke iiplani zempilo kwinqanaba elifanayo lezinyithi zinexabiso elifanayo le-actuarial, nangona ziyakwazi ukuhluka ngamaphuzu ambalwa eepesenti.
Ithini Ukuxabiseka Kwexabiso?
Ixabiso lexabiso le-planari likuxelela ukuba yeyiphi ipesenteji yeendleko zonyango lwempilo ukuba isicwangciso se-inshurensi yempilo kulindeleke ukuba ihlawule abaxhamli bayo. Isicwangciso esinomlinganiselo we-actuarial wama-60 ekhulwini kulindeleke ukuba sihlawule malunga neepesenti ezingama-60 zeendleko zonyango lwabaxhamli babo. Abaxhamli baxhamli baya kuhlawula amanye ama-40 ekhulwini kwiindleko zabo zokunakekelwa kwempilo ngendlela yokunciphisa , ukuthengiswa kwemali kunye neentlawulo .
Ixabiso elichanekileyo libalwe kwisicwangciso sezempilo ngokubanzi (ngokusekelwe kwiprogram "yabantu abalinganayo") hhayi ngamalungu ngamnye.
Ngoko ke, ngokuqhelekileyo kubo bonke ababhalisele isicwangciso sezempilo, ixabiso le-actuarial lichaza ipesenteji zeendleko zonyango eziza kuhlawulwa ngesicwangciso. Nangona kunjalo, ipesenti yeendleko zakho zonyango lwempilo esi sihlawulelo siya kuhluka kuye ngokuthi usebenzisa njani i-inshorensi yakho yempilo.
U mzekelo
Ngokomzekelo, masithi isicwangciso sakho sezempilo sinexabiso le-actuarial ye-80 ekhulwini, oko kuthetha ukuba isicwangciso segolide.
Ukuba usebenzisa kuphela i-inshorensi yakho yempilo xa unyaka wonke, mhlawumbi ukutyelela ikliniki yokunakekelwa ngokukhawuleza kwimeko yentsholongwane, unokufumana ukuba isicwangciso sakho sezempilo asihlawuli nantoni na kwiindleko zonyango lwakho lweminyaka. Ukuba awuzange uhlangabezane ne-deductible yakho kunyaka, mhlawumbi uya kuphelisa ukuhlawula i-bill yexesha elikhawulezayo. Imali oyihlawuleyo iya kukhankanywa kwi-deductible yakho. Kule meko, isicwangciso sakho sempilo asizange sihlawule i-80 ekhulwini zeendleko zakho zonyango. Uhlawule iipesenti ezili-100 zeendleko zakho zonyango.
Nangona kunjalo, kuzo zonke izicwangciso zobulungu, amacala afana nomzekelo ongasentla uya kulungelelaniswa ngamaxesha apho isicwangciso sempilo sikhokhela ubuninzi beebhilile ezipheleleyo zelungu. Umzekelo, umntu ofunyanwe nomhlaza kwaye ephelela ngama-400,000 kwii-billing zonyango zonyaka uya kuhlawula kuphela i-$ 7,350 kwi-in-ukunakekelwa kwenethiwekhi ngo-2018 . Isicwangciso se-inshurensi yempilo siya kuhlawula lonke, eliya kuba likhulu kune-98 pesenti yebhili-mali.
Kwaye amanye amalungu angaguliyo ngawo wonke unyaka uya kuxhamla ekubeni izicwangciso ze-ACA ezihambelanayo zihlawula iipesenti eziyi-100 zowilwayo kwiinkonzo zonyango zokukhusela ezifana neemvavanyo zonyaka kunye nokulawulwa kokuzalwa.
Abo bantu abazange bahlawule nantoni kwiindleko zabo zonyango lwempilo kunyaka.
Xa iindleko zababhalisi bezicwangciso zizonke ziphela ekupheleni konyaka, isicwangciso esinomlinganiselo we-actuarial wama-80 ekhulwini siya kuhlawula malunga ne-80 ekhulwini zeendleko zonyango bonke abaxhamli kunye nabo.
Ukubalwa kwexabiso lokubaluleka akubandakanyi iimali-mali ze-inshurensi zempilo okanye izinto iprogram yezempilo ayifuni. Ngokomzekelo, ukuba i-inshorensi yakho yempilo ayifuni ukuhlinzwa ngokunyuka kwegazi, indleko yokuhlinzwa kokulahlekelwa kwesisindo ayiyi kubandakanywa xa ikhupha nexabiso lecebo lezempilo.
