Indlela Uxhaso Lwakho Lokusebenza Ngaphandle Kwamapokhethi

Izinsizakalo zokwabelana ngezindleko zifakiwe ezinhlelweni zesiliva uma ufanelekile

Ukuthenga umshuwalense wezempilo kuyabiza, futhi ukukhokhwa ngenyanga yokuqala akuyona kuphela izindleko ezihilela umshuwalense wezempilo. Kumele ukhokhe amadokhumenti , ama- copayments , kanye nokuqinisekiswa kwemali uma usebenzisa umshwalense wakho wezempilo. Lezi zindleko ezengeziwe ezingaphandle kwe-pocket, eyaziwa ngokuthi ukwabelana ngezindleko, zingafaka izinkulungwane zamaRandi ngonyaka.

I- Care Affordable Act yenze izinsizakalo zomshuwalense wezempilo ukuze zithenge futhi zisebenzise umshuwalense wezempilo ezingabizi kakhulu kubantu abanemali ephansi futhi ethobekile.

Kunezinhlobo ezimbili:

1. Ukuxhaswa okunciphisa amaphrimiyamu omshwalense wakho wanyangazonke ukuze ukuthenga umshuwalense wezempilo kungabizi kakhulu. Funda kabanzi mayelana nalokhu, " Umsebenzi Wempesheni Yomshuwalense WezeMpilo-Ukuqonda I-Premium Tax Credit ."
   
2. Izinsizakalo ezisiza ukukhokhela izindleko ze-pocket ezifana ne-deductibles, i-copayments, ne-coinsurance. Lezi ziyaziwa njengezinsizakalo zokwabelana ngezindleko, noma ukunciphisa ukwabelana ngezindleko. Ziza ezingxenyeni ezimbili, nakuba zombili izingxenye zizenzekela ngokuzenzakalelayo ezinhlelweni zesiliva ezibhalisiwe ezifanele:
   
   • Ingxenye eyodwa inciphisa inani olikhokhayo imali yakho yokubambisana, i-copayments, kanye ne-coinsurance njalo uma usebenzisa umshwalense wakho wezempilo. Funda kabanzi mayelana nale nsizakalo, " Yeka indlela Usizo Lokuxhasa Ngayo Imali Yomshuwalense Wezempilo ."
   • Ingxenye ezimbili inciphisa ukuphuma kwakho kwe-pocket okuphezulu ngakho ukhokhela kancane uma izindleko zakho zokunakekelwa kwezempilo ziphakeme.

Iyini i-Out-Of-Pocket Maximum?

Ukukhishwa kwe- out-of-pocket , noma umkhawulo ongaphandle kwe-pocket, yisibalo esiphezulu kunazo zonke esimweni esizokwenza ukhokhe izindleko zokwabelana ngezindleko ezifana ne-deductible yakho, i-copayments, ne-coinsurance ngonyaka ngamunye.

Uma usukhokhele okwanele ekudonsheni, ukukhokhelwa kwama-copayments nokuqinisekiswa kwemali ukufinyeleleka ngaphandle kwe-pocket esiphezulu, umshuwalense wakho wezempilo ukhokhela zonke izindleko zakho zokunakekelwa kwezempilo ezikuyo yonke unyaka.

Uma ungasebenzisi umshwalense wakho wezempilo okuningi, izindleko zakho zokwabelana ngezindleko ngeke zifinyelele umkhawulo ongaphandle kwe-pocket.

Kodwa-ke, uma unenkinga yezempilo engapheli noma ngisho nesifo esisodwa esibi noma ukulimala, ungakhokha kalula ngokwanele ekuqinisekisweni kwemali kanye nezindleko ezidonswayo ukuze ufinyelele ekuphumeni kwepokhethi.

Isibonelo, uma uwela esiteji futhi uphule umlenze wakho ngenkathi unciphisa isihlahla, isabelo sakho segumbi lokuphuthumayo, izindleko zokuhlinzeka kanye nezibhedlela zingadlula u-$ 10,000 uma inqubomgomo yomshuwalense wezempilo ingenayo umkhawulo ongaphandle kwepokhethi.

Kodwa-ke, uma inqubomgomo yakho yomshuwalense wezempilo inomkhawulo ongaphandle kwe-$ 6,000, uyayeka ukukhokha uma ukhokhele u-$ 6,000 kumabhilidi akho okunakekela impilo. Ngemuva kwalokho, umshuwalense wakho wezempilo ukhokhela amaphesenti angu-100 akhokhelo lwezempilo impilo yonke unyaka. Uzokhokha u- $ 6000 kunama- $ 10,000. Uma udinga ukukhathalela okwengeziwe ngokuhamba kwesikhathi, uhlelo lwakho lwezempilo luzokhokha lonke izindleko.

