Kwesinye isikhathi, kungase kube ngcono noma kuyadingeka ukuba ube nezinhlelo ezihlukene
Abashadile bavame ukumbozwa ngenqubomgomo yomshwalense efanayo. Kodwa lokho akunakwenzeka ngaso sonke isikhathi, futhi akuyona inketho eyenza umqondo omkhulu. Ake sibheke imithetho esebenzayo ekuqhakambiseni umlingani, kanye nemibandela okufanele uyibuze ngaphambi kokunquma ukuthi ngabe wena nomngane wakho womshado kufanele nibe-noma ningaba nomgomo womshuwalense wempilo efanayo.
Ukungaphandle kwe-Pocket Exposition
Imindeni idinga ukucubungula ukukhishwa kwe-pocket ye-pocket kwanoma yiluphi uhlelo lwezempilo noma izinhlelo abazinayo noma ezicabangayo. I-Cost Affableable Care Act imingcele yezindleko ezingaphandle kuka- $ 14,700 emndenini ngo-2018 , futhi ivimbela noma yiluphi ilunga elilodwa lomndeni ekukhokheleni okungaphezulu izindleko ezingaphandle kwe-pocket (ngezinsizakalo ze-in-network) kunezingama $ 7,350 . Kodwa umkhawulo womndeni ongaphandle kwe-pocket usebenza kumgomo owodwa ohlanganisa amalungu omndeni.
Uma umndeni uhlukaniswa emaqenjini amaningi-kubandakanya umshuwalense oxhaswe ngumqashi, ukuthengiswa kwemakethe ngamunye, noma iMedare-imingcele engaphandle kwemiphakathi isebenza ngokuhlukile ngenqubomgomo ngayinye. Ngakho-ke uma umndeni uqala ukuba nomlingani oyedwa ohlelweni olulodwa kanye nomunye oshade naye ohlelweni oluhlukile nabantwana bomlingani, uhlelo ngalunye luyoba nomkhawulo ongaphandle we-pocket, futhi ukuvezwa okuphelele kungaba ngaphezulu kunokuba ngabe kungaba wonke umndeni wawuhlelweni olulodwa.
Izidingo zezempilo
Uma omunye oshade naye enempilo kanti omunye unesimo esibalulekile sezokwelapha, isinqumo esingcono kakhulu sezezimali singase sibe sinezinqubomgomo ezimbili ezihlukene.
Umlingani ophilile angase akhethe uhlelo oluphansi lokuhlinzekwa ngenethiwekhi yokuhlinzeka ngokunciphisa futhi ukukhulisa okungekho emphakathini, ngenkathi oshade naye abanezimo zezokwelapha angase afune uhlelo olubi kakhulu olunezinsizakalo ezithe xaxa ezinezinethiwekhi eziningi zomhlinzeki futhi ezingezansi izindleko ze -pocket.
Lokhu ngeke kube njalo, ikakhulukazi uma omunye umlingani efinyelela ohlelweni oluxhaswe umqashi oluphezulu oluzozihlanganisa zombili nge-premium efanele. Kodwa kuye ngezimo, eminye imikhaya ithola ukuthi kuwukuhlakanipha ukukhetha izinhlelo ezihlukene ngokusekelwe kwezidingo ezithile zezokwelapha.
Imiphumela Yama-akhawunti Wokulondoloza Impilo
Uma unayo i- Akhawunti Yokulondoloza Impilo (HSA) noma unesithakazelo sokuba nomunye, uzofuna ukwazi ukuthi kunamapulani omshwalense wezempilo ohlukile.
Ungakwazi ukufaka ama-$ 6,900 ukuya ku-HSA ngo-2018 uma unomsebenzi wokuba "umndeni" ngaphansi kwe-HSA-ephakeme eqeqeshiwe yezempilo (plan HD). Ukwakhiwa komndeni kusho okungenani amalungu amabili omndeni ahlanganiswe ngaphansi kwepulani (okungukuthi, noma yini enye ngaphandle kokubheka "kuphela" ngaphansi kwe-HDHP).
