I-Arhente ngayinye ine-Own Exchange kwaye Yonke ihluke
https: // www. / i-actuarial-value-and-yakho-ye-inshurensi-4147819 Njengomphumo woMthetho woNonophelo ongenakunqwenelekayo, usayinwe ngumthetho ngoMashi 2010 nguMongameli Obama, urhulumente ngamnye unomashishini oshishino lomshuwalense. Ukutshintshana kwafumaneka ukuba kusetyenziswe ngo-Oktobha 2013, kwaye sele ikhonza ukususela kwi-portal ukuba abantu bathenge i-private insurance scheme (nganye yeemarike zempilo) (nganye imarike inceda abantu abafuna ukuthenga i-inshorensi yabo kuba abanakho ukufikelela ukuxhamla kumqeshi okanye kwinkqubo karhulumente efana ne-Medicare).
Abanye abantu abafanelekile kwiMedicaid banokubhalisa nge-exchanges, nangona oku kuxhomekeke kwisizathu sokuba loo mntu unelungelo lokuxilongwa, njengokuba ubhaliso luqhutyelwa ngokuhlukileyo kubantu abakufanelekelayo ngokusekelwe kuphela kwimali engenayo, ngokumalunga nalabo abafanelekile ukuxhomekeka kwezinye izinto, njengokukhulelwa okanye ukukhubazeka.
Kwaye iqela elincinci liceba amashishini amancinci atholakale ngokutshintshiselana, nangona loo nxalenye yemarike yabo ithande abantu abambalwa ababhalisile, kwaye urhulumente wezepolisi wamemezela ngoMeyi 2017 ukuba abayi kuphinda basebenze inkqubo yokubhalisa ibincinane (esetyenziswe kumazwe angama-33 ngo-2017) emva kokuphela kuka-2017. Kunoko, ukuqala ngo-2018, amashishini amancinci kulawo mabango abhalisa ngokuthe ngqo kwiinkampani zomshuwalense okanye ngoncedo lomthengisi, kwaye ahlawule iipriyamu kubaqhankqalazi kunokuba enze iintlawulo ze-premium ngokusebenzisa utshintshiselwano.
Ukutshintshiselana kuBhaliso lweeNgingqi
Kubalulekile ukuqonda ukuba ukutshintshisana kukuphela kwesikhulumi sokuthenga umyalezo.
Ukuba uthenga i-inshurensi yempilo nge-Covered California, umzekelo (ukutshintshiselwa kwamanye amazwe eCalifornia), i-Covered California ayikho inkampani yakho yinshurensi. Kunoko, inkampani yakho ye-inshorensi iya kuba yiNtsholongwane yeNtsholongwane okanye i-Blue Shield, okanye i-Anthem okanye nayiphi na enye yabashurensi abazimeleyo ababonelela nge-Covered California.
Nangona i-inshorensi yezempilo iyanzima kakhulu kuneetikiti ze-airline, cinga ngokutshintshiselwa njengentlanzi njengeTravelocity okanye i-Expedia. Ibonisa wena iinketho ze-inshorensi kwindawo yakho kwaye ikuvumela ukuba uthenge lowo ofuna. Kodwa nje ngokuba uhambo lwenu luya kunikezelwa yinqwelo-moya oyikhethayo-kungekhona ngo-Travelocity okanye i-Expedia-yakho yinshurensi yempilo iya kunikwa ngumbhaki wenkampani yangasese, kungekhona ngokutshintshiselwa.
I-States yayinokhetho lokudala ezo zintengiselwano okanye ukuxhomekeka kwirhulumente wezepolisi ukudala utshintshiselwano kubo. Ezinye iindawo zineengxoxo ze-hybride ezinokubambisana phakathi koburhulumente karhulumente kunye neseburhulumenteni, okanye utshintshiselwano olwenziwa ngurhulumente olusebenzisa iqonga lokubhalisa lika-federal (HealthCare.gov). Ngo-2018, kukho i-12 exhasayo ngokubanzi, u-five exchange-run-runs usetyenziso lwe-HealthCare.gov kubhaliso, iintsebenziswano ezithandathu zentsebenziswano kunye no-28.
Kwaye ukucacisa enye ingongoma apho ngezinye izikhathi idala ukudideka, amagama "utshintshiselwano" kunye ne "marketplace" asetyenziswa ngokungafaniyo. Kodwa igama elithi "imarike" lisetyenziselwa ngokubanzi ngokubanzi. Ngako-ke xa utshintshiselwano lwempilo yomshuwalense okanye indawo yemarike ibhekisela ngqo kwi-portal kwimeko nganye abantu abangayisebenzisa ukuthelekisa iinketho ezahlukeneyo nokubhalisa, igama elithi "imarike yempilo yomshuwalense" isebenza ngokubanzi ngokubanzi, kwaye ingaquka izicwangciso zokutshintshiselana kunye nomqeshi- izicwangciso ezixhasiweyo kunye nezicwangciso ezikhulu kunye nezicwangciso ezikhulu .
