Eminye Imithetho Ehlukile Yenza isicelo se-Medicaid kanye ne-Premium Subsidies
Uma ungumfiki ofika e-US, enye yezinto zokuqala ohlwini lwakho lokuthola ukuthola umshuwalense wezempilo. Ngokungafani namanye amazwe amaningi, i-US ayinayo yonke inzuzo yezempilo, kanti nakuba i-Medicare ne-Medicaid yizinhlelo zempilo ezixhaswe nguhulumeni, azitholakali kwabokufika abasha.
Ngakho ake sibuke imibuzo eminye evame ukubuzwa mayelana nokuthi yini etholakalayo kwabangaphandle, kufaka phakathi abafikayo nalabo abaye base-US isikhathi eside.
Ingabe i-ACA Premium Subsidies Limited kuZakhamizi zase-US?
Izinkokhelo ze-Premium (izikweletu zentela zama-premium) ezithengiswaneni zitholakale ezizakhamuzi ezikhona ngokusemthethweni, ezifaka uhlu olude lwezimo zokufuduka (inothi ukuthi i-Deferred Action for Childhood Arrivals-DACA-ayithathwa njengesimo esifanele sokufuduka ekuthengeni ukushintshaniswa).
Eqinisweni, izinsizakalo ze-premium zitholakale kwabangenayo abasafufusa abanenzuzo engaphansi kwezinga lobuphofu, okungekho icala labo abangewona abafuduki noma abafuduki abaye bahlala endaweni yase-US ngokomthetho iminyaka engaphezu kwemihlanu.
I-ACA idinga abantu abanenzuzo engaphansi kwezinga lobuphofu ukuthola iMedicaid esikhundleni sezinhlelo zangasese ekushintsheni, yingakho izinsizakalo ze-premium zingatholakali kubafakizicelo abanenzuzo engaphansi kwezinga lobuphofu. Kodwa abafuduki bamuva abafanelekile kwi-Medicaid eyesekelwa ngemali kuze kube yilapho bebehlala e-US okungenani iminyaka emihlanu (bathi banenketho yokusebenzisa imali yabo yokwandisa ukusabalaliswa kweMedicaid kwabangenayo abafudukayo, abanye abakwenzayo, ikakhulukazi uma kunjalo abesifazane abakhulelwe).
Ngesikhathi i-ACA ibhalwa, abameli beqaphela ukuthi umthamo we-ACA ophansi ongenayo wemalikelo ye-premium (okungukuthi, izinga lobuphofu) uzoshiya abafuduki bamuva abathola imali engenayo ngaphandle kokukhetha okuyiqiniso. Ngakho bahlinzekela ngokuqondile izinsizakalo ze-premium ezazohlanganisa abokufika abasha ngenzuzo engaphansi kwezinga lobuphofu.
Kule nkinga, imali engenayo yomfakisicelo iphathwa njengokungathi ibumpofu (noma amaphesenti angu-133 obukhulu bobuphofu emazweni asandise iMedicaid, lapho leyo imali engenayo ephansi kunazo zonke eyenza umuntu afaneleke ukuthola izinsizakalo ekushintsheni esikhundleni seMedicaid) . Ngo-2017, lokhu kusho ukuthi obhalisile kuzodingeka akhokhe amaphesenti angu-2.04 omholo wakhe ngenjongo yesibili yesiliva ephansi kakhulu ekushintsheni (nansi incazelo yokuthi izibalo zisebenza kanjani).
Kuyathakazelisa ukuthi igebe lokubheka ababhikishi ababezama ukuvimbela abafuduki basanda kusebenza esikhundleni sokuba izigidi ezingu-2.6 ezingezona abafakizizwe ezineminyaka eyishumi nesishiyagalolunye (18), zithi zikhethe ukungavumelani izimali zikahulumeni ukuze zandise iMedicaid (okukhethwa kukho okushiwo yiNkantolo Ephakeme ka-2012 ubusa ukuthi lokho kwaqeda ilungelo likahulumeni wesifundazwe sokumisa imali yonke yokuxhaswa nge-Medicaid ngokuzimisela kombuso ukwandisa ukwaziswa).
