Amathiphu amane okwenza ukuthi izidakamizwa zakho ze-HIV zingabi nakakhulu

Izindleko eziphezulu zokunakekela zidinga uhlelo lokuthenga olungaziwa

Ukunikeza ukunakekelwa kwempilo kwekhwalithi ye-American average kunzima ngaphandle kwenselele eyengeziwe yokugula okungapheli. Ngokusobala, kubantu abaphila negciwane lesandulela ngculaza, izinselele ezinkulu zinikezwa izindleko eziphezulu zezidakamizwa ze-HIV, isidingo sokunamathela ngokucophelela kokwelashwa , kanye nesidingo sokuqhubeka, ukwelashwa okuqhubekayo nokunakekelwa.

Ngokwesibonelo, cabangela ukuthi isilinganiso, izindleko zomuntu ngamunye ze-HIV zingaphezu kuka-$ 400,000-futhi lokhu kubantu abaqala ukwelashwa ekuseni futhi ikakhulukazi bagweme izifo ezihambisana nesifo esilandelayo (noma esingalashwa) .

Manje engeza kulezi izindleko ze-HIV zokwelapha, ezithatha umthamo wamanani aphakathi kuka $ 2,000 ngenyanga, futhi izithiyo zikhula ngokucacile. Ngisho nokutholakala kwezidakamizwa ezidakamizwa, eziningi zalezi mithi zihlala zingenakulungiswa ngenxa yezenzo "ezimbi" zokuthi ama- insurers angadinga kuphi kusuka kumaphesenti angama-20 kuya ku-50 ekhokhweni lokukhokhiswa kwemali yesiguli semithi ngayinye.

Lokhu kusho ukuthi umuntu onamaholo "aphansi" angu-20 angabhadala kalula phakathi kuka-$ 440 kuya ku-$ 480 ngenyanga ukuze athole i- Triumeq , enye indlela ejwayelekile, eyodwa yepilisi. Futhi lokho akucabangi ngisho nezindleko zokudonswa kwemali kanye nezinye izindleko ezingaphandle kwezingxenye zezinkokhelo ezingafaka izinkulungwane zamaRandi ngaphambi kokuba izinzuzo zakho zize zikhawule.

Kodwa-ke ukukhathazeka ngamathemba kungaba-ikakhulukazi kubantu abahola imali engenayo abangakwazi ukukhokhela ama-co-payments noma izinzuzo ezihlinzekwe ngamaqembu aphansi engenayo-kunezixazululo.

Abanye bangase bakudinge ukuthi ulungise isu lomshwalense wakho wamanje, kanti abanye bangakuvumela ukuba ufinyelele ezinhlelweni zokusiza okungenzeka ukuthi uzicabange ukuthi awufanelekile.

Kulabo abafuna usizo, nansi izindlela ezilula ezine zokunciphisa izindleko eziphezulu zokwelapha nokunakekelwa kwe-HIV.

1. Qala ngokukhomba ukufaneleka kwakho kosizo

Ukungaqondi kahle ukuthi izinhlelo zokusiza i-HIV zenzelwe ukusiza kuphela abantu baseMelika abathola imali encane kakhulu.

Futhi kuyilapho kuyiqiniso ukuthi izinhlelo eziningi zezinhlangano zikahulumeni nezombuso zikhawulela ukufinyelela kulabo abahlala ngaphansi noma ngaphansi kwe-federally poverty poverty line, akuzona njalo.

Njengoba kunikezwe izindleko eziphakeme zokuphathwa kwegciwane lesandulela ngculaza nokunakekelwa, inamba eningi emangalisayo iyatholakala kubantu abathola imali engama-dollar ayi-65,000 noma imindeni enomholo wonyaka wezingu-80 000. Lokhu kungenxa yokuthi izinzuzo zihlinzekwa kakhulu kulabo abathola imali engenayo eguquguqukayo ehlelwe phansi kunamaphesenti angu-200 kuya ku-500 amaphesenti wezinga lobuphofu elisemthethweni (noma i-FPL).

