Kuphela eNew York naseMinscow Kuye kwaqulunqwa i-BHPs
Icandelo 1331 loMthetho woNonophelo loNcedo ongenakunceda uvumela urhulumente ukuseka iNkqubo yezeMpilo eSeko (BHP) ukubonelela ngeenkonzo zempilo kubantu abafumana imali eninzi ukuze bakwazi ukufumana iMedicaid, kodwa abasafuna uncedo oluninzi kunokuba i-ACA iya kunika ngenye indlela. Naliphi na ilizwe lingasungula i-BHP, kodwa i-New York ne-Minnesota kuphela yenze njalo.
Iindleko ze-BHP zifunyaniswe ngemali kunye ne-federal finance, idibene nama-premium amancinci kunye nokwabelana ngeendleko kumalungu.
I-ACA idinga kuphela i-BHP ukuqinisekisa ukuba amalungu akudingeki ukuba ahlawule ngaphezulu kwiiprayimali kunye nokwabelana ngeendleko abaza kuhlawula phantsi kwesicwangciso sezempilo esifanelekileyo (ngokukodwa, isicwangciso sesilivere esiphantsi kwesindleko ngokwemivuzo yeprayim, kunye neplatinum okanye isicwangciso segolide-kuxhomekeke kwimali engenayo-ngokwemali ye-out-of-pocket) ekutshintshiseni, kodwa ababhalisa kwi-BHP eNew York naseMinscow banamaxabiso amaninzi aphantsi kunokuba babe nocwangciso lwempilo olufanelekileyo.
Ngubani ofanelekileyo kuMgangatho wezeMpilo weNkqubo?
Iiprogram zezeMpilo eziSiseko zikhethwa ngokhetho. Kodwa ukuba ziphunyeziwe, ukufaneleka kukuchazwe kwinqaku le-ACA:
- Uninzi lwabantu banelungelo lokufumana ingeniso ye-BHP xa benemali engenayo phakathi kweepesenti ezingama-133 (ngokwenza oko, ngama-138 ekhulwini kunye nokunganakwa kwengeniso eyakhelwe ngaphakathi) kunye nama-200 ekhulwini kwinqanaba lehlwempu. Ngomhla we-2018, umyinge ophezulu wokufumana umntu omnye u-$ 24,120. Njengoko i-ACA ibhaliwe, abantu abanemali engenayo engaphantsi kwe-133 ekhulwini kwinqanaba lehlwempu babekulindeleke ukuba babe ne-Medicaid coverage, ngoko ke i-BHP iza kubamba apho i-Medicaid ishiye khona. Nangona kunjalo, kukho iziganeko ezingama-19 eziye zanqwenela ukwandisa iMedicaid, ezenza ukuba kubekho i-gap yokungabikho kwi-18 kubo (abantu abaninzi abanomvuzo ongaphantsi kwezinga lehlwempu abavumelekanga kwiinkxaso-mali ze- premium ngokutshintshiselana). Kodwa ezi zizwe kuphela eziye zaphunyezwa kwi-BHP ziye zandisa iMedicaid.
- Ukunikezela ngokusemthethweni abafuduki abangabikho e-US ubuncinane iminyaka emihlanu bafanelekile ukuba bafumane ingxelo ye-BHP ukuba banemivuzo engaphantsi kwe-133 ekhulwini lobuhlwempu. Oku kungenxa yokuba abafudukayo abasandul 'ukungafaneleki kwiMedicaid (nangona kwimeko eye yandisa iMedicaid) kungakhathaliseki ukuba yintoni ingeniso , de kube yile mthethweni e-US iminyaka engamahlanu ubuncinane.
Amanyathelo amabini asele azinzile iinkqubo zezempilo eziphambili
Amabini amabini-eNew York naseMinnesota-asele iiNkqubo zeZiseko zoMpilo.
Inew york
I-BHP yaseNew York ibizwa ngokuba yiSicwangciso esiPhambili, kwaye safumaneka ekuqaleni kuka-2016. Iziqulatho zeCandelo eliPhambili lokujonga kunye neendleko zifumaneka apha kwaye zilapha . Ayikho iiprayimari zabhalise kunye ne ngeniso ukuya kuma-150 ekhulwini kwinqanaba lehlwempu, ngaphandle kokuba bafuna ukongeza i-dental and vision coverage. Abo baneengeniso phakathi kwe-150 ne-200 ekhulwini le-intlupheko bahlawula i-20 / ngenyanga ngenyanga.
