Uyini umehluko phakathi kwe-copayment ne-coinsurance? Kokubili i-copay kanye ne- coinsurance kusiza izinkampani zomshuwalense wezempilo zisindise imali (ngakho-ke ugcine amaphrimiyamu akho aphansi) ngokukwenza ube nesibopho sezingxenye zakho zemithetho yezempilo . Bobabili yizinhlobo zokwabiwa kwezindleko , okusho ukuthi ukhokha ingxenye yezindleko zokunakekela kwakho futhi inkampani yomshuwalense wezempilo ikhokha ingxenye yezindleko zokunakekela kwakho.
Umehluko phakathi kwe-copay no-coinsurance ungaphakathi
- ukuthi isabelo sezindleko sihlukaniswa kanjani phakathi kwakho nenkampani yomshuwalense wezempilo.
- inani lomngcipheko wezezimali ngalinye elikubeka kuwe.
Indlela i-Copay esebenza ngayo
Ikhophi yokukhokha isamba esibekiwe okhokha ngaso sonke isikhathi uma usebenzisa uhlobo oluthile lwenkonzo yokunakekelwa kwezempilo. Isibonelo, ungase ube ne-$ 40 copay ukubona udokotela oyinhloko wokunakekela kanye nekhophi ye-$ 20 ukuze ugcwalise umuthi. Ukhokha inani le-copay; inkampani yakho yomshuwalense wezempilo ikhokhela lonke lo mthethosivivinywa. I-copay yakho yalowo msebenzi othize ayishintshi kungakhathaliseki ukuthi udokotela uyaliphikisana kangakanani, noma ngabe ubiza imali engakanani.
Ngokungafani ne- deductible ekhokhwa kanye ngonyaka, ukhokha ikhophi ngayinye uma usebenzisa lolu hlobo lwezinsizakalo zezempilo. Ngakho-ke, uma unayo i-copay ye-$ 40 ukuze uvakashele ihhovisi likadokotela futhi ubona udokotela izikhathi ezintathu ngesonto lakho elinyanyisiwe, uzodingeka ukhokhe u-$ 40 ukuvakashelwa ngamunye, kube ngu-$ 120.
Ukuthi Ukusebenza Kwezimali Kusebenza kanjani
Ngesiqiniseko sokukhokha, ukhokha iphesenti yezindleko zesevisi yezempilo (ngokuvamile emva kokuba uhlangabezane ne-deductible yakho, futhi kufanele uqhubeke nokukhokha imali yezimali kuze kube yilapho usuhlangabezane nesiphakamiso esiphezulu seplanethi yakho ngonyaka). Ikhamphani yakho yomshuwalense wezempilo ikhokhela zonke izindleko.
Isibonelo, uma unesiqiniseko se-20% esibhedlela, lokhu kusho ukuthi ukhokha imali engama-20% wezindleko zesibhedlela, kanti umshwalense wakho wezempilo ukhokha enye i-80%.
Njengoba izinkampani zomshuwalense wezempilo zixoxisana ngemali ehlisiwe kusuka kubanikezeli babo be- in-network , ukhokha imali yezinkokhelo ngezinga elincishisiwe . Isibonelo, uma udinga i-MRI, indawo ye-MRI ingaba nesilinganiso esilinganiselwe sama- $ 600. Kodwa, njengoba inkampani yakho yomshuwalense wezempilo uye waxoxisana nesilinganiso esinqunyiwe esingu-$ 300, izindleko zemali yakho yezimali zingaba ngu-20% wezinga lokuncishiswa kwamaRandi angu-300, noma i-$ 60. Ukukhokhisa imali yokukhokhisa ngesilinganiso esiphelele kunokuba isilinganiso esinqunyiwe yisiphambeko esivamile sokukhokhisa esizokukhokhela ngaphezu kwakho okufanele ukhokhe. Uma uhlelo lwakho lusebenzisa imali yezimali, uzofuna ukuqinisekisa ukuthi umthethosivivinywa uthunyelwa kuqala kumphathi wakho womshuwalense wezempilo nganoma yikuphi ukulungiswa okudingekayo, bese ingxenye yakho ikhokhelwe kuwe (ngokuphambene nokukhokha iphesenti lakho phezulu ngaphambili wenkonzo).
Izinzuzo kanye Nokuzikhokha kweCopay vs. Coinsurance
Inzuzo ye-copay yukuthi akumangazi ukuthi ingakanani insizakalo izokukhokhela. Uma i-copay yakho ingu-$ 40 ukubona udokotela, wazi kahle kangakanani ukuthi uzokweleta ngaphambi kokwenza ngisho nokuqokwa.
Ngakolunye uhlangothi, uma le nsizakalo idla kancane kunekhophi ye-copay, kufanele ukhokhe i-copay egcwele (lokhu kungase kube yinye isikhathi ngenxa yemigomo ejwayelekile, okungenzeka ibe nezindleko zokuthengisa kangangokuthi ikhophi yakho yezempilo ye-Tier 1 izidakamizwa zingase zibe ngaphezulu kunezindleko zokuthengisa izidakamizwa). Uma ubona udokotela njalo noma ugcwalisa imiyalelo eminingi, ama-copayments angafaka ngokushesha.
