Lapho Isikhathi Siphelela
Iningi labantu likhokha ukunakekelwa kwezempilo. Bangakanani abakhokhayo kuxhomeke ohlelweni lwezempilo abasebenzisa.
Kungakhathaliseki ukuthi kukhona ku- Medicare , uhlelo lwe-Health Insurance Marketplace, umshuwalense oxhaswe ngumqashi, noma omunye umshwalense womshuwalense wangasese kuzodingeka akhokhe amaphrimiyamu ngenyanga ukuze asebenzise le plan. Bazokhokha futhi ama- deductibles kanye nama-copayments nokuqinisekiswa kwemisebenzi abayitholayo.
I-Medicaid , noma kunjalo, isebenza kancane kancane. Kuye ngesimo, amasevisi we-Medicaid angase abe mahhala kubantu abathile. Ezinye kodwa hhayi zonke izifunda zizodinga amaprimiyamu; ezinye zizodinga i-copayments. Ezinye izifunda zenze ngisho nezidingo zomsebenzi ukunquma ukufaneleka. Isiphakamiso samuva seMedicaid ukufaka imingcele yokuphila kuhlelo.
Kungakhathaliseki uhlelo lwezempilo olusetshenzisiwe, kungasabeka ukwazi ukuthi, ngisho noma othile ekhokhela isabelo sakhe, izinzuzo zabo zingasuswa ngemuva kwesikhathi esithile, kungakhathaliseki ukuthi impilo noma isidingo. Uma isiphakamiso seMedicaid sidlula, sizokulandela umkhawulo omude wemingcele yokuphila ehlelwe ngabashuwalense abedlule.
Imingcele Yokuphila Ngomshwalense Wobumfihlo
Ngaphambi koMthetho Wokunakekelwa Okunganakekelwa (ACA) owadlula ngo-2010, izinkampani zomshuwalense wangasese zinezindlela zokwengeza imikhawulo yabo yokuphila emaqenjini abo.
Abagcini bomshuwalense bengekho kuphela okwandisa izindleko zeprimiyamu kubantu ababenemibandela ekhona ngaphambili , bayeka ukukhokhela ukunakekelwa ngemuva kokuthi imali ethile isetshenziswe.
Kungakhathaliseki ukuthi kunomkhawulo waminyaka yonke noma umkhawulo wokuphila (inani lomuntu obhalisile ohlelweni) usetha ukuthi umshwalense uzokhokha malini, abahlomuli bazobanjwa nazo zonke izindleko ezisele ngemuva kokuba umkhawulo ufinyelelwe.
Ngokuthakazelisayo, i-ACA ayikwenzi nje kuphela ngezimo zokuphikisana kodwa ngezikhathi zeminyaka yonke nokuphila, okungenani uma kuziwa ezinsizeni zezempilo ezibalulekile .
Abantu abakugula kakhulu abengeke bashiywe ngaphandle kokunakekelwa kwezempilo uma beyidinga kakhulu.
Imingcele Yokuphila Kwamanye Emithi
I-Medicare yilona uhlelo lwe-federal olunikeza ukunakekelwa asebekhulile kanye / noma labo abaneziphene ezifanelekayo. Ingxenye A , enye yezingxenye ezine ze-Medicare, inikeza ukuhlinzekwa kwezibhedlela ezingenasifo esibhedlela , ukuhlala isikhathi esifushane ezindaweni zokuhlengikaza abanekhono , kanye ne- hospice .
Nakuba abantu abaningi kungadingeki bakhokhe amaphrimiyamu weNgxenye A , lokho akusho ukuthi kukhululekile. Ama-Deductibles kanye ne-coinsurance kumele akhokhwe ngezinsizakalo ezinikezwe ngesikhathi ngasinye sokuhlomula. Kukhona nezinsuku zokugcina impilo okumele zicatshangelwe.
Ingxenye A ihlanganisa izinsuku ezingu-90 esibhedlela nganoma iyiphi inzuzo. Ngemuva kokukhokha leyo deductible, izinsuku zokuqala ezingu-60 zikhululekile kumzuzi. Ngo-2018, izinsuku ezingu-61 kuya kwezingu-90 zizodinga ukuqinisekiswa kwe-$ 335 ngosuku. Ngemuva kwezinsuku ezingu-90, umzuzi uzokhokhela zonke izindleko ephaketheni noma angene ezinsukwini zokugcina izinsuku zokuphila. Ngalesi simo, bazokhokha u- $ 670 ngosuku ngosuku lwezinsuku zokuphila. Umuntu ngamunye unamalanga angama-60 anjalo angawasebenzisa ngaphezu kwesikhathi sabo sokuphila.
Izinsuku zokugcina izimpilo zingasetshenziswa kokuhlala esibhedlela esisodwa noma ukuhlala izikhathi eziningi. Kuye ngezidingo zomuntu ngamunye.
Imingcele Yokuphila Yonke Yezokwelapha
I-medicaid ixhaswe ngokuhlanganyela yihulumeni ophethwe nguhulumeni kanye nesifundazwe kodwa ulawulwa yizizwe.
Nakuba uhulumeni wesifundazwe ebeka izindinganiso ezincane zokuhlinzekwa kweMedicaid, umbuso ngamunye ungasikisela ukushintshwa kulawo mazinga nge- 1115 Medicaid waivers .
Kuze kube manje, i-Indiana neKentucky ziye zavunyelwa uhulumeni wesifundazwe ukuthi afake izidingo zomsebenzi zokufaneleka kweMedicaid. Umqondo wukuthi abantu "abanamandla" kufanele bakhuthazwe ukuba basebenze. Ukwenza kanjalo kuzokwenyusa izinkinga ukuthi bazokwazi ukuthola izinhlelo ezixhaswe ngumqashi, kunokuthembela ku-Medicaid. Abanye abangu-8 bathi, kuhlanganise ne-Arizona ne-Maine, banomsebenzi wokulinda umsebenzi.
