Iimali zeeNkampani ze-Inshurensi ezizimeleyo zithatha imali kuRhulumente
Ungeke uvale i-pinch, kodwa i-federal government iqinisekile. Iinkampani ze-inshorensi ezizimeleyo zingenza inzuzo kumarhulumente xa zinikela into ebonakala ngathi "inkululeko" yeenkonzo zonyango. Ukuba uke wafumana ukuhlolwa kobuncipheko kwi-Medicare ekhaya, ungafuna ukwazi indlela inkampani yakho yomshuwalense ingasebenzisa ngayo ulwazi lwakho lwezempilo.
Ukwahlukana phakathi kweMveli yeMveli kunye ne-Medicare Benevantage
I-Medicare yasekuqaleni yinto oye waziwa njenge-Medicare.
Kwaba khona kunye noNcedo lwezoKhuseleko lweNtlalo ka-1965 kwaye unikezela ngomshuwalense webhanki (iSahlulo A) kunye ne- inshorensi yonyango (iSahluko B) . Ngo-2006, i-Medicare Part D yongezwa njengenxalenye yonyango ye-Medicare enika i- drug prescription .
Oko kuchaza iNgxenye A, B, no-D, kodwa kuthiwani ngeCandelo C?
Yilapho i-Medicare Advantage iqala khona. I-Medicare Part C, i-Medicare Advantage (eyayisakuba yiMedarethayi +, i-Alternate Medicare) . Isicwangciso seNzuzo yeMedarethi sinokuthi singabandakanyi inzuzo yeCandelo D.
Zonke izicwangciso ze-Medicare Benevantage zibandakanya ukuba yiyiphi inxenye A kunye neNgxenye B kodwa kodwa, ukuba bayakukhetha, banikezela iinkonzo ezongezelelweyo. Ngoba? Kungenxa yokuba esikhundleni sokuqhutywa nguRhulumente, ezi zicwangciso ziqhutywa ngamashishini e-inshurensi yabucala.
Indlela uRhulumente waseburhulumenteni asebenza ngayo kunye neeNkampani ze-Intshuwalense
Kutheni ukuba inkampani yomshuwalense yangasese ifuna ukubhalisa abantu kwi-Medicare?
Ngenkcazo, abaxhamli baya kuba ngamashumi angama-65 ubudala nangaphezulu okanye ukuba bancinane, baya kuba nokukhubazeka kwexesha elide . Kungakhathaliseki ukuba ujonga njani, basengozini ephezulu yokuba neengxaki zonyango ezingapheliyo ezinokufuna imali eninzi yokunakekelwa kwempilo.
Iinkampani ezingenayo inzuzo ziye zangena kwi-Medicare ishishini kuba urhulumente wephondo uhlawula ukuba akwenze.
Urhulumente uya kubahlawulela inani ngalinye "ngenyanga" ukunyamekela. Oku kuthetha ukuba kukho izinga eliqhelekileyo elihlawulwa nguRhulumente ngamnye kumntu ngamnye obonisa isicwangciso seMedare Benevantage. Imali yenkampani ye-inshurensi ibuyiselwa, nangona kunjalo, iphakanyiswa nayo yonke imeko yesifo esingapheliyo. Oku kusekelwe kumanqaku okuhlolwa kwemingcipheko ebalwayo.
Indlela yoVavanyo lweeMpilo zeMpilo
Ingumnqweno onomdla wokufumana ilungelo lokufikelela kwirekhodi yezocwangco echanekileyo ebonisa uluhlu oluninzi lwezonyango ezingapheliyo. Ngale ndlela, banokufumana amanqaku aphezulu okuhlola umngcipheko weMedare kunye nemali eyongezelelweyo yemali.
Umbuzo wukuthi ngaba baya kuwusebenzisa loo mali eyongezelelweyo ukuba bayinyamekele okanye ukuba bayakukhetha ukuxhoma loo madola kunoko.
Enyanisweni, abaqinisekiso bangebucala abanakho ukufikelela ngqo kwiirekhodi zakho zonyango. Iirekhodi zezokwelapha zigcinwa liziko lakho lonakekelo lwempilo, kungekhona inkampani yomshuwalense. Umshuwalense unokubona kuphela ukufunyaniswa okuhlawulwa ngabagqirha kunye nabanye ababoneleli ngezempilo. Ngokukhawuleza, kunokuba kukho ulwazi oluphawuliweyo kwitshathi lonyango elingahlawulwanga kwinkqubo.
Ukuze kuphuculwe amanqaku abo okuhlola ingozi, i-insurer yakho ingafuna ukuthumela ugqirha wakho kwikhaya lakho ukuze ufumane loo ngcaciso.
Abakwazi ukuxhomekeka kwiinkcukacha ezinikezelwe ngomnxeba. Ukuze ulwazi lubale kumaphulo okuhlola umngcipheko weMedare, kufuneka kube nodibana ubuso nobuso kunye nomboneleli wezonyango.
UkuHlola kwangaphakathi
Inkampani yakho ye-inshorensi inokufikelela kuwe ukutyelela ekhaya ngokukhethekileyo. Inokuthi ibhalwe ngokubhekiselele ekutyekeleni ngokomzimba okanye kwintlalo. Ngayiphi na indlela, bayakhuthaza inkonzo njengendlela yokuqinisekisa ukuba abathengi babo banempilo kwaye banokhuseleko emakhaya abo. Ulunge, kodwa, bayinikela ngesihlawulelo.