Ngaphambi kuka-2014, amacebo ezempilo awadingeki ukuba afake umkhawulo wokuphelelwa yisikhathi. Amalungiselelo amaningi enza, nakuba kwakukhona ukuhlukahluka okukhulu ngokuqondene nokuthi imingcele ephezulu yayivela kanjani kwelinye icebo ukuya kwelinye. Futhi ezinye izinhlelo azizange zithathwe kalula.

Akusekho icala ngenxa ye-ACA. Ngaphandle kwamacebo amakhulu amakhulu nezinhlelo eziningi, zonke izinhlelo kumele zithinte izindleko ezingaphandle kwamaRandi 6,850 umuntu ngamunye ngo-2016 (umkhawulo womndeni uphakeme kabili njengomkhawulo ngamunye), nakuba uzokhula futhi ngo-2017 (izimfuno ze-ACA azifaki ku-Medicare; abantu abane-original Medicare coverage abanayo umkhawulo ezindleko zabo ezingaphandle kwe-pocket, yingakho abaningi abane-Medicare ababhalisile banomsebenzi wokufaka isicelo, ngokubhalisa ku-Medicare Advantage esikhundleni I-Medicare yokuqala, noma ngokuthenga uhlelo lwe-Medigap).

Yini engabandakanyi ku-Out-Of-Pocket Maximum?

I-out-of-pocket maximum ayifaki amaphrimiyamu omshwalense wakho wanyanga zonke. Akubandakanyi izindleko zezinto ezingahlanganiswa nomshuwalense wezempilo noma akuzona izinzuzo zezempilo ezibalulekile. Isibonelo, uma umshuwalense wakho wezempilo ungahlanganisi izinsizakalo zokukhishwa kwesikhwama, izindleko zakho ze-acupuncture ngeke zibheke ekuphumeni kwakho kwepokhethi. Akubandakanyi ingxenye ekhokhisiwe- ebhokisiwe yokunakekelwa oyithola kumhlinzeki wezempilo ongaphandle kwe-network . Funda kabanzi ku-" Yini Engayifinyeleli Kokulinganiselwa Kwakho Kwe-Pocket? "

Kungakanani Okungaphandle Kwe-Pocket Ngaphambi Kokuxhaso?

Yonke inqubomgomo yomshuwalense wezempilo yomndeni kanye nomndeni owathengiwe ngemali yomshuwalense wezempilo ongenakuthengisa kumele ube nomkhawulo ongaphandle kwepokhethi.

Uhulumeni wesifunda ulawula ukuthi umkhawulo ophakeme ungakanani, futhi inani elivunyelwe lishintsha njalo ngonyaka.

Ngo-2016, ukukhishwa kwe-out-of-pocket angeke kube ngaphezu kuka-$ 6,850 kumuntu ngamunye noma u-$ 13,700 umndeni. Kodwa inqubomgomo yomshuwalense wezempilo ingaba nomkhawulo ongaphandle kwe-pocket kunalokho.

Ngabe Umshwalense Wempilo Umsizi Unomningi Kangakanani Ukunciphisa I-Out-Of-Pocket Maximum?

Kungakanani imali ekhokhelwa ngayo inciphisa umkhawulo wakho ongaphandle kwe-pocket kuncike kwimali yakho engenayo. Lapho imali yakho engenayo isondelene kakhulu ne- federal level level (FPL), izinga lakho lokuphuma ngaphandle kwe-pocket lizoncishiswa. I-FPL iyashintsha njalo ngonyaka futhi ihlukahluka kuye ngokuthi usayizi womndeni nokuthi uhlala kuphi (i-Alaska ne-Hawaii inezinhlobo ezahlukene ze-FPL).

I-FPL isetshenziselwa ukunqamulela imali yakho yenkxaso ka 2016 ingu-$ 11,770 umuntu ngamunye, i-$ 15,930 yombhangqwana, ne $ 20,090 emndenini wezintathu. Ungathola i-FPL eminye iminyaka nobukhulu bomndeni lapha.

Njengoba kokubili i-FPL nomkhawulo wesifundazwe emalini angaphezulu kwe-pocket kushintshana ngonyaka, i-dollar inani lokunciphisa kwakho lizoshintsha unyaka ngamunye.

