Yintoni ecacisa iindleko zakho kunye nantoni na umyinge waseMerika welizwe
Ingxubusho enkulu yakutshanje malunga nokulungiswa kwempilo e-US iye yajolisa kwiindleko zomshuwalense wezempilo, ezingenakho ukuthenga abantu abaninzi baseMerika.
Nangona kunjalo, isiKhuseli soPhephelo kunye noMthetho ononophelo loNonophelo ongenakunqunyulwa ngumthetho ngomhla we-23 Matshi 2010, ngokubhekiselele ekufikeleleni kwi-inshorensi yezempilo kwaye uqinisekise ukuba bonke abemi baseMerika abafuna ukukhuselwa baya kukwazi ukufumana i-inshorensi yempilo.
Akucaci ukuba umgaqo-nkqubo uza kuthintela njani indleko yomshuwalense wezempilo, ngokukodwa iiprayimali kunye neendleko ze-out-of-pocket. Kungenzeka ukuba iindleko ziya kuqhubeka ukwandisa kwikamva elibonakalayo.
Ubuninzi bomshuwalense wezempilo uza kuxhomekeka kangakanani kuxhomekeke kwiminyaka yakho, imeko yempilo yakho (indlela enempilo okanye engafanelekanga), apho kwilizwe ohlala kuyo, ingeniso yakho kunye nesimo sakho somsebenzi.
Kukho iindlela ezininzi onokufumana ngayo i-inshorensi yempilo, kwaye nazo ziyakwazi ukufumana ukuba uza kuhlawula phi. Ezi ziquka:
Iinshurensi yezempilo enikezwe ngumqeshi. Iinkampani ezininzi ezininzi kunye neenkampani zaseMelika zibonelela nge-inshurensi yempilo njengenzuzo yomqeshwa. Uninzi lwabantu baseMelika abanempilo yomshuwalense bayifumana kwinkampani abasebenza kuyo.
Intshuwalense yezempilo oyithenga kuwe. Ukuba uqeshwe okanye usebenzela inkampani encinci engaboneleli ngomshuwalense wezempilo, kuya kufuneka uthenge i-inshorensi.
Iinshurensi yezempilo enikezelwa nguRhulumente. Ukuba uneminyaka engama-65 okanye ngaphezulu, ukhubazekile, okanye unokufumana imali encinci okanye engenayo imali, unakho ukufumana ilungelo lokufumana i-inshurensi yempilo ehlawulwa nguRhulumente, njenge-Medicare neMedicaid.
Iintlawulo zeeNtshurensi zeMpilo ziquka ntoni?
Kukho izinto ezininzi ezinokumisela ukuba ininzi yinshurensi yakho yezempilo iyakubiza njani inyanga nganye.
Iintlawulo zeeNyanga
I-premium yintlawulo yemali ehlawulwa kwinkampani yomshuwalense okanye isicwangciso sezempilo ukubonelela ngezempilo, kubandakanya ukuhlawula iinkonzo ezinxulumene nempilo ezifana nokutyelela ugqirha, izibhedlele, kunye neyeza.
Ukuba unomshuwalense ohlobene nomsebenzi, umqeshi wakho uhlawula i-premium yenyanga. Inokwenzeka ukuba, inkampani yakho iya kufuna ukuba uhlawule inxalenye yenyanga yokuqala yenyanga, eya kutsalwa kwi-paycheck yakho. Ukuba uqeshwe okanye uzithenge i-inshurensi yakho yempilo , uhlawula yonke i-premium yenyanga.
Ingaba ufumana i-inshurensi yempilo emsebenzini okanye uthenge i-inshorensi yakho, i-premium yakho ingaba phezulu okanye iphantsi kuye kuxhomekeke kukuphi uhlobo lwe-inshorensi oyikhethayo. Izicwangciso ezineendleko eziphezulu eziphezulu (i-deductibles, i-coinsurance, kunye ne-copayments) zihlala ziphantsi kweeprayimari eziphantsi kunye nezicwangciso ngeendleko eziphantsi kwe-pocket ziphezulu. Kwakhona, isicwangciso sempilo (njenge- HMO ) efuna ukuba usebenzise unxibelelwano lwagqirha kunye nezibhedlele ngokuqhelekileyo linomvuzo ophantsi. Wena uza kuhlawula enye inshorensi yezempilo ehlanganisa amalungu osapho lwakho.
Ukuba uthenge i-inshorensi yangasese (okanye amanye amalungu omndeni), ii-premiums zakho ziza kuba ziphakamileyo xa unabantu abadala, ukuba unomsebenzi osebenzayo "onobungozi" (njengomqeqeshi wendiza) okanye unempilo engapheliyo (ezifana nohlobo lwe-2 lweswekile okanye uxinzelelo lwegazi oluphezulu)
Iindleko ze-Pocket Out-of-Pocket
Iindleko ezingaphandle kwee-pocket yiyo oya kuhlawula iinkonzo ezinxulumene nempilo ngasentla naphaya kwe-premium yakho yenyanga. Ngokuxhomekeke kwisicwangciso sakho sezempilo, ezi ndleko zingabandakanya i-annucable annuable, co-inshurensi kunye neepayiliyelwe ukutyelela ugqirha kunye neziyobisi.
