Izinhlelo ze-Medicare zenzalo ziza ezinhlobo ezine eziyisisekelo
I-Medicare Advantages Plans, noma i-Medicare Part C, inikezela abahlomuli be-Medicare okunye okunye okunye kuM Medicare wendabuko. Lezi zinhlelo zivumela iziguli ukuba zikhethe uhlelo olunganikeza ukuguquguquka okudingayo ukuze kuhambisane nezidingo zabo ezithile. Lokhu kungase kukhangise njengoba abaningi abahlomula ngemithi bengenayo imali engenayo.
Izinhlelo ze-Medicare Advantage Imihlomulo Ehlanganisiwe
Izinkampani ze-Medicare Advantage Plan kumele zilandele isimiso esifanayo semithetho elawula uhlelo lwe-Medicare. Izivumelwano ze-Medicare ezinhlanganweni zomphakathi noma ezizimele ukuze zinikeze izinketho ezihlukahlukene zokuhlinzeka ngezempilo ezihlanganisa izinzuzo ezifanayo ezibizwa nge-Medicare Part A ne-Part B.
- I-Medicare Ingxenye A ibizwa ngokuthi umshuwalense wesikhungo ngoba iyasiza ukukhokhela ukunakekelwa kwesiguli esitholayo esibhedlela sokugula, esibhedlela esibucayi esibhedlela, isikhungo sokuhlengikaza abanekhono (SNF), ukunakekelwa kweziguli kanye nokunakekelwa kwezempilo ekhaya.
- I-Medicare Part B ingxenye ye-Medicare ebizwa ngokuthi umshuwalense wezokwelapha. Le ngxenye ye-Medicare ikhethela iziguli uma zifinyelela eminyakeni engama-65 ubudala, futhi zikhokhiswa i-premium yenyanga. Ingxenye B ihlinzeka ngamasevisi amaningi angahlanganiswa neNgxenye A.
Izinhlobo zemikhakha ye-Medicare Benevantage - Ingxenye C
Kunezinhlobo ezine ezahlukene zeMicrosoft Advantage Plans abazokwazi ukuzikhethela kuzo. Lezi zihluka endleleni abahlinzeki bakhokha ngayo, kanye nama-copays nezinye izidingo zeziguli.
1. I-Health Maintenance Organisation noma Izinhlelo ze-HMO
Izinhlelo ze-Medicare ze-HMO zisebenza ngendlela efanayo nokunakekelwa okulawulwa kwe-HMO izinhlelo. Isici esivela kakhulu ngecebo le-HMO yindlela yokukhokha kwayo. Ihhovisi lezokwelapha lithola ukukhokha okuhleliwe, njalo ngenyanga ngesiguli ngasinye. Leli nani lihlala lingalingani kungakhathaliseki ukuthi bangaki ukuvakashela isiguli, izindleko zezindleko ezifakiwe, noma ngisho nalapho bengakutholi ukunakekelwa nhlobo. Ezinye izici ze-HMO yizi:
- Kuncishiswe kubahlinzeki be-inthanethi ngaphandle kwezimo eziphuthumayo
- Ukudluliselwa okudingekayo kudingekile ukubona isazi
- Ukugunyazwa kwangaphambili kuyadingeka kumasevisi athile
- Amalungu akanayo ama-copay angasetshenzisiwe futhi aphansi
2. Inhlangano ehlinzekwa ngabanikezeli noma amapulani we-PPO
Izinhlelo ze-Medicare PPO zifana nezinhlelo zokunakekelwa kwePPO. Ama-PPO akhokhela indlela yokukhokha-ye-service. Ukuvakasha kwamaHhovisi, ukuhlolwa kwebhulethi, ama-X ray, noma ezinye izinsizakalo zikhokhwa ngabanye ngokulandela isimiso semali. Le ndlela yokukhokha ivumela ihhovisi lezokwelapha ukuthi lithole ukubuyisela okuphezulu kwesicoco ngasinye sokunakekelwa. Ezinye izici ziyi:
- Abahlinzeki be-in-network nabangaphandle be-inthanethi bavunyelwe, kodwa iziguli zikhokha kancane uma abahlinzeki base-inthanethi besetshenzisiwe
- Akukho ukudluliselwa okudingekayo ukuze ubone udokotela
- Ukugunyazwa kwangaphambili kuyadingeka kumasevisi athile
- Amalungu angaba nomthwalo wemithwalo yokudonswa kwemali, i-copays, ne-coinsurance
- Inikeza izinzuzo ezengeziwe uma kuqhathaniswa neMedare yendabuko, ngezindleko ezengeziwe
- Kuhlanganisa i-out-of-pocket yonyaka ephezulu
3. Izinhlelo ze-Private Fee-For-Service noma i-PFFS
Into ebaluleke kakhulu yokwazi ngeMigomo ye-Medicare PFFS ukuthi ivumela abahlinzeki ukuba "balinganise imali" kuze kufike kumaphesenti angu-15 ngaphezu kwenani lokukhokha lezinhlelo zokusebenza. Amapulani e-PFFS asebenza ngokufanayo nezinhlelo zokusiza.
Izinhlelo zomshuwalense wokuzikhokhela zenza ukukhokhelwa ehhovisi lezokwelapha ngokusekelwe kwendlela yokukhokhela imali. Kukhokhwa-ngensizakalo, ihhovisi lezokwelapha likhokhwa inani elibekiwe lohlobo ngalunye noma iyunithi yesevisi eyenziwe. Ukuvakasha kwamaHhovisi, ukuhlolwa kwebhulethi, ama-X ray, noma ezinye izinsizakalo zikhokhwa ngabanye ngokulandela isimiso semali. Le ndlela yokukhokha ivumela ihhovisi lezokwelapha ukuthi lithole ukubuyisela okuphezulu kwesicoco ngasinye sokunakekelwa.
4. IziMfuno Ezikhethekile Zezidingo noma i-SNP
Izinhlelo ze-Medicare Special Needs zihloselwe abazuzi abahlala nezimo ezithile ezingapheli, izifo, noma izifo. Izinzuzo zikhawulelwe ezigulini ezilandelayo:
- Yiba nesimo esithile esingapheli noma esikhubazayo njenge-HIV / Aids, isifo sikashukela, izimo zempilo yengqondo, ukwehluleka kwenhliziyo ye-congestive (CHF), ukubiza amagama ambalwa nje
- Hlala ekhaya elihlengikazi noma uthole ukunakekelwa ekhaya
- Thola izinzuzo zombili zeMedare and Medicaid
Abathwali
Izinhlelo ze-Medicare Advantage ngezinye izikhathi zidideka nezinhlelo zokunakekelwa eziphathiswe abasebenzi basehhovisi lezokwelapha. Eziningi zalezi zinhlelo zihlinzeka ngezinkampani ezinkulu zomshuwalense wezempilo ezifana nalezi:
- I-Aetna
- I-AARP
- I-United Health Care
- I-Blue Cross Blue Shield
- WellCare
Kubalulekile ukwazi imigomo ye-Medicare Advantage endaweni yakho nokuthi ungafaka kanjani izimangalo ukuze uvimbele ukukhokha okulimele.