Yinkqubo enkulu yokuthengisa, kwaye abaninzi abakhulileyo bayayithanda. Ufumana iyure yobudlelwane kunye nodokotela ekuthuthukisweni kwekhaya lakho xa udla ixesha elide kwiofisi yegqirha.
Udokotela ovakatyelayo uhlola amayeza akho, imbali yakho yezokwelapha, imbali yakho yentsapho, imbali yakho yentlalo, kwaye wenza uvavanyo olulula oluquka ukukhangela kwengcinezelo yegazi . Nangona lo ugqirha akayi kukuphatha okanye akunike amachiza, zonke iinkcukacha eziqokelelweyo ziya kwabiwa kunye nodokotela wakho oyintloko. Okubaluleke ngakumbi, kwenkampani yomshuwalense, idatha eqokelelwe ingasetyenziselwa ukuphucula amanqaku okuhlola umngcipheko wakho.
Ngaba oku kutyelela ngokwenene kuphucula umgangatho wokunyamekela umntu owamkela ngexesha elide? Oku akuzange kufumaneke ukuba kunjalo. Oko kuboniswe ukuba bakwenze, nangona kunjalo, kukuphucula ukunyaniseka kwamalungu kwisicwangciso se-inshorensi. Okugqithiseleyo kwinqanaba, baye banyusela ngokubanzi imali yentlawulo kwi-Medicare.
Iindleko Zinyani ze-Medicare Benevantage
Ingaba uhamba kwi-Original Medicare okanye i-Medicare Benevantage indlela, usenokholo lokuhlawula iNgxenye A kunye neeNgqungquthela ze-B kwi-Rhulumente. Ngombulelo, uninzi lwabantu lunokufumana iiPrayim ze- Part A zabo mahhala . Ukuba ukhetha icebo le-Medicare Benevantage, unakho ukuhlawula i-premium yenyanga kwenkampani yomshuwalense. Izicwangciso ezimbalwa ze-Medicare Izibonelelo zifumaneka ngaphandle kweprayimenti, nangona zimbalwa zikhona.
Nangona umgangatho wakho we-Medicare umngcipheko uphakamileyo, isicwangciso sakho se-Medicare Benevantage siya kukuhlawula ngokufanayo. Inkampani yakho ye-inshorensi ibamba imali eyongezelelweyo kodwa loo mali ayinakunikwa yona. Inkampani ibhanki kwaye ekugqibeleni igqibe indlela yokuyisebenzisa.
Kuqikelelwa ukuba izicwangciso ze-Medicare Advantage zigqityiwe urhulumente malunga ne-$ 70 yezigidigidi ukususela ngo-2008 kuya ku-2013 ngokusekelwe kwiimpawu zengozi zeMedare. Ukuba umgangatho uyaqhubeka, uhlengahlengiso lwe-Medicare (ixesha elide i-Medicare Trust Fund luza kuhlala ngayo) lingaba yingozi.
Umbuzo usalokhu: Ngaba i-Medicare Benevantage iyonke inenzuzo kwindlela yokuhlaziywa kweendleko? Ngo-2012, iFundwealth Fund ifumene ukuba iipesenti ezingama-75 ze-Medicare Benevantage zicwangcise ngakumbi kwiinkathalo kunokuba i-Original Medicare. Izicwangciso ze-Medicare Izibonelelo ezithile kwezinye iidolophu, kodwa ke, zaziphumelele ukugcina iindleko ezingaphantsi kweMveli yeMveli.
Ngaba sinako ukunika iMedare kwiinkampani ze-inshorensi ukuba ziyaqhubeka nokubeka inzuzo phambi kwabantu?
> Imithombo:
> Ngaba i-Medicare I-Advantage Indleko engaphantsi kweMithi yoLuntu? Iwebhusayithi yeFundwealth Fund. http://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-inzuzo--stst-less. Ipapashwe ngoJanuwari 28, 2016.
> Iiprogram ze-Medicare Advantage Plans zisebenza njani? KwiWebhare.gov website. https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html.
> Medicare Benevantage. Iwebhusayithi yakwaHenry J. Kaiser Family Foundation. http://kff.org/medicare/fact-sheet/medicare-advantage/. Ipapashwe ngoMeyi 11, 2016.
> Shulte F, uDonald D, Durkin E. Kutheni i-Medicare Iindleko zokufumana iindleko zabathengi abongezelelweyo Iibhiliyoni ezingaphezulu. Isiko soBungqina beNtanethi. https://www.publicintegrity.org/2014/06/04/14840/why-medicare-enzuzo-bafundi- abathengi-iibhiliyoni- ngokubanzi-. Ishicilelwe ngoJuni 4, 2014.
> Ukuqonda Ulungiso loMngcipheko kwi-Medicare Benevantage. Iwebhusayithi ye-Medicare Alliance engcono. http://bettermedicarealliance.org/sites/default/files/Understanding_Risk_Adjustment_in_Medicare_Advantage_February_2016.pdf. Epapashwe ngoFebruwari 2016.