Ngisanda kuzwa umsizi omshuwalense wezempilo omusha u-newbie. Uthe usekhokhele imali engaphezu kwenyanga yonyaka, kodwa umshuwalense wakhe wezempilo wayengazange akhokhe ihhovisi lakhe udokotela. Ngenkathi ebiza uhlelo lwakhe lwezempilo ukuthola ukuthi kungani bengakhokhi, utshelwe ukuthi wayengafinyelelanga okwamanje.
Wacabanga ukuthi izinkokhelo zepulamende ayezenza ngenyanga ngayinye kufanele zidalwe ekudonseni kwakhe ngonyaka. Ngeshwa, umshuwalense wezempilo awusebenzi ngaleyo ndlela; amaprimiyamu awaqali ku-deductible yakho.
Uma amaPhoyisomali Awubaleki KuDeductible Yakho, Khona-ke Ayini?
Imishanguzo yomshuwalense wezempilo yindleko yenqubomgomo yomshwalense wezempilo. Yilokho oyikhokhela inkampani yomshuwalense wezempilo ngokushintshanisa isivumelwano somshuwalense ukuze ubeke ingxenye yengozi yemali yezindleko zakho zokunakekelwa kwezempilo ngale nyanga.
Kodwa, noma ngabe ukhokhela izinkokhelo zakho zomshuwalense wezempilo, umshuwalense wakho wezempilo awukhokhi imali engu-100% yezindleko zokunakekelwa kwezempilo. Wabelana izindleko zezindleko zakho zokunakekelwa kwezempilo nomshuwalense wakho lapho ukhokha imali yokudonswa kwemali , ukukhokhelwa kwezimali, nokukhokhelwa kwezimali, ndawonye owaziwa njengezindleko zokwabelana ngezindleko. Inkampani yakho yomshuwalense wezempilo ikhokhela zonke izindleko zokunakekela impilo yakho, uma nje ulandele imithetho yokunakekelwa ephethwe kwezempilo wezempilo ukuze uthole ukunakekelwa kwezempilo.
Ukwabelana ngezindleko kuvumela izinkampani zomshuwalense wezempilo ukuthi zithengise izinqubomgomo zomshuwalense wezempilo ngamaprimiyamu angabizi ngoba:
- Uma une "isikhumba emdlalweni", uzogwema ukunakekelwa awudingi ngempela. Isibonelo, ngeke uhambe kudokotela kuyo yonke into encane uma kufanele ukhokhe imali yokukhokhwa kwama-$ 50 njalo uma ubona udokotela. Esikhundleni salokho, uzohamba kuphela uma udinga ngempela.
- Ingozi yezezimali umshwalense ubhekene nesilinganiso semali eyabelwe ukukhokha. Wonke ama-dollar akhokhela ekudonsheni kwakho, ama-copayments, kanye ne-coinsurance uma uthola ukunakekelwa kwezempilo ngenye idola elingaphansi kwekampani yomshuwalense wezempilo okufanele ukhokhe.
Ngaphandle kokwabiwa kwemali efana ne-deductibles, ama-premium yomshuwalense wezempilo angaphezulu nakakhulu kunamanje.
Iyini Ingozi Yakho Yezezimali? Yini Ozokweleta?
Uma u-insured, incazelo yokwabelana ngezindleko kumgomo wakho womshuwalense wezempilo noma Isifinyezo Sezinzuzo Nezokuphepha utshela ukuthi yiziphi izindleko zakho zokwelapha ozikhokhayo nokuthi ingakanani inkampani yakho yomshuwalense wezempilo okhokhela yona . Kumele ukucacise ngokucacile ukuthi imali yakho engakanani, ingakanani imali yakho yama-copay, nokuthi ingakanani imali yakho yokubambisana nayo.
