Xa i-Medicare ihlawula ixesha, ayikhathaleli
Unokuba nethemba lokuba ukugula ngokwaneleyo ukuhlala esibhedlele ngobusuku obuya kubakho ukufumana i-Medicare ukuhlawula isabelo sabo esilungileyo. Into enhle emehlweni akho nakwamehlo e-Medicare, nangona kunjalo, ingafani kakhulu.
Ngo- Medicare kulindeleke ukuba kuphelelwe yimali ngo-2030 , ngaphambili xa i-GOP ilawula ukupasa umthetho wayo wokuhlawula irhafu, inkqubo ijolise ekunciphiseni iindleko apho ikwazi khona.
Ukwenza oku ngokunciphisa iindleko ezithile kuwe. Le mithetho ilandelayo ibalulekile ukuba uqondisise, ingakumbi njengoko isekelwe ngakumbi xa izinto zenzeka kunezempilo.
Ulawulo lweMibini-phakathi kobusuku
Ngaphambi kolawulo lweBili-Midnight Night , ukuhlala esibhedlela kwakusekelwe kwiimfuno zonyango. Ukubeka nje, ukuba unesifo esibi kakhulu, wabukelwa njengesigulana ngenxa yokuba isibhedlele yayiyindawo efanelekileyo yokufumana loo nkathalo; oko kukuthi iimvavanyo kunye neenkqubo azikwazanga ukuba zenzeke ngokufanelekileyo kwiofisi yegqirha, isebe lesibhedlele esibhedlele, ekhaya lakho, okanye nakwiziko lokunesi.
Yonke into yatshintsha ngo-2013 xa iMithetho-mbini yoBusuku beBusuku ibonakala. Ngoku, akubalulekanga kuphela ukuba unesizathu esivumelekileyo sezonyango sokungeniswa njengesigulana, kodwa ukuhlala kwakho esibhedlele kufuneka kulindeleke ukuba kuthathe phakathi ezimbini ezimbini:
Isibhedlele sihlala ukuqala ngo-11: 59 ngomhla kaJanuwari 23 ukuya kutsho ngo-12: 1 ekuseni ngoJanuwari 25 (iiyure ezingama-24, i-1 iminithi) zifana nomnye ukususela ngo-12: 1 ngomhlaka-23 Januwari ukuya ku-12: 00 AM. NgoJanuwari 25 (iiyure ezingama-48). Zomibini zihlala ziphakathi ezimbini.
I-Medicare igxininise ngokukhawuleza umgaqo kwimigangatho kunokuba lixesha langempela umntu ahlala esibhedlele. Oku akunakulungeleli abaxhamli, kwaye ngenxa yesi sizathu, abantu abaninzi kunye nezibhedlele baye bathatha inxaxheba kulwaphulo-mthetho kumarhulumente.
Oko Kukubiza: Xa ungagunyaziwe njengesigulana, ubeka phantsi koqwalaselo.
Ukuhlala isigulane kuhlawulwa kwi- Medicare Part A , ngelixa ukugcinwa kwenkcazo kuhlawulwa kwi- Medicare Part B. Icandelo A lihlawulisa enye idityanisiweyo yokuhlala kwakho, i-$ 1,316 ngo-2017, ngaphezu kweepesenti ezingama-20 zazo zonke iirhafu zegqirha. Icandelo B, nangona kunjalo, uhlawulisa iipesenti ezingama-20 kwinkonzo nganye efunyenweyo, kubandakanywa nemirhumo yogqirha . Nangona isibhedlele asivumelekanga ukuba sikuhlawule imali engaphezulu kwonyaka we-Part A owenyulwayo kwintonzo enye, iindleko zongeza ngokukhawuleza. Ngokuqhelekileyo, ukugcinwa kokubakho kudla iindleko ezingaphezulu kokufumana isigulane esinexesha elifanayo, nokuba ngaba ufumene iinkonzo ezifanayo.
I-Rational Skills Nursing Facility I-Three-Day Rule
Abantu banokudinga ukunakekelwa abanonophelo emva kokubhedlele esibhedlele . Basenokuthi bangasayi kufuna iphakamileyo eliphezulu lokunakekelwa esibhedlele esibonelelayo, kodwa kusenokukhuseleka ukubuyela ekhaya. Basenokufuna ukunakekelwa okongeziweyo, ukubeka esweni ngokufutshane, kunye neenkonzo eziqhelekileyo, njengokonyango lomzimba kunye nokusebenza . Ukuhlala kwisibonelelo esinonophelo lwezonyango (iSNF) okanye isikhungo sokuvuselela iimeko ezifanelekileyo zifanelekile kula maxesha.
Ukufaneleka kwemvume yokungena ngesibhedlele, nangona kunjalo, akuthethi ukuba ufanelekile ukunyamekela ukulungiswa emva kokugula kwakho.
Konke kuya kweSNF-Day Day Rule.
Umgaqo uthi ufuna ukuvunyelwa ukuba unikwe isifo sengqondo kwisithuba seentsuku ezintathu ezilandelelanayo ukuze ufanele ukuhlala kwindawo yokunesi. Ngelishwa, usuku othunyelwa ngalo kwisibonelelo alubala. Ngokwenene, kufuneka uhlaliswe njengesigulana iintsuku ezine:
Ukuba ubeke phantsi koqwalaselo lwakho ngosuku lokuqala, loo mini ayiyi kubalwa kwimfuno yakho yemihla emithathu.
