I-asterisks ehambisana nokuvinjelwa kokuphila kwansuku zonke kanye nezinhlamvu zokuhlomula zonyaka
Esinye sokuvikelwa komthengi ku-Care Affordable Act sivinjelwe ama-maximums wenzuzo yonyaka nonyaka. Ama-maxum wokuthola isikhathi esiphezulu awasavunyelwe nhlobo, ngisho nasezinhlelweni eziningi. Unyaka - kodwa hhayi impilo yonke - imingcele yokuhlomula ingaqhubeka isetshenziselwa izinhlelo eziningi, kodwa hhayi izinhlelo zeqembu.
Lokhu kusho ukuthi abathengi abasengcupheni yokuzitholela abadinga ukwelashwa komdlavuza ngehlelo lempilo elinesamba esingu-$ 300,000 sezinzuzo zokuphila.
Futhi abantu abanezimo zezokwelapha ezingapheli futhi eziyinkimbinkimbi abasasekho engozini yokukhipha uhlelo lwabo uma izikweletu zabo zokwelapha zifinyelela emngceleni othize.
Kodwa kunezigcawu ezimbalwa ezibalulekile ukuyiqonda.
Izinzuzo zezempilo ezibalulekile
Lapho i-ACA ibhalwa, abomthetho banquma ukuthi kunezinhlobo eziyishumi zokunakekelwa ezazibhekwa njengezibalulekile. Bazibiza ngokuthi izinzuzo ezibalulekile zezempilo, futhi wonke amaqembu nezinhlelo ezincane nezinhlelo ezincane nezinsuku eziphumelelayo zikaJanuwari 2014 noma kamuva kumele zibandakanye ukuhlinzekwa kwabo (amazinyo ezitholwa ngabantwana yingenye yezinzuzo zezempilo ezibalulekile, kodwa imithetho ayifani nokutholakala kwamazinyo ezingane).
Umkhawulo wokuphila kwama-lifetime kanye nama-maximum wonyaka wenzuzo usebenza kuphela ezinsizeni ezibalulekile zezempilo. Kuyavunywa, cishe konke ukunakekelwa okudingekayo kwezokwelapha kuwela ngaphansi kwesambulela sezinzuzo zezempilo ezibalulekile, ngoba ezinye zezigaba ziningi kakhulu (isibonelo, ukunakekelwa kwabagulayo kungenye yezinzuzo ezibalulekile zezempilo, kanti ukunakekelwa kwesineke kungenye).
Kodwa njengesibonelo, izinsizakalo zamazinyo omdala azibhekwa njengenzuzo ebalulekile yezempilo ngaphansi kwe-ACA. Kuyinto engavamile kakhulu ukuthola uhlelo lwezempilo oluhlanganisa ukuhlanganiswa kwamazinyo omdala okuhlanganisiwe, kodwa kukhona. Kodwa-ke, izinhlelo ezinjalo zingakwazi ukubeka inqwaba yezinzuzo zonyaka nezinzuzo zokuphila kwamazinyo omdala wamazinyo, ngoba akuyona enye yezinzuzo zezempilo ezibalulekile.
Izindaba zenethiwekhi
Ukuvinjelwa kwe-ACA ngesikhathi sokuphila kanye nemingcele yokuhlomula yonyaka kusebenza kokubili ukunakekelwa kwenethiwekhi kanye nokungaphandle kwenethiwekhi. Kodwa izinhlelo zezempilo azidingeki ukuba zihlinzeke ukunakekelwa kwe-out-of-network. Uma benza kanjalo, abakwazi ukuphoqa umkhawulo we dollar ngezinzuzo zonyaka noma zokuphila.
Ama-HMO ngokuvamile agcina kuphela ukunakekelwa okutholakala kubahlinzeki be-in-network, ngaphandle uma kwenzeka okuphuthumayo okwenzeka ngaphandle kwendawo yesevisi, noma lapho indawo eseduzane yokuphuthumayo engeyona ingxenye yenethiwekhi ye-HMO. Kodwa ngenxa yokunakekelwa okungekho kokuphuthumayo okutholiwe ngaphandle kwenethiwekhi ye-HMO, isiguli ngokuvamile sizoba nesibopho kulo lonke umthethosivivinywa.
