I-Medicare HMO ne-PPO Ukukhethwa kanye nezinketho
Uhlelo lwe-Medicare Advantage Plan luhlinzekwa yizinkampani zangasese zomshuwalense wezempilo ezivunyelwe yi-Medicare futhi zinezinkontileka zokukunikeza izinzuzo zemithi.
Yini Okuyiyona I-Medicare Advantage Plan Cover?
Uma ujoyina uhlelo lwe-Medicare Advantage Plan, uhlelo kumele luhlinzekele konke okuyingxenye ye- Part A (Inshuwalense Yesibhedlela) kanye neNxenye B (Imithi Yomshuwalense Wezokwelapha), kubandakanya ukunakekelwa okuphuthumayo nokuphuthumayo.
Inzuzo eyinhloko kuphela engavunyelwe yizi zinhlelo zokunakekelwa kwezibhedlela - le nzuzo ihlanganiswa yiMithi Yezokwelapha Ngisho noma ngabe ukhetha i-Medicare Advantage Plan.
Izinhlelo eziningi ze-Medicare Advantage zihlinzekela okwengeziwe, njengokubona, ukuzwa, amazinyo, nokuhlolwa okujwayelekile nezinye izinhlelo zezempilo nempilo. Amalungiselelo amaningi kunazo zonke ahlanganisa ukuhlinzekwa kwezidakamizwa ze- Medicare ( Medicare Part D ).
Izinhlelo eziningi zeMercare Advantage ziphathwa izinhlelo zokunakekelwa , ikakhulukazi inhlangano yokugcinwa kwezempilo (HMO) noma inhlangano ehlinzekwayo yokuhlinzeka (PPO). Lezi zinhlelo zingadinga ukuthi ukhethe udokotela oyinhloko wokunakekelwa (PCP), uthole ukuhanjiswa kusuka ku-PCP yakho ukubona ochwepheshe, futhi usebenzise odokotela kuphela, izibhedlela, nezinye izikhungo zezokwelapha nezinsizakalo eziyingxenye yenethiwekhi yomhlinzeki wezempilo .
Ezinye izinkampani zempilo yomshuwalense wezempilo zinikeza uhlelo lwe-Medicare Advantage Plan olubizwa ngokuthi uhlelo lwe-Private Fee-for-Service (PFFS) Lokho okungakuvumela ukuba ubone noma yikuphi udokotela noma usebenzise noma yisiphi isibhedlela esamukelwe yiMedare.
Kodwa-ke, ngokungafani neMithi Ye-Original, ungase ube nekhophi yokuvakasha odokotela hhayi bonke abahlinzeki abangase bakuvume ukukuphatha. Noma kunjalo, ohlelweni lwe-PFFS, akudingeki ukhethe i-PCP futhi awudingi ukudluliselwa ukuze ubone isazi.
Yini Indleko Yokuthola Imithi Ekhokhelwa Imithi?
Inyanga ngayinye, i-Medicare ikhokhela uhlelo lwakho lokuhlomula imali ehleliwe ukuze unikeze ukunakekelwa kwakho.
Uhlelo lokuhlomula lube nesibopho sokukhokha udokotela, esibhedlela kanye nabanye abahlinzeki bokunakekelwa.
Nakuba uhlelo lwakho lokuhlomula kufanele lulandele imithetho ka-Medicare, lungakukhokhisa izindleko zokukhokhelwa kwepayimali kanye nezengeziwe, njenge-copayment yokuvakasha kudokotela, uxhaso lwempahla yezokwelapha ezihlala njalo (njengesitulo sabakhubazekile), kanye ne-deductible yonyaka imithi yokwelashwa.
Wena futhi unesibopho se-Medicare Part B yakho yenyanga yenyanga, okukhishwa kwisheke sakho sokuphepha komphakathi.
Isibonelo: uGeorge C. uhlala eMassachusetts futhi unomsebenzi we-Medicare Advantage Plan nge-Fallon Community Health, enye yezinhlelo zezempilo eziphakeme kakhulu ezweni. Unenhlelo ye-HMO ngokufaka izidakamizwa. Izindleko zakhe zezinyanga eziyinhloko ze-plan yilezi $ 208.40 (i-Medicare Part B premium ye $ 96.40 kanye ne-$ 112 ekhokhwa yi-Fallon). Futhi, izindleko zakhe ezingaphandle kwezimali zihlanganisa ikhodi eyi-$ 15 yokuvakashelwa kwe-PCP ngayinye, i-$ 20 ekuvakasheni ngamunye ochwepheshe, ukuqinisekiswa kwe-10% yezinto zokwelapha ezihlala njalo, kanye ne-deductible yonyaka ka-$ 310 yemithi yokwelashwa.
Ngingajoyina kanjani uhlelo lwe-Medicare Benevantage Plan?
Ngokujwayelekile, ungajoyina i-Medicare Advantage Plan uma unayo i-Medicare Part A ne-Part B futhi uhlala endaweni lapho kukhona khona uhlelo lokuhlomula olwamukela amalungu amasha.
