Eminyakeni embalwa edlule, kube khona izindaba eziningi kakhulu ezindabeni ngezibhedlela ezicela iziguli ukuthi zikhokhe imali yazo ngaphambi kokuba zinikezwe izinsizakalo zezokwelapha. Kungani lokhu kwenzeka, futhi abathengi badinga ukwazi ukuthini indlela yokunakekela impilo yethu yamanje?
Indlela Ebe Yaba Ngayo
Esikhathini esidlule, kwavunywa ukuthi iziguli zilindeleke ukuthi zikhokhelwe amakhophi abo ngesikhathi sokusebenza, kodwa amacala abiwe ekudonsheni azokhokhiswa ngemuva kweqiniso.
Ngakho-ke uma uhlelo lwakho lwezempilo lunemakhophi angu-$ 20 ukuze uvakashele ihhovisi, ihhovisi likadokotela lizoqoqa lokho lapho ufika ukuze uqashwe. Kodwa uma uhlelo lwakho ludla imali eyi-$ 2,000 futhi ungena ekuhlinzekeni, ngeke ukhokhe lutho ngesikhathi sokuhlinzwa, kodwa uzothola isikweletu esivela esibhedlela ngemva kwamasonto ambalwa.
Okokuqala, babezothumela isimangalo kumshwalense wakho, lapho izinga lokuxoxisana lizobalwa khona futhi inani kulokho lizobhalwa. Khona-ke umshuwalense uzokhokha isabelo sabo, futhi azise isibhedlela ngesabelo sesiguli saleso sikweletu. Ngaleso sikhathi, isibhedlela singakuthumela umthethosivivinywa we-deductible yakho kanye nanoma yikuphi ukuqinisekiswa okusebenzayo.
Kungani Iziguli Zigcwaliswa Ngokuqhubekayo Ngaphambili?
Usengathola ukuthi isibhedlela sakho sisebenzisa indlela yendabuko yokulinda ukukuthumela ibhilikhithi kuze kube yilapho inqubo yakho isiphelile futhi inkampani yakho yomshuwalense isucubungula ibhilidi lakho.
Kodwa kuyavame ukuba izibhedlela zicele ukukhokha-okuyingxenye noma ngokugcwele-kokudonswa kwakho ngaphambi kwezinsizakalo zezokwelapha ezihleliwe.
Lokhu kubangelwa izici ezihlukahlukene, kufaka phakathi izindleko zezokwelapha ezandayo nokwandisa ama-deductibles kanye nezindleko ezingaphandle kwe-pocket. Kodwa ngokuvamile, umqondo wukuthi izibhedlela azifuni ukunamathela izikweletu ezingakhokhelwa.
Bayazi ukuthi emva kokuba inqubo isiphelile, iziguli zingakwazi noma zingakhokheli ingxenye yezindleko ezibafanele. Isibhedlela singathumela iziguli ekuqoqweni, kodwa ukuthola ukukhokha phambili kuyindlela ephumelela kakhulu yokuqinisekisa ukuthi umthethosivivinywa ukhokhwa.
Yini Okufanele Ngiyenze Uma Isibhedlela Sifuna Ukukhokha Ngaphambili?
Okuhle, lokhu kuyinto ofuna ukuxoxa ngayo nehhovisi lokukhokhisa esibhedlela ngaphambi kwesikhathi senqubo yakho. Ukuthola amahora angu-18 ngaphambi kokuhlinzwa kwakho esibhedlela ukuthi ufuna ukukhokha imali yakho engama-$ 4,000 ngokushesha, kuyinto ecindezelayo, ukusho okungenani.
Uma uhlela inqubo yezokwelapha lapho kuzokhishwa imali yakho, buza mayelana nezinqubomgomo zesibhedlela kusukela ekuqaleni. Xoxa nomshuwalense wakho ukuze ubone ukuthi banezinkhulumiswano zenkontileka nesibhedlela esidinga ukuthi umthethosivivinywa uthunyelwe kumshwalense ngaphambi kokuba isiguli sikhokhiswe. Uma kungenjalo, isibhedlela singathanda kakhulu ukuthi ukhokhe okungenani ingxenye ye-deductible phambili.
Uma ungabaza, kuwukuhlakanipha ukuxhumana nomnyango womshuwalense wombuso ukuze ubone ukuthi baneseluleko yini mayelana nemithethonqubo nemithethonqubo esifundazweni ephathelene nemikhuba yokukhokha kwezokwelapha. Uma wazi ngokwengeziwe, kungcono uzokwazi ukuhamba ngesistimu.
