Iinkcazo ezimbini ezahlukeneyo zeCwangciso soBhenkmark
Kwiminyaka ukususela kwi-Care Affordable Act (ACA) yenziwe, igama elithi "isicwangciso sokumatshekisha" lisetyenziswe ngokubanzi. Kodwa isetyenziswe ukuchaza ezimbini iinkalo ezahlukeneyo zomthetho, ezinokudidanisa abathengi. Ngokuqhelekileyo, umongo uza kukuvumela ukuba uchaze ukuba yeyiphi inkcazo echazwe kuyo, nje ngokuba uqonda zombini iindidi zezicwangciso zokulinganisela.
Isicwangciso seBenmark sichaza:
- Isicwangciso sesilivere esiphantsi-indleko esezantsi-ntshintsho kwendawo nganye, kwimarike yomshuwalense, OKANYE
- Isicwangciso ngasinye esisebenzisayo sichaza iimfuno zezempilo ezibalulekileyo kuloo meko kwiiplani zeqela kunye namancinci.
Ezi zimbini zihluke kakhulu, kodwa zombini zinegama elifanayo, ngokuqinisekileyo kunokukhokelela ekudidekeni. Makhe sijonge indlela uhlobo ngalunye lwesicwangciso sokutshatyalaliswa lusebenza ngayo.
Isicwangciso Sesilivere Sesixa Sesibili-mali SesiXhosa
Kubantu abakufanelekile kwiinkxaso-mali ze-premium ze- ACA (iikhredithi zerhafu ye-premium) , imali yesibonelelo isekelwe ekugcineni i-premium yenkxaso-mali emva kwe-second-cost-lowest cost plan kwi -percentage pre-determined income income . Isicwangciso sesibili-xabiso esiphantsi sibizwa ngokuthi isicwangciso sokutsalwa.
Isicwangciso sokulinganisela siyahluka ukusuka kwenye indawo ukuya kwelinye, kwaye ukususela kunyaka omnye ukuya olandelayo ukususela ekubeni isimo sawo sibonakaliswe ngokupheleleyo ngentlawulo yaso eselinye isiqhelo nakwezinye izicwangciso zesilivere ezikhoyo kuloo ndawo.
Ngoko-ke, ngaphakathi kwiphondo, kukho izicwangciso ezahlukeneyo zokubhenkcela ukuba urhulumente unemakethe yoshishino yomshuwarensi eqineleyo eyahluka ukusuka kwenye indawo ukuya kwelinye, okanye kunokubekho icebo elilodwa eliphethe indawo yokubeka uphawu kummandla wonke, ukuba urhulumente unomnye inshurensi okanye amaninzi a-inshurensi anexabiso elifanayo kwilizwe.
Ngethuba lokubhalisa okuvulekileyo kumntu ngamnye wokuthengwa kweemarike (Novemba 1 ukuya kuDisemba 15), abathengi banokubona ukuba iindleko zesicwangciso sokutshatyalaliswa ziya kuba yonyaka ozayo. Baza kubona ukuba yeyiphi imali-ukuba nayiphi na-obhalisiweyo uya kufumana kwiinkxaso ze-premium, ngokusekelwe kwinqanaba lokubhalisa eliya kubabiza, iindleko zesicwangciso esiyifunayo, kunye nepesenti zabo ezihambelanayo. yengeniso yabo abaya kulindeleka ukuba bahlawule isicwangciso sokulinganisela; izibalo ezichazwe apha).
Isicwangciso sokutshekisha isingeniswa yinkampani eyahlukeneyo yinshurensi ukususela kunyaka ukuya kutsho, kuba i-insurers itshintsha amaxabiso abo ngonyaka. Ixabiso liza kusekwa kunyaka, ngoko ke isicwangciso sokutshintshela indawo kwindawo ayiyi kuguqulwa kude kube ngumnyaka ozayo ngaphandle kokuba umgcini-mali aphuma kwimarike eminyaka-le nto (ayinqabile, kodwa kwenzeke-ezinye ze- ACA CO-OPs baphoqelelwa ukuba bavale umnyaka we-2015 kunye no-2016). Kodwa kunyaka olandelayo, ama-insurers 'rankings kwizinga lesantya liyakwazi ukujikeleza, njengoko abanye abatshorensi bephakamisa amanani abo ngaphezu kwamanye, kwaye abanye banciphisa iirhafu zabo kunyaka omnye ukuya kutsho.
