Uma usungumshwalense wezempilo omusha, uqonda ukuthi udingeke ukhokhe kangakanani izindleko zezindleko zakho zokunakekelwa kwezempilo, uma kufanele ukhokhe, nokuthi malingakanani ithebhu uhlelo lwakho lwezempilo oluzoyithatha lungase ludideke.
Umshuwalense wezempilo owehliswayo kanye ne- copayments yizo zombili izinhlobo zokwabelana ngezindleko , okubhekisela endleleni izinkampani zomshuwalense wezempilo ezihlukanisa ngayo izindleko zokunakekelwa kwezempilo nawe.
Ngakho-ke, umehluko phakathi kwe-deductible ne-copayment? Zihlukana uma kufanele ukhokhe, kufanele ukhokhe malini, futhi yini eseleyo ukuze uhlelo lwakho lwezempilo lukhokhwe.
Yini Umshwalense Wezempilo Owenziwe Deductible?
I-deductible yinani elilinganiselwe olikhokhela unyaka ngamunye ngaphambi kokuba umshwalense wakho wezempilo ukhawule ngokugcwele. Uma usukhokhele imali yakho yokudonswa, uhlelo lwakho lwezempilo luqala ukuthatha isabelo salo semali yezinkokhelo zezempilo. Nakhu ukuthi kusebenza kanjani.
Ake sithi uhlelo lwakho lunokudonswa imali engu-$ 2,000, futhi lubala zonke izinsizakalo ezingasizo zokuvimbela kuze kube yilapho zihlangene. Uthola umkhuhlane ngoJanuwari bese ubona udokotela wakho. Ibhilidi kadokotela lingu-$ 200 (ngemuva kwesaphulelo sakho sezinhlelo zempilo). Unesibopho kulo lonke umthethosivivinywa ngoba awukakhokhi imali yakho yokudonsa okwamanje kulo nyaka. Ngemuva kokukhokha imali ekhokhwa idokotela engu-$ 200, unayo i-$ 1,800 eyashiywe ukuhamba nge-deductible yakho ngonyaka.
Ngo-Mashi, uwela futhi uphule ingalo yakho. Umthethosivivinywa ngemuva kwesaphulelo sakho sokuxoxisana sezempilo sika-$ 3,000.
Ukhokha u-$ 1,800 walowo mthethosivivinywa ngaphambi kokuba uhlangabezane ne-deductible yakho yonyaka ka-$ 2,000. Manje, umshuwalense wakho wezempilo ukhalela futhi usize ukhokhe lonke imali.
Ngo-Ephreli, uthola ukukhishwa kwakho kususiwe. Umthethosivivinywa u-$ 500. Njengoba usuvele uhlangabezane ne-deductible yakho yonyaka, akudingeki ukhokhe noma yikuphi ekubhekaneni ne-deductible yakho.
Umshwalense wakho wezempilo ukhokhelwa ngokugcwele kulo mthethosivivinywa.
Kodwa-ke, lokhu akusho ukuthi umshuwalense wakho wezempilo uzokhokha lonke umthethosivivinywa futhi akudingeki ukhokhe noma yini. Ngisho noma usuqedile ukukhokha imali yakho yonyaka, ungase udingeke ukukhokha imali noma ukukhokhelwa kwemali , kuze kube yilapho usuhlangabezane nesiphakamiso esiphezulu seplanethi yakho ngonyaka.
Ngaphansi kwe-ACA, ngo-2018, wonke amacebo angakaze azalwe , ama-non-grandmothered aphephe izindleko ezingaphandle kwe $ 7,350 kumuntu oyedwa kanye no-$ 14,700 emndenini. Iningi lezinhlelo zezempilo cap libhalisa izindleko ezingaphandle kwamapokhethi emazingeni angaphansi kwalolu mingcele, kodwa azikwazi ukudlula.
