Unokukunceda ugcine imali kwiindleko zemithi yonyango
Ukuba unogqirha lwezonyango zamachiza wakho ugqirha ugqirha, uya kufuna ukuqhelana nenkampani yakho yomshuwalense, i-Medicare okanye inkqubo yexabiso lokuhlawula izilwanyana ezibizwa ngokuba yi- formulary .
Isikhundla sezonyango kwi-formulary's tier system price will make a difference in your expenses.
Yintoni iFormulary?
Umvuzo wakho, nokuba ngaba yinkampani yomshuwalense yabucala, iMediare, iTricare, Medicaid okanye enye inkqubo igcina uluhlu lwezilwanyana eziza kuhlawula ngokuba lubizwa ngokuba yi-formulary yayo.
I-formulary yayo ibandakanya iziyobisi eziqhelekileyo, iziyobisi zonyango ngamanye amaxesha izidakamizwa ezingaphezulu kwee-counter (i-OTC) ezazisetyenziswa ngamayeza kuphela. Ngokomzekelo, i-Prilosec kunye neNaproxen isetyenziselwa ukuba imithi kuphela, kodwa zombini ngoku i-OTC iziyobisi. Ezinye izicwangciso zokuhlawula ziquka iProlosec kunye neNaproxen kwiifomthi zazo.
Ziziphi ii-Formulary Tiers?
Amacandelo amaqela eziyobisi eziwela ngaphakathi kwenkcazo kunye namaqela axabiso:
- Inqanaba 1 okanye iNqanaba I-I: Izidakamizwa zentshukumo 1 zihlala zixhomekeke kwiziyobisi eziqhelekileyo , iindleko eziphantsi kakhulu kweziyobisi. Ngamanye amaxesha ezinye, izidakamizwa ezihlaziyiweyo ezihlaziyiweyo ziya kuwela kulo mgca. Umlinganiselo wezilwanyana zamatyala usithwala i-co-pays ephantsi, ngokuqhelekileyo i-$ 10 ukuya kwi-25.
- Umgangatho wesi-2 okanye iNqanaba lesi-II: Umgangatho wesi-II uvame ukubandakanywa ngegama lomenzi wegama okanye kwii-generic ezibizayo. Ukuba kufuneka uthabathe igama lomhlaza , umhlawuli wakho uya kuba neelwimi lezonyango ezikhethiweyo ezikhethiweyo (ngenxa yokuba ixabiso layo lingaphantsi, kuchazwe ngezantsi.) Le mikhiqizo ekhethiweyo ifumaneka kwiNqanaba 2. I-Tier II izidakamizwa zihlawula ixabiso eliphakathi -i-payout, ngokuqhelekileyo i-$ 15 ukuya kwi-$ 50.
- Umgangatho wesi-3: okanye iNqanaba lesi-III: Ixabiso elibiza igama lonyango, kwaye ngokuqhelekileyo inkampani yakho yomshuwalense ayifuni ukuba ufumane imithi (ngenxa yokuba iindleko zayo ziphezulu, kuchazwe ngezantsi) nazo zithathwa ngokungakhethi. Zifumaneka kwiNqanaba lesi-3. Izidakamizwa zeNqanaba III ziza kusinceda ngaphezu kwezona ziphantsi, ngokuqhelekileyo zihlawulwe i-$ 25 ukuya kwi-75.
- Umgangatho wesi-4 okanye i-Tier IV, ebizwa ngokuba ngamachiza okhethekileyo: Ezi zinto zivame ukuvunywa iziyobisi, kwaye zibiza kakhulu ukuba umhlawuli wakho ufuna ukuphazamisa imiyalelo yesichengiso. Umgangatho IV ungumntu omtsha, owenziwe ngowokuqala ngo-2009.
Ukubaluleka kweNqanaba IV kubonakala kukubambisa-zonke iziyobisi ezibizayo. Kunokuba banike i-dollar ethile yokuhlawula i-co-pay payers, abahlawuli baya kubela ipesenti, njengama-60%. Ngokomzekelo, izidakamizwa ezibiza kakhulu i-chemo, ixabiso elibiza kwi-$ 1,000 linokuhlawula isiguli sika-600.