Ukucacisa, imali engenayo yonyaka eyashintshayo (noma i-MAGI) ayiyona inani lemali wena nomngane wakho oshade naye owenza isikhathi esingaphezu konyaka. Esikhundleni salokho, imali engenayo ehlelekile (i-AGI) itholakale ekubuyiselweni kwentela yakho yonyaka (umugqa 37 ngo-1040, umugqa 21 ku-1040A, nolayini wesi-4 ku-1040EZ) kanye nokubuyisela emuva okulandelayo:

Njengoba lezi zibalo zikhona, ungakwazi ukubala i-MAGI yakho futhi unqume ukuthi iwela ngaphansi kwesigqebhezana se-FPL esinikezwe uhlelo oluthile lwesifundazwe, lombuso noma oluxhaswe ngasese.

Vele ukwandise i-MAGI yakho ngomngcele obekiwe (isib., Amaphesenti angaphansi kwama-300 we-FPL) ukuze ubone ukuthi ufaneleka yini.

I- federal level level (FPL) , okwamanje, isilinganiso esinikezwe uMnyango Wezempilo Nemisebenzi Yomuntu wase-US (DHHS) ukucacisa ukuthi umuntu noma umndeni ufanelekile yini izinhlelo zokusiza zikahulumeni ezifana neMedicaid . Ngo-2016, i-DHHS ibeke imihlahlandlela elandelayo ye-FPL kubantu kanye nemindeni:

(I-FPL kokubili i-Alaska neHawaii incane kakhulu.)

Ukusebenzisa le mihlahlandlela, umuntu ogama lakhe elingaphansi kwama-138 amaphesenti we-FPL angakulungele ukuxilongwa nge-Medicaid esekelwe engenayo kuphela. Ngokufanayo, usizo lungatholakala kulowo i-MAGI yakhe iphansi ngamaphesenti angu-200 noma ngaphezulu kwamaphesenti angu-500 e-FPL. Isikhathi esiningi esinganikeza izinzuzo emindenini ephezulu engenayo ephila ne-HIV.

Uphakama kangakanani?

Ezimweni ezinzima zama dollar, umbhangqwana oziqashile waseMassachusetts ohambisa ngokubambisana nemali engenayo yonyaka ka-R90 000 kanye nomshuwalense wezempilo wangasese ungase ube ne-MAGI engaba ngu-$ 76,000. EMassachusetts, ukufinyelela kuHlelo Lokusiza Ngezidakamizwa ze-HIV (HDAP) luvulekile kumabhangqwana anama-MAGI angaphansi kwamaphesenti angama-500 e-FPL (noma $ 80,100 ngo-2016). Phakathi kwalokhu kubalwa, lo mbhangqwana uzoba i-HDAP efanelekile.

Ngokuphambene nalokho, umbhangqwana ofanayo ngeke ukwazi ukufaneleka eTexas njengoba nje ukufaneleka kwesimo sezwe kufakwe ngamaphesenti angu-200 eFPL (noma $ 32.040 ngo-2016). Kodwa-ke, izinhlelo eziningi ezixhaswe ngemali ( bheka ngezansi ) zingase zitholakale kulabo abakhuphe imali engenayo.

2. Thatha indlela yokuHlola lapho ukhetha uhlelo lomshwalense

Ukusebenza ukuthi iyiphi inqubo engcono kakhulu wena nomndeni wakho kuthanda ukuhlanganisa iphazili efanelekayo. Uma ungumuntu ophila negciwane lesandulela ngculazi, ngokuvamile uzoba ukhokhelo wakho waminyaka yonke kanye ne- deductible yakho yonyaka kanye nezindleko zakho zokukhokhela izidakamizwa zaminyaka yonke ukuze ulinganise ukusetshenziswa kwakho kwezempilo. I-equation elula ngokwanele, izobonakala.

Noma akunjalo?

Njengoba kunikezwe izindleko eziphezulu zezidakamizwa ze-HIV, akuyona into engavamile ukuzithola ukhokhela ngaphezulu-noma-ngaphansi izindleko zenyanga zenyanga kungakhathaliseki ukuthi uthola inqubomgomo ephezulu yokukhokhela ama-premium / aphansi / okuphansi okukhokhelwayo okukhokhelwayo noma i-premium / high high deductible / high co-pay policy.