Ngaphantsi kwesiCwangciso esiPhambili, ubhalise ngenzuzo engenayo ukuya kuma-150 ekhulwini kwintlupheko (i-$ 18,090 enye umntu ngo-2018) akanawo ama-copays okanye enye ukwabelana ngeendleko kwiinkonzo ezininzi, nangona kukho i-copays ezinokuthobeka ezinama-dollar. Abo baneengeniso ngaphezulu kwe-150 ekhulwini lezinga lehlwempu baye bahlawula iipayili yeenkonzo ezininzi, nangona kungekho ncitshulwa kwaye i-share-sharing share is far lower than it would be in a plan private through the New York State Health. eNew York).
Izibonelelo eziyimfuneko zibonelelwa ngabashurensi bangebucala abanesivumelwano kunye nelizwe laseNew York. Kukho aba-inshurensi abangama-16 abathatha inxaxheba kwisicwangciso, nangona baninzi ababonelela ngesicwangciso esiyimfuneko kwiindawo ezimbalwa zombuso ( le tstshana ibonisa apho ngamnye umshwalense enikeza iSicwangciso esibalulekileyo).
Abemi baseNew York bangabhalisela iSicwangciso esibalulekileyo ngeNew York State Health. Ukutshintshiselwa kwemali kuthatha ukufaneleka kweMedicaid, iSicwangciso esiPhambili, kunye nezicwangciso zempilo ezifanelekileyo (kunye okanye ngaphandle kwe-premium inkxaso), kuxhomekeke kwimbuyekezo kunye nezinye izinto ezifanelekileyo.
Ukususela ngoDisemba 2017, kwakukho abantu abayi-720,000 ababhalise kwiCwangciso esibalulekileyo sika-2018.
Minnesota
I-BHP yaseMinnesota ibizwa ngokuba yi-MinnesotaCare, kwaye ibe yiNkqubo yezeMpilo eSisiseko ukususela ngo-2015 (i-MinnesotaCare yinkqubo ekhoyo eMinscow ukususela ngo-1992, kodwa yaguqulwa yaba yi-BHP phantsi kwe-ACA izikhokelo ngoJanuwari 2015, umhla wokuqala ovunyelwe phantsi kwe-federal imithetho).
Isishwankathelo se-MinnesotaCare coverage sifumaneka apha. Abantu abangaphantsi kwe-21 abahlawulanga ukwabelana ngeendleko, kodwa kukho iikopi zokubhalisa abantu abaneminyaka engama-21 ubudala nangaphezulu, kunye ne-deductible ye-$ 2.95 ngenyanga (i-deductible kuphela kufuneka ihlawulwe xa ufuna iinkonzo zonyango ngenyanga).
Iintlawulo zeMinnesotaCare zisekelwe kwimali engenayo, kwaye ingaba ziphezulu njengama-80 / inyanga ngamnye ngomntu ngamnye onemali engenayo ekupheleni kwinqanaba lokufaneleka (iipesenti ezingama-200 zentlupheko, eyi-$ 24,120 enye, kunye ne $ 49,200 Intsapho yezine; qaphela ukuba intsapho yabantwana abane nale ngeniso iya kufumana i-MinnesotaCare kubazali, kodwa abantwana bayafaneleka ukufumana iMedicaid ukuba abaneminyaka engama-18 okanye abatsha).
Njengokuba kunjalo eNew York, eMinnesota izivumelwano kunye nabanini-bhankanyi bangebucala ukubonelela ngezibonelelo phantsi kweNkqubo yezeMpilo oyiNtloko. Ukususela ngo-2017, kukho iinqununu ezisixhenxe ezineenkontileka zikaRhulumente ukubonelela nge-MinnesotaCare. Abemi baseMinnesota bangabhalisela i-MinnesotaCare nge-NNure, utshintshiselwano lukaRhulumente. Ukutshintshiselwa kwenza ukuba ulungelelwaniso lwezigqibo zoNcedo lwezoNyango (iMedicaid), i-MinnesotaCare, kunye nezicwangciso zempilo ezifanelekileyo (kunye okanye ngaphandle kwe-premium inkxaso), kuxhomekeke kwingeniso nakwezinye izinto ezifanelekileyo.
Ukususela ngoNovemba 2017, kwakukho abantu abangaba ngu-93 000 ababhalise eMinnesotaKu-2018.