Ukuze uzuze kusibonelelo esinciphisa ukukhishwa kwe-out-of-pocket yakho, kufanele ubhalise ohlelweni lwesiliva ngokusebenzisa ukushintshaniswa. Ucabanga ukuthi ukhetha uhlelo lwesiliva, ngosizo lwe-2016, uma imali yakho ingenayo:

• Amaphesenti angu-100-200 we-FPL,
  • umkhawulo wakho ongaphandle kwe-pocket ngeke ube ngaphezu kuka-$ 2,250 umuntu ngamunye.
  • umkhawulo wakho ongaphandle kwe-pocket ngeke ube ngaphezu kuka-$ 4,500 emndenini.
• Amaphesenti angama-200 kuya ku-250 eFPL,
  • umkhawulo wakho ongaphandle kwe-pocket ngeke ube ngaphezu kuka-$ 5,450 kumuntu ngamunye.
  • umkhawulo wakho ongaphandle kwe-pocket ngeke ube ngaphezu kuka-R10,900 kumndeni.

Ngo-2017, umkhawulo ongaphandle kwamaphesenti wabafakizicelo abanomholo phakathi kwamaphesenti angu-100 no-200 we-FPL uzokwanda kancane, ube ngu-$ 2,350, kanti umkhawulo ongaphandle kwe-pocket kubantu abanenzuzo phakathi kwamaphesenti angu-200 no-250 we-FPL uzokwanda $ 5,700 (kuzo zonke zombili izimo, umkhawulo womndeni ophakeme umphindwe kabili umkhawulo ngamunye).

Ukunciphisa okukhethekile kuyatholakala kumaNdiya aseMelika aseMelika anemali engaphansi kwamaphesenti angu-300 eFPL. Esikhathini sabo, umshuwalense wezempilo uyoqeda konke ukwabelana ngezindleko nganoma yiziphi izinzuzo ezibalulekile zezempilo.

Uma Ingumsizi, Ingabe Uthola Imali?

I-sub-out-of-pocket esiphezulu yenkxaso-mali ayikwenzeki ngempela ukukunika imali. Esikhundleni salokho, kungase kusindise imali ngoba ukhokhela kancane ngaphambi kokuba ufinyelele ukuphuma kwakho kwepokhethi.

Uma ufinyelela lokho okunciphise ukukhishwa kwe-pocket esiphezulu futhi uqhubeke nokusebenzisa izinsizakalo zokunakekelwa kwezempilo, inkampani yakho yomshuwalense wezempilo izophela ekukhokheleni okunye ukunakekelwa kwakho kunokuba ungayitholanga insizakalo. Uma kunjalo, uhulumeni wesifundazwe uzobuyisela inkampani yakho yomshuwalense wezempilo ngenxa yemali eyengeziwe eyichithe ngenxa yenkxaso yakho.

Ubani Ongakulungele Ukuxhaswa Kwesikhwama Somshuwalense WezeMpilo Ephezulu?

Ukuze ufanelekele le nsizakalo:

• Imali engenayo kufanele ibe ngamaphesenti angu-100 kuya ku-250 we-FPL.
• Kufanele uthole umshuwalense wakho wezempilo ngokusebenzisa ukushintshwa komshuwalense wezempilo wombuso wakho.
• Kumele ukhethe uhlelo lwezempilo lwe -silver-tier (ngokungafani nezinsizakalo ze-premium, ezibalwe ngokusekelwe ezinhlelweni zesiliva, kodwa zitholakalayo ukuthi zisetshenziswe kuwo wonke amazinga ezensimbi zensimbi)
• Uma ushada, isimo sakho sokufaka intela kufanele sishade ngokufaka ngokuhlanganyela. Isimo sokushada esikufake ngokwehlukana siyokungafaneleka. (Kukhona okukhethekile uma ungakwazi ukufaka ngokuhlanganyela ngenxa yezimo zokuhlukunyezwa ekhaya.)
• Kumele uhlale e-United States ngokusemthethweni.
• Awukwazi ukuboshwa.
• Awufanelekile ukuthola ukukhokhelwa kusuka kumqashi wakho okubhekwa njengengabizi futhi unikeze inani eliphansi .

Ungayifaka Kanjani Le Mxhaso?

Asikho isidingo sokwenza noma yini eyengeziwe ukuze uthole uxhasomali lokwabelana ngezindleko. Uma uyakufanelekela ngokusekelwe kwimali engenayo, izofakwa ngokuzenzakalelayo ezinhlelweni zesiliva ezitholakalayo kuwe nge-exchange.