Ngaphezu kwalokho, umkhawulo wakho wezempilo we-plan- out-of-pocket kufanele uvezwe ngokucacile kumgomo wakho noma Isifinyezo seZinzuzo nokuPhepha. Ngo-2018, umkhawulo ongaphandle kwe-pocket awukwazi ukudlula u-$ 7,350 kumuntu oyedwa noma u-$ 14,700 umndeni, ngaphandle uma unomsebenzi wezempilo omkhulu noma omkhulu . Le mikhawulo engenhla kwizindleko ezingaphandle kwe-pocket izokwanda ngo-2019 ku-$ 7,900 ehlongozwayo umuntu ngamunye kanye no-$ 15,800 emndenini. Nganoma yimuphi unyaka, izinhlelo eziningi zitholakala ngemingcele ye-out-of-pocket ngaphansi kwale mi-maximums engenhla, kodwa ayikwazi ukudlula umkhawulo wesifundazwe.
Umkhawulo ongaphandle kwe-pocket uvikela ekulahlekelweni kwezimali okungenamkhawulo uma kwenzeka izindleko zokunakekelwa kwempilo ephakeme ngempela. Ngemuva kokuthi ukhokhe ngokwanele ekudonsheni, ama-copays, kanye nokuqinisekiswa kwemali ukuze ufinyelele i-out-of-pocket yakho esiphezulu minyaka yonke, uhlelo lwakho lwezempilo luqala ukumboza amaphesenti angu-100 wezindleko zenethiwekhi yakho, ukunakekelwa kwezempilo okudingekayo kwabanye unyaka. Awudingi ukukhokha enye ukwabelana ngezindleko ngalowo nyaka. Kodwa-ke, usadingeka ukhokhe izinkokhelo zakho zenyanga noma inqubomgomo yomshuwalense wezempilo uzokhanselwa .
Ngakho-ke, yini okungenani ongayithola, futhi yini ongayithola kakhulu? Uzokweleta okungenani uma ungadingi ukunakekelwa kwezempilo unyaka wonke.
Kulesi simo, ngeke ube nezindleko zokwabelana ngezindleko. Konke ongayikhokhwa yi-premium yakho yenyanga. Thatha izindleko zakho zenyanga zama-premium bese uyilandisa ngezinyanga ezingu-12 ukuthola imali yakho yonyaka yonke yomshwalense wezempilo.
Uzokweleta kakhulu uma unezindleko zokunakekelwa kwezempilo ngempela ngoba udinga ukunakekelwa njalo noma unesiqephu esisodwa esibi kakhulu sokunakekelwa, njengokuhlinzwa okudingayo. Kulolu cala, okuzokweleta kakhulu ekukwabeleni izindleko yi-out-of-pocket yakho yenqubomgomo enkulu. Engeza i-out-of-pocket yakho esiphezulu ekukhokhweni kwama-premium akho wonyaka, futhi lokho kufanele kuchaze umkhawulo ongaphezulu kulokho ongakhokhela khona izindleko zokunakekelwa kwempilo ngonyaka.
Qaphela, noma kunjalo. Akuzona zonke izindleko zezempilo ezihlanganisiwe. Isibonelo, ezinye izinhlobo zomshuwalense wezempilo ngeke zikhokhele ukunakekelwa ngaphandle uma uzithola kumhlinzeki we- in-network (futhi uma uhlelo lwakho lwezempilo lugcina ukunakekelwa kwe-out-of-network, uzoba neductible ephezulu futhi ngaphandle ukuvezwa kwe-pocket for services out-of-network). Abaningi bomshuwalense wezezempilo ngeke bakhokhele izinsizakalo ezingekho emzimbeni. Ezinye izinhlelo zezempilo ngeke zikhokhele izinhlobo ezithile zokunakekelwa ngaphandle uma uthola ngaphambi kokugunyazwa kwalo.
Ngubani obeka i-Premium yeNqubomgomo Yomshuwalense Wezempilo?
I-premium yindleko yokuthenga umshuwalense, kungakhathaliseki ukuthi usebenzisa uhlelo noma cha. Kodwa ezimweni eziningi, abantu abaqinisekisiwe ngenqubomgomo akudingeki bakhokhele amaphrimiyamu aphelele ngokwabo. Cishe isigamu samaMelika sithola umshuwalense wabo wezempilo ngecebo elixhaswe ngomsebenzi, noma njengesisebenzi, noma njengomlingani noma othembekile kumsebenzi.
