Kutheni umntu efuna ukufumana isicwangciso se-inshurensi enye? Kuxhomekeke kubani oyicelayo. Unokufuna uncedo olongezelelweyo ukuqinisekisa ukuba ufumana zonke iinkonzo zonyango ozifunayo. I-Medicare kunye nabanye bango-inshurensi, ngakolunye uhlangothi, banomnye umdla. Ukuba unesicwangciso esingaphaya kwesinye sezempilo, unokukwazi ukutshintsha umthwalo wentlawulo kwenye indawo.
Ungaxhalabi. Omnye uhamba ngeyilwayo, kwaye xa nje wonke umntu ehamba ngokucwangcisa, akufanele ube nguwe. Kufuneka uqonde ukuba ngubani oza kuhlawula kuqala kwaye ngubani, ukuba ubani, uya kuhlawula nayiphi na indleko ezishiywe. Le yilapho i-Medicare Secondary Payer ifaka khona.
Kutheni Unokufuna Uninzi Kunokuba Uncedo Lwamagciwane
I-Medicare inikezela ngononophelo lwempilo ngaphezu kwezigidi ezingama-56.8 zaseMerika, kodwa oko akuthethi ukuba iquka yonke into ayifunayo. Cinga ngezi zinto eziqhelekileyo ezeMagare ezikushiya ukuba uzihlawule ngaphandle kwepokothini:
- Ukwenza i-Acupuncture
- Ukunyamekela ngexesha lokuhamba kwamanye amazwe kunye nokungaqhelekanga
- Iinkonzo ze-Chiropractors ngaphandle kokulungisa isilumkiso somgudu
- Ukulungisa iso lens (iilensi zoqhagamshelwano okanye iiglasi)
- Ukunyamekela (ukuhlamba, ukugqoka, indlu yangasese)
- Amazinyo
- Ukunakekelwa kweenyawo
- Zokuva
- Unonophelo lwangaphantsi ekhaya lononyango
- Ukuthutha okungxamisekileyo kokungabikho okungaqhelekanga
- Amachiza amaninzi, amavithamini kunye nezongezelelo
- Imirhumo yemithi kwiindidi ezithile
- Ukuhamba kwemigodi yeemfama
Olu alukho uluhlu olupheleleyo, okwenyani, kodwa akumangalisi ukuba abanye abantu baphishekele ezinye iinkcukacha zezempilo ukuze bazalise isithuba. Nangona kukho ukhetho lweMicrosoft Supplement Plans, nolwaziwa njengezicwangciso zeMedigap , ukukunceda ukukhupha iindleko ze-Medicare ngaphandle kweendleko zepokoth ( iipayili, u-coinsurance, kunye ne-deductibles ), ezi zicwangciso azikongezi ngokwenene izibonelelo zempilo kwi-coverage yakho.
Endaweni yoko, abantu abaninzi baye kwi-inshurensi njengamalungiselelo eempilo axhaswe ngumqeshi, iinzuzo zemikhosi, kunye neenzuzo zokuthatha umhlala-phantsi ukuze zifumane i-coverage.
I-Medicare kunye neSicwangciso seMpilo esixhaswe nguMqeshi
Umhlala-phantsi weeNtlalontle zeNtlalo ezisetyenziselwa ukuba uneminyaka engama-65 ubudala, ubudala obufanayo ukuba uyafaneleka kwi-Medicare . Yonke into yatshintsha ngo-1983 xa iCongress yadlulisela imithetho yokwandisa iminyaka yobudala yomhlalaphantsi ngokusekelwe kumhla wokuzalwa kwakho. Kubantu abazalwa phakathi ko-1943 no-1954, ubudala bokuthatha umhlala-phantsi sele ngoku iminyaka engama-66 ubudala. Ubudala bomhlalaphantsi bukhula ngokunyuka ukuya kuma-67 ubudala ubudala kwabo bazalwa emva kowe-1960. Ukuthatha umhlalaphantsi ngaphaya kweli xesha elimiselweyo kuya kubangela ukuba ufumane imali encinci kwiNtlalo yoKhuselo.
Isiphumo sokuphela kukuba abantu abaninzi basebenze ixesha elide ukwenzela ukukhulisa imali yabo yomhlalaphantsi. Ukusebenza kubanika ukufikelela kwiinkonzo zempilo ngabaqeshi babo ukuba banokukhetha ukuqhubeka bodwa, qhubekani xa usayinela kwi-Medicare, okanye ukhansele kwaye ubeke endaweni ye-Medicare.