Ukufaneleka kwakho kwezinsizakalo ze-premium nezinsizakalo zokwabelana ngezindleko kuzothathwa ngokushintshaniswa uma ufaka ulwazi lwakho lomuntu siqu ohlelweni lwabo. Yilungele ukunikeza imininingwane yomshuwalense wezempilo mayelana neholo lakho, usayizi womndeni, nomqashi uma unomsebenzi. Thola ukushintshwa komshuwalense wezempilo wombuso wakho.

Ngaphandle kwezimo ezikhethekile , ungathenga umshuwalense wezempilo kuphela ngokusebenzisa ukushintshaniswa komshuwalense wezempilo ngesikhathi sokubhaliswa ngonyaka ovulekile . Vula ukubhalisa ukuze uthole umshuwalense wezempilo ngo-2017 kusukela ngoNovemba 1, 2016 kuya kuJanuwari 31, 2017 (lokhu kusebenza kumshuwalense wezempilo ozithengela wena, ngokuphambene nokwaziswa okuvela kumqashi).

Uma uthola uxhasomali oluncishisiwe olungaphandle kwe-pocket, qinisekisa ukwazisa ukushintshwa komshuwalense wezempilo uma imali yakho ingashintsha phakathi nonyaka. Uma imali yakho engenayo iyancipha, ungase uvumelekile ukuba uhlaziye isibonelelo sakho ukuze uthuthukise ukuphuma kwakho kwepokhethi.

Indlela i-Out-Of-Pocket Insizakalo Elawula ngayo futhi Amanani Aguquliwe

I-Care Affordable Act ekuqaleni yashilo ukuthi umkhawulo ongaphandle kwe-pocket ungancishiswa ngu

• 2/3 kubantu abanemali kusuka kumaphesenti angu-100-200 we-FPL.
• 1/2 kubantu abanemali kusuka kumaphesenti angu-200-300 we-FPL.
• 1/3 kubantu abanemali kusuka kumaphesenti angu-300-400 we-FPL.

Noma kunjalo, akusilo ukuthi kuphelile kanjani ukusebenza. UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi ukhethe ukuthi ngeke kwenzeke ukukhipha isisindo esingaphezulu kwe-pocket esiningi kubantu abangenza amaphesenti angaphezu kwama-250 e-FPL ngaphandle kokuphula ezinye izingxenye zomthetho noma okwenyuka ekudonseni kwabamukeli abathile . Ngakho-ke, ekubuseni kokugcina kuveza indlela umxhaso osebenza ngayo, i-HHS yashintsha lawo manani ukunciphisa ukuphuma kwepokhethi ngokuphathelene nalokhu:

• 2/3 kubantu abanemali kusuka kumaphesenti angu-100-200 we-FPL
• 1/5 kubantu abanemali kusuka kumaphesenti angama-200 kuya ku-250 we-FPL
• Akukho ukunciphisa kubantu abanemali engaphezulu kwama-250% we-FPL.

I-HHS ingenza izinguquko kulezi zimali ngonyaka ngamunye lapho ishicilela "Isaziso Sokuzuza Nezikhawulelo Zokukhokha" zonyaka ozayo.

_Imithombo:

_{UMnyango WezeMpilo Nemisebenzi Yabantu, Isaziso Sezinzuzo Nezikhawulelo Zokukhokha Zonyaka ka-2016, Kufinyelelwe ngoJuni 6, 2016.}

_{UMnyango WezeMpilo Nemisebenzi Yabantu, Isaziso Sokuzuza Nezikhawulelo Zokukhokha ngo-2017. Ifinyelele ngo-Juni 6, 2016.}

_{Isaziso Semihlomulo Nezikhawulelo Zokukhokha zika-2014, uMnyango WezeMpilo kanye Nezisebenzi Zabantu, http://www.gpo.gov/fdsys/pkg/FR-2013-03-11/html/2013-04902.htm. Ifinyelele ngo-Septhemba 10, 2013.}

_{Inani le-Actuarial Value ne-Cost-Sharing Reductions Bulletin, uMnyango WezeMpilo kanye Nezinsizakalo Zabantu, http://www.cms.gov/CCIIO/Resources/Files/Downloads/Av-csr-bulletin.pdf}

_{Isivikelo Sokubekezela Nokunakekelwa Kwezinkinga , isigaba 1402 (c). Ifinyelele ngo-Septhemba 9, 2013.}

_{UJost, uThimothewu, "Ukusetjenziswa kweNtuthuko yezeMpilo: Imiraro yokuSebenza neNtlawulo yokuThoma" efinyelelwe kwi-HealthAffairs.org, Septemba 9, 2013.}