Ngokusho kocwaningo lwezinzuzo zomqashi ka-2017 Kaiser Family Foundation, abaqashi bakhokhela cishe amaphesenti angu-70 emishayamu yezimali yomndeni yabasebenzi abanomshwalense wempilo oxhaswe ngemisebenzi. Yiqiniso, kungase kubhekiswe ukuthi iminikelo ye-premium yomqashi iyingxenye yempesheni yomsebenzi, okuyiqiniso. Kodwa abacwaningi bekungabaza ukuthi abasebenzi bayothola yonke leyo mali ngemali eyengeziwe uma umshuwalense wezempilo oxhaswe ngumqashi kufanele aqedwe, ngoba umshuwalense wezempilo uyinzuzo ekhokhelwa intela yesikhwama semali yokukhokhela umqashi.
Phakathi kwabantu abathengisa umshwalense wabo wezempilo emakethe ngayinye, izinhlelo zikhona ngokusebenzisa ama- ACA exchange and exchange- off . Kubantu abathenga ukuthengiswa ngezingxoxo, amaphesenti angu-84 athola izikweletu zentela ye-premium (izinsizakalo) ngo-2017 ukuze ahlasele ingxenye yamaphrimiyamu abo. Phakathi kwabantu abasho ukuthi bathembele ngokugcwele ku-HealthCare.gov, isilinganiso sokuqala sokusizwa sasiyimali engu-$ 476 / ngenyanga ngo-2017, kanti isilinganiso semali esivela emva kokusizwa se-$ 153 / ngenyanga. Ngokusobala, izinsizakalo ze-premium zihlanganisa iningi lamaphrimiyamu amaningi wabhalisile.
Kodwa abantu abazithengayo ngokwabo ngaphandle kwezokuhwebelana bakhokhela amaphrimiyamu aphelele ngokwabo, njengabantu abathenga ukuthengiswa ngezingxoxiswano kodwa imali yabo engenayo ingaphezulu kwamaphesenti angu-400 wezinga lobuphofu (ngokubhekisela, lelo phuzu lokunqunywa liyi $ 98,400 umndeni we-r for 2018).
Funda kabanzi
- Yini Eba Ngokwemshwalense Yempilo Yakho Imali?
- Ukunakekelwa KwezeMpilo Uthola Ngaphandle Kokukhokha I-Deductible yakho
- Indlela Yokubala Ukukhokha Kwezimali Zakho
- Yini Engayifinyeleli Kokulinganiselwa Kwakho Okungaphandle Kwamapokhethi?
- Deductible vs Copayment-Uyini umehluko?
> Imithombo:
> Amasevisi weMediare and Medicaid Services, 2017 Isitatimende Sokubhalisa Esiphumelelayo . Ngo-Juni 12, 2017.
> Amasevisi we-Medicare ne-Medicaid Services, 2017 Indawo yokuhweba Isikhathi sokubhalisa Ukusebenzisa Amafayela Womphakathi.
> I-Federal Register, Isivikelo Sokugula kanye Nomthetho Wokunakekelwa Okungathintekiyo; Isaziso se-HHS Sokuhlomula kanye neMigomo Yokukhokha ka-2019 (umthetho ohlongozwayo). Novemba 2, 2017.
I-Federal Register, Ukuvikelwa Kweziguli kanye Nokunakekelwa Kwezintambo ezizinzile; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2018; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi olusetshenzisiwe futhi oluhlelekile. NgoDisemba 22, 2016.
> Kaiser Family Foundation, Ukuphepha Kwempilo Yomphakathi Yonke Inani labantu. 2016.
> Kaiser Family Foundation, 2017 Umqashi WezeMpilo Wezinzuzo Zomqashi. Ngo-September 19, 2017.