I-Obamacare Ngaba i-ACA; Ukwandiswa kweMedicaid Ingxenye ye-Obamacare
Ngokwenene, i- Obamacare yinto yokuqhayisa nge-Care Act. Ekuqaleni yayisetyenziswa ngongcamango ochasene nomthetho, kodwa uMongameli u-Obama wamkela isigama-magama ngo-2012, kwaye sele isetyenziswe ukususela oko kubini abachasi kunye nabalandeli be-ACA.
Ekubeni i-Obamacare iyafana ne-ACA, iquka zonke iinguqulelo zolawulo ezisebenzayo kwimarike yempilo yomshuwalense ngamnye (kokubili kunye nokutshintshiselana , zonke izicwangciso ezintsha zonyango zihambisana ne-ACA), kunye neenguqu ezisebenzayo iqela elincinci kunye neeklasi ezinkulu.
Kwakhona luquka ukunyuka kweMedicaid, eyona nto ingundoqo yeCAA. Kwaye iquka igunya lomntu kunye namagunya omqeshi-i-ACA "i-stick" yokukhuthaza abantu ukuba bafumane ukuxhaswa-kunye ne-premium-subsities-i-carrots-eyenza i-couverture ifikeleleke kakhulu kwiintengiso ze-inshurensi yezempilo.
Nangona abalawuli beRiphabhliki kunye neCandelo loLawulo lweTrump bachitshiyelwe ukuchithwa kweenxalenye ezininzi ze-ACA kulo lonke u-2017, inxalenye yodwa yomthetho ekugqibeleni yachithwa yiyo isigwebo somntu ngamnye, kwaye ukuchithwa akuyi kusebenza ukususela ngo-2019 . Ibhaso yerhafu ye-GOP (uMthetho wokuThuthwa kweRhafu kunye neMisebenzi) owenziwe ngoDisemba 2017 uya kugqitywa isigwebo somntu ngamnye, kodwa isohlwayo siya kusavanywa (ekuqaleni kuka-2019) kwimbuyekezo yentela yabantu abangaqinisekanga ngo-2018 .
Ngoko i-ACA ihlala ingagqibekanga ngo-2018, kwaye ezininzi iinxalenye zayo ziyakuthi zihlale zihambelana ngo-2019 nangaphezulu.
Ukusetyenziswa kohlobo lwe "Obamacare" = Izicwangciso ezithengisiweyo kwiShintsho
Nangona igama elithi Obamacare lisebenza ngokukodwa kwi-ACA yonke, abantu basebenzise ngokubhekiselele kwizicwangciso ze-inshurensi zempilo nganye ezithengiswa kwi- inshurensi yezempilo . Ngoko ngenjongo yale nqaku, siya kuhamba kunye nokusetyenziswa kwegama, kwaye sijonge ukuhluka phakathi kwezicwangciso kunye neMedicaid.
"I-Obamacare" izicwangciso zizicwangciso zabucala; Uxilongo luxhaswa ngu rhu lumente
Uhlobo olubaluleke kakhulu phakathi kweMedicaid kunye ne- Obamacare kukuba izicwangciso zezempilo ze-Obamacare zinikwe iinkampani zomshuwalense zempilo yabucala ngelixa i-Medicaid yinkqubo karhulumente.
I-Medicaid, inkqubo ye-inshorensi yempilo yabemi base-United States abahlali abaphantsi-mali, yinkqubo yenhlalakahle yezenhlalakahle ezifana nezitampu zokutya ze-SNAP okanye iiNkxaso zoTshanje kwiiNtsapho ezihluphekileyo.
Igama elithi Obamacare lisetyenziselwa ukuchaza i-inshurensi yempilo yabucala ethengwe nge-Intanethi ye-Care Affordable ye-Care Act. I-Obamacare iinjongo zomshuwalense zempilo zinikwa iinkampani ze-inshorensi zempilo ezifana ne-Blue Cross, iKaiser Permanente, iMolina, i-Aetna, i-Cigna, i-Wellpoint nabanye. Izicwangciso zezempilo ze-Obamacare azilawulwa nguRhulumente, kodwa kufuneka zihambisane nemimiselo eyahlukeneyo karhulumente.