Gcina ukhumbule ukuba i-Medicare ayivumeli ugqirha okanye isibhedlele ukuba utshintshe ngokutsha iilaydi. Nangona isibhedlele sakho sihlala sikhulu kuneemigangatho ezimbini, ezo ntsuku azikwazi ukuguqulwa kwisimo sengqondo esinezithuba emva kweqiniso.
Oku kuthetha ukuba uya kufuna ixesha elide lokubhedlele esibhedlele ukuze ufanelekele ukunakekelwa ekhaya ngononophelo.
Oko Kukubiza: Ukuba udibana ne-SNF-Day Day, iNqanaba le-Medicare I-A liya kufikelela kuzo zonke iindleko zeziko lakho loongikazi onokukwazi ukuhlala kwiintsuku ezingama-20. Uya kuhlawula i-$ 164.50 ngemali ngo-2017 iintsuku ezingama-21 ukuya kwi-100. Emva koko, wena uwedwa. Ukuba awuvunyelwanga njengesigulane kwiintsuku ezintathu ezilandelanayo, kunjalo, zonke iindleko zokuvuselela ziya kuhlawulwa kuwe ngqo. Kwimeko enjalo, akukho ne-Medicare Part A okanye iNgxenye B iya kugubungela ezi nkonzo.
Ngaphandle kweMimiselo yexesha leMedare
Imithetho iyatshintsha xa utyunjwa. Iinkqubo ezithile ziluhlu olulodwa lwezonyango, oluthetha ukuba amaziko e-Medicare kunye neeNkonzo zeMedicaid (CMS) aqonda ubunzima bokuhlinzwa okhethekileyo aze avume ngokuzenzekelayo ukuba bangenayo imithi. Umthetho weBini-Ubusuku bemizuzu ayisebenzi kule meko:
Ukuba uqulethwe kwiNkqubo yoLondolozo lwabiwo-Medicare, unakho ukufaneleka ukukhishwa kwi-SNF-Day-Day Rule.
Ukunciphisa oku ngaphandle, i-Medicare yendabuko (Icandelo A kunye neCandelo B) lihambelana noMgaqo-we-Midnight-Rule kunye noMthetho weSuku oPhulo lweZintathu. I-Medicare Benevantage (iSahluko C) , ngakwelinye icala, inokunikela ngokuguquguquka okukhulu. Into enokuba yinto enhle neyingozi.
Okulungileyo: Isicwangciso seMpilo ye-Medicare sinokukhetha ukuchasisa iSNF-Day Day Rule. Kungakhathaliseki ubude besihlala sakho esibhedlele, unako ukufikelela ekunyamekelweni kokuvuselela okufunekayo.
Ezimbi: Izicwangciso ze-Medicare Benevantage ziyakwazi ukuphuma kwii-operesenti kwi-list-only list, oku kuthetha ukuba akudingeki ukuba bavume ukuba bafumane isifo sokugula. Bayikwazi ukuzibamba njengezicwangciso zonyango. Oku kungakhokelela ekubeni uphando oluthile lukhuphe iindleko zeefolthi.
I-Ugly: Ngokuqhelekileyo, izicwangciso ze-Medicare Benevantage zilandela uMgaqo-we-Two-Midnight Rule.
ILizwi
Isikhathi yinto yonke. I-Medicare igxininisa njani inxalenye yeCandelo A liya kuhlawula ngokubeka imingcipheko ngexesha. I-Two-Mid Mid Rule Rule kunye neSNF-Day Rule Rule ithambekele ekunakekeleni kwi-Medicare Part B, apho udla ukuhlawula ngaphezulu kwipokothini yeenkonzo ezifanayo. Ngelishwa, unokufumana kunzima ukufumana unonophelo olulindeleyo kwixabiso olifanelweyo.
> Imithombo:
> Christina Alexander, et al., Abamangalelwa, ngokumalunga noThomas E. Inani, uNobhala wezeMpilo kunye neNkonzo zoLuntu, uMmangalelwa . Inkundla yesithili saseMerika, iSithili saseConnecticut. http://www.medicareadvocacy.org/wp-content/uploads/2017/08/Order-on-Class-Certification.pdf. Ipapashwe ngoJulayi 31, 2017.
> Umgaqo-nkqubo wezeMpilo ngokufutshane: Ulawulo oluphakathi kweBili-Midnight Night. Imicimbi yezeMpilo , uJanuwari 22, 2015. http://www.healthaffairs.org/do/10.1377/hpb20150122.963736/full/.
> I- Medicare Coverage of Care Skills Nursing Facility . Amaziko e-Medicare neeNkonzo zeMedicaid. https://www.medicare.gov/Pubs/pdf/10153.pdf. Ukuhlaziywa kukaJanuwari 2015.
> Uqeqesho lweZiko loLondolozo lweZiko lokuHlalwa kweeNyanga ezintathu. Amaziko e-Medicare neeNkonzo zeMedicaid. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/SNF-Waiver-Guidance.pdf. Upapashwe ngo-Agasti 2017.