IiNkqubo zeMpilo eziPhambili zixhaswa njani?
Ngaphantsi kwe-ACA, urhulumente wephondo uza kunikezela ngezimali nge-BHP inkxaso elinganayo nama-95 ekhulwini kwindleko yokuba uhulumeni wesigqeba uza kuchitha kwiinkxaso ze-premium kunye nokunciphisa iindleko kwimeko (kuba abantu abagqityiweyo banokufaneleka kwi-BHP endaweni kunezicwangciso zesebe zesilivere ezisezantsi-ncinane kwizitshintshiselwano, kunye neenkxaso-mali zokuqala kunye nokunciphisa iindleko).
Ngaphambi kuka-2015, iNicroCare yayiprogram exhaswa ngemali eyenziwe nguRhulumente eyanikezela ukuxhamla kubantu abangafanelekanga kwiMedicaid, kunye nabangenayo imali ephakamileyo njengama-275 ekhulwini lobuhlwempu. Ukutshintshela kwi-BHP kwakungenzuzo ngemali kwiMinnesota, njengoko ivumelekile kwimali engundoqo yemali kunokuba ixhomekeke ngokupheleleyo kwiimali zikaRhulumente (abantu baseMinnesota abafumana imali phakathi kwama-200 ne-275 ekhulwini kwinqanaba labuhlwempu ngoku sele bezicwangciso zempilo ezifanelekileyo ngeNkxaso, njengoko I-ACA idinga ukuba i-BHP ifake kwi-cap eligunyazo kuma-200 ekhulwini kwinqanaba lehlwempu).
Kwakuyinzuzo kwizezimali eNew York ukuseka i-BHP ngokunjalo. Ukususela ngo-2001, i-New York yanikezele nge-Medicaid inkxaso-mboleko yombuso kubantu abavela kutshanje (abangazange bafaneleke kwi-Medicaid yokuxhaswa ngemali ngokubambisana kunye norhulumente kunye neseburhulumenteni, ekubeni i-Medicaid imali ayinakusetyenziswa ukugubungela abafuduki abasanda kuphuma eMelika. ngaphantsi kweminyaka emihlanu). Ekubeni i-BHP ifikeleleka kubantu abafudukayo, ukutshintshwa kweNew York kwimodeli ye-BHP kuthetha ukuba akusafanele ukuba bathembele ngokugcwele kwiimali zikaRhulumente ukugubungela abafuduki abavela kwintsimi engaphantsi.
Isigqibo soLawulo lweTrond ngo-Oktobha 2017 ukuphelisa inkxaso-mali yezemali yokunciphisa iindleko kuya kunciphisa inani lemali ye-BHP eyayifumana phambili, kodwa imali eyonke yemali ye-BHP iya kuba yimali eyayiza kutshalwa yi-federal government kwi-premium-subsidies. Imali eya kuba yichithwe kwixabiso lokunciphisa iindleko yincinci encinci yenani. Ukupheliswa kwemali yokunciphisa iindleko kusekho ukuxhalabisa ngokubanzi eNew York naseMinnesota, nangona bobabini belizwe beqhubeka nokuqhuba i-BHPs kunye ne-2018 yokufumana inkxaso kubakho abafanelekileyo abafanelekileyo abanezikhokelo ezifanayo ezisetyenziswe kwiminyaka edlulileyo.
Ngaba amanye amazwe aya kusekwa i-BHP?
Inkqubo ye-BHP iyafumaneka kuwo wonke umhlaba, kodwa akunakwenzeka ukuba ezinye iindawo ziya kugqiba ukuseka. Ngokubanzi, urhulumente kufuneka awandise iMedicaid kwaye aqiniseke utshintshiselwano lwempilo yomshuwalense wezempilo ukwenzela ukuba i-BHP ibe yinto enokwenene. Nangona iiplani zempilo ezifanelekileyo ekutshintshiseni azithembeli kuzo zonke kwiimali zikaRhulumente, i-BHP ifake urhulumente kwi-hook yokwenza imali ingabikho, ukuba i-fineral federal ayanele (zombini i-New York ne-Minnesota kufuneka ifake ezinye iindleko ze-BHPs, kwaye ukupheliswa kwemali yenkxaso-mali yokunciphisa iindleko kwandisa kwandisa intlupheko phakathi kweendleko zeprogram kunye noko urhulumente wephondo ahlawula).