Injongo ye-inshurensi yempilo yentsholongwane ukwenzela ukuba i-inshurensi yezempilo ibe nexabiso eliphezulu kwaye ilula ukuyithenga.
Ukuxhaswa kweNkulumbuso kunye neNkxaso-mali yokuXhawula ngeNdleko: Kufumaneka kuphela kwiShintsho
I-ACA iquka inkxaso-mali ye-premium (iikhredithi zerhafu ye-premium) kunye neenkxaso-mali zokwabelana ngeendleko (ukunciphisa ukwabelana ngeendleko) ukwenza iiprayimenti zifikeleleke kwaye zinciphise iindleko ezingaphandle kwezinto ezibhalwe ngabanye ababhalisile. Ezi zenkxaso-mali zisekelwe kwingeniso kwaye ziyafumaneka kwiibhalisi eziphantsi kwamanani aphantsi kunye nabangaphakathi.
Zomibini iintlobo zenkxaso-mali zifumaneka kuphela xa uthengela ukukhutshwa kwakho ngokutshintshiselana. Nangona isicwangciso esifanayo sisifumaneka-esitshintshiselwano (ngokukodwa kwinkampani yomshuwalense), kuya kufuneka ukhokhe ixabiso elipheleleyo ukuba uthengisa nayiphi na indawo ngaphandle kweyatshintshiselwano.
Kwaye nangona inkxaso-mali yezemfundo yokunciphisa iindleko yachithwa ekupheleni kuka-2017, iinzuzo zokunciphisa iindleko ziyaqhubeka zifumaneke kubhalisa abazithengela izicwangciso zesilivere ekutshintshiseni kunye nabangeniso kwiingcebiso zokufaneleka zokunciphisa iindleko. (okt, akukho ngaphantsi kwama-250 ekhulwini lobuhlwempu, kwaye akukho ngaphantsi kwama-100 ekhulwini lobuhlwempu kwiimeko ezingazange zandise iMedicaid, okanye i-139 ekhulwini yezinga lehlwempu kwiimeko ezandise iMedicaid).
Ngubani Ongasebenzisa Ukutshintshiselana?
Bonke abemi baseUnited States nabemi abasemthethweni abangenalo ivalelwe kwaye abafanelekanga kwi- Part A Medicare bayakufanelekela ukuthenga isicwangciso sezempilo ekutshintshisweni kwimeko abahlala kuyo. Abafuduki abangenayo imibhalo abakwaziyo ukubhalisa kwiinkcazo ngokutshintshiselana, ngaphandle kwenkxaso-mali ye-premium .
Amashishini amancinci angaphinda athenge ukuthengwa kwintsebenziswano; kwiinkoliso ezininzi, oku kuphelelweyo kumashishini anabasebenzi abangaba ngu-50 , nangona kukho iindawo ezimbalwa (iCalifornia, iColorado, iNew York neVermont) apho amashishini anabasebenzi abayi-100 angasebenzisa ukutshintshela ukukhusela ukukhutshwa. Qaphela ukuba kumazwe asebenzisa ukutshintshiselana kwamancinci kwezeMpiloCare.gov, ukutshintshiselwa akusayi kubamba ukubhaliswa, kwaye kunoko ukuba amabhizinisi abhalise ngqo kunye nabanini-mshwalense.
Njengomphumo we-Grassley Amendment kwi-ACA, iCongress kunye nabasebenzi bafuneka ukuba bafumane ukuthengiswa kwintengiso. Ukujongana nale mfuneko kwaye uqinisekise ukuba iCongress kunye nabasebenzi abazange baphelelwe yimpeshelweni yabo ye-premium yomqeshi, urhulumente wenza i-workaround evumela ukuba iCongress kunye nabasebenzi babhalise kwizicwangciso zeqela elincinci ngokusebenzisa utshintshiselwano olusesikweni kwi-District of Columbia (DC Health Link) . I-DC Health Link echazwe ngo-Ephreli 2017 ukuba malunga nama-11,000 abo ababhalise kwiqela elincinci babengamalungu eCongress kunye nabasebenzi babo.
I-One Stop Stop kunye neNkcukacha zoLwazi
Inzuzo ebalulekileyo ye-inshurensi yempilo yentsholongwane ukwenzela ukuba kube lula ukuba uqhathanise ukhetho kwaye ubhalise kwisicwangciso sezempilo. Ezinye zeendlela zokutshintshisana zikhuthaza ukukhetha nokukhuphisana kubandakanya:
- Izicwangciso zezempilo zempilo yakho kwiikhowudi yakho zifakwe kwiwebhusayithi egcinwe nguRhulumente wakho okanye urhulumente wephondo. Kule ndawo, ungafunda malunga neenjongo zezempilo kunye neendleko, uze ubhalise.