Lokhu kungenxa yokuthi izidakamizwa ze-HIV zizohlala zibekiwe kwi-"tiel" ephakeme ebiza izidakamizwa uma unomgomo ophansi wezindleko. Futhi, ngisho noma kungenjalo, imali yakho yokudonswa yonyaka cishe iyobekwa phezulu kangangokuthi uzophela ukuchitha imali eningi ngaphambi kokuba ukwazi ukufinyelela noma yiziphi izinzuzo.

Kodwa akusiyo njalo indaba. Nazi ambalwa amathiphu alula wokukhetha inqubomgomo yomshuwalense ofanele uma ungumuntu ophila ne-HIV:

3. Yenza Ukusetshenziswa Okuhle Kwe-Adap Izinzuzo

Uhlelo lwe- AIDS Drug Assistance Program (i-ADAP) luye lwabhekwa isikhathi eside njengesisombululo sokuqala semithi ye-HIV kubantu abaphansi kuya kubaphakathi baseMelika. Kusukela ekuqaleni kwawo ngo-1987, ububanzi besihlelo buye banda kakhulu, ngezinye izifunda manje ezihlanganisa ukunakekelwa kwezokwelapha, ukuhlolwa kwelebhu, usizo lwe-inshuwalense, kanye nokwelashwa kwegciwane lesandulela ngculazi kulezizinzuzo zabo.

Njengamanye izinhlelo ezixhaswe ngezimali, ukufaneleka kufanele kusekelwe ngokuyinhloko ngemali engenayo, imibundu yayo ingahluka kakhulu kusuka kuhulumeni kuya kuhulumeni. Ubufakazi bokuhlala kanye nemibhalo yesimo se-HIV kuyadingeka.

Ngenkathi amazwe amaningi ezokwehlisa ukufaneleka kwabomakhelwane base-US kanye nabahlali ababhaliwe kuphela, abanye abanjengeMassachusetts neNew Mexico manje banwebisa usizo lwe-ADAP kwabangaphandle abangaphandle kwamanye amazwe.

Okwamanje, izinyathelo eziyisithupha zase-US zivimbela izinzuzo kubantu ngabanye noma emindenini izimpahla zomhlaba siqu eziwela phansi ngaphansi komkhawulo othize, kusukela kusuka ngaphansi kwezingu-$ 25,000 eNew York State kuya ngaphansi kwamaRandi angu-4 500 eGeorgia.

I-ADAP yokuthola imali yokuthola imali ekhona manje ichazwe kanje:

I-ADAP ivame ukubhekwa njengomkhokheli wokuthatha isikhathi sokugcina, okusho ukuthi, ngaphandle uma ufaneleka ukuthola i-Medicaid noma i-Medicare, kuzodingeka ubhalise ngendlela ethile yomshuwalense wangasese noma umqashi osekelwe kumqashi. (I-handful of states inikeza ukuxhaswa okuxhaswe kulabo abangakwazi ukukhokha kanye / noma abavumelekile ku-Medicaid.)

Ngaphambi kokuba uzibophezele kunoma yimuphi umkhiqizo womshuwalense, xhumana nomhlinzeki we-ADAP wombuso wakho ukuze ubone ukuthi ufaneleka yini ukuthola usizo. Ngokusekelwe ezinhlobonhlobo zezinzuzo ozokwazi ukufinyelela kuzo, ungakhetha ukuthi ukuhlinzekwa komshuwalense kufanelekile kunesidingo sakho ngasinye.

Uma, isibonelo, izindleko zemithi yindleko zakho eziphakeme kakhulu futhi awuboni nanoma yisiphi esinye isisetshenziswa esikhulu sempilo yonyaka, ungakwazi ukukhetha umkhiqizo womshuwalense nge-premium ephansi yenyanga kanye nokudonswa okuphezulu nokuphuma ngaphandle kwe- isikhwama esiphezulu. Ngale ndlela, ungadinga kuphela ukukhokha ukuhlolwa kwakho kwegazi kabili kanye nokuvakasha kudokotela, akukho okunye okunye.

