Kutheni i-Medicaid izaliswa ngokugqibela
I-Medicaid yinkqubo ehambisana ngokuxhaswa ngemali kunye neprogram encedisayo kunye neendleko zonyango zabantu abanomvuzo omncinci. Abamkeli beMedicaid baquka abantu abadala abaneengeniso eziphantsi, abantwana kunye nabantu abaneentlobo ezithile zokukhubazeka. Ngelixa abaninzi abantu abafumana iingeniso zeMedicaid abanalo nayiphi na inshurensi, kukho abo banomnye umboleki-ntlawulo, njengowomntu oxhaswa yi-inshurensi okanye i- Medicare , ngaphezu kweMedicaid.
Ukuba kukho omnye umvuzo, ngoko uMedicaid uhlala ehlawula umvuzo wokugqibela. Oku kuthetha nje ukuba iMedicaid ihlawula ngokugqibela xa kukho enye inshurensi. Oku kubizwa ngokuba yi-third party responsibility (TPL), kunye nomnye umhlawuli-mali ngumntu wesithathu onoxanduva lokubhengezwa. Eminye imibutho emibini iyigulane kunye neMedicaid.
I-inshurensi yasePrayimari - uxanduva lweZithathu kunye neMedicaid
Iofisi yezobugcisa okanye omnye umboneleli wezempilo unako ukuhlawula i-Medicaid ukuba ibuyiswe kwiinkonzo. Oku kunokubangela ukukhanyela kubuyiselwe kumniki-nkonzo ebacebisa ukuba bahlawule i-inshurensi yokuqala. Oku kwenzeka ngenxa yokuba i-Medicaid inefayile leyo ummkeli enomnye umshuwalense.
Abafumanayo kufuneka bahlale bexhaswa yiMedicaid nayiphi na inkcazelo ye-inshurensi yezempilo. Ababoneleli banembopheleleko yokwazisa iMedicaid ye-inshurensi yecandelo labathathu abayifumene ngalo, kunye nokwazisa iMedicaid nayiphi na intlawulo yeentlawulo abafumanayo egameni lommkeli.
Ngokomzekelo, iofisi yegqirha icela isigulane ekutyelelweni ngalunye kuluhlu lwabanikezeli be-inshorensi yezempilo abangabhenela ibango labo. Ukuba isigulane siphendula ukuba sisayine ne-Acme Health Care, oku kubikwa kwi-Medicaid. Iofisi yegqirha kufuneka ithumele ibango kwi-Acme kwaye ingabi kwi-Medicaid.
I-arhente ye-State Medicaid kufuneka iyanqabe amabango apho kukho umthwalo wecala lomntu wesithathu ekhoyo xa befumana ibango ngaphandle kwamaxwebhu enkokhelo yentlawulo yomshuwalense. Ukongezwa kwe-inshorensi eyongezelelweyo akugcini nje kuphela kwi-Medicare kunye ne-inshorensi yempilo. Kwakhona kubhekiselele kwi-inshorensi yemfanelo ngenxa yeengozi zezithuthi kunye nokulimala okunxulumene nomsebenzi okanye ukugula.
Ukuhlawula i-Medicaid Ukuhlawulwa kweMfanelo yeThathu
Kwimimandla yokuba ityala lenkampani yesithathu likhona, ukuba iMedicaid ivunyelwe inani leenkonzo ezibonelelwe kunaphezulu kwentlawulo yentlawulo yesithathu, iMedicaid iya kuhlawula umlinganiselo ukuya kwisixa esivumelekileyo seMedicaid. Nangona kunjalo, kwiimeko ukuba intlawulo yesithathu ingaphezulu koko i-Medicaid evumelayo, iMedicaid yenza "inkokhelo yentlawulo". Oku kuthetha ukuba umniki-mvume kufuneka amkele inkokhelo yomshuwalense oyintloko njengentlawulo epheleleyo kwaye ayikwazi ukulinganisela isigulana isigidimi.
Umzekelo, i-Medicaid ivunyelwe inani le-process 500 $. Ukuba umntu we-inshorektha wesithathu uhlawula i-$ 400, i-Medicaid iya kuhlawula i-$ 100 ekhoyo. Nangona kunjalo, ukuba umntu wesithathu uhlawula i-$ 500 okanye ngaphezulu, i-Medicaid iya kwenza inkokhelo. Le mali ingafuneka ukuba iphume kwipokothini yesigulane.
Ukulahlwa kusenokuqhubeka
Kubalulekile ukugcina engqondweni ukuba i-Medicaid ayikho i-insurer.
I-Medicaid yinkqubo eyenza iintlawulo zonyango egameni lommkeli. Ukuba umboneleli okanye ummkeli ahluleki ukuthobela nayiphi na imfuno ye-inshorensi yempilo ekhokelela ekuhlawuleni intlawulo, iMedicaid inokukhanyela ngenxa yokungahambisani.
I-Medicaid ilawulwa nguburhulumente. Ngoko ke, ngalinye lizwe linemfuno yalo yokuhlawula. Abahlawuli kufuneka baqhagamshelane nenkqubo yeMedicaid kwilizwe labo ukuze bafumane ulwazi oluthile lokuhlawula.
Qaphela ukuba iMedicaid yandisiwe phantsi koMthetho woNonophelo ongenakunqwenelekayo , ukuguqula iimfuno zokufaneleka kunye nemali yemali nganye efumanayo. Nangona kunjalo, ngowe-2016, bekukho ama-19 asele athi ukukhetha ukuphuma kule nkcazo.