Ukuchithwa : I-deductible yimalini omele uyihlawule i-pocket ngonyaka ngamnye ngeendleko ezinxulumene nempilo phambi kokuba umgaqo-nkqubo wakho we-inshorensi uqale ukuhlawula. Izidumbu eziqhelekileyo ziqhelekileyo kwii- PPOs iinkonzo zonyango ezifumanekayo ngaphandle kwenethiwekhi ye-PPO. Ukuba unayo i-Medicare, kuya kufuneka ukuba uhlawule i-deductible kwiinkonzo zonyango kunye ne-differentible deductible kumachiza phantsi kwe- Medicare Part D.
I-inshorensi : Enye i-inshorensi yempilo idinga ukuba uhlawule ipesenteji yeendleko zeenkonzo ezinxulumene nempilo emva kokuba udibene ne-year deductible yakho. Oku kwaziwa ngokuba yi-coinsurance kwaye kaninzi i-20% yesicwangciso sakho sempilo siyayivuma.
Ngokomzekelo, uMnu Jones unesicwangciso sezempilo seentsapho nge-deductible ye-$ 500 ngonyaka kunye no-20% lwemali-mali. NgoFebruwari, umfazi kunye nabantwana babini bahlolwa. UMnu Jones wahlawula ugqirha kule nkonzo, ebiza i-$ 510. Ngo-Matshi, omnye wabantwana wagula kwaye indleko yokutyelela i-ofisi yayingama-$ 50. Ekubeni i-deductible yonyaka idibeneyo, isicwangciso sezempilo sihlawule ugqirha wama-40 (80%) kwaye uMnu Jones wahlawula ugqirha i-$ 10 (20%).
Ikhoyayili : Imali ye-ikopiyure yintlawulo ephathekayo, okanye imali ehleliweyo enokufuneka uyihlawule ngenkonzo ethile enxulumene nempilo. Iikhoyayiti ziqhelekileyo kwizicwangciso zokunyamekela (ezifana nee-HMO kunye ne-PPOs) kunye nezicwangciso zeziyobisi ezifana ne-Medicare Part D.
Ngokomzekelo, iifayili zeefayili ziyi-$ 20 ukuze uvakatye ugqirha, u-R50 wama-50 ukuya kwindwendwe ye-urgence, kunye ne-$ 10 ukuya kwi-40 kwi-medication.
Yintoni Umyinge weMelika oyiNtlawulo yeNtsholongwane yezeMpilo?
Lo ngumbuzo onzima ukuphendula. Abangaphezu kwezigidi ezingama-85 baseMerika bafumana i-inshorensi yempilo ngoorhulumente, kuquka ne-Medicare, i-Medicaid, inzuzo yezilwanyana, kunye nomkhosi (zombini umsebenzi kunye nabathathe umhlalaphantsi). Okwangoku, abangaphezu kwezigidi ezingama-45 baseMerika abanakho i-inshorensi yezempilo.
Abaninzi baseMelika abanomshuwalense wezempilo bayifumana kumqeshi wabo kwaye ngaphezu kwezigidi ezingama-26.5 zaseMerika zihlanganiswe zizicwangciso ezizithengiweyo ngqo kwiinkampani zomshuwalense.
Ingxelo (Intshuwalense Yempilo Yomntu 2009: Uvavanyo olupheleleyo lweeNkumali, ukuFumaneka, kunye neNzuzo) eyenziwa ngo-Oktobha 2009, iMicrosoft Insurance Plans (i-trade group emele izicwangciso zempilo) inikele ngolwazi olunika ingqiqo yintoni inshuwalense yezempilo Iindleko zomgaqo-nkqubo xa kuthengwa ngumntu.
- Ngokomyinge, i-premium yonyaka yayiyi-2,985 yezigidi zomntu omnye kunye no-6,328 kwintsapho.
- I-premium yonyaka ihluke ukusuka kummandla ukuya kwilizwe. Ngokomzekelo, i-premium yesicwangciso sezempilo seentsapho eNew York yayingama-13,296, ngelixa isicwangciso esifanayo e-Iowa sasingama-$ 5609.
- Iipresimari zonyaka zeplani zempilo zahluke ngokuxhomekeka ukuba i-deductible yonyaka iphezulu okanye iphantsi. Ngokomzekelo, izicwangciso zentsapho ezingenayo i-deductible zine-premium ye-$ 12686 ngonyaka, ngelixa iiplani ze-R10 000 ngonyaka zithengwa nge-premium ye-$ 5380 ngonyaka.