Kutheni Izidakamizwa Zibhaliswe Ngamaqela?
Le mpendulo yegama elilodwa kulo mbuzo: imali.
Uluhlu lwezonyango luhlobo lomsebenzi wezinto ezimbini: iindleko zayo zangempela kunye neendleko zokuxoxisana zabahlawuli. Ingakumbi ixabiso leziyobisi lihlawula umhlawuli, umgangatho ophezulu, kwaye kuya kuba neendleko kwiigulane.
Amachiza ahlukeneyo kumgangatho ngamnye weziyobisi adweliswe kwiintlobo ezahlukeneyo. Ngokomzekelo, iklasi yeziyobisi ezinceda abantu abaneGERD (isifo se-reflux gastroesophageal) kuthiwa iproton pump inhibitors, okanye ii-PPIs. I-PPI encinci iyindleko, ebizwa ngokuba yi-omeprazole, yaye ihlala ifunyenwe kwiNqanaba I. Ezinye ze- PPI ezinamaxabiso athile , njenge Prilosec okanye i-Prevacid, zidlalwa kwiCandelo II. IiPIs ezibiza kakhulu, njenge-Aciphex okanye i- Nexium , zidweliswe kwi-Tier III.
Ukusebenzisa umzekelo we-PPI apha ngentla: Umhlawuli angathetha intengo yakhe kunye nomenzi okanye umthengisi wezinye izidakamizwa ezibiza kakhulu, njenge-Aciphex okanye iNexium ukuya kwindawo ephantsi kakhulu. Ukuba benza oko ngempumelelo, eso sizabisi saba "yinto ekhethiweyo," edla ukuba itywala yesiXhosa. Ukuba abanako ukuthetha ngokuthe ngqo, kuya kufakwa kwiNqanaba III kwaye kuya kubiza izigulane ezininzi, nazo.
Ngaba Bonke Abathengi Basebenzisa Amanqaku Afanayo?
Hayi, bonke abahlawuli abayibhalisi iilisi ezifanayo kwii-third tiers. Njengoko nje umzekelo, isabelo somboleki sixhomekeke kwiindleko zayo. Ukuba uMhlawuli-mali angathethisana nexabiso elincinci lonyango oluthile ngaphandle kweengxowa-mali ze-Payer B, ngoko uMhlawuli-mali angabhala uluhlu lohlobo lwe-Tier II ngelixa uMhlawuli-B ungabhala phantsi kwiNqanaba III.
Ndingayifumana Njani i-Formulary ye-My Health Insurance?
Naliphi na umhlawuli wezempilo uya kwenza ukuba ifomula yayo ifumaneke kuwe-bafuna ukuba ube nayo kwaye uyisebenzise. Kuya kufumaneka lula kwiwebhusayithi yayo, okanye ungabiza inombolo yenkonzo yabathengi kwaye ubacele ukuba bayithumelele kuwe.
Akuqhelekanga kumhlawuli ukuba enze utshintsho kwifomula yakhe okanye ukuhambisa isicatshulwa kwinqanaba elinye ukuya kwelinye. Ukuba uthabatha isicatshulwa imihla ngemihla okanye rhoqo, unokwaziswa xa utshintsho lwenzeka. Kwakhona, uya kufuna ukuphinda uhlolisise unyaka ngamnye ngexesha lobhaliso oluvulekile, xa unethuba lokwenza utshintsho kwisicwangciso sakho sokubhengezwa, ukuba ubone ukuba isilwanyana sakho sitshintshile isikhundla salo kwifom yefayili.
Ungayigcina njani imali ngokusebenzisa i-Formulary yakho yokuhlawula?
Ukuba unokuqonda okuyisiseko kweeklasi zamachiza kunye nexabiso lentengo, ungasebenzisa nodokotela wakho ukuba ukhethe isiza esiza kukuhlawula ubuncinci. Ukuphonononga iklasi yesigqirha, kwaye ufumane isikhundla salo kwifom yakho yomhlawuli wokuqinisekisa ukuba ufumana izilwanyana ozifunayo ngemali encinci yemali.