Ngenxa yokuthi lezo zindawo azizange zandise i-Medicaid, abantu abadala abangenabantwana abaxhomeke ekutheni ngokuvamile abavumelekile ku-Medicaid kungakhathaliseki ukuthi imali yabo iphansi kangakanani. Futhi ngenxa yokuthi izinsizakalo ze-premium azitholakali kubantu abanenzuzo engaphansi kwezinga lobuphofu (njengoba bebefanele babe ne-Medicaid ngaphansi kwe-ACA), labo bantu abanalo nje ukufinyelela okungokoqobo kumshuwalense wezempilo, njengoba bakhokhela inani eliphelele lokukhokhelwa 'Ngokujwayelekile kuyasebenza kubantu abanenzuzo engaphansi kwezinga lobuphofu.
Kodwa kuzo zonke izimo, abafuduki basanda kuvele abanomthetho okhona ngokusemthethweni bayakwazi ukuthola izinsizakalo ze-premium ngisho noma imali yabo engenayo ingaphansi kwezinga lobuphofu.
Ukushintshaniswa Kanjani Ukuthi Abafakizicelo Banikezwa Ngokusemthethweni?
Phakathi nenqubo yokubhalisa, ukuhwebelana kumele kuqinisekiswe ukuthi obhalisile ukhona ngokusemthethweni e-US Kunesigaba esenzweni lapho abantu abangewona izakhamuzi abangena khona isimo sabo sokufuduka futhi bafaka imininingwane efana nenombolo evamile noma inombolo ye-I-94 (nangu uhlu oluphelele lwemibhalo engasetshenziselwa ukufakazela isimo sokufuduka, nokuthi ungayifaka kanjani uma ubhalisa nge-HealthCare.gov; ukushintshaniswa kombuso kunezinqubo ezifanayo).
Uma ungakwazi ukufaka inombolo yedokhumenti noma uthola iphutha, uzoba nenketho yokulayisha ikhophi yemibhalo yakho yokufuduka, noma uyithumelele ekushintsheni. Uma ungakwazi ukunikeza amadokhumenti okufuduka nhlobo, ukufakwa kwakho kungaphelelwa ukukhanselwa ngokuzenzakalelayo.
Ngo-2014, kwakunabantu abangaba ngu-109 000 ababhalisiwe kwi-HealthCare.gov lapho bengakwazi ukunikeza ubufakazi bokuhlala kwezomthetho wase-US. Futhi phakathi no-2015, ukuhanjiswa kwaqedwa kwabanye abantu abangu-306,000 ababhalise izinhlelo ze-HealthCare.gov ngo-2015 kodwa babengakahlinzeki ngamadokhumenti adingekayo wokuthutha.
Ngakho-ke uma ubhalisa futhi unenkinga ngesistimu eqinisekisa isimo sokufuduka, ungasivumeli nje, uma ukufakwa kwakho kungagqanyulwa uma wenza. Finyelela ku-exchange for usizo, kungaba efonini noma kumuntu othile esikhungweni sokubhalisa, futhi uqinisekise ukuthi amadokhumenti akho avunyelwe.
Yimuphi Umthombo Otholakala Kubafaki Abafudukayo Abangu-65 noma Abadala?
Ngaphambi kuka-2014, kunezinketho ezimbalwa zokufika kwabangemuva abaneminyaka engu-65 noma ngaphezulu. Imiphakatsi yomshuwalense wezempilo yomuntu ngamunye ayengatholakali kunanoma ubani oneminyaka engama-64 ubudala, futhi njengoMedicaid, kuneminyaka emihlanu elinde ngaphambi kokuba abahambeli bamuva bangene eMedare. Ngakho-ke abafuduki abadala babevame ukuthembela kumshuwalense wokuhamba isikhathi eside, ngaphandle uma befinyelela ohlelweni oluxhaswe ngumqashi e-US
Ngisho nangemva kweminyaka emihlanu, i-Medicare yayivame ukungenakulungiswa kwabokufika. Njengoba i-Medicare ixhaswa kancane ngemali yentela ekhokhelwa abasebenzi base-US ngesikhathi sokusebenza kwabo, i- Medicare Part A (umshuwalense wesibhedlela) yi-premium-free kuphela kubantu abaye bakhokhela intela ye-Medicare okungenani iminyaka eyishumi (abashadile abahlala ekhaya bangafaneleka I-Medicare isekelwe kumlando womsebenzi womlingani).