Kuyafaneleka ukuba uqaphele, nangona kunjalo, ukuba ngaphezu kwekota-ezintathu zeMedicaid ebhalisa kuwo wonke amaziko e-Careicaid alawulwa yiMedicaid, oko kuthetha ukuba i-inshurensi yabo ilawulwa ngabashurensi abazimeleyo nabo bathengisa i-inshurensi yorhwebo kubantu ngabanye nakwamashishini. Ezi zicwangciso zisebenza ngekhontrakthi kunye norhulumente karhulumente ukubonelela ngeMedicaid.
Oku kungadideka kubantu, kwaye kuhlanganiswe yinto yokuba kwiinkqubo ezininzi, inkqubo yeMedicaid ayinayo "iMedicaid" egameni layo (i-Apple Health eWashington, umzekelo, kunye neBadgerCare Plus eWisconsin).
Ngubani ofumana iMedicaid Vs. Ngubani ofumana i-Obamacare
Kunzima ukufumana iMedicaid kunokuba ufumane isicwangciso sezempilo sase-Obamacare.
Ukuba ungumhlali wezomthetho waseUnited States, ungathengisa isicwangciso se-inshurensi yezempilo yase-Obamacare ngokusebenzisa i-ACA yakho yoshishino lokutshintshiselwa yinshuwalense ngaphandle kokuba awufaneleki kwi- Medicare . Ukuba ingeniso yakho i-100% kunye ne-400% yentlupheko yentlupheko yomhlaba , unakho ukufumana isibonelelo sokuncedisa ukuhlawula inxalenye yenyanga ye- premium yomshuwalense wezempilo (inqaku lokuba umgca ongaphantsi ukulungelelanisa inkxaso-mali yi-139 ekhulwini kwinqanaba lehlwempu ekuthi ziye zandisa i-Medicaid; kulawo mazwe, i-Medicaid iyafumaneka kubantu abaneengeniso ukuya kuma-138 ekhulwini kwinqanaba lehlwempu).
Ukuba ingeniso yakho ingaphezu kwe-400% ye-FPL okanye ngaphantsi kweepesenti ezingama-100 ze-FPL, awuyi kufumana uncedo lokuhlawula i-inshurensi yezempilo edayiswe kwii-Obamacare zokutshintshana, kodwa ungathenga isicwangciso se-Obamacare. Kule meko, uya kuba noxanduva lokuhlawula i-100% ye-premium yenyanga. [Qaphela ukuba abemi basemthethweni abanemali engaphantsi kwinqanaba lehlwempu banelungelo lokufumana inkxaso-mali ye-premium ukuba abafanelekile kwiMedicaid ngenxa yexesha elilindelekileyo lokulinda abafuduki.
Imigaqo yokufumana iMedicaid igxininise kwaye iyahluka ukusuka kummandla ukuya kwimeko. Injongo yangaphambili ye-ACA kukuba bonke abahlali abasemthethweni abanomvuzo ukuya kwi-138% ye-FPL baza kufumana i-Medicaid yokufumana i-free forums. Nangona kunjalo, isigqibo seNkundla ephakamileyo senze ukuthobela le nxalenye ye-Care Affordable Care Act. Oku kwaphumela kwinkqubo yokudideka apho abanye bathi banenkqonkqo enzulu kakhulu ye-Medicaid yokufaneleka ngenxa yokuba iinkokeli zabo zakhetha ukungawwandisi umonakalo we-Medicaid, kodwa ezinye iindawo zineendlela ezifanelekileyo zokulungelelanisa iMedicaid kuba iinkokeli zabo zakhetha ukungenelela kwe-ACA's Medicaid .
Ngomnyaka ka-2018, kukho iingu-19 ezithi azizange zandise iMedicaid. Abantu abayizigidi ezingama-2.4 kwi-18 kulawo mazwe bakuloo nto eyaziwa ngokuba yi-gap: Umvuzo wabo uphantsi kakhulu kuncediso-mali (phantsi kobuhlwempu), kodwa awanakufaneleka kwi-Medicaid).