Ngakolunye uhlangothi, uma uneminye imibandela ekhona noma ubona phambili izindleko zezokwelapha eziphakeme zonyaka, ungadinga inqubomgomo ehlinzeka nge-deductible ephansi noma ngaphandle kwepokhethi. Kulesi simo, i-ADAP ingakwazi ukukhuphula kakhulu izindleko zokwelapha futhi kungenzeka, kwezinye izimo, inikeze ukufinyelela kwemithi esetshenziselwa ukuphatha izifo ezihambisana ne-HIV.

Okusemqoka yilokhu: sebenze nommeleli wakho we-ADAP futhi umnike imininingwane eminingi kokubili izinzuzo zakho zenqubomgomo kanye nokwelashwa kwamanje kwezidakamizwa. Ngale ndlela, ungenza isinqumo esiphelele esilandelayo esibhekene nesabelomali sakho nesidingo sakho sokunakekela impilo.

4. Thatha Inzuzo Egcwele Yomsizakalo Wezidakamizwa Zomkhiqizi

Uma kuziwa ekunciphiseni izindleko ezingaphandle kwe-HIV yezidakamizwa, sivame ukugxila cishe kuzo zonke izinhlelo zikahulumeni / zombuso futhi ukhohlwe ukuthi usizo luyatholakala kalula cishe wonke umkhiqizi omkhulu wezidakamizwa ze-HIV. Lezi zivame ukuhlinzekwa njengosizo lomshuwalense wokukhokhela ukukhokhelwa noma izinhlelo zokusiza iziguli ezisekelwa ngokugcwele (PAPs).

Usizo lokukhokhela i-HIV (co-pay) luyatholakala kubantu abanikezwe ngokuyimfihlo futhi linikeza imali kusuka noma yikuphi kusuka ku-$ 200 ngenyanga ukuya ekusizeni okungenamkhawulo emva kokukhokha kokuqala kwe-$ 5 (njengezidakamizwa ze-Edurant, Intelence, ne-Prezista).

Inqubo yesicelo ilula, futhi ngokuvamile ayikho imikhawulo esekelwe engenayo. Lokhu kungaba inzuzo enkulu kulabo abathengisa umshuwalense omusha, okubenza bakwazi ukukhetha imikhiqizo engabizi ephansi lapho izindleko zabo zokukhokhela izidakamizwa noma izindleko zezimali eziwela phansi ziwela ngaphansi kwenzuzo enqunyiwe yonyaka / ngenyanga.

Ake sithi, isibonelo, ukuthi usezidakamizwa ze-Triumeq, lapho umkhiqizi enikeza inzuzo yonyaka yokukhokhela ama-$ 6,000 ngonyaka. Uma i-Triumeq ifakwe kwisibopho sezidakamizwa esidinga ukukhokhelwa ngokuhlanganyela, ngokuvamile lokho kunenzuzo ngokwanele ukumboza zonke izindleko zokukhokha.

Kodwa, ngakolunye uhlangothi, ungenzenjani uma i-Triumeq iwela ngaphansi kwezingxenye ezidinga amaphesenti angu-20, amaphesenti angu-30, noma amaphesenti angu-50 eqinisekisayo? Uma kunjalo, ungase ukwazi ukuthola inqubomgomo nge-pocket ephansi ephuma ngaphandle. Khona-ke ungasebenzisa usizo lokukhokhela ukukhokhela zonke izindleko zezidakamizwa kuze kube yilapho usufinyelela esiphezulu sakho sonyaka, emva kwalokho zonke izindleko-izidakamizwa, ama-X-rays, ukuvakashelwa odokotela-zihlanganiswe amaphesenti angu-100 ngumshwalense wakho.

Enye indlela yizinhlelo zosizo lwegciwane lesandulela ngculazi (PAPs) . Ama-PAP aklanyelwe ukuhlinzeka ngemithi yamahhala kubantu abangaqinisekisiwe abangafanelekile kwi-Medicaid, Medicare, noma i-ADAP. Ukufaneleka kufanele kuvunyelwe kumuntu noma kumindeni yakhe engenayo yonyaka wangaphambilini yayingamaphesenti angama-500 ngaphansi kwe-FPL (nakuba okungekho okwenziwe ekwenzeni icala ngamacala amaklayenti e-Medicare Part D noma abantu abangagunyaziwe abanakekelwa izindleko zezempilo).