Ngemuva kweminyaka emihlanu, abafuduki abaneminyaka engama-65 noma ngaphezulu bangathenga i-Medicare ngisho noma bengakhokhanga ohlelweni lwe-Medicare ngezintela zokukhokha. Ngo-2017, i-Medicare Part A ingu-$ 413 / inyanga kubantu abangenawo umlando womsebenzi, kanti i-Medicare Part B ingu- $ 134 / inyanga (wonke umuntu ukhokhela i-premium ye- Medicare Part B , kungakhathaliseki ukuthi umlando womsebenzi). Ukufakwa kwe- Medigap ne- Medicare Part D yizithako ezibalulekile ezingafakwa kwi-Medicare, kodwa ziza nama-premium engeziwe.
Kodwa abahambeli abahamba ngokusemthethweni bangakwazi ukubhalisela izinhlelo ezizimele emakethe ngayinye ngokushesha nje lapho befika e-US, futhi ngenxa ye-ACA, abasenakuvinjelwa ukwenza kanjalo uma bengaphezu kweminyaka engu-64 (imakethe ngayinye Ukutholakala kuyatholakala kungakhathaliseki ubudala, uma nje lowo muntu engabhalisi ku-Medicare). Ngaphezu kwalokho, izinsizakalo ze-premium zitholakala kungakhathaliseki ubudala, futhi njengoba kuchazwe ngenhla, izinsizakalo zitholakale kwabokufika basanda kunenzuzo engaphansi kwezinga lobuphofu.
Njengamanje, ngaphansi kwe-ACA, amaphrimiyamu eqembu ngalinye namancane amarekhodi asebekhulile abanjwe ngaphezulu kokuphindwe kathathu i-premium ekhokhiswayo oneminyaka engu-21 ubudala. Ngakho-ke oneminyaka engu-85 ubudala uzokhokhiswa inani elifanayo njengeneminyaka engu-64 ubudala (kuzo zombili izimo, izikhathi ezingamatshumi amathathu ezithweswe umfana oneminyaka engu-21, ngaphandle uma isimo sidinga isilinganiso esincane; eliphakeme kunamathathu kuya kwelinye).
I-American Health Care Act (AHCA), eyadlulisela iNdlu ngoMeyi 2017 futhi iphinde icatshungulwe eSenate , izokwandisa inani, kodwa-ke, ukuze abhalise abadala bebekhokhiswe izikhathi ezinhlanu ngokubhalisa abancane (noma ngaphezulu, uma isimo sifuna ukufuna ukuyeka nokusebenzisa isilinganiso esiphezulu).
Kukhona izinhlelo zomshuwalense wokuhamba kanye nezinhlelo zezempilo ezitholakalayo ezingenayo, kodwa zivame ukulinganiselwa kunamapulani atholakala ekushintshaneni, ngezinhlamvu zokuhlomula kanye nemibandela ekhona ngaphambili. Lezi zinhlelo azibhekwa njengento encane ebalulekile, okusho ukuthi inhlawulo ye - ACA yokungafihliwe kuhlolwa kulabo abavela kwamthetho abahlala ngokusemthethweni abathembele kulezi zinhlelo, ngaphandle uma bekhokhwa inhlawulo.
I-AHCA izoqeda inhlawulo ye-ACA ekuqaleni kuka-2016, kodwa kuze kube yilapho umthetho wokuqeda inhlawulo inqunywe, kusekhona inhlawulo yokungabikho okungenani okungenani okumele kubanjwe kubalulekile ngonyaka ka-2017 , ngaphandle uma ufaneleka ukuthola ukukhokhwa kwezigwegwe .
Ingabe Ummemezeli Ungangena Ekukhuleni Ngaphandle Kokubhalisa Okuvulekile?
Yebo. Ukuba yisakhamuzi sase-US noma ukuthola isimo esisemthethweni e-US yisenzakalo esifanelekayo, esinika umuntu izinsuku ezingu-60 ukuthi angene kuloluhlelo ngokusebenzisa ukushintshwa komshuwalense wezempilo (inothi ukuthi lena ingenye yezenzakalo ezimbalwa ezifanelekayo ezingabangela isikhathi sokubhalisa esikhethekile sezinhlelo zokushintshanisa , isikhathi sokubhalisa esikhethekile sitholakala kuphela ekushintsheni).
