Yiyiphi Imboleko Ebonakalayo?

Umvuzo oThengwayo ochazwe kwaye uchazwe kwisiNgesi esicacileyo

Kwihlabathi le-inshurensi yezempilo, ukuxhaswa kwemali-mboleko yintengiso yomshuwalense owawunayo ngaphambili ukuba ufumane iitaliti xa ufaka isicelo se-inshorensi entsha.

Kutheni ungadinga iitaliti ngenxa yokubambisa i-inshorensi ngaphambili? Kwezinye iimeko, i-insurer yakho entsha iyakwenza isohlwayo ngenxa yokuba ungenayo inqaku elifanayo lexesha elidlulileyo. Nangona kunjalo, ukuba unomsebenzi ofanayo wokuthenga ngetyala kwixesha elidlulileyo, uza kufumana isikweletu malunga naloo gaziso kwaye awuyi kuhlawulwa.

Imiba eBini kwiMibandela yokuHlawuleka

I-Medicare Ingxenye D kunye noMyinge onetyala

Ukuba awuyi kubhalisa kwi-Medicare Part D yesigqirha sokusetyenziswa kweziyobisi xa uqala ukufaneleka, ngokuqhelekileyo xa uphendukela kwiminyaka engama-65 ubudala, uya kuhlawulwa ngokuhlawula iiprayimari zenyanga eziphezulu ukuba emva koko uthathe isigqibo sokuthenga i-Medicare Part D ukufihla.

Lo mgaqo ukhona ukukhusela abantu ekudleni le nkqubo. Ngaphandle kwalo mgaqo, abantu bangayilahla isabelo se-Part D ukugcina kwiipresimenti zenyanga zonke xa benamaxabiso aphantsi kweziyobisi, kodwa bhalisela i-Part D ekujoliswe kuyo xa izidakamizwa zabo zenyanga zibiza ngaphezu kweendleko zenyanga zomshuwalense. I-Medicare ivimbela le midlalo yeenkqubo ngokwenza abantu ababhalisele i-Medicare Part D bahlawule ukuhlawula isigwebo semali ngendlela ephakamileyo yeprayimari zenyanga. Kwiinyanga zonke uyahamba ngaphandle kokubhengezwa, i-premium ye-Medicare Part D yakho iya kuba yi-1% ephezulu. Ukuba ubhalisa iinyanga ezingama-25 ngokukhawuleza, iiprayimari zakho ziya kuba ngama-25% aphezulu ngokude nje ngokuba unayo i-Medicare Part D.

Nangona kunjalo, akunakulungele ukukuhlawulisa ngeprayimari eziphezulu ukuba isizathu sokuba awuzange uthenge ukuxhaswa kwe-Medicare Part D xa uqala ukufaneleka ngenxa yokuba sele sele unesigxina esifanelekileyo sokukhuselwa kwezidakamizwa kumqeshi wakho, umanyano, umqeshi womlingane okanye umhlala phantsi. cwangciso. Kule meko, awuzange uzame ukudlala umdlalo; ukuba uzama ukuphepha ukuhlawula kabini kwisiganeko esifanayo.

Faka ingcamango yokubambisa imali. Ukuba unako ukubonisa ukuba uneminye imivuzo ebonelela ngeenzuzo ezifanayo, uya kunikelwa ngetyala ngaleyo ngxelo kwaye uza kuhlawula i-premium eqhelekileyo, kungekhona i-premium yesihlomelo.

Inkcazo yokusetyenziswa kwezidakamizwa ezinokubaluleka kwemali ebizwa ngokuba yi-Medicare Part D kufuneka ihlangabezane neendlela ezilandelayo:

• Ukukhutshwa kwezidakamizwa zamachiza oqhubekayo ngaphandle kwekhefu kwithuba leentsuku ezingama-63 okanye ngaphezulu kuba uqale ukufaneleka ukubhalisa kwi-Medicare Part D.
• Ixabiso le- actuarial ye-inshurensi lilingana okanye likhulu kunexabiso le-actuarial yecebo eliqhelekileyo le-Medicare Part D.

Uyazi njani ukuba i-post-drug coverage yakho iya kubalwa njengento yokuthenga ngetyala kwi-Medicare Part D? I-insurer yakho yangoku kufuneka ikuxelele. Abashuseli bafanele ukuba bathumele isaziso sokubhengezwa kwemali-mboleko kubo bonke ababhalisile abafanelekileyo kwi-Medicare Part D. Esi saziso sifanele sifike ngaphambi kokuba i-Medicare yakho yokuqala ibe yingxenye ye-D yokufaneleka kwaye ngaphambi kokuba kufike ixesha lokubhalisa elivulekileyo .

I-Medicare Ingxenye B kunye noMyinge onetyala

Imithetho efana nayo iyinyaniso kwi- Medicare Part B. Le nxalenye ye-Medicare ejongene neenkonzo zogqirha kunye nezogqirha, kwaye bonke abaxhamli beMedare bahlawula i-premium kwiNgxenye ye-B (ngokungafani neCandelo A, elikhululekile kubhaliso abaninzi, kuba bahlawula irhafu ye-Medicare ngenyanga yentsebenzo).