I-Coinsurance iyingozi kunawe ngoba ngeke ukwazi ukuthi uzokweleta malini kuze kube yilapho insizakalo isenziwa. Isibonelo, ungase uthole isilinganiso se- $ 6000 ngokuhlinzwa kwakho okuzayo. Njengoba unesiqiniseko sezimali esingu-20%, isabelo sakho sezindleko kufanele sibe ngu-$ 1200.
Kodwa, kuthiwani uma udokotela ohlinzayo ehlangana nenkinga engalindelekile phakathi nokuhlinzwa futhi kufanele alungise lokho, futhi? Isikweletu sakho sokuhlinzwa singaphuma ku-$ 10,000 kunokuba kuqhathaniswa nokulinganisa kwasekuqaleni kwe-$ 6000. Njengoba u-coinsurance yakho ingu-20% wezindleko, manje usufanele ukhokhe u-$ 2000 kunama-$ 1200 owawuhlelile (uhlelo lwakho lwezempilo lwe-out-of-pocket maximum luzofaka inani elikweleta lona, ngakho lokhu akuyona ingozi engenamkhawulo).
Izinkampani zomshuwalense zithanda amalungiselelo okubambisana nezimali ngoba ziyazi ukuthi kuzodingeka ubeke isabelo esikhulu sezindleko zezinto ezibizayo ngaphansi kohlelo lokukhokhelwa kwezimali kunokuba ungathanda uma ukhokha ikhophi elula. Bathemba ukuthi kukugqugquzela ukuqinisekisa ukuthi udinga ngempela ukuhlolwa okubizayo noma inqubo ngoba ingxenye yakho yezindleko ingaba nemali eningi, noma ngabe i-20% kuphela noma i-30% yesikweletu.
Ngabe i-Deductible iyasebenza?
Izinhlelo eziningi zomshuwalense wezempilo zine- deductible okumelwe zihlangane ngaphambi kokuthi kuhlukaniswe imali yezimali. Lokhu kusho ukuthi uzokhokha izindleko ezingu-100 zezinhlelo zokuxoxwa kwezokwelapha kuze kube yilapho usufinyelela ekudonseni, bese kuhlukaniswa imali yezimali uhlangabezana ne- out-of-pocket yakho esiphezulu yonyaka.
Ama-Copay ngokuvamile asebenza ngokuqondile kusukela ekuqaleni, noma ngabe awuzange uhlangabezane ne-deductible yakho okwamanje, ngoba bavame ukufaka izicelo ezinsizakalweni ezihlukile kwi-deductible. Ngakho-ke uhlelo lwakho lungase lube ne-deductible kanye ne-coinsurance esetshenziswa ekunakekeleni iziguli, kodwa ama-copays asebenza ekuvakasheni ihhovisi kanye nemigomo.
Indlela i-Copay ne-Coinsurance esebenzisene ngayo ndawonye
Ngokujwayelekile akudingeki ukhokhe kokubili ikhophi kanye nokuqinisekiswa kwemali kuleyo nsizakalo yezempilo. Isibonelo, kungaba okungavamile ukukhokha i-copay yama-$ 40 ukuze uvakashele ihhovisi likadokotela, futhi kufanele ukhokhe imali yokukhokhela imali engu-20% yezindleko kulolo hambo olufanayo. Kodwa-ke, akusikho emthethweni kubanxusa bezempilo ukuthi badinga lokhu. Funda isifinyezo sezinzuzo ngokucophelela uma ukhetha uhlelo lwezempilo ukuze uqaphele uma uhlelo lwezempilo ludinga le ndlela kabili yokwabelana ngezindleko.
Ungase uphelise ngesikhathi esifanayo ukhokhe i-copay kanye ne-coinsurance ezingxenyeni ezihlukene zesevisi yezempilo eyinkimbinkimbi. Nakhu ukuthi lokhu kungase kusebenze kanjani. Ake sithi une-copay ye $ 50 yokuvakashelwa udokotela ngenkathi usesibhedlela futhi u-30% wezinkokhelo zokubambisa esibhedlela. Uma udokotela akuvakashela izikhathi ezine esibhedlela, uzophela ukukhokhela ikhophi ye-$ 50 ngayinye yalezo zihambeli, inani elilodwa lama-$ 200 kumacala e-copay. Uzothola futhi isibhedlela ukukhokha imali ye-30% yesabelo sakho se-bill yesibhedlela. Kungase kubonakale sengathi uceliwe ukuthi ukhokhe kokubili ikhophi kanye nokuqinisekiswa kwemali yokuhlala esibhedlela esifanayo. Kodwa, ukhokha ngempela i-copay ngezinsizakalo zodokotela, nokuqinisekiswa kwezinsizakalo zesibhedlela, ezikhokhiswa ngokwehlukana.