I-Metal Tiers ihambelana njani nexabiso?
- Izicwangciso zempilo zeBronze zixabisa malunga nama-60 ekhulwini
- Izicwangciso zezempilo zesilivere zixabisa malunga nama-70 ekhulwini
- Izicwangciso zezempilo ze-Gold-tier zixabisa malunga nama-80 ekhulwini
- Izicwangciso zezempilo zePlatinum zinexabiso elimalunga nama-90 ekhulwini
Ngokusebenzisa inkqubo ye-metal-tier, abantu abangayiqondi kakuhle indlela ixabiso le-actuarial isebenza ngayo liyaqonda into enokuthi i-plan-tier plan inika izibonelelo ezingaphezulu kunecebo lobhedu (kodwa njengoko kuchazwe ngezantsi, abantu abanemali engenamathotho abakhetha Isicwangciso sesilivere sinokugqiba ukufumana igolide okanye iplatinum yeenzuzo, ngenxa yenkxaso-mali ye -ACA eyanciphisa iindleko ze-pocket ).
Ngaba kufuneka ndikhethe uBronze, iSiliva, iGolide okanye iPlatinum?
Yenza isiseko sakho sokhetho lwentsimbi kwi-balance balance how you are willing to pay in premiums and how much cover you need. Izicwangciso zexabiso eziphezulu zinama-premium aphezulu, kodwa zihlawula ipesenti ephezulu yeendleko zonyango lwakho kunendleko eziphantsi, izicwangciso zexabiso eliphantsi.
Ngamanye amanqaku angezantsi aqulethe amacandelo malunga nabani na abafanele bajonge kwaye ngubani omele aphephe loo nxalenye yentsimbi. Ukuba ukhetha isicwangciso sezempilo, emva kokuba uzimisele isicwangciso sensimbi, qiniseka ukuba awunalo uluhlu lwabantu abakufanele baphephe loo nto.
- Isicwangciso seBronze-Yintoni na?
- Isicwangciso Sesilivere-Yintoni?
- Isicwangciso seGolide-Yintoni?
- Isicwangciso sePlatinum-Yintoni? (phawula ukuba ezininzi iinkalo azikho izicwangciso zeplatinum ezikhoyo)
Ukufaneleka kwakho kwenkxaso-mali karhulumente kunokuchaphazela ukhetho lwakho lwentsimbi yesinyithi. Ukuba unelungelo lokuxhaswa kweendleko zorhulumente (aka, ukunciphisa iindleko, okanye i-CSR) ukukunceda ukuhlawula iidroductions zakho, i-copays, kunye ne-coinsurance, awuyi kufumana inkxaso xa ungathengi isicwangciso sezempilo esiliva-tier usebenzisa i- inshorensi yempilo yomshuwalense . Ukuze ufunde kabanzi malunga nenkxaso-mali, funda, " Ngaba Ndinokufumana Uncedo Lokuhlawula Intshuwalense yezeMpilo? "U
Ukuba unako ukufumana inkxaso-mali yokwabelana ngeendleko kwaye uthenge isicwangciso sesilivere, unokugqiba ukufumana ingcaciso efana necebo legolide okanye iplatinum, ngenani lecebo lesilivere. Ngoko kubalulekile ukunyamekela iinkcukacha zesicwangciso ngasinye esifumaneka, endaweni yokucinga nje ukuba enye inqanaba lezitye liya kuba yindlela engcono kunezinye.
Kwaye kwenye i-counter-intuitive twist, iiprayimari zezicwangciso zegolide kwezinye iindawo, kubhaliso abathile, ngokwenene ziphantsi kweeprayimari kwizicwangciso zesilivere, ngo-2018. Kungenxa yokuba ulawulo lweTrump luye lwayeka ukuhlawula iinkampani zomshuwalense kwiindleko ze-CSR ngasekupheleni 2017, kunye ne-inshurensi kwiindawo ezininzi zongezelela iindleko ze-CSR kwisiqulatho sesilivere. Oku kwabangela ukuxhaswa kweprayimenti enkulu nakwezinye iindawo, kunye nexabiso lentsimbi elingalandeli iipateni ezilindelekileyo (oko kukuthi, ukugubungela okungcono kunexabiso eliphezulu). Unokufunda ngokubanzi malunga nendlela oku kusebenza ngayo apha , kodwa inqaku lokuthabatha kukuba xa ufumana inkxaso-mali yeprayim, unokufumanisa ukuba isicwangciso segolide asibiza kakhulu kunecebo lesilivere, kwaye unokufumanisa ukuba isicwangciso sobhedu sithengi kakhulu.