Ukuba uhlala kummandla oye wandisa i-Medicaid coverage, uza kufaneleka kwiMedicaid ukuba ukuguqulwa kwakho kwemali engenayo ingekho ngaphezu kwe-138% yeFPL. Le nkonzo yokuxilwa kwemilingo ihlala ikhululekile kuwe, nangona abanye bathi bahlawulisa i-premium yenyanga yokuqala yokubhengezwa kwabantu abanenzuzo ngenqanaba lehlwempu.
Ukuba uhlala kwimeko engazange ikhulise i-Medicaid coverage, kuya kufuneka uhlangabezane ne-criteria egqibeleleyo yokufaneleka. Ezi ndlela zizinzileyo ziyahluka ukusuka kummandla ukuya kwilizwe. Ziquka inkcazo engaphantsi kwenzuzo kwaye inokufuna ukuba ube ilungu leqela elijongene nentsholongwane njengabantu asebekhulile, abakhubazekileyo, abangaboniyo, abantwana, abafazi abakhulelweyo, kunye nabazali okanye abadala abanomdla wabantwana abancinci.
Ngoko, umzekelo, ukuba ungekho umntwana, uneminyaka eneminyaka engama-30 ubudala enempilweni enemali engenayo ye-R10 000 ngonyaka, nokuba ngaba awufanelekanga kwi-Medicaid kuxhomekeke kwimeko ehlala kuyo. Ukuba uhlala kwimeko ephakamileyo Ukuxhaswa kwemilingo kumntu wonke owenza u-138% we-FPL, uya kufumana iMedicaid kuba uhlangabezana nemigangatho yokufumana ingeniso. Ukuba uhlala kummandla ongazange ukwandise i-Medicaid coverage, awuyi kufaneleka kwi-Medicaid, nangona imali yakho engenayo iphantsi, ekubeni awukhubazekanga, ukhulile, uyimfama, okanye umzali womntwana oselula (Wisconsin uhlukile; urhulumente alwamkelanga inkxaso yemali yokwandisa iMedicaid, kodwa anika iMedicaid kubahlali abaneengeniso ukuya kwinqanaba lentlupheko, ngoko akukho nciphiso ekwaseWisconsin).
Ixesha eliBhalisiweyo lokuBhaliswa kwe-Obamacare Vs. Bhalisa nayiphi na ixesha kwiMedicaid
Abantu abafanelekayo banokubhalisa kwi-Medicaid kulo nyaka. Kodwa ukubhalisa kwiiplani ze-Obamacare zifumaneka kuphela ngexesha lokubhalisa okuvulekileyo kwonyaka okanye xa uhlangabezana neendlela zokufaneleka zokufumana ukubhaliswa okuthe ngqo. Ngaphandle koko, kuya kufuneka ulinde kuze kube yithuba elizayo lokubhalisa ukufaka isicelo se-Obamacare plan (inqaku lokuba oku kuyinyani nokuba ungabhalisa ngokutshintshiselana okanye utshintshiselwano; izicwangciso ezithengiswa ngaphandle kokutshintshaniswa zihambisana ne-ACA kwakhona, kwaye ube neefestile ezibhalisiweyo ezincinci; i-Nevada yinto engafaniyo, apho izicwangciso zokutshintshiselana ngaphandle zithengiswa unyaka wonke, kodwa ngexesha lokulinda iintsuku ezingama-90 ngaphambi kokuba i-postage iqalise ukusebenza).
Xa ufaka isicwangciso se-Obamacare ngexesha lokubhalisa okuvulekileyo (okucwangciselwe ukuqhuba nganye ukuwa ukususela ngoNovemba 1 ukuya kuDisemba 15), i-coverage ayifuni ukusebenza ngoJanuwari 1 wonyaka olandelayo. Ngokomzekelo, ukuba ubhalisa kwisicwangciso se-Obamacare ngexesha lokubhalisa okuvulekileyo ekwindla ka-2018, isicwangciso sakho se-Obamacare siza kusebenza ngoJanuwari 1, 2019 (kukho imigaqo eyahlukileyo yomhla osebenzayo kwezinye iimeko xa abantu befaka isicelo ngenxa isiganeko esifanelekayo , njengokuzalwa komntwana).
