I-Medicaid uhlelo lwezenhlalakahle oluhlinzekela izinsizakalo zomshuwalense wezempilo kubantu abahola imali encane e-United States. Kungakhathaliseki ukuthi ungumamukeli weMedicaid noma ufisa ukuba munye, ukuqonda ukuthi i-Medicaid isebenza kanjani kungenza kube lula ukuthola ukunakekelwa kwezempilo okudingayo. Uma ungeyena umzuzi we-Medicaid, kodwa usebenza ngokunakekela abamukeli be-Medicaid, ukuqonda ukuthi i-Medicaid isebenza kanjani ingakusiza ukuthi uthole iziguli zakho okudingayo.
Indlela iMedicaid isebenza Ngombono Womamukeli
Ukufaneleka kweMedicaid
Ukufaneleka kokudinga i-Medicaid okungenani kuncike ekutholeni imali engenayo. Kwamanye amazwe, izakhamuzi ezinezinzuzo ezingamaphesenti ayisishiyagalolunye nesishiyagalolunye (6%) zezinga lobuphofu elisemaphandleni noma ngaphansi zizokwazi ukuthola iMedicaid. Ukuze ufanelekele i-Medicaid kwamanye amazwe, kufanele uhlangabezane nezinga elihlukile lokuthola imali futhi ube yilungu leqembu elibuthakathaka njengengane, owesifazane okhulelwe, umuntu osekhulile, umuntu okhubazekile, umuntu oyimpumputhe noma umzali osemusha ingane.
Ngaphezu kwalokho, ezinye izifunda zidinga ukuthi uhlangabezane nemihlahlandlela yefa ukuze uthole iMedicaid. Isibonelo, noma ngabe ungumuntu osekhulile ongenayo imali, ungase ungakufanelekeli i-Medicaid uma une-$ 100,000 ehlezi e-akhawunti yomhlalaphansi ngoba amafa akho aphezulu kakhulu.
Kuvame ukuthi uthi kunezindlela eziningana umuntu angase afanelekele ku-Medicaid. Isibonelo, ungase ufanelekele ukuthola imali engenayo engaphansi kwe-138% ye-FPL, ngokuthola imali engenayo engaphansi kuka-200% ye-FPL nokukhulelwa, noma ngokuthola Imali engenayo ye-Supplemental Security.
Zingaki izindlela ezikhona zokufanelekela i-Medicaid futhi indlela efanele yokufaneleka ihluka kusuka kumbuso kuya kwesimo.
Izinzuzo ze-Medicaid
Izinzuzo ozithola uma uthola i-Medicaid zihluka kusuka kumbuso kuya kuhulumeni futhi ziyahlukahluka kumuntu nomuntu ngaphakathi kwesimo. Imithethonqubo ye-Federal idinga ukuthi izinzuzo ezithile eziyisisekelo zinikezwe abahlomuli abathile abasengozini kuwo wonke amazwe.
Kodwa-ke, ngaphezu kwalokho, uthi kunezimo eziguquguqukayo ekunqumeni ukuthi yiziphi izinzuzo zokuhlinzeka ngamaphi amaqembu abantu.
Isibonelo, umbuso ungase unikeze bonke abahlomulayo abafanelekayo kwi-Medicaid ngaphansi kwesethi eyodwa yezinqubo ngezinzuzo zomshuwalense wezempilo waseMedicaid. Kungase inikeze abantu abafanelekayo ngaphansi kwesethi yezinqubo ezahlukene ngezinzuzo ezimbalwa kuphela iqembu lokuqala elitholile.
Indlela ofinyelela ngayo izinzuzo zakho ze-Medicaid uma ungumamukeli we-Medicaid uhluka kusuka kuhulumeni kuya kuhulumeni nakumanye amazwe. Noma kunjalo, izindlela ezimbalwa zivamile.
- Imali-Yesevisi. Uma izinzuzo zakho ze-Medicaid zinikezwa ngendlela yokukhokha-ye-service, ukhululekile ukuvakashela noma yimuphi udokotela, esibhedlela, noma omunye umhlinzeki oyokwamukela izinkokhelo zeMedicaid. Umhlinzeki ngamunye uyokhokhelwa yi-Medicaid ngenkonzo ayinikezela ngaso sonke isikhathi lapho ufuna ukunakekelwa.