Ama-PAP angasindisa impilo yabantu abahlala emazweni afana neTexas, lapho i-Medicaid ne-ADAP ivinjelwe khona kuphela kubahlali abaphansi kakhulu (okungukuthi, ngamaphesenti angu-200 ngaphansi kwe-FPL). Namuhla, ama-PAP amaningi atholakalayo kulabo abangamaphesenti angama-500 angaphansi kwe-FPL, ngaphandle kwemingcele ehambisana nokwabiwa kwenani.

Ngaphezu kwalokho, uma ukuguqulwa kokufaneleka kwesimo ngokungazelelwe kungakufanelekeli i-ADAP, ungase ukwazi ukufaneleka ukusiza usizo lwe-PAP ngisho noma ungena ngaphandle kwemingcele enqunyiwe engenayo. Ngokubanzi, ama-PAP alula kakhulu ukubhekana nokufaka isikhalazo uma kuqhathaniswa namahhovisi wombuso, futhi ngokuvamile angakunikela kwezinye izinhlelo ezingezona uhulumeni ezinikeza usizo oluthile lwe-HIV.

Futhi ukucabanga okunye kokugcina

Ngenkathi ukuthengwa kuyisihluthulelo empumelelweni yokwelashwa, ungalokothi uvumele intengo yedwa ukuphoqa ukhetho lwezokwelapha. Ngenkathi ungakwazi ukulondoloza i-dollar embalwa ngokuchazayo okukhethwa kukho iphilisi elilodwa (isibonelo, i-Atripla) yezingxenye zomuthi ngamunye (uSustiva + Truvada), ushintsho olunjalo akumele lwenziwa ngaphandle kokubonisana ngqo nodokotela wakho wokuphatha.

Lokhu kuyiqiniso ikakhulukazi uma unquma ukushintsha emgomeni lapho ingxenye yimuphi umuthi ehlukile kulabo okwamanje okhona. Ukuguqulwa kwemithi yokwelashwa kungakhuphula ingozi yokumelana nezidakamizwa ngaphambi kwesikhathi , okuholela ekuhlulekeni kokuqala kokwelashwa .

Okubalulekile lokhu: kungcono ukuhlola ngokugcwele zonke izindlela zokusizwa ngaphambi kokucubungula noma yikuphi ukuguqulwa kokwelashwa okungahle kungonakalise impilo yakho. Ukuze uthole olunye ulwazi, xhumana ne-Partnership for Assistance Assistance (PPA) engeyona inzuzo, ehlanganisa iziguli ezizosiza ngezinhlelo zokusiza mahhala, noma i-HarborPath, iqembu elingelona inzuzo eliseCharlotte, eNorth Carolina elihambisa izidakamizwa ze-HIV ukuze zikwazi ukufaneleka , abantu abangaqinisekisiwe.

> Imithombo:

> Farnham, P .; I-Gopalappa, iC .; Isihlengo, S ..; et al. "Ukubuyekezwa Kwezindleko Zokuphila Zonke Zokunakekelwa Nezinga Lokuphila Lokulinganiselwa Kubantu Abathintekayo nge-HIV e-United States: Ukuhamba Ngesikhathi Esizayo Nokuthola Ukuhlolwa Kwangaphambili Nokungena Ekunakekelweni." I-Journal ye-Immune Deficiency Deficiency Syndromes. Okthoba 2003; 64: 183-189.

> Kaiser Family Foundation (KFF). "Isilinganiso sama-Single Premium ngabasebenzi ababhalisiwe Ngomshwalense Wezempilo Osekelwe Ezikoleni - 2015." I-Oakland, eCalifornia; kufinyelelwe ngoDisemba 8, 2016.

> KFF. "Amaphesenti Aphakathi Nenyanga Ngomuntu Ngomunye Umakethe." 2013; kufinyelelwe ngoDisemba 8, 2016.