Manje, izifundazwe ezinhlanu ziphakamisa izidingo zokuphila kwimihlomulo.
Izingane, abesifazane abakhulelwe kanye nabantu abakhubazekile babezokhululeka emkhawulweni wokubhalwa. Eqinisweni, kubonakala sengathi "abanamandla" baseMelika bahloselwe yizifunda uma kuziwa emingceleni yokuphila.
I-Arizona ne-Maine baye baxhumene nemikhawulo yabo yokuphila emfuno zomsebenzi. Iwashi iqala ukufaka uphawu lapho abantu bengakutholi izidingo zomsebenzi zaleso simo. I-Kansas, i-Utah ne-Wisconsin ziphishekela imingcele yokuphila yabantu abadala abangenabantwana noma ngabe bahlangabezana nezidingo zomsebenzi. Inothi, iningi labantu abadala abangenabantwana laba kuphela abafanelekele uhlelo emva kokunwetshwa kweMedicaid.
| Isimo | Izidingo zomsebenzi | Isikhathi |
| I-Arizona | Yebo | Iminyaka emihlanu |
| Kansas | Cha | Izinyanga ezingu-36 |
| Maine | Yebo | Izinyanga ezingu-36 * |
| I-Utah | Cha | Iminyaka emihlanu |
| Wisconsin | Cha | Izinyanga ezingu-48 |
* I-Maine ihlose ukukhawulela ukusabalala ezinyangeni ezintathu kuphela phakathi nanoma yisiphi isikhathi sezinyanga ezingu-36.
Ukukhathazeka kuye kwaphakanyiswa ngalezi ziphakamiso.
Okokuqala futhi okubaluleke kakhulu, akubona bonke abaqashi abaphansi abahlinzeka ngemali yezempilo. Ngisho noma umuntu ehlangabezana nezidingo zomsebenzi, angase angakwazi ukufinyelela kwezinye izinhlobo zokunakekelwa kwezempilo. Imingcele yesikhathi sokuphila yayizopholisa abantu ngokusekelwe kumigomo yomqashi wabo, into engekho ngaphansi kokulawula kwayo.
Abanye bathi i-Medicaid ihloswe ukuba ibe inetha lokuphepha, hhayi uhlelo lwezenhlalakahle. Abantu abagulayo futhi besenkingeni bangase bathathe inshuwalense yabo lapho beyidinga kakhulu. Kuba yinkinga yokuziphatha.
Izwi elivela
Ngonyaka ka-2010, i-ACA yamisa abaqinisekisi abazimele ukuba bangabekezeli imingcele yokuphila emisebenzini ebalulekile yezempilo, nakuba bebengakwazi ukubeka imingcele kwamanye amasevisi. I-Medicare ibeka umkhawulo ukuthi zingaki izinsuku zesibhedlela ezizozihlanganisa. Manje iMedicaid ingase iphakamise imikhawulo yokuphila, futhi. Izifunda ezinhlanu zithumele ama-1115 waivers ukucela izinguquko ezinhlelweni zabo ze-Medicaid. Kungakhathaliseki ukuthi kuhlobene nezidingo zomsebenzi noma ukukhuliswa kweMedicaid, abantu bangase babhekane nokunciphisa ukufinyelela kokunakekelwa kwezempilo.
> Imithombo:
> Mayelana ne-ACA: Imingcele Yezinzuzo. UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu. https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/index.html. Kubuyekezwe ngoJanuwari 31, 2017.
> Imithetho Yokugcina Yezinhlelo Zama-Grandfathered, I-Preexisting Condition Exclusions, Imingcele Yokuphila Kanye Nonyaka, Izikhalazo, Ukuvikelwa Kwezindleko, Izikhalazo, kanye Nokuvikelwa Kwamaphesenti Ngaphansi Komthetho Wokunakekelwa Ongathintekayo. Imithetho yokugcina. Isevisi yangaphakathi yeNgeniso, uMnyango Wezezimali; Ukuphathwa Kwezokuvikeleka Kwezabasebenzi, uMnyango Wezabasebenzi; Amasevisi e-Medicare & Services Medicaid, uMnyango WezeMpilo kanye Nezinsizakalo Zabantu.Ukubhaliswa. 2015 Nov 18; 80 (222): 72191-294. https://www.gpo.gov/fdsys/pkg/FR-2015-11-18/pdf/2015-29294.pdf.
> Haefner M. 5 Izizwe Zifuna Ukulungiswa Ukubeka Imingcele Yokuphila Yesikhathi Sokuphila Ngesikhathi Sokuphila: Izinto ezingu-6 zokukwazi. Ukubuyekezwa kweBergker Hospital. https://www.beckershospitalreview.com/payer-issues/5-states-seek-waiver-to-impose-lifetime-medicaid-coverage-limits-3-things-to-know.html. Kubuyekezwe ngo-Februwari 7, 2018.
> Isiguli esibhedlela esibhedlela. Medicare.gov. https://www.medicare.gov/coverage/hospital-care-inpatient.html.
> Musumeci M, Rudowitz R, Hinton E, Antonisse L, Hall C. Isigaba 1115 Ukuhlaziywa Kwama-Medicaid Ukubonisa Amakhophi: I-Current Landscape Yokuvunyelwa Nokulindela Ama-Waiver. I-Henry J. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/section-1115-medicaid-demonstration-waivers-the-current-landscape-of-proproved-and-pending-waivers/. Kushicilelwe ngo-February 1, 2018.