Isicwangciso sakho sempilo esixhaswe ngumqabane sinokugubungela lakho iqabane kunye nabaxhomekeke kuyo , kanti i-Medicare ikugubungela yedwa. Ezi zicwangciso zingabhekisela kwiinkonzo zeMedare. Ukuba ufanelekile kwixesha lokuBhalisa oluKhethekileyo , unokukwazi ukuchazela ukubhalisa kwi-Medicare ngaphandle kokujongana nezohlwayo emva kwexesha xa ubhalisa.
Oku kungakusindisa i-dollar enkulu kuba awuyi kuhlawula i-premium kwizicwangciso ezimbini ezahlukeneyo.
Xa unesibini ye-Medicare kunye nesicwangciso sezempilo esixhaswe ngumqeshi, i-Medicare iya kuhlawula kuqala kuphela kwiimeko ezithile. Isigqibo sisekelwe kwiminyaka yakho, nokuba unesifo se-renal (ESRD) esiphelweni okanye esinye isiphene , kwaye bangaphi abantu abasebenzela umqeshi wakho.
Ukuba awuhambisani nemigqaliselo ye-Medicare ukuhlawula kuqala, isicwangciso sakho sempilo esixhaswe ngumqeshi siya kukhutshwa. Into abangayihlawulelwayo iya kuhlawulwa kwi-Medicare. I-Medicare iya kuhlawula iinkonzo zempilo enokuthi zifake i-cover ngokukhawuleza njengoko ziyabona njengemfuneko yempilo.
| I-Medicare iya kuhlawula kuqala | I-Medicare iya kuhlawula isibini |
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I-Medicare neCOBRA
Ngombulelo kuMthetho wokuQiniswa koHlahlo lwabiwo-mali lwe-Omnibus (COBRA) ka-1985 ungaqhubeka nocwangciso lwakho lwezempilo oluxhaswe ngumqeshi emva kokuba ushiye umsebenzi wakho. Umthetho ufuna ukuba abaqeshi abangama-20 okanye abangaphezu kwexesha elipheleleyo abasebenzi banikeze ukufikelela okuqhubekayo kwisicwangciso sabo sempilo ngexesha elide, ngokuqhelekileyo kwiinyanga ezili-18, emva kokuba umsebenzi wakho uphela ngendlela yokuphelisa okanye ukuyeka. Ubungakanani benkxaso yeCOBRA inokwandiswa ukuya kwiinyanga ezingama-36 ukuba iimeko ezithile zidibeneyo.
I-Medicare ne-COBRA banalo ubudlelwane obunzima. Ukuba usuvele u-COBRA xa ubhalisa kwi-Medicare, ukukhutshwa kwe-COBRA yakho kuya kuphelelwa ngomhla oya kubhalisa kwi-Medicare. Ukuba usenayo i-Medicare xa uvumelekile kwiCOBRA, uvumelekile ukuba ubhalise kwi-COBRA.
Ukuba unayo i-COBRA kwaye ufanelekile kwi-Medicare ngeli xesha, unesigqibo esibalulekileyo sokwenza. Ukubhalisa kwi-Medicare kuthetha ukuba uya kulahlekelwa zibonelelo zakho ze-COBRA, nangona unakho ukuqhubeka nokukhutshwa kweqabane lakho kunye nabaxhomekeke kubo. Ukuba ukhetha ukulibala ukubhalisa kwi-Medicare, qaphela ukuba uya kubhekana nezohlwayo emva kwexesha ekugqibeleni ubhalise. Iintlawulo zeCOBRA azikufanelekeli ixesha lokuBhalisa oluKhethekileyo kunye ne-Medicare.
| I-Medicare iya kuhlawula kuqala | I-Medicare iya kuhlawula isibini |
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I-Medicare neMbuyekezo yeMsebenzi
Inxephezelo yomsebenzi isebenza ngokungafaniyo kunokuba isicwangciso sakho sempilo esixhaswe ngumqeshi. Isivumelwano esinikezelwe nguRhulumente phakathi kwakho nomqeshi wakho othi awuyi kuwatyala xa nje uhlawula iindleko zakho zonyango kwanoma yikuphi ukulimala emsebenzini. Xa ufumana inzuzo yeembuyekezo zomsebenzi, awukwazi ukufuna umonakalo wokuhlawulwa kwesi senzo. Ukuba unqabile ezo ntlawulo, unokumangalela umonakalo njengentlungu nokuhlupheka.