Ezinye izinhlelo zihlanganisa kuphela izifunda ezithile ngaphakathi kombuso futhi kufanele uhlale kwenye yalezi zifunda lapho kuhlinzekwa khona uhlelo.
Ezinye izinhlelo ze-Medicare Advantage zibamba izinkomfa zendawo ukuze zenze izinhlelo zabo futhi ungathola futhi ugcwalise isicelo sephepha ngaleso sikhathi. Ungabhalisa ngokubiza uhlelo, uvakashele iwebhusayithi ye-plan, noma ku-www.medicare.gov. Isayithi le-Medicare likuvumela ukuba uqhathanise izinhlelo endaweni yakho. Futhi ungajoyina ngokubiza u-Medicare ngo-800-633-4227.
Uma ushintshela ohlelweni oluhlukile lwezinzuzo, konke okumele ukwenze ukujoyina uhlelo olusha futhi uzozulazula ngokuzenzakalelayo kusuka ohlelweni lwakho oludala.
Ngeke ube nokulahlekelwa kokufaka kwakho.
Imingcele ye-Medicare uma ungakwazi ukujoyina, ukushintsha noma ukulahla uhlelo lwe-Medicare Advantage Plan. Ungakwazi ukujoyina uhlelo uma uqala ukufaneleka ku-Medicare. Lesi yisikhathi sokuqala izinyanga ezintathu ngaphambi kwenyanga uvula iminyaka engama-65 futhi uphela izinyanga ezintathu emva kwenyanga uvula iminyaka engu-65.
Isibonelo, uma uvula iminyaka engu-65 ngo-Ephreli 28, isikhathi sakho sokufaneleka siqala ngoJanuwari 1 futhi siphela ngoJulayi 30.
Uma ukhubazekile futhi unomshwalense wezokukhubazeka komphakathi, ungajoyina uhlelo lokuhlomula izinyanga ezintathu ngaphambi kwezinyanga ezintathu emva kwenyanga yakho eyi-25 yokukhubazeka.
Futhi ungashintsha noma ulahle inzuzo yakho ngesikhathi sokubhalisa phakathi kukaNovemba 15 noDisemba 31 wonyaka ngamunye.
Ukuze uthole imininingwane eyengeziwe ku-Registered Medicare Advantage Plan, vakashela iwebhusayithi ye-Medicare.
Yikuphi Okunye Okudingeka Ngikwazi Ngohlelo Lwe-Medicare Benevantage?
Kubalulekile ukuthi uqonde umehluko phakathi kweMicrosoft Medicare neMicrosoft Advantage Plans . Ezinye izinto okufanele uzikhumbule mayelana nezinhlelo zokuhlomula ziyi:
- Kumelwe ulandele imithetho! Isibonelo, uma usuhlelweni lwe-HMO, kufanele ukhethe i-PCP bese usebenzisa amasevisi wenethiwekhi kuphela.
- Ungakwazi ukujoyina uhlelo lokuhlomula ngisho noma unesimo esisodwa noma ngaphezulu esandulele . Asikho isikhathi sokulinda.
- Uma uhlelo lwakho lokuhlomula lukhetha ukungasabambi iqhaza kuMedare, ungajoyina olunye uhlelo noma ubuyele ku-Original Medicare.
- Uma uhlelo lwakho lokuhlomula alubandakanyi ukufakwa kwezidakamizwa zemithi kadokotela, ungajoyina uhlelo lwe-Medicare Part D esifundazweni sakho. Kodwa-ke, ngokusho kukaMedricare: "Uma ukhona ohlelweni lwe-Medicare Advantage Plan olubandakanya ukutholakala kwezidakamizwa zemithi futhi ujoyine i-Medicare Prescription Drug Plan, uzobe usuhlakazekile kusuka ku-Medicare Advantage Plan yakho bese ubuyela kuMnyango WezeMpilo Wokuqala."
- Uma nje ubhalisile ohlelweni lwe-Medicare inzuzo, awudingi ukuthenga inqubomgomo ye-Medicare Supplement Insurance (Medigap). Eqinisweni, akukho emthethweni ukuthi umuntu akuthengise inqubomgomo ye-Medigap uma uhlelekile ohlelweni. Izinzuzo ezinikezwa inqubomgomo ye-Medigap zihlanganiswa uhlelo lwakho lokuhlomula futhi isengezo asikhokheli imali yokudonswa kwemali yakho, ukukhokhelwa kwezimali noma ukukhokhelwa kwezimali.
Izinhlelo ze-Medicare Advantage kanye nokuguqulwa kwempilo
Izinhlelo ze-Medicare Advantage zibiza uhulumeni wesifundazwe ngaphezu kweMederal Medicare. Kusukela ngo-2012, i-Medicare izoqala ukwehlisa izinsizakalo kulezi zinhlelo.
Uma ubhalise ohlelweni lwe-Medicare Advantage, kungenzeka ukuthi ukhokhe i-premium ephakeme noma ubhekane nezinzuzo ezincishisiwe. Kodwa-ke, la macebo angeke anciphise noma yiziphi izinzuzo ongazithola ezivela kumuthi wendabuko.