Amapulani we-PPO ngokuvamile ahlanganisa ukunakekelwa kwe-out-of-network, kodwa ngekhasi eliphakeme elidonswe futhi elingaphansi kwekhasi lesiguli. I-ACA's $ 6,850 yekhanda ekukhokhweni kwe-out-of-pocket ngo-2016 isebenza kuphela ekunakekelweni kwenethiwekhi; iziguli ezikhetha ukuphuma ngaphandle kwenethiwekhi noma ngokungazisebenzisi umhlinzeki ongewona wenethiwekhi zingaphetha ngezindleko eziphezulu kakhulu ezingaphandle kwe-pocket. Kubuye kube yinto evamile kakhulu i-PPO ihlela ukuba ibe nokuchayeka okungekho emkhakheni wokukhishwa kwemithi yokwelapha etholakala ngaphandle kwenethiwekhi yomsebenzi. Kodwa uma lolu hlelo luhlanganisa ukunakekelwa kwe-in-network kwezinzuzo zezempilo ezibalulekile, ngeke ukwazi ukubeka isikhathi esiphezulu sokuzuza noma sokuzuza ngonyaka.
Qaphela ukuthi kubalulekile ukuqonda umehluko phakathi kwama-caps wokuhlomula nama-caps-out-of-pocket; i-cap yokuhlomula iyinani eliphakeme ukuthi inkampani yomshuwalense izokhokha, futhi yilokho okungasavunyelwe. I-out-of-pocket cap yilapho isiguli kufanele sikhokhele ngesikhathi sonyaka onikeziwe, kungakhathaliseki ukuthi izimangalo zayo eziphelele ziphakeme kangakanani; yilokho okufakwe ku-$ 6,850 ngo-2016 ukuthola ukunakekelwa kwe-inthanethi ngezinzuzo ezibalulekile zezempilo (i-cap izoba ngu-$ 7,150 ngo-2017; inothi ukuthi lokhu kuyisikhulu esivunyelwe - izinhlelo zingakwazi futhi zibe nemingcele ephansi kakhulu ye-pocket kunalokhu).
Kukhona okungenzeka kube nemingcele, abakwazi nje ukuba babe ngama-dollar
Ukuvinjelwa kwe-ACA ngesikhathi sokuphila kanye nemingcele yonyaka yokuhlomula yezinzuzo zezempilo ezibalulekile kusebenza kumingcele echazwe ngokwemadola.
Ngakho izinhlelo zezempilo azisekho imali engu-$ 3,000,000 yenzuzo yokuphila, isibonelo, noma i-cap $ 500,000 yenzuzo yonyaka.
Kodwa izinhlelo zezempilo zisakwazi-futhi zenze-zibeke eminye imikhawulo ekunakekeleni okungakanani okuzozihlanganisa. Isibonelo, uhlelo lungabonisa ukuthi luzohlinzeka ngezivakashi ezingama-20 ukuvakashelwa ngokomzimba ngonyaka, noma izinsuku ezingama-60 zobuhlengikazi abanekhono ngonyaka. Ngisho nalapho ukunakekelwa okubuzwayo kuwela ngaphansi kweminye imidwebo ebalulekile yokuhlomula kwezempilo, abathwali bangakwazi ukunciphisa ukufakwa. Abavele nje abakwazi ukukwenza ngomkhawulo okukhulunywa ngawo emarereni. Ngakho ngeke bakwazi ukusho ukuthi ungaba nokwelapha okungokwenyama okungu-$ 2,000 ngonyaka, naphezu kokuthi bangasho ukuthi ungavakashela iziguli ezingu-20 kuphela ngonyaka.
Imithombo:
I-Federal Register, i-PPACA - HHS Isaziso seNzuzo neMigomo Yokukhokha ka-2017. Ifinyelele ngo-5/14/2016.
I-Yarbrough, uCassandra, i-MPP; Vujicic, Marko, PhD ;; Nasseh, Kamyar, PhD., I-Health Policy Institute kanye ne-American Dental Association, Izinzuzo Eziningi Zamazinyo ku-2015 Umshwalense Wezempilo Emakethe Ezimakethe. Ifinyelele ngo-1/19/2016.