Ungakanani Kangakanani Owe?
Buza esibhedlela ukukunikeza ukulinganisela kwalokho oyokukhokha, ukukhumbula ukuthi izindleko zokwelapha ezixoxisanayo ziphansi kakhulu kunezindleko zokuthengisa. Isibonelo, ake sithi deductible yakho ngu-$ 5,000, uhlela i-MRI, futhi awukakhokhanga noma yikuphi ukukhishwa kwakho kwonyaka. Izindleko ezilinganiselwe ze-MRI zingaphezu kwama-$ 2,600, nakuba zihluka kakhulu esibhedlela esisodwa kuya kwesinye. Futhi noma yiliphi inani lemali yesibhedlela cishe liphakeme kakhulu kunezinga elixoxwa ngalo ukuthi umshwalense wakho unalo esibhedlela. Isibhedlela singase sikhokhe imali engu- $ 2,000, kodwa izinga lokukhokhelwa kwe-insurer lingase libe ngu-$ 1,295, isibonelo.
Uma kunjalo, inani oyodingeka ukhokhele ekudonseni kwakho kungaba ngu-$ 1,295, hhayi $ 2,000 .
Lokhu akuyona inkinga ngempela uma unenkambiso kaningi kaningi kakhulu kunezindleko zakho. Uma usuzoba nokuguqulwa kwamadolo, okulinganiselwa ku-$ 50,000, futhi imali yakho ekhishwe ngu-$ 5,000, uzodingeka ukhokhe ngokugcwele. Isibhedlela singase sikucele ukuthi ukhokhe konke noma ingxenye yaso ngaphambili, noma bangakukhokhela ngemuva kokuhambisa isimangalo kumshwalense wakho, kodwa akukho lutho olutholakala ukuthi uzodingeka ukhokhe u-$ 5,000 ogcwele.
Esikhathini esandulele mayelana ne-MRI, noma kunjalo, inani langempela ozodingeka ukhokhe aliqinisekisiwe kuze kube yilapho umshwalense wakho esebenzile isimangalo. Uma isibhedlela sikucela ukuba ukhokhe ingxenye yesamba sakho esinqunyiwe kusengaphambili futhi akucaci ukuthi uzokwenzakala kangakanani, qiniseka ukuthi uxoxisana nesimo sakho nomshuwalense ngaphambi kokuba unikeze imali esibhedlela. Ngandlela-thile, uzofuna ukuqinisekisa ukuthi ukhokha kuphela imali umklomelo wakho we-EOB ekugcineni athi unecala, kunokuba inani elibhekiswe esibhedlela.
Ingabe Kukhona Uhlelo Lokukhokha Lutholakala?
Izibhedlela ziqhubeka nokusebenza namabhange ukuhlela izinhlelo zokukhokha iziguli ezizidinga, ngokuvamile ezingenasithakazelo kanye nokutholakala okungaxhomeki emlandweni wesikweletu wesiguli. Uma isibhedlela sikucela ukuba ukhokhe imali yakho yokudonswa ngaphambi kwenkambiso yezokwelapha futhi akukho ndlela engokoqobo ongayenza, buze mayelana nokuthi kungenzeka yini uhlelo lokukhokha.
Isibhedlela sifuna ukuthi uthole ukunakekelwa okudingayo uphinde uphile kahle, kodwa futhi akafuni ukukhonjwa isikweletu esibi uma ungakwazi ukukhokha ingxenye yakho yesikweletu. Uhlelo lokukhokha oluvumela iziguli ukuba zelulele umthethosivivinywa wazo ezinyangeni eziningana noma ngisho neminyaka zikhetheka isiguli esingenakekelwa noma isibhedlela singakhokhiwe nhlobo. Uma ungakwazi ukukhokha imali abayifunayo, khombisa inani ongayikhokha, bese ubuza ukuthi bazokuvumela yini ukuthi uhlele izinkokhelo zokuphumula.
Buza ukuthi kukhona umphathi wezehlakalo noma isisebenzi senhlalakahle esibhedlela ongasiza iziguli ekuhambeni kwenqubo yokukhokha nokukhokha. Akudingeki ukuthi ufunde lokhu wedwa, futhi kungase kuvele ukuthi izidingo zokukhokha esibhedlela zingaba nezimo ezingcono kunokuba zivele kuqala.