Kodwa i-takeaway ibonisa ukuqonda ukuba i-premium yakho inkxaso-mali isekelwe kwisixa esiza kukuhlawula ukuba uthenge isicwangciso sokwenza uphawu.
Ungasebenzisa loo mali-mali ukuba uthenge nayiphi na isicwangciso sezinga lesinyithi ekutshintshisweni. Awunanto yokuthenga isicwangciso sokutsalwa, kodwa ukuxhaswa kwe-premium yakho kuya kuba ngumlinganiselo ofanayo, kungakhathaliseki ukuba yiyiphi iplani oyikhethayo (imali yakho ye-premium-subsidy amount premium iyahluka kakhulu, kuxhomekeke kwisicwangciso okhethayo).
ImiGangatho eSebenzi kaRhulumente kwiNzuzo yezeMpilo ebalulekileyo
Olunye uhlobo lwesicwangciso sokulinganisela isicwangciso sobume kwinqanaba ngalinye ekuqaliseni ukuba zeziphi iingenelo ezifakwe zizicwangciso zeqela kunye namancinci kwilizwe. Zonke izicwangciso zeqela kunye namacandelo amancinci kufuneka zigubungele iinkonzo ezilishumi ezibalulekileyo zezempilo ze-ACA (kukho enye indlela yokwenza amazinyo omntwana / umboniso wempilo, kodwa ezinye iintlonelo zezempilo eziyimfuneko kufuneka zidibaniswe kuzo zonke izicwangciso zeqela ze-ACA ezivumelanisiweyo).
Kwaye ngelixa izicwangciso zeqela elikhulu azidingeki ukuba zibandakanye iingenelo zempilo ezibalulekileyo, abanako ukunyusa ama-maximums amaxesha onke okanye amaxesha onke okuxhamla kuzo zonke iinkonzo ezibalulekileyo zezempilo ezizibandakanya kuzo.
Ngoko kubalulekile ukucacisa oko kubalulekile njengenzuzo ebalulekileyo yezempilo. I-ACA ichaza ngokubethelwa ngamabomu, ngokugcina inkcazo yeziseko ezilishumi zempilo ezibalulekileyo kwiinqonga zebhola eziza kufaneleka kwisiqingatha sephepha. Umthetho uqaphele kwakhona ukuba iSebe lezeMpilo kunye neNkonzo zoLuntu (HHS) liya kuqeshwa ukuba kuqinisekiswe ukuba i-coverage "iya kufana nokulingana neenzuzo ezibonelelwe phantsi kwecwangciso lomqeshi.
Ukusuka apho, urhulumente wesigqeba ushiye iHHS ukulungisa iinkcukacha. I-HHS, kwakhona, yenza umsebenzi ngamnye kwilizwe ngokuchonga isicwangciso sokumisela esasetyenziselwa njengesicwangciso sokubaluleka kwamacandelo amancinci namacandelo amancinci kwimeko. Ngo-2012, i- HHS yashicilele uluhlu lwe-FAQ malunga nezicwangciso zokubeka uphawu , ukulungiselela ukuthobela inkqubo, kwaye ukhokelo olongezelelweyo lushicilelwe ngo-2015 . Amazwe avunyelwe ukukhetha isicwangciso sokutshekisha kwabo kwisinye sezi zinto ezine ezilandelayo ("inkulu" inqunywe ngokusekelwe kubhaliso):
- Esinye sezicwangciso zeqela elincinane kunazo zonke kwilizwe
- Enye yezona zicwangciso ezintathu zentlalo-ntle yomsebenzi wesibonelelo sempilo (isibonelelo esinikezelwa kwabasebenzi baseburhulumenteni)
- Enye yezona zicwangciso zentlalo-ntsebenzo yezempilo ephakamileyo emithathu (ama-FEHBP anikezelwe kubaqeshwa bombuso)
- Isicwangciso esikhulu se-HMO esingenalo iMedicaid esinikwe kwiimarike zorhwebo.
Ingcamango yokuba enye yezo zikhetho ziza kunika ubungqina obuqinileyo, obuqinileyo, kwaye bekungeke kube lula ukubonelela "amathambo angenalutho" kuba bekunikezelwa abasebenzi baseburhulumenteni okanye babekhethwe ngamashishini amaninzi ukuze baqinisekise abasebenzi babo.