Ukuba Zonke izicwangciso kwiNqanaba elinikezelweyo lixabiso elifanayo, Kutheni ungakhethi nje?
Nangona zonke iiplani ezikwinqanaba elithile liza kuba nexabiso elifanayo lexabiso, ziyahluka ngezinye iindlela. Thatha loo ngxabano ingqalelo xa ukhetha isicwangciso; khetha isicwangciso esisebenza kakuhle kwimeko yakho.
Ngokomzekelo, isicwangciso esinye segolide sinokudityaniswa kwe-$ 1,500 kunye ne-coinsurance ye-15 ekhulwini. Esinye isicwangciso segolide sinokuba nexabiso elincinci elithintekayo kunye ne-coinsurance ephezulu kunye ne-copays. Ukuba ungeke ukwazi ukuhlawula i-deductible enkulu phambi kokuba i-inshorensi yakho ikhuphe, ungakhetha icebo kunye nexabiso elincinci nangona i-premium ephezulu. Uyazi ukuba ixabiso le-actuarial zonke izicwangciso zegolide zifana ngokufanayo, ngoko ukhetho lwakho lwenziwe ngokusekelwe kwindlela ongathanda ukusebenzisa ngayo i-inshurensi kunokuba ungakanani.
Amanye amanqaku athelekiswayo abandakanya inethiwekhi yesicwangciso sezempilo. Ngaba ugqirha wakho kwi-network kunye nazo zonke izicwangciso zempilo oziqhathanisayo? Ngaba intlanethi nganye yesibonelelo sabanikezeli baninzi ngokwaneleyo ukukunika ukhetho lwababoneleli ukuba unqwenele ukuba ungamthandi ugqirha othile okanye isibhedlele kwaye ufuna ukutshintshela kwenye?
Iifom yefom yezilwanyana zamachiza (izihlomelo zezilwanyana ezikhuselekileyo) ziya kuhlukahluka kwi-insurer enye kwenye. Ngoko unokuba ukhangela izicwangciso ezintathu zesilivere ezahlukeneyo, kodwa enye yazo ihlanganisa isicatshulwa esithile esithathayo.
Ngaba esinye isicwangciso sinikeza inkululeko enkulu yokuzikhethela kunomnye? I-HMO ngokuqhelekileyo ayiyi kuhlawula umxhesho ophuma kuyo . Nangona kunjalo, ii- PPO ziza kuhlawula ukunyamekelwa kwe-out-of-network, kodwa ngezinga elingaphantsi kunokuba uhlale u-inethiwekhi. IipPOs azifumaneki kuzo zonke iindawo, kodwa xa zikhona, zivame ukuba phakathi kwezinto ezikhethileyo. Ngaba uzimisele ukuhlawula iiprayimari eziphezulu kwisicwangciso esikuvumela ukuba unakekele ngaphandle kwenethiwekhi ukuba unqwenela? Okanye ngaba unokuyeka ukukhulula inkululeko yokuzikhethela, kodwa uhlawule iiprimiyamu eziphantsi?
Ingaba umgangatho wemilinganiselo yesicwangciso esinye kulunge ngakumbi kunecebo elikhuphisanayo? Ngaba iiprayimari zesicwangciso esinye sincinane kunokuba zicwangcise izicwangciso ezineempumelelo ezifanayo?
Ukuba uceba ukusebenzisa i-inshurensi yakho yonyango, qhathanisa ama-maximums out-pocket of the plans. Ukuba isicwangciso esinye sinesithuba esingaphantsi kwe-pocket esiphezulu kunezinye iiplani kwisigxina esifanayo, ungasindisa imali ukhetha isicwangciso kunye nesithuba esingaphantsi kwe-pocket. Uya kufumana ulwazi oluthe xaxa malunga nendlela le nkqubo isebenza ngayo " Indlela Yokugcina Umshuwalense Wezempilo Ukuba Ufikeleleka Ngaphandle kwePocket ."
> Imithombo:
> I-Register ye-Federal, amaziko eMedicaid kunye neeNkonzo zeMedicaid, iSebe lezeMpilo kunye neNkonzo zoLuntu. 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.