Umkhawulo ongaphandle kwe-pocket usebenza kuwo wonke ukunakekelwa kwe-in-network okubhekwa njengenzuzo ebalulekile yezempilo . Ihlanganisa inani elibhalisa ukukhokha imali ekhishwayo, i-copays, ne-coinsurance; uma izindleko ezihlanganisiwe zifinyelela ku-plan-out-of-pocket esiphezulu, ilungu ngeke likhokhe enye enye yonke into ngonyaka (ngokuba in-inethiwekhi, ukunakekelwa okudingekayo kwezokwelapha okubhekwa njengenzuzo ebalulekile yezempilo), kungakhathaliseki ukuthi ngabe ngabe ngabe ufuna i-copay noma i-coinsurance.
Iyini ikhophi yomshuwalense wezempilo?
Ikhophi yokukhokha yinani elilinganiselwe olikhokhela njalo uma uthola uhlobo oluthile lwenkonzo yokunakekelwa kwezempilo.
Nakhu ukuthi kusebenza kanjani.
Ake sithi umshuwalense wakho wezempilo udinga ikhophi ye $ 30 njalo uma ubona udokotela wakho wokunakekela oyinhloko , u-$ 50 njalo uma ubona udokotela wezobuchwepheshe, no-$ 20 njalo uma ugcwalisa umuthi ojwayelekile .
Uma ubona i-PCP yakho ngo-Meyi 1, ukhokha udokotela u-$ 30 ngalolo suku. Uhlelo lwakho lwezempilo luhola konke okusemthethweni kulowo mvakashele. Uma ubuyela emuva ku-PCP yakho ngo-Meyi 5, kufanele ukhokhe enye ikhophi ye-$ 30 yokukhokha. Uhlelo lwakho lwezempilo lukhokhela lonke lo mthethosivivinywa, futhi.
I-PCP yakho ikuthumela kuchwepheshe. Uma ubona ochwepheshe ngoMeyi 12, ukhokha ikhophi ye-$ 50 kumchwepheshe. Umshuwalense wakho wezempilo ukhokhela okusele kwesigqebhezana sochwepheshe.
Inani olikhokhayo ngokukhokhwa kwemali ngokuvamile alinakubalwa ekuhlangabezaneni ne-deductible yakho, kodwa kubalwa ekubhekisweni kwezindleko zakho eziphelele zonyaka (kubonga ku-Obamacare, inani lakho eliphelele lokuphuma ephaketheni likhishwa minyaka yonke). Ngakho uma une $ 2,000 deductible ngaphezu ama-copay ahlukahlukene ukuze ubone udokotela wakho oyinhloko wokunakekelwa noma udokotela noma unomuthi ogcwalisiwe, kuzodingeka uhlangabezane ne-deductible yakho yezokwelapha ngaphandle kwalezo ezihlanganiswe nama-copays.
Kuyini okufanayo?
I-deductible kanye nemali yokukhokhwa kwemali kokubili yizinkokhelo ezilinganiselwe, okusho ukuthi azishintshi ngokususelwa ekutheni inani lezinsizakalo zokunakekelwa kwezempilo libiza kangakanani. Lokhu kuhluke kolunye uhlobo lwezokwabelana ngezindleko, ukuqinisekiswa kwezimali, okukhokhwa kukho iphesenti yesikweletu kodwa kunani elilinganiselwe.
Uyazi uma ubhalisela umshuwalense wezempilo ukuthi ingakanani imali yakho eyokwenzelwa yona leyo minyaka; ayifani ngokususelwa kunhlobo luni lwezinsizakalo ozithola noma ukuthi lezo zinsizakalo ziyabiza kangakanani. Uma unemali engu-$ 1,000 ekhokhwayo, uzokhokha imali engu-$ 1,000 ekhishwayo uma ngabe izibhedlela zakho zibiza u-$ 2,000 noma u-$ 200,000. Kodwa amanye amapulani ane-deductible ehlukile esebenza emithini yemithi kadokotela, ngaphezu kwe-deductible kwezinye izinsizakalo zezokwelapha. Futhi i- Medicare Ingxenye A ine-deductible esebenza esikhathini esizuzayo kunokuba unyaka wekhalenda. Kodwa isamba semali esinqunyiwe, isethi esisebenzayo kungakhathaliseki ukuthi kunani izindleko zokunakekelwa kwezokwelapha.