Kodwa abantu kunye neentsapho ezinemivuzo encinane kakhulu kwi-Medicaid zisebenza kakuhle yi-BHPs. Kwiindawo ezingenayo i-BHP, kukho "i-cliff" ebonakalayo ngokufanelekileyo ngokwemigangatho yeprayimali kunye nokwabelana ngeendleko phakathi kweMedicaid kunye nezicwangciso zangasese ekutshintshisweni, kunye ne-premium inkxaso kunye nokunciphisa indleko kwicebo langasese ( inzuzo yokunciphisa iindleko ziyafumaneka, nangona ukuba urhulumente wesigqeba awusayi kuhlawula i-insurers ukubonelela ezo ntlawulo).
Umntu onomyinge we-Medicaid uya kuhlawula encinci okanye angabikho kwiiprayimari, kwaye ukwabelana ngeendleko kunqunyanyelwe kwixabiso elincinci phantsi kwemithetho yomthetho. Ukuba lowo mntu ufumana umncinci omncinci kwaye umvuzo wakhe ukhula ukusuka ku-$ 16,600 ukuya kwii-16,700 zamawaka (ngo-2017), uya kulahlekelwa ukufaneleka kwiMedicaid (ecinga ukuba useburhulumenteni owandise iMedicaid). Ukuba yena useburhulumenteni kunye ne-BHP kunye nengeniso yakhe iphakame kakhulu kwi-Medicaid, uya kulungeleka kwi-BHP kwithuba apho uya kuhlawula i-premium ye-nomination (okanye akukho nanye, eNew York, ngokusekelwe kwingeniso yakhe ), kwaye iindleko zakhe zangaphandle ziza kuqhubeka zithobekile.
Kodwa ukuba unesimo ngaphandle kweBHP, kuya kufuneka athenge isicwangciso sezempilo esifanelekileyo ekutshintshisweni. Ngokuxhomekeka apho ahlala khona, unokufumana ilungelo lokufumana inkxaso-mali yeprayimenti enkulu ngokwaneleyo ukufihla iindleko ezipheleleyo zeplani ye-bronze, kodwa ezo zicwangciso ziza neendleko ezingaphezulu kwee-pocket (ngokubanzi ubuncinane i-$ 6,500 ngo-2018, kwaye ngokuqhelekileyo ziphezulu njengoko i-$ 7,350 evumelekileyo kakhulu. Ukuba ukhetha endaweni yokukhetha isicwangciso sesilivere (esiza kubandakanya ukunciphisa ixabiso lentengo, ngoko ke kufuneka ube neendleko ezingaphantsi kwee-pocket), uya kuhlawula malunga neepesenti ezi-3 zomvuzo wakhe kwiiprayimari. Kwaye kunye neenzuzo zokunciphisa iindleko, uya kuhlawula ngaphezulu kwii-deductibles kunye ne-copays kunezinye zeBHP ezimbini ezikhoyo zifuna ukuba abhalise ukuba bahlawule.
Ngamanye amagama, ukusetyenziswa kwe-BHP kunceda ekugqibeleni ulwahlulo phakathi kwe-Medicaid coverage / iindleko kunye negalelo elizimeleyo / iindleko, kwaye kubangele kwiindleko zokunakekelwa kwezempilo ezingaphezulu eziphathekayo kubantu abanomvuzo wabo ophezulu kakhulu ukufaneleka kweMedicaid. Kodwa ukuseka i-BHP kunokufuna ukuba i-state isebenzise imali yayo, kwaye iya kubandakanya ukuguqulela abantu abaxhasiweyo (abafumana iiprojekthi phantsi kweeprogram zempilo ezifanelekileyo) kwinkqubo entsha, enokudidanisa abahlali baseburhulumenteni kunye nabanikezeli bezonyango, kwaye banokuphazamisa ngokuhambelana nokunyamekela.
> Imithombo:
> Imindeni yaseU.SA. Izikhokelo zeNtlupheko.
> HealthCare.gov. Funda uMthetho woNonophelo ongenakunceda. Icandelo le-4, u-Flexibility kwi-State ukuseka ezinye iinkqubo. Icandelo 1331 (iphepha 93 lombhalo).
> Isebe leeNkonzo zaBantu baseMinnesota. MinnesotaCare (Ulwazi lweNkqubo, Ukufaneleka, iiNzuzo, Ulwazi loLwazi).
> IzeMpilo yeNtshona YaseNew York. Isicwangciso esibalulekileyo.