- Ukunakekelwa Okuphethwe. Uma izinzuzo zakho ze-Medicaid zinikezwa ngokunakekelwa okuphethwe njenge- HMO , ungathola ukunakekelwa kuphela kubahlinzeki ngaphakathi kwenethiwekhi yokuhlinzeka ukunakekelwa ephethwe. Ukwengeza, kungase kudingeke uthole imvume ngaphambi kokuthi uthole izinhlobo ezithile zokunakekelwa, noma ube nokudluliselwa kusuka kudokotela wakho wokunakekela oyinhloko . Ngokuvamile, izinhlelo ze-Medicaid zizokwenza isivumelwano nezinkampani zomshuwalense wangasese ukuhlinzeka ngezinsizakalo zokunakekelwa eziphethwe. Kulesi simo, izinsizakalo zakho zeMedicaid zinganikezwa noma ziphathwe yinkampani yangasese yomshuwalense wezempilo njengoBlue Cross, UnitedHealthcare, Humana, noma ezinye izinkampani zomshuwalense wangasese.
Kwezinye izimo, angeke ube nesinqumo sokuthi uthola yini uhlelo lokunakekelwa oluphethwe noma uhlelo lokukhokhela izinsiza uma ubhalisa ku-Medicaid. Kwezinye izimo, ungase ukwazi ukukhetha phakathi kwabo uma ubhalisa. Noma, unganikezwa uhlelo lwe-hybrid lapho inhlangano yakho ivumelana khona nenhlangano yokunakekelwa ephethwe ukuhlinzeka ngezinzuzo zakho eziningi ze-Medicaid, kodwa izinzuzo ezimbalwa zeMedicaid zakho zinikezwa ngemali yokukhokhela imali. Isibonelo, mhlawumbe ukunakekelwa kwezokwelapha, ukunakekelwa esibhedlela, ukunakekelwa kokuvimbela , amarebhu kanye nama-x-rays kunikezwa ngenkontileka yokunakekelwa ephethwe, kodwa izinsizakalo zokuthutha zezokwelapha zingase zinikezwe ngemali yokukhokhela imali.
Kungakhathaliseki ukuthi i-Medicaid isebenzisa kanjani ukuletha izinzuzo kuwe, cishe labo bonke abahlinzeka ngemisebenzi yokunakekelwa kwempilo yakho bangama odokotela, abahlengikazi, imitholampilo kanye nezibhedlela emphakathini wakini. Kungenzeka ukuthi uzothola ukunakekelwa esibhedlela esifanayo noma eqenjini elifanayo labodokotela ukuthi amanye omakhelwane bakho abangewona amaMedicaid abasebenzisa, noma ngabe uzokhokha kancane kulawo masevisi kunokuba omakhelwane bakho bakhokhe.
Kwezinye izindawo, kungase kudingeke uzothengele ukuze uthole udokotela ozokwamukela iziguli ezintsha zeMedicaid ekusebenzeni kwakhe. Kwezinye izindawo, akukho inkinga ukuthola umhlinzeki.
Ngokungafani nomshuwalense wezempilo wangasese, abahlomuli abaningi baseMedicaid bathola i-Medicaid ngaphandle kokukhokhela izinkokhelo zenyanga. Ngokufanayo, izinsizakalo eziningi zokunakekelwa kwezempilo zihlinzekwa abahlomuli beMedare ngaphandle kokukhokha imali ekhokhelwayo , i- copay noma i-coinsurance yenkonzo. Kodwa-ke, ezinye izifunda zihlola izindlela zokukhokhisa izimali zokubiza izindleko zemisebenzi yamanye amasevisi. Isibonelo, umbuso ungahlinzeka ngezinsizakalo zamakamelo eziphuthumayo mahhala uma kwenzeka izimo eziphuthumayo, kodwa zingase zikhokhise i-copay ye $ 25 uma ukuvakashelwa kwe-ER kungokwenziwe okungakunakekelwa ehhovisi likadokotela wakho.
Ukufaka isicelo se-Medicaid
Ungenza isicelo se-Medicaid noma yiziphi izindlela ezimbili ezahlukene.
- Faka isicelo ngokuxhumana nehhovisi lenqubo yakho ye-Medicaid ngqo. Thola ulwazi loxhumana nabo ohlelweni lwe-Medicaid lombuso wakho kusuka kukhasi le-Medicaid.gov leSayithi Lama Profiles.