Kodwa isohlwayo sibalwa ngokungafaniyo. Kwiinyanga ezili-12 ezili-12 ongazange ubhalise kwiNgxenye B emva kokuba ufanelekile, kwaye ngelo xesha ungenayo inzuzo yokuthenga ngetyala eyathatha indawo yenkcazo yeNgxenye B, i-premium ye-Part B iya kunyuswa ngama-10 ekhulwini. Ngoko ukuba ungabhalisi kwiCandelo B kude kube ziinyanga ezingama-37 emva kokuba ufanelekile, kwaye awunayo i-creditable coverage ngelo xesha, uya kuhlawula iiprayimari zeNgxenye B eziphakamileyo ezingama-30 kunezinga eliqhelekileyo, Ukuphumla kwexesha ojongene neNgxenye B.

Ukuba uya kulibazisa ukubhaliswa kwiCandelo B, ukukhutshwa kwesikweletu sakho kufuneka kuvela kwisicwangciso esixhaswe ngumqeshi (sakho okanye umlingane wakho).

Ngokungafani neCandelo D, echazwe ngasentla, iinzuzo zezempilo ezingasetyenziswanga zithathwa njenge-creditable coverage yokubambezeleka kweCandelo B. Ukuba unomvuzo wokuthatha umhlala-phantsi wezempilo, kuya kufuneka ubhalise kwiCandelo B xa uqala ukulungelelaniswa ukuze ukhuphe ukuhlawulwa emveno kwexesha.

Isimo esandulelayo esikhoyo, amaxesha okulinda, kunye nemboleko

Ngaphambi kokuba Umthetho woNonophelo ongenakunqwenelekayo , iimeko eziye zangaphambili ziyisithintelo kubantu abafumana ukuthengwa kwiimarike, kunye nakwiimarike ezixhaswe ngumqeshi. Kwimarike yomntu ngamnye, i-inshorensi kwiinkoliso ezininzi zinokwenqaba nje izicelo ezivela kubantu abaneemeko esele ikhona ngaphambili, ngaphandle kwemeko ekhoyo ngaphambili, okanye ukwandisa i-premium. Ngokuqhelekileyo kwakungekho nkxalabo ukuba loo mntu wayenomsebenzi wokubhengezwa ngetyala okanye ayikho.

Ngoku, i-ACA ibinqanda imeko ekhoyo phambi kwayo yonke i-inshorensi enkulu yonyango ngaphandle kwezicwangciso zempilo ngamnye. Izicwangciso ezininzi azizange zifumaneke ukuthengwa ukususela ngo-2010, kodwa abantu abaye bawafumana ukususela ngaphambi kokuba i-ACA yenziwe ngokusemthethweni bayakwazi ukuyigcina ixesha elide nje ukuba umgcini-mali uza kubavumela ukuba bahlale besebenza, kwaye ezininzi zezicwangciso zazikho ngaphambili imeko engekho.

Kodwa kwimakethi exhaswe ngumqeshi, uMthetho we-Intsholongwane wokuPhathwa kwe-Intshuwalense kunye ne-Accountability Act (i-HIPAA) uye wanciphisa impembelelo yeemeko ezikhoyo ngaphambili ukususela kwiminyaka ye-1990. Ngaphantsi kwe-HIPAA, izicwangciso ezixhaswe ngumqeshi azikwazanga ukulahla abhalise ngokusekelwe kwimbali yonyango, kwaye nangona iimeko zokulinda zikhona ngaphambili, ziyakuncitshiswa okanye zichithwe xa ababhalisile bekwazi ukubonisa ubungqina bokuqala kweentengo zemboleko. Ukufunda ngokubanzi malunga nendlela i-HIPAA eyancedisa ngayo abantu abaneemeko ezisekhona ngaphambili basebenzise ukukhutshwa kwabo kwemali, bona " Iziganeko eziPhambi kwangaphambili - Ukuqonda okungazange kubonelelwe kunye neMboleko ."

Nangona i-HIPAA ikhuselekile, abantu ababhalisayo kwizicwangciso ezixhaswe ngumqeshi akusayi kubakho ukubonisa ubungqina bentengo yokukhawulwa kwemali ukuze kuphephe ixesha lokulinda kwexesha elikhoyo, njengoko i-ACA ayivumeli ixesha elilindelekileyo lokulinda.

_Imithombo:

_{Umgaqo weMimiselo yeSizwe, 42 CFR 423.46 - Ukuhlawulwa kwexesha elide.}

_{I-Code of Regulations ka-Federal, 42 CFR 423.56 - Iinkqubo zokuqaphela nokubhalwa kwimeko yokuthenga ngetyala.}

_{Medicare.gov. Icandelo B Isigwebo sokuBhaliswa kwexesha elide.}

_{Medicare.gov. Isaziso semboleko.}