Uma unenhlelo elifanele le-HSA lapho uyingxenye yodwa eqinisekisiwe, umkhawulo wakho we-HSA ngo-2018 u-$ 3,450. Wena nomlingani wakho ngamunye ningaba nama-HSA ahlukile futhi ahlukene nama-HSA-aphakeme afanelekayo amahlelo ezempilo ezidonswayo. Kodwa uma omunye wenu enesipiliyoni esifanelekayo se-HSA (engenamalungu omndeni owengeziwe ohlelweni) kanti enye inomsebenzi womshuwalense wezempilo ongeyona i-HSA-afanelekayo, umnikelo wakho we-HSA uzokhawulelwa ku-$ 3,450 ngo-2018.
Umshuwalense Wezempilo Oxhaswe Ngumqashi
Cishe isigamu sabo bonke abantu baseMelika bathola umshuwalense wabo wezempilo kusuka ohlelweni oluxhaswe ngumqashi-yilolu hlobo olulodwa olulodwa olubanzi lokufaka. Uma bobabili abashadile basebenzela abaqashi abahlinzeka ngemisebenzi, ngamunye angaba ohlelweni lwakhe. Uma abaqashi benikeza ukuxhaswa kwabashadile, lo mbhangqwana unganquma ukuthi kunengqondo yini ukuba nezinhlelo zawo siqu, noma wengeze omunye umlingani ohlelweni oluxhaswe ngumqashi.
Kukhona izinto eziningana okumelwe uzigcine engqondweni uma unquma inkambo engcono kakhulu yezenzo:
- Abaqashi akudingeki ukuthi banikeze ukukhokhelwa kwabashadile. I-Care Affordable Act idinga ukuthi abaqashi abakhulu ( abasebenzi abangama-50 noma ngaphezulu ) banikeze ukuhlinzekwa kwabasebenzi babo besikhathi esigcwele, futhi bafune ukuba nabo banikeze ukuhlinzekwa kwabantwana abaxhomeke kubasebenzi. Kodwa asikho isidingo sokuthi abaqashi banikeze ukwaziswa kwabashadile bomsebenzi.
- Lokho kusho ukuthi iningi labaqashi abahlinzeka ngokubambisana livumela abashadile ukuba babhalise ohlelweni. Abanye abaqashi banikeza ukuvota komlingani kuphela uma lowo oshade naye engenawo uhlelo lokuxhaswa ngumqashi.
- Ngaphansi kwe-ACA, ukuqashwa kwabaqashi abakhulu banikezela abasebenzi babo besikhathi esigcwele kumele kubhekwe njengengakhokhwa, noma ngabe umqashi ubhekana nokuhleleka kwezezimali. Kodwa ukuzimisela ukukwazi ukukwazi ukukwazi ukukhokhela kuncike ekubanjweni kwezindleko ze-premium yomsebenzi, kungakhathaliseki ukuthi izindleko zokwengeza abaxhomekile noma oshade naye ohlelweni . Lokhu kwaziwa njenge-glitch yomndeni , futhi imiphumela eminye imindeni ibhekene nezindleko ezibalulekile zokwengeza umndeni ohlelweni oluxhaswe ngumqashi, kodwa futhi nokungafaneleki ukusizwa ekusizeni.
- Kodwa abaqashi abaningi bakhokha ingxenye yengonyama yezindleko zokwengeza amalungu omndeni, nakuba kungadingeki ukuba benze kanjalo. Ngo-2017, ama-premiums ajwayelekile okukhishwa komndeni ngaphansi kwezinhlelo ezixhaswe ngumqashi ayeyizigidi ezingu-18,764. Kule mali, abaqashi bakhokhela isilinganiso samaRandi ayi-13,049, noma cishe amaphesenti angu-70. Kodwa lokhu kuyahluka kakhulu kuye ngokuthi ubukhulu benkampani; amafemu amancane akakwazi kakhulu ukukhokhela ingxenye ebalulekile ye-premium yokwengeza abaxhomekile nabalingani ekuqhathaneni kwabasebenzi babo.