Nangona kunjalo, xa ufaka isicelo seMedicaid kwaye uyamkelwa kwinkqubo yeMedicaid, akukho xesha lokulinda ngaphambi kokuba ufikelelo lwakho lusebenza.
Umlinganiselo wokubuyisela umonakalo weMedicaid Vs. Ayikho Impendulo Yokubuyisela I-Obamacare
Kwezinye iziganeko, ukuxilongwa kweMedicaid kungasetyenziswa kwakhona. Umzekelo, ukuba uneminyaka engama-5 ukhulelwe xa ufaka isicelo kwaye ufumana ukuxhaswa kweMediicaid, i-Medicaid inokuhlawula ngokwenene unyango lokubeleka olunezinyanga ezi-1-4 zokukhulelwa kwakho, nangaphambi kokuba ufake isicelo seMedicaid. Oku akuyinyaniso kwiinkqubo zomshuwalense zempilo yabucala ezithengiswa kwi-Obamacare exchanges.
Kuyaphawuleka ukuba ulawulo lweTrump luqalise ukuvumela izicelo zokumisela ezivela kwilizwe ezifuna ukuphelisa ukukhawuleza kokubuyisela phantsi kweMedicaid. Ngaphandle kokungenwa kwe-retroactive, i-Medicaid iyafana ne-inshurensi yempilo yabucala ngokubhekiselele xa i-coverage ingasebenza.
Ulwabiwo-mali oluNcinci lweMali yokuCamngca. Obamacare
Kwiimeko ezininzi, i-Medicaid ayifuni kakhulu kwiindlela zokuhlawulwa kwemali , i-coinsurance , okanye i- deductibles . Ekubeni i-Medicaid ijoliswe kulabo abaneemali eziphantsi kakhulu, nantoni na ngaphandle kwembonakaliso encinci yokwabelana ngeendleko bekuya kuba nzima ukufumana abaxhamli beMedicaid kwaye ibonise umqobo onokuyinyamekela.
Ngakolunye uhlangothi, izicwangciso zempilo ze-Obamacare ziza kunye neentengo ezidityanisiweyo, iimali zokuthenga kunye ne-coinsurance. Ekubeni i-deductible yeeyure eziliqela zeedola ingaba nzima kubantu abanemivuzo ehlazileyo yokuhlawula, kukho inkxaso -mali yokwabelana ngeendleko ezifumaneka kulabo abangaphantsi kwe-250% ye-FPL enceda ukunciphisa iindleko zokwabelana ngeendleko. Abo benza ngaphezulu kwe-250% ye-FPL banomthwalo wemali epheleleyo yoluphi ulwabiwo-mali olufunwa yiSicwangciso sabo sezempilo sase-Obamacare.
Ukuxilongwa kunye neMedareri iya kuhlanganiswa; I-Obamacare & Medicare Ayikwazi
Kusemthethweni ngokusemthethweni kwaye kunenzuzo ukuba ube ne- Medicare kunye ne-Medicaid ngokukhawuleza ngexesha elifanayo ukuba ufanelekile zombini. Enyanisweni, kukho negama labantu abanabo bobabini: bobabini bafanelekile .
Nangona kunjalo, akakho inzuzo yokuba ne-insamari ye-Obamacare ye-inshurensi yempilo kunye ne-Medicare. Akukho mthethweni kwi-inshurensi yabucala ukukuthengisa isicwangciso ngasinye semarike emva kokuba ufanelekile kwi-Medicare, nangona abanakukunyanzela ukuba ulahle isicwangciso se-Obamacare esele uyenayo xa ufanelekile kwi-Medicare. Kodwa kwimeko enjalo, uya kulahlekelwa nayiphi na inkxaso-mali ye-premium oyifumanayo xa ufanelekile kwi-Medicare, kwaye akukho nxu lumano lwe-Medicare kunye nemarike nganye. Ngoko ke ngokubanzi ikwacetyiswa ukuba i-Obamacare ababhalise idibanisa ukukhutshwa kwabo ngabanye xa befanelekile kwi-Medicare.