- Faka isicelo ngokugcwalisa isicelo somshuwalense wezempilo ku- Career Affordable Care Act . Uma kubonakala sengathi uzofanelekela i-Medicaid, ukushintshaniswa kuzokwenziwa uhlelo lwakho lokusebenza lwe-Medicaid noma luthumele uhlelo lwakho lokusebenza ohlelweni lwakho lwe-Medicaid. Kulesi simo, uzonikezwa iziqondiso ezengeziwe mayelana nokuthi yini okudingeka uyenze ukuze uqedele isicelo sakho seMedicaid. Thola ukushintshwa komshuwalense wezempilo wakho wombuso ngokusebenzisa le Finder Marketplace ku-Healthcare.gov.
Indlela iMedicaid isebenzayo Ngombono Kahulumeni
I-medicaid uhlelo oluhlanganyelwe lwe-federal nezwe. Uhulumeni wesifunda ubeka imithethonqubo ehlinzeka ngohlaka olubanzi jikelele ukuthi zonke izinhlelo zeMedicaid kumele zilandele. Umbuso ngamunye uhlela futhi ugijime uhlelo lwawo lweMedicaid ngaphakathi kwaloluhlaka lwemithetho kahulumeni.
Njengoba imithetho ye-federal ivumela kakhulu ukuguquguquka kwemiklamo, izinhlelo ze-Medicaid ziyahlukahluka kusuka kumbuso kuya kwesimo. Isibonelo, uma umuntu ethola i-Medicaid kwelinye izwe kwakufanele ahambe, angase angahlangabezane ne-eligibility criteria esimweni sakhe esisha. Uma ehlangabezana neMigomo yokufaneleka yokufaneleka eMbusweni wakhe omusha, izinzuzo zeMedicaid ezitholwa khona zingase zihluke kulabo abatholayo esimweni sakhe sangaphambili.
Imali Yokuxhaswa Kwengqondo
I-Medicaid ikhokhwa ngezimali ezivela kuhulumeni kahulumeni kanye nohulumeni kahulumeni ngamunye. Uhulumeni wesifundazwe uhlinzeka ngemali engu-50-83 yezimali ezidingekayo kumamukeli wendabuko we-Medicaid. Amazwe ahlinzeka ngemali eyisele.
Izakhamizi ezicebile zombuso, zisekelwe emalini engenayo, inani eliphansi lezimali ezihlinzekwa nguhulumeni wesifundazwe. Zonke ezinye izimali zivela kuhulumeni wakho. Ungabona kahle ukuthi yimaphi amaphesenti wezimali zakho zohlelo lwe-Medicaid ezivela kuhulumeni wase federal lapha.
Okunye okuphawulekayo emthethweni we-50-83% wokuxhasa ngemali ye-Medicaid yi- Medicaid ukunwetshwa okudalwe uMthetho Wokunakekelwa Okunganakekelwa. Uhulumeni wesifunda kufanele afinyelele 90-100% wezindleko zokuhlinzeka ngeMedicaid kulabo abathola kuphela iMedicaid ngenxa yokwanda kwe-ACA's Medicaid.
I-Medicaid ne-Care Affordable Act
Abalobi be-ACA ekuqaleni bahlose ukuthi wonke amazwe ahlinzeke ngokuhlinzekwa kwe-Medicaid kubahlali abanemali engu-138% ye-FPL noma ngaphansi. Kodwa-ke, isinqumo seNkantolo Ephakeme senze lokhu kukhululwa kwe-Medicaid. Amanye amazwe akhethe ukwandisa iMedicaid njengoba ekuqaleni ehloselwe abalobi be-ACA; ezinye izizwe zikhethile ukuba zingakhulisi iMedicaid. Ezizweni ezingazange zandise i-Medicaid, kunzima kakhulu ukufaneleka ku-Medicaid futhi amaphesenti amakhulu wabakhileyo abahola kancane ahlala engaqinisekisiwe kunezizwe ezakhe ukwandisa iMedicaid.
Funda kabanzi mayelana neMedicaid
I-Medicaid iyinkimbinkimbi eyinkimbinkimbi, eguquguqukayo ehlala njalo lapho ohulumeni basekhaya nabasemagunyeni bebambisana nohulumeni basekhaya, amabhizinisi angasese-profit, non-profit, kanye nabantu abazimele. I-Medicare ne-Medicaid ndawonye inikeza izinzuzo zezempilo kubantu abangaphezu kwezigidi eziyikhulu.