Abanye abafuduki bakamuva bangenele izinhlelo ezixhaswe ngumqashi, futhi lezo zihlelo nazo zinezikhathi ezikhethekile zokubhalisa kubantu abaqashiwe ngaphandle kokubhaliswa okuvulekile noma abanomcimbi ofanelekayo . Ngakho-ke nakuba ukubhaliswa okuvulekile- kokubili izinhlelo ezixhaswe ngabanye kanye nabaqashi-kuphela eziza ngqo kanye ngonyaka, abafuduki abasha banethuba lokubhalisa kungakhathaliseki uma befuduka.
Abangabathumeli Abangenayo Abangenayo Abanikezwayo?
Ngaphansi kwemithetho ye-ACA, abahambeli abasemthethweni bangakwazi ukubhalisa ezinhlelweni ezinikezwa nge-exchange, futhi bangathola izinsizakalo ze-premium uma imali yabo engenayo ibenza bafaneleke. Kodwa i-ACA ayinayo imibandela evumela abafuduki abangabhalwanga ukuthi bathole ukuthunyelwa.
Umthetho uvimbela ngokucacile abafuduki abangabhalisiwe ukuthi bangathengi ukuthengiselana-ngisho noma bekhokha inani eligcwele; bheka isigaba 1312 (f) (3) se-ACA . Abafuduki abangabhalwanga ngogunyaziwe nabo abakufanelekile ku-Medicaid. Njengoba bengakwazi ukubhalisa ukuhwebelana noma ukuxilongwa, abafuduki abangabhalwanga ngabangaphandle baxoshwa kwi- ACA's penalty .
I-California yaqala ukusebenzisa izimali zikahulumeni ukwenza i-Medicaid (Medi-Cal) itholakale ezinganeni ezingekho ngaphansi kwamakhompiyutha kusukela ngo-2016, kanti izingane ezingu-170 000 zathola ukuhlolwa ngenxa yalokho.
Izikhulu zaseCalifornia zifuna ukuthatha lesi sinyathelo futhi zivumele abantu abadala abangabokufika ukuba bathengise ukukhokhelwa (ngaphandle kokuxhaswa) e-California exchange, Covered California. Uhulumeni wabeka umthetho (SB10) ngoJuni 2016 ukuze uqhube ibhola kulokhu, futhi uthumele isinqumo sokukhishwa kuka-1332 kuhulumeni wesifundazwe ngoSepthemba 2016 , njengoba kuvunyelwe ukugunyazwa kombuso ukuze kuguqulwe imithetho okwamanje yokuvimbela abafuduki abangabhalwanga ukuthenga ngisho nezinhlelo zokushintshaniswa kwentengo ephelele.
Kodwa ngoJanuwari 2017, izinsuku ezimbili ngaphambi kokuba uDonald Trump ivuliwe, iCalifornia isusa isiphakamiso sawo esingu-1332 phakathi kokukhathazeka ukuthi i-Trump Administration ingasebenzisa idatha e-Covered California ukuze ithole futhi ixoshe abafuduki abangabhalwanga.
Abahambeli abangenazikhombisi-ndlela bangathola ukukhokhelwa ngaphansi kwezinhlelo ezixhaswe ngumqashi noma izinhlelo zezempilo zabafundi uma befanelekile, futhi bangakwazi futhi ukuthenga ukuthengwa kwemakethe ngamunye uma nje bezithengisa . Kodwa okwamanje, abakwazi ukubhalisa ekubhaliseni ngemali yomshuwalense wezempilo kunoma yisiphi isimo.
> Imithombo:
> Healthcare.gov. Isimo sokufuduka kanye neMakethe.
> Insizakalo yangaphakathi yeNgeniso, Inqubo Yokuthola Imali Yonyaka 2016-24 .
> Kaiser Family Foundation: I-Gap Yezokuphepha: Abadala Abangama-Uninsured Emasimini Angenzani Ukwandisa I-Medicaid. Ngo-Okthoba 19, 2016.
> Medicare.gov. I-Medicare Izindleko Zika-2017 Esikhazimulayo.
> Isikhungo SoMthetho Wezokuthutha Kwazwelonke. "Misela Ngokusemthethweni" Abantu Abafanelekile Ngaphansi Komthetho Wokunakekelwa Okunganakekelwa.