Ezinye izinhlelo zezempilo zinama-copays asebenza kwezinye izimo kepha avuselwa kwabanye. Isibonelo esivamile ama-copays asebenza ekuvakasheni kwamagumbi okuphuthumayo kodwa ayaxoshwa uma uqeda ukuvunyelwa esibhedlela. Ngaphansi kwalolu hlobo lwepulani, ukuvakashelwa ku-ER okungabangela ukufakwa esibhedlela kungase kube yi-copay eyi-$ 100. Kodwa uma isimo sína ngokwanele ukuthi uphele esibhedlela, awudingi ukukhokha i-copay eyi-$ 100, kodwa esikhundleni sakho kufanele ukhokhe imali yakho yokubambisana nokuthengiswa kwemali (ukuvakasha okugcwele esibhedlela, kufaka phakathi isikhathi sakho ku-ER futhi isikhathi sakho njengesiguli esivunyelwe), kuze kube ngaphandle kwe-pocket esiphezulu secebo lakho.
I-Copays ne-Coinsurance yeDakamizwa yeMithi
Umehluko phakathi kwe-copay kanye ne-coinsurance ingase idideke ngokukhethekile ngokufakwa kwezidakamizwa zemithi. Abaningi bomshuwalense wezempilo bane- formulary yezidakamizwa ezikutshela ukuthi yiziphi izidakamizwa uhlelo lwezempilo oluhlanganisa , futhi yiluphi uhlobo lokubizwa kwezindleko oludingekayo. I-formulary ibeka izidakamizwa ngezigaba ezahlukene zamanani, noma amathaya, futhi idinga ukulungiswa okuhlukile kwamanani we-tier ngayinye.
Isibonelo, i-tier ephansi kakhulu ingaba izidakamizwa ezijwayelekile kanye nezidakamizwa ezivamile, ezindala, ezishibhile. Lowo wesithathu angadinga i-copay ye-$ 15 ukuze unikezwe izinsuku ezingu-90 zomuthi. I-tier yesibili ingase ibe yizidakamizwa ezibizayo zegama lomkhiqizo futhi idinga i-copay ye-$ 35 ukuze unikezwe izinsuku ezingu-90. Kodwa i-top tier (ngezinhlelo eziningi zempilo, lokhu kungu-Tier 4 noma 5, kodwa ezinye izinhlelo zezempilo ziphula izidakamizwa zibe yizingxenye eziyisithupha) zingaba izidakamizwa ezibiza kakhulu ezibiza izinkulungwane zamaRandi ngomthamo ngamunye.
Ngalesi sigaba, uhlelo lwezempilo lungase lushiye ama-copay-ukwabelana ngezinkokhelo ezisetshenziselwa abantu abaphansi futhi ushintshe ekuqinisekisweni kwezimali ezivela kumaphesenti angu-20 kuya kuma-40%. I-coinsurance yemithi ebiza kakhulu kakhulu ivumela umshwalense ukuba anciphise ingozi yemali ngokushintsha isabelo esikhulu sezindleko zezidakamizwa emuva kuwe. Lokhu kungadideka ngoba okuningi kwemigomo yakho kuzodinga i-copay ehleliwe, kodwa imithi ebiza kakhulu, izidakamizwa eziphezulu, zizodinga iphesenti ye-coinsurance esikhundleni se-copay.
Uma ungaphansi kwalesi simo futhi ubheke ukuthi kungenzeka ukhokhe izinkulungwane zamaRandi ngenyanga ngezidakamizwa ezikhethekile, uzojabula ukwazi ukuthi uma usuhlangabezane nesiphakamiso sakho esingaphandle kwesiphakamiso sonyaka, wakho uhlelo lwezempilo luzoqala ukukhokhela amaphesenti angu-100 emali yemithi yonyaka osele. Ngaphandle uma uhlelo lwakho lukhulu noma lukhulu, i-out-of-pocket esiphezulu ayikwazi ukuphakama kunezigidi ezingu-7,150 ngo-2017, kanti i-$ 7,350 ngo-2018 (leyo mingcele isebenza kumuntu oyedwa; uma umuntu ongaphezu komuntu oyedwa emndenini wakho adinga ukunakekelwa kwezokwelapha, okuhlangene umkhawulo ubuye kabili phezulu).
I-Coinsurance vs. Copay ingaba yinto edidekayo, kodwa ukuqonda umehluko phakathi kwe-copay ne-coinsurance kusho ukuthi uhlonyelwe kangcono ukukhetha uhlelo lwezempilo oluhlangabezana nokulindela kwakho, isabelomali sezindleko zezokwelapha, nokubamba amaphutha ezindlekweni zakho zezokwelapha.
> Imithombo:
> UMnyango WezeMpilo Nezinsizakalo Zabantu, Ukuvikelwa Kweziguli kanye Nokunakekelwa Okunakekelwayo, I-HHS Isaziso Sokuzuzwa Nezimpawu Zokukhokha Zonyaka ka-2017. Mashi 8, 2016.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Ukuvikelwa Kweziguli Nomthetho Wokunakekelwa Okunganakekelwa, Isaziso se-HHS Sokuhlomula Nezikhawulelo Zokukhokha ze-201 8. NgoDisemba 22, 2016.