Uyazi futhi uma ubhalisela umshuwalense wezempilo ukuthi izidingo zakho ze-copayment yezempilo yakho ziyini, ngoba nazo ziyimali ehleliwe. Uma ubona ochwepheshe, uma uhlelo lwakho lwezempilo ludinga i-copay ye $ 50 ukuze ubone isiprofetho, uzokhokha u-$ 50 ukuthi ngabe umthethosivivinywa oyingcweti uwu-$ 100 noma u-$ 1000 (uma nje ubuchwepheshe bezinhlelo zenethiwekhi yakho yezempilo, futhi ugcwalisa noma yikuphi ukugunyazwa noma izidingo zokudlulisela ukuthi uhlelo lwakho lwezempilo lunalo).
Ukukhokhwa kwezimali kanye nokwehliswa kwempahla nakho kufana nalokho, ngenxa ye- Care Affordable Act , e-United States izinsizakalo ezithile zokunakekelwa kwezempilo ezivimbelayo azikho ngaphansi kwe-copayments noma uhlelo lwakho lwezempilo oludonswe (ngaphandle uma unesiphakamiso esikhulu). Uma ubona udokotela ngokuvakashela ukunakekelwa kwezempilo okuvimbela, ngisho noma ungazange ukhokhe i-dime ngokukhipha imali yakho yonyaka, ngeke ukhokhe noma yikuphi ukukhishwa kwakho kokuvakasha. Ngeke ukhokhe ikhophi yokuvakasha, noma (inothi ukuthi ezinye izinsizakalo ezingase zinikezwe ngesikhathi sokuvakashelwa ukuvimbela ngeke zihlanganiswe ngokugcwele, ngoba izigunyaziso zokunakekela izivimbelo zifuna kuphela izinzuzo ezithile zokunakekelwa kokuzivikela okufanele zihlanganiswe ngokugcwele. Hlola nomshuwalense wakho ngaphambi kokuthi uhlele ukuvakashelwa kokuvikela ukuvikela ukuqinisekisa ukuthi uyaqonda ukuthi yini ehlanganisiwe nokuthi yini engekho).
Yini ehlukile?
I-deductible ngokuvamile inani okufanele ukhokhe futhi kaningi kufanele ukhokhe. Ama-Deductibles ngokuvamile akhulu kunama-copays, kodwa kufanele ukhokhe kuphela kanye ngonyaka (ngaphandle uma ukhona kwi- Medicare , lapho kwenzeka ukuthi i-deductible isebenze isikhathi ngasinye kunenzuzo yokulandela unyaka wekhalenda). Uma usuhlangabezane ne-deductible yakho yonyaka, akudingeki ukhokhe futhi kuze kube ngonyaka ozayo.
Kodwa ama-copayments aqhubekayo. Uqhubeka ukhokhela ama- copayments njalo uma uthola inkonzo yokunakekelwa kwezempilo okuyidingayo kungakhathaliseki ukuthi yimaphi ama-copayments okhokhile phakathi nonyaka. Indlela kuphela yokuyeka ukukhokhwa kwama-copayments uma usufinyelele ohlelweni lwakho lwezempilo olungaphandle kwepokhethi ngonyaka. Ukufinyelela okuphezulu kwe-pocket kungavamile kubantu abaningi, futhi kwenzeka kuphela uma usuphethe izindleko zezempilo eziphakeme ngempela ngonyaka.
Indlela Abasebenza Ngayo Ngamanye
Funda ukuthi i-deductible yakho ne-copay bahlanganyela kanjani ku-" Ingabe I-Copays Count Toward Your Health Insurance Deductible? " Nethi " Yini Eyibheka Ngomshwalense Wempilo Yakho ? "
> Imithombo:
> I-Federal Register, uMnyango WezeMpilo Nemisebenzi Yabantu. Ukuvikelwa kwesineke kanye noMthetho Wokunakekelwa Kwezinkinga; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2018; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi olusetshenzisiwe futhi oluhlelekile. NgoDisemba 22, 2016.