Qaphela ukuba le nkqubo ayikho ngokuzenzekelayo; kufuneka uqale ukukhanselwa kwe-Obamacare yakho. Xa ufanelekile kwi-Medicare, kuya kufuneka uququzelele ukukhanselwa komgaqo-nkqubo we-inshorensi yempilo yakho yase-Obamacare ngokuqala kwe-Medicare. Oku kuyinyaniso ukuba ubhalisela i-Medicare Parts A kunye no- B , okanye i-Medicare Part C, iSicwangciso seMpilo ye-Medicare Advantage plan .
Kutheni Kuthetha Ukungafani Phakathi Kokuxilongwa Ne-Obamacare Kungaba Nzima
Ukuqonda umahluko phakathi kweMedicaid kunye ne-Obamacare kungadideka kuba
- Ngokuqhelekileyo, ufunda ufanelekile kwiMediicaid xa ugcwalisa isicelo se-inshurensi yezempilo kwi-ACA yakho yoshishino lomshuwalense. Ukuba ukutshintshiselwa kugqiba ukuba ufanelekile kwiMediicaid kwimeko yakho, iya kutshintsha loo nkcazelo kwiMedicaid, ukuqala inkqubo yohlelo lweMedicaid. Ekubeni ungenise isicelo sakho se-inshurensi yempilo kwi-Obamacare yomshuwalense wempilo yomshuwalense, kunokudideka xa ugqiba ukufumana iMedicaid endaweni yesicwangciso se-Obamacare yangasese.
- Nangona i-Medicaid yinkqubo karhulumente, kwiinkoliso ezininzi, iinkonzo zeMedicaid kubaninzi babhalise zibonelelwa ngekampani yenkampani yomshuwalense yabucala. Enyanisweni, ngokutsho kweKaiser Family Foundation, ngaphezu kwekota-ezintathu ze-Medicaid abafumanayo zilawulwa ngononophelo lwezicwangciso zempilo. Umxhamli we-Medicaid ufumana ikhadi lakhe le-ID ye-Medicaid evela kwi-UnitedHealthCare, i-Humana, iKaiser, okanye i-Blue Cross, unokucinga ngephutha ukuba ufumene inshorensi yezempilo yase-Obamacare. Enyanisweni, inkqubo yakhe yaseMedicaid yenze isivumelwano kunye nomshuwalense wabucala ukulawula ukunakekelwa kwabamkeli beMedicaid. Nangona inkampani yabucala ilawula iintlawulo zeMedicaid, iinzuzo ngokwabo ziyiMedicaid kunye nemali yokuhlawula ezo ntlawulo ekugqibeleni zivela ekudibaniseni iimali zentlawulo karhulumente kunye nabarhulumente.
Ekubeni uninzi lwabantu abathengi i-inshurensi yezempilo kwi-ACA exchange exchange insurance ufumana uncedo lokuhlawula loo inshurensi yezempilo ngendlela yoxhaswa nguRhulumente we-federal, kunokudideka ngendlela u-inshammethi yempilo yabucala (i-Obamacare) yonyango. ezahlukileyo kunokuba urhulumente-uxhaswe ngeMedicaid.
> Imithombo:
> Amasebe e-Medicare kunye neeNkonzo zeMedicaid, Imibuzo ebuzwa rhoqo ngokuphathelele kwi-Medicare kunye ne-Marketplace . Agasti 1, 2014.
> I-Kaiser Family Foundation, i-Gap Coverage: AbaNcinci abaNcinci kwiZizwe ezingenakwandisa iMedicaid. Novemba 1, 2017.
> I-Kaiser Family Foundation, i-Total Medicaid ephethwe ngoBhaliso lwaBantwana, ngo-2014.