- Abanye abaqashi bangezela ama-premium kuma-premiums abawakhokhela abashadile uma oshade naye enenkululeko yokwenza umsebenzi endaweni yakhe yomsebenzi. Uma umqashi wakho enza lokhu, izindleko eziphelele kuzodingeka zicatshangelwe uma uhlahlela izinombolo ukuze ubone ukuthi kungcono yini ukuba bobabili bomshado kuhlelo olufanayo, noma umlingani ngamunye asebenzise uhlelo lwakhe oluxhaswe ngumqashi.
- Ngakolunye uhlangothi, amaphesenti angaba ngu-10 abaqashi abanikeza isinxephezelo esengeziwe kubasebenzi babo ababhalisa ohlelweni lomlingani kunokuba babhalise ohlelweni lomxhaso lomqashi. Lezi yizinto ozozifuna ukubhekana nazo nomnyango wakho wezidingo zabasebenzi ngesikhathi sokubhalisa kokuqala kanye nesikhathi sakho sokubhalisa sonyaka ovulekile. Uma uqonda ngokwengeziwe isikhundla somqashi wakho ekuqhakambiseni umlingani (nomqashi womlingani womlingani wakho), uyohlomele kangcono ukwenza isinqumo.
Umshwalense weMpilo ngamunye
Uma uthenga umshuwalense wakho wezempilo, noma nge-exchange noma ngaphandle-exchange , ukhona kulokho okwaziwa ngokuthi imakethe ngayinye. Unenketho yokubeka bobabili abashadile ohlelweni olulodwa, noma ukhetha amapulani amabili ahlukene.
Ungakhetha amapulani ahlukene ngisho noma ubhalisa ekushintsheni ngezimali ezikhokhelwa nge- premium Ukuze ufanelekele ukuthola izinsizakalo, abhalisile abashadile kumele bafake ukubuyiswa kwentela ehlangene, kodwa akudingeki ukuba babe nomgomo womshuwalense wezempilo. Ukushintshaniswa kuzobala inani lemali yakho yesibonelelo esekelwe kwimali yakho yasekhaya bese uyisebenzisela izinqubomgomo ozikhethayo. Uzobuyisana nemali ekhokhelwa intela yakho yentela ngendlela efanayo ongayenza uma unomgomo owodwa ohlanganisa umndeni wakho, futhi inani lemali engenayo eliyothola lizofana nalokhu elizokwenza uma uhlangene ohlelweni olulodwa (inani olikhokhayo kuma-premiums azoba ahlukene, noma kunjalo, njengoba imali ekhokhelwayo ngaphambi kokubambisana izohlelwa ngokungafani nezindleko zangaphambi kokubambisana ukuze bobabili bomshado kuhlelo olulodwa).
Ungakhetha futhi ukuthi umlingani oyedwa athole uhlelo lokushintshanisa futhi elinye uhlelo lokushintshana. Lokhu kungase kube into okufanele ucabangele uma, isibonelo, omunye oshade naye uthola ukwelashwa kwabahlinzeki abasebenza kuphela kwinethiwekhi nabathwali bokushintshana. Kodwa khumbula ukuthi azikho izinsizakalo ezitholakala ngaphandle kokushintshaniswa, ngakho-ke oshade naye onomsebenzi wokushintshanisa uzokhokha inani eligcwele lokubheka. Futhi ngenkathi oshade naye enomsebenzi wokubambisana naye usafanelekile ukuthola izinsizakalo ezisekelwe kwinani lemali engenayo yomndeni kanye nenani labantu abasendlini, inani lemali yesibonelelo lingancike kakhulu ( nansi izibonelo zokubonisa ukuthi lokhu kusebenza kanjani ).