- Ukuba unganqongophelo lokufikelela kwi-intanethi, ukutshintshisana kunokunika izixhobo ukuba ufumane ulwazi kunye nokubhalisa izinto ngeposi kunye nakwiindawo ezikhethiweyo zikarhulumente kwindawo yakho; kukho i-person-assisters ekhoyo kulo lonke ilizwe ngeli xesha lokubhalisa okuvulekileyo kunyaka ngamnye ukuququzelela ubhaliso kubantu abakhetha ukunceda ubuso nobuso uncedo.
- Ukuvumela ukuba uqhathanise ukucwangcisa izicwangciso, ukutshintshana kufuneka kusetyenziswe ifomu eliqhelekileyo, iinkcazo, kunye nezinto zokuthengisa. Ungabhalisa kwi-intanethi, ngomntu, ngeposi okanye ngomnxeba.
- Iziko lokufowunela ukuqinisekisa ukubonelela ngeenkonzo ezilungileyo zabasebenzisi
Izicwangciso zeZempilo
Ukuba uthenga i-inshorensi ngokutshintshiselana, uya kuba nako ukhetho lokufumana impilo efanelekileyo kuwe nentsapho yakho. Izicwangciso zezempilo ezikhoyo zibandakanya isethi ebalulekileyo yeenzuzo ezibonelela ngeenkonzo ezinonophelo zonyango ngeendlela ezahlukeneyo zokwabelana ngeendleko.
Kwakhona, iindleko zakho zokuphuma kwenyanga (i-deductibles, i-copayments, kunye ne-coinsurance) yakho ihlawuliswe kwimali ebekwe nguRhulumente wombuso ngamnye ngonyaka. Ngo-2018, ubuninzi be-out-of-pocket yomntu oyedwa bengu-$ 7,350 umntu omnye, kunye ne-14,700 zamawaka kwintsapho. Izicwangciso zingaba nemida ephuma ngaphandle kwezantsi phantsi kwezi mali, kodwa zingekho ngaphezu kwazo.
Zonke izicwangciso zithengiswa ngokutshintshiselana kwinye yezinto ezilandelayo ezintlanu :
- Isicwangciso seBronze: Ukuvelisa umyinge wama-60 ekhulwini kwiindleko zempilo ebalulekileyo kwizinga eliphakathi.
- IsiCwangciso seSiliva: Ukuvelisa umyinge wama-70 ekhulwini kwiindleko zempilo ebalulekileyo kwizinga eliphakathi.
- IsiCwangciso seGold: Ukuvelisa umyinge wama-80 ekhulwini kwiindleko zempilo ebalulekileyo ebantwini abanzi.
- Isicwangciso sePlatinum: Ivelisa umyinge wama-90 ekhulwini kwiindleko zempilo ebalulekileyo ebantwini abanzi.
- Isicwangciso esiyingozi: Ukuvelisa umyinge wama-60 ekhulwini weendleko zempilo ebalulekileyo ebantwini abaqhelekileyo, kwaye kubandakanya ukunakekelwa kweefisi eziphambili kunye nokunyamekela kokukhusela phambi kokuncitshiswa. Yonke into isebenza kwi-deductible, kwaye ihlanganiswa kuphela emva kokuba idibene. Izicwangciso ezinobungozi zifumaneka kuphela kubantu abaneminyaka engama-30 okanye abo bafanelekela ukuxolelwa kanzima kwigunya lokuthenga
Qaphela ukuba kumazwe amaninzi, kukho uhla lwe-minimis -4 / + 2 oluvunyelwe isilivere, igolide, kunye neeplatinum, kunye ne -4 / + 5 ye-minimis uluhlu oluvunyelwe iiplani zebhedu. Ngoko icebo legolide linokufihla phakathi kwama-76 ekhulwini kunye nama-82 ekhulwini kwiindleko eziqhelekileyo, kwaye isicwangciso sobhedu singabhalwa phakathi kwama-56 no-65 ekhulwini kwiindleko.
> Imithombo:
> Amasebe e-Medicare neeNkonzo zeMedicaid. Ixesha elizayo le-SHOP: I-CMS ihlose ukuvumela amaShishini amancinci kwi-SHOPs usebenzisa i-HealthCare.gov ngakumbi Ukunyaniseka xa ubhalisa kwi-Healthcare Coverage. Meyi 15, 2017.
> Amasebe e-Medicare neeNkonzo zeMedicaid. Iziko loLwazi loThengi kunye noLawulo lweNtshuwalense. Iingqinisiso ezichaziweyo zikaRhulumente. Juni 2, 2017.
> Isebe lezeMpilo kunye neNkonzo zoLuntu, uMkhuseli weMonde kunye noMthetho woNonophelo ojongene noThathaka, ukuThuthukiswa kweMarike . Ngo-Apreli 13, 2017.
> IRejista yeSithili, uMkhuseli weMonde kunye noMthetho wokuNakekelwa koNonophelo ongenakunciphisa Isaziso seNzuzo yeeNzuzo kunye neParameters yokuhlawula i-2018; Izilungiso kwiiNyanga zokuBhalisa eziKhethekileyo kunye neNkqubo yokuCwangciswa kwabasebenzisi. Disemba 22, 2016.