Nangona uhlawula iipriyamu kwisicwangciso sakho sempilo esixhaswe ngumqashi, iipommumshini zokuhlawulela abasebenzi zihlawulwa ngumqeshi wakho. Akukho ziindleko kuwe. Emva kokulimala, ubeka ibango kwaye uvavanyo luyenzeka ukuze uqinisekise ukuba okanye ingozi yakho yayingumphumo weendawo zokusebenzela kwindawo.
Kungenjalo ukuba imbuyekezo yomsebenzi iphikisana nebango lakho okanye iyingxowankulu kuphela ngokusekelwe kwimeko esele ikhona . Umzekelo, ukuba unentlungu engapheliyo kodwa ubuhlungu bakho bubuyela emva kokulimala, kunokuba nzima ukuba ubone ukuba umqeshi wakho unembopheleleko kangakanani. Amagqabhagqirha e-Medicare kule nqanaba ukwenza iintlawulo zokuqala.
Imbuyekezo yomsebenzi inokubuyisela iindleko zakho zonyango ngelixa zivela okanye zinganikeza ixesha lokuhlala. Ezinye zeemali zingafakwa kwi-Workers 'Compensation Medicine Setting Outstanding Arrangement (WCMSAA), ilungiselelo elijoliswe ukugcina imali yonyango lwexesha elizayo naluphi na ukulimala okubangelwa iingxaki zexesha elide. I-Medicare ayiyi kuhlawula kude kube yimali kwi-WCMSAA iphelile.
| I-Medicare iya kuhlawula kuqala | I-Medicare iya kuhlawula isibini |
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I-Medicare neMpilo yeeMpilo
Ukuba ungumlindi, ilungu lenkonzo elisebenza ngokusebenzayo, okanye ilungu elisebenzela umhlala-phantsi, unelungelo lokufumana iinkonzo zempilo kwi-Veteran Administration (VA) okanye inkqubo ebizwa nge-TRICARE. Ezi nzuzo zihambelana ne-Medicare ngendlela ekhethekileyo.
Okokuqala kunye nokugqwesileyo, ii-VA ziya kunikwa kuphela ngononophelo olufunyenweyo kwiziko eligunyaziwe ngu-VA.
Okwesibini, i-Medicare ayiyi kuhlawulela inkokhelo ehlawulwe yi-VA kunye nenye. Akukho mbambano we-payer oyintloko okanye ongowokugqibela.
Okwesithathu, i-TRICARE kunye ne-Medicare basebenza kwikhonsathi. I-Medicare isebenza njengomhlawuli-mali oyintloko kwiinkonzo ze-Medicare-kunye ne-TRICARE iquka nayiphi na inzuzo ye-Medicare okanye ixabiso lemali-mali ehambelana nezo nkonzo. Xa inkonzo ingagqitywa yi-Medicare, i-TRICARE iya kuba ngumhlawuli oyintloko.
Ngokuxhomekeke kwinkathalo oyifumayo, kunokwenzeka ukuba ube ne-Medicare kunye ne-TRICARE esebenza njengomhlawuli oyintloko ngexesha elifanayo!
> Imithombo:
> I- Medicare kunye nezinye iiNzuzo zezeMpilo: Isikhokelo sakho sokuba ngubani ohlawula kuqala. Amaziko e-Medicare neeNkonzo zeMedicaid. https://www.medicare.gov/Pubs/pdf/02179-Medicare-Coordination-Benefits-Payer.pdf.
> Medicare Ukubhalisa iDashboard. Amasebe e-Medicare ne-Medicaid Services website. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html. Ukuhlaziywa kukaJulayi 2016.
> I-Medicare yeSekondari yeSekondari. Amasebe e-Medicare ne-Medicaid Services website. https://www.cms.gov/Medicare/Ulungelelaniso-Benefits-and-Recovery/Ulungelelaniso-Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Medicare-Secondary-Payer.html. Ukuhlaziywa ngoJanuwari 30, 2014.
> Imbuyekezo yeBasebenzi abaSebenzi beMedareya Beka iMalungiselelo engekho. Amasebe e-Medicare ne-Medicaid Services website. https://www.cms.gov/Medicare/Ulungelelaniso-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Malungiselelo/WCMSA-Overview.html. Ukuhlaziywa kwe-Apreli 18, 2016.