Uma omunye oshade naye engakwazi ukuthola uhlelo oluxhaswe ngumqashi futhi omunye umlingani ufanelekile ukungezwa kulolu hlelo kodwa ukhetha ukuthenga uhlelo lomakethe ngalunye esikhundleni, akukho mali yokukhokhela i-premium ayatholakala ukuze ahlaziye izindleko zepulani ngalinye, ngoba izinsizakalo ayitholakali kubantu abanokufinyelela kokuthengiswa okuxhaswe ngumqashi.
Umshwalense Wezempilo Oxhasiwe Kahulumeni
Kwezinye izimo, omunye umlingani angase afanelekele umshuwalense wezempilo oxhaswe nguhulumeni, kanti enye ingekho. Ezinye izibonelo zifaka:
- Omunye umlingani uphendukela eminyakeni engama-65 futhi ufaneleke ku- Medicare , kanti enye isencane kuneminyaka engama-65. Ngisho noma bobabili bobabili bafanelekile ku-Medicare, yonke inzuzo ye-Medicare yedwa, kunomndeni. Umlingani ngamunye uzoba nokuqhathaniswa okuhlukile ngaphansi kwe-Medicare, futhi uma befuna ukwesekwa okungeziweko (mhlawumbe ngokusebenzisa uhlelo lwe- Medicare Advantage olufaka i-Original Medicare, noma i- Medigap ne- Medicare Part D ukuze lunikeze iMederal Medicare), umlingani ngamunye uzoba nenqubomgomo yakhe.
- Omunye umlingani ukhutshazekile futhi ufanelekela iMedicaid noma i-Medicare, kanti enye inamandla.
- Owesifazane okhulelwe angase afanelekele i- Medicaid noma i- CHIP (iziqondiso ziyahlukahluka ngesimo), kuyilapho oshade naye engenzi.
Uma omunye umlingani efaneleka umshwalense wempilo oxhaswe nguhulumeni, omunye angakwazi ukuqhubeka nomshuwalense wezempilo wangasese. Lesi simo singashintsha ngokuhamba kwesikhathi. Isibonelo, owesifazane okhulelwe angase angasakwazi ukuthola i-Medicaid noma i-CHIP ngemuva kokuzalwa komntwana, futhi kungase kudingeke abuyele ohlelweni lwomshuwalense wezempilo wangasese ngaleso sikhathi.
Akukho ukulingana komuntu oyedwa-ngokusho ukuthi ngabe abashadile kufanele babe nesishuwalense esifanayo somshuwalense wezempilo. Kwezinye izimo, azikwazi ukufinyelela izinhlelo ezifanayo, futhi kwezinye izimo, kubazuzisa ukuba babe nezinhlelo ezihlukene, ngezizathu ezihlukahlukene.
> Imithombo:
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Ukuvikelwa kwesineke kanye noMthetho Wokunakekelwa Kwezinkinga; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2018; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nomthengi osebenzayo kanye nohlelo oluhlelekile. NgoDisemba 22, 2016.
> Insizakalo yangaphakathi yeNgeniso, Inqubo Yokuthola Imali Yenzuzo 2017-37 .
> I-Kaiser Family Foundation, Amaphrimiyamu Omphakathi Wempilo Yomndeni Yonyaka Yonyaka Yokusebenza Yenyukela Ukuzithoba Ku-3% kuya ku-$ 18,142 ngo-2016; Abasebenzi abaningi Bhalisa Emiphakathini Ephezulu-Deductible With Option Savings Over Eminyakeni emibili eyedlule.
> Kaiser Family Foundation, Izinzuzo zezeMisebenzi zabaSebenzi, 2017 Ukufingqiwe kokuthola.
> Kaiser Family Foundation, Ukuphepha Kwempilo Yomphakathi Yonke Inani labantu.
> Medicaid.gov. Izinga lokufaneleka le-Medicaid ne-CHIP.