Ngokuya ngesimo sakho sezezimali, kufanele ubuze mayelana nohlelo lokunakekelwa kosizo lwezempilo, noma ngabe bangabhala ingxenye yezindleko zakho ngokusekelwe kwimali engenayo.
Ingabe Izibhedlela Zinganakwa Ukunakekelwa Ngokusekelwe Emandleni Okukhokha?
Ngezinye izikhathi kukhona ukungaqondi kahle ngezibopho zezibhedlela ngokuhlinzeka ukunakekelwa kungakhathaliseki ukuthi unelungelo lokukhokhela isiguli. Kusukela ngo-1986, i-Emergency Medical Treatment and Labor Act (EMTALA) idinga zonke izibhedlela ezamukela i-Medicare (okungukuthi zonke izibhedlela zase-US) ukuhlinzeka ngezinsiza zokuhlola nokuzinza kunoma iziphi iziguli ezifika ekamelweni eliphuthumayo, kuhlanganise nabesifazane abakhuthele umsebenzi, kungakhathaliseki isimo somshuwalense wesiguli noma ikhono lokukhokha ukunakekelwa.
Ikamelo eliphuthumayo liyadingeka ukuba libuke zonke iziguli ukuze lithole ukuthi iyiphi inkinga, futhi linikeze izinsizakalo zokuzinza-azikwazi ukuvumela isiguli ukuba sife ephansi ngenxa yokungabi namali. Kodwa akudingeki ukuthi banikeze noma yini engaphezu kokuqiniswa uma bengenaso isiqiniseko sokuthi isiguli sizokwazi ukuyikhokhela, futhi i-EMTALA ayidlulisele kunoma yikuphi ukunakekelwa ngaphandle kwamasevisi aphuthumayo.
Ngakho-ke inqubo yezokwelapha esandulelwe ngaphambili ngeke ibe ngaphansi kwanoma yimiphi imithetho edinga izibhedlela ukuhlinzeka ukunakekelwa kungakhathaliseki ikhono lomguli lokukhokha.
Ukwandisa Izidakamizwa Zibeke Iziguli Nezibhedlela Esikhundleni Esibucayi
Izinga elingavunyelwanga liye lahleka kakhulu kusukela uMthetho Wokunakekelwa Ongenakusiza waqalwa. Ngokombiko we-US Census , amaphesenti angu-14,5 abantu base-US abazange baqinisekiswe ngo-2013, futhi lokho kuye kwawa ngamaphesenti angu-8.6 ngo-2016. Nakuba lokho akungabazeki into enhle, abanye balabo bantu abasanda kuphelelwa yisikhathi baye baphuma kakhulu izindleko.
I-ACA ibeka umkhawulo ukuthi izindleko eziphezulu ze-in-out-of-pocket zingaba yini , kodwa umkhawulo ngokwayo uphakeme kakhulu. Ngo-2018, izinhlelo zezempilo zingaba nezindleko ezingaphandle kwe-$ 7,350 zomuntu ngamunye no-$ 14,700 emndenini. Futhi ngo-2019, i-HHS ihlongoze ukwandisa lawo ma-caps angaphezulu kuma $ 7,900 no-$ 15,800, ngokulandelana. Izinhlelo eziningi zezempilo zinemikhawulo engaphandle kwezimali, kodwa ama-deductibles kumalungiselelo emakethe athile avame ukuphindwa izinkulungwane zamadola ( ukunciphisa izindleko zokunciphisa izindleko zokunciphisa lezi deductibles kubantu abafanelekayo, uma nje bekhetha isiliva plan in the exchange).
Izinhlelo ezixhaswe ngumqashi kufanele zihambisane ne-ACA's cap ngezindleko zokuphuma ngaphandle, kodwa zivame ukuba nezindleko zokudonswa kwemali kanye nezindleko ezingaphandle kwezimakethe ezingaphansi kwalezo ezimakethe. Ngonyaka ka-2017, isilinganiso esithathwe ngabantu abasemshwalense wempilo exhaswe ngumqashi sasiyi-$ 1,221, kodwa lokho kwakubandakanya inhlanhla engu-19 yabasebenzi abangenawo amadokhumenti. Uma sibheka kuphela amaphesenti angu-81 abasebenzi abathintekayo abadonsayo, isilinganiso sabo sokudonswa singaphezu kwama-$ 1,500.