Ngomhla we-2014 ukuya ku-2016, isicwangciso sokubaluleka sasisicwangciso esanikezelwa ngo-2012 (ukususela apho apho amazwe abeka izicwangciso zabo zokubeka uphawu). Abanye babo bekufuneka baxhaswe ukuze baqinisekise ukuba bahlanganise yonke i-EHB, ekubeni izicwangciso zazingakabandakanywa ukuba zibe yi-ACA-kuthotyelwe ngo-2012. Ngo-2017 nangaphezulu, isicwangciso sokubheka isicwangciso esinikezwa ngo-2014. Phantse onke amazwe akhethile iiplani zeqela elincinane njengendlela yokubeka uphawu. Iinkcukacha ezicacileyo zeplani yokukhethwa kwecwangciso lokuzibonakalisa kwinqanaba lelizwe zikhoyo apha.
Iimarike zomntu kunye neeplani zeqela elincinane ezinikezelwa kummandla kufuneka zibandakanye i-coverage "elingana ngokulinganayo" kwiintlawulo ezibonelelwa ngesicwangciso sokutshintshwa kwenkqubo ekhethiweyo. Kukhona ukuqhubeka ukusuka kwelinye ilizwe ukuya kwelinye, njengoko i-ACA ichaza iiparitha eziqhelekileyo ze-EHB. Kodwa ukuhluka kwezicwangciso zeendlela zokubeka umgangatho welizwe kutheni uza kubona ezinye iinkonzo-ezinjengonyango lokungabikho kwempilo-ezichazwe ngokwahlukileyo ukusuka kurhulumente ukuya kwilizwe, ngokusekelwe kumagunya asebenzayo kwimeko yelizwe, okanye ulwahlulo oluvela kwisicwangciso somlinganiselo wesinye sombuso ukuya kwelinye.
Ngo-Oktobha 2017, i-HHS yapapashwa inzuzo ecetywayo kunye nemilinganiselo yokuhlawula i-2019, eyayiquka ezinye iinguqu ezicetywayo ezihambelana nezicwangciso zokulinganisela ze-EHB. Ukuba kugqityiwe njengoko kuphakanyisiwe, i-state iya kuba nobunzima obongezelelweyo obunokuqala ukususela ngo-2019, kubandakanya ukhetho lokufumana esinye isicwangciso sokulinganisela selizwe njengalo, okanye ukubandakanya amacandelo ahlukeneyo ahlukeneyo eenjongo zokuzicwangcisa ukuvelisa isicwangciso sokulinganisela. Ukongezelela, amazwe aya kukwazi ukukhetha okanye ukuyila isicwangciso esitsha sonyaka wokugqibela, kunokuba kufuneka aqhubeke nokusebenzisa isicwangciso sokutshekisha okugqityiweyo ngo-2017.
ILizwi
Xa uva umntu ekhuluma ngesicwangciso sokubaluleka ngokumalunga ne-ACA, umongo uza kukuvumela ukuba uluphi uhlobo lwesicwangciso sokutshekisha.
Ngaba bathetha ngecebo lesibini eliphantsi kwexabiso lesilivere elinikezelwa kumashishini atshintshiselwano, okanye malunga nesicwangciso esinikezwe ngurhulumente ukuba sikhonze njengezinto eziphambili zepakethi apho zonke i-ACA ezihambelanayo kunye neqela elincinci liceba urhulumente usekelwe? Emva kokuba uqinisekisile oko, iinkcukacha ezingentla ziyakunceda wenze ingqiqo yengxoxo.
> Imithombo:
> Amasebe e-Medicare neeNkonzo zeMedicaid. Iziko loLwazi loThengi kunye noLawulo lweNtshuwalense. Iimilinganiselo zezeMpilo ezibalulekileyo: Ukuqinisekisa umgangatho, Umgangatho ongenakunciphisa.
> Amasebe e-Medicare neeNkonzo zeMedicaid. Iziko loLwazi loThengi kunye noLawulo lweNtshuwalense. IiNkcukacha ngeeNzuzo zeMpilo eziPhambili (EHB).
> Amasebe e-Medicare neeNkonzo zeMedicaid. Izinzuzo zezeMpilo ezibalulekileyo: Uluhlu lweeMveliso zeQela elincinane kunazo zonke zikarhulumente . Aprili 8, 2015.
> House.gov. Umbhalo woKhuselo lweMonde kunye noMthetho woNonophelo ojongene noThathaka .
> INkonzo yeNgeniso yangaphakathi. Inkqubo yeNgeniso 2017-36 .
> Kaiser Family Foundation. Izibonelelo zezempilo eziyimfuneko (EHB) Izicwangciso zeBhenmarkmark, 2017.