Kodwa i-Federal Reserve ibike ngo-2017 ukuthi amaphesenti angu-44 abaphendulile ku-Survey of Economics Household and Decision Making ngeke bakwazi ukufika nge $ 400 ukumboza ibhilidi elingalindelekile, noma kuzodingeka bathengise okuthile ukuze bahlanganise izindleko. Lokho kuveza i-conundrum lapho abantu benenkinga yezokwelapha engalindelekile kodwa edingekile kanye ne-deductible ephezulu.
Ibuye ihlinzekwe i-conundrum yezibhedlela-ezenziwa ngenye indlela ngokuhlinzeka ngempilo ezakhamuzi zendawo, kodwa futhi kudingeka ukuthi iqoqe imali eyanele yokuhlala ngokwezimali. Ukufuna ukukhokhelwa okungenani okuyingxenye ye-deductible kuyindlela eyodwa yezibhedlela ukugwema izimo lapho iziguli ziphela zingakwazi ukukhokha izikweletu zabo.
Cabanga nge-HSA Uma Uthola i-HDHP
Uma umqashi wakho enikeza uhlelo lwezempilo oluphakeme olufanelekayo lwe-HSA (HDHP) , noma uma uthenga umshuwalense wakho wezempilo emakethe ngayinye, cabangela ukubhalisa kwi-HDHP. Akulona iqiniso elifanele kuwo wonke umuntu, kodwa uma uhlanganiswa i-HDHP, ungafaka imali yentela ngaphambi kwe-HSA, futhi kuyoba lapho uma uyidinga.
Ngonyaka we-2018, ungafaka imali engama-$ 6,900 ku-HSA uma unomndeni wakho ngaphansi kwe-HDHP, futhi ufike ku-$ 3,450 uma une-self-cover kuphela ngaphansi kwe-HDHP. Ngisho noma ungakwazi kuphela ukufaka imali encane ngenyanga ngayinye, izokwengeza ngaphezu kwesikhathi, futhi akukho "ukuyisebenzisa noma ukulahlekelwa" ukuhlinzekwa-imali ihlala ku-akhawunti yakho kuze kube nini noma uma udinga ukuyihoxisa. Ungakha umkhumbi ku-HSA ngenkathi une-HDHP, bese uyihoxisa ngosuku oluthile ukuze ukhokhe izindleko zezokwelapha esikhathini esizayo, noma ngabe awusenayo i-HDHP yokufinyelela ngaleso sikhathi.
Ngakho-ke iphuzu lokuthatha umkhondo lapha ukuthi uma ufinyelela ohlelweni olufanelekayo lwe-HSA, ukubhalisa futhi nokwenza iminikelo ku-HSA kuzokwenza kube lula ukubhekana nesimo esingase sibe khona esikhathini esizayo esibhedlela ngokuzumayo sikucela ukuthi ukhokhe isikhunta esibalulekile ngemali ngaphambili ngaphambi kokuthola ukunakekelwa kwezempilo.
Uma umqashi wakho enikeza kanye ne-FSA, lokho kuyindlela enhle, kodwa khumbula ukuthi imali engasetshenzisiwe ku-HSA yakho izohlala ku-akhawunti kusukela ngonyaka owodwa kuya kwesinye- akusikho ngezimali ze-FSA .
> Imithombo:
> Ibhodi labaPhathi be-Federal Reserve System. Isitatimende sephephandaba. I-Federal Reserve Board ibika Umbiko we-Economic Well-Being yaseMelika. Ngo-Meyi 19, 2017.
> I-Federal Register. Ukuvikelwa kwesineke kanye noMthetho Wokunakekelwa Kwezinkinga; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2018; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi olusetshenzisiwe futhi oluhlelekile. NgoDisemba 22, 2016.
> I-Federal Register. Umthetho ophakanyisiwe: Ukuvikelwa kwabagulayo kanye noMthetho Wokunakekelwa Ngezinkinga; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2019. Novemba 2, 2017.
> Kaiser Family Foundation. Izinzuzo Zempilo Yabasebenzi, Ucwaningo Lweminyaka Yonyaka ka-2017. Ngo-September 19, 2017.
> United States Census Bureau. Ukuphepha kwe-Health Insurance e-United States: 2016 . Ngo-September 12, 2017.