Izincazelo ezimbili ezihlukene zeBenmarkmark Plan
Eminyakeni kusukela ngo-Care Affordable Act (ACA) yasungulwa, igama elithi "ipulani lokubheka" lisetshenziswe kakhulu. Kodwa isetshenziselwa ukuchaza izici ezimbili ezihluke kakhulu zomthetho womthetho, okungadideka kubathengi. Ngokujwayelekile, umongo uzokuvumela ukuba ubone ukuthi iyiphi incazelo ekhonjisiwe, uma nje uqonda zombili izinhlobo zezinhlelo zokulinganisela.
Uhlelo lweBenmarkmark lubhekisela ku:
- Uhlelo lwesibili lwezindleko zesiliva eliphansi kakhulu ekushintsheni endaweni ngayinye, emakethe yomshwalense ngamunye, OR
- Uhlelo olusetshenziswa ngumbuso ngamunye ukuchaza izinzuzo ezidingekayo zezempilo kuleso simo ngezinhlelo zeqembu ngalinye namancane.
Lezi zimbono ezimbili ezihluke kakhulu, kodwa bobabili banegama elifanayo, okungaholela ekudidekeni. Ake sihlole ukuthi uhlobo olunye lwepulani lokubonisa uphawu lusebenza kanjani.
Uhlelo Lwesibili Lwezindleko Zesiliva Eshintsheni
Kubantu abakufanelekele ukuxhaswa kwe-premium ye-premium (izikweletu zentela ye-premium) , imali yesibonelelo isekelwe ekugcineni i-premium yenkxaso yesimali ye-yesibili-ephansi kunawo wonke isiliva ohlelweni lwesilinganiso se-pre-determined of the income of the registrar . Leli hlelo lesibili-elibiza kakhulu libizwa ngokuthi i-benchmark plan.
Uhlelo lokulinganisa luyahlukahluka ukusuka kwenye indawo ukuya kolunye, futhi kusukela ngonyaka owodwa kuya kwesinye kusukela isimo sawo njengoba uphawu lokubekwa lubekwe ngokuphelele ngentengo yalo ngokuphathelene namanye amapulani esiliva atholakala kule ndawo.
Ngakho-ke ngaphakathi kwesifunda, kungase kube nezinhlelo ezihlukene zokuhlelwa kwamabhentshi uma umbuso unomshwalense oqinile womshuwalense ohluka endaweni eyodwa kuya komunye, noma kungenzeka kube necebo elilodwa eliphethe indawo yokubheka kuzo zonke izifundazwe, uma uhulumeni engashadile umshuwalense noma ama-insurers amaningi anezindleko eziqhubekayo kulo lonke izwe.
Ngesikhathi sokubhalisa okuvulekile kokuthengiswa kwamakethe ngamunye (Novemba 1 kuya kuDisemba 15), abathengi bangabona ukuthi izindleko zesicwangciso sokubheka kuzoba yini ngonyaka ozayo. Bazobona nokuthi yimaphi imali-uma ngabe-obhalisile bayothola izinsizakalo ze-premium, ngokusekelwe ukuthi uhlelo lokubheka luzobiza kangakanani labo abhalise, izindleko zepulani langempela abafuna ukuzithenga, nemali engenayo (kanye nephesenti elihambisanayo ngemali yabo engenayo ukuthi bazobe bekulindeleke ukuthi bakhokhele uhlelo lokubheka; izibalo zalokho zichazwe lapha).
Uhlelo lokulinganisa lunganikezwa inkampani yomshuwalense eyahlukene kusukela ngonyaka owodwa kuya olandelayo, njengoba izinkampani zomshuwalense zishintsha amanani abo ngonyaka. Amanani azobekwa wona ngonyaka, ngakho-ke uhlelo lokubonisa indawo endaweni angeke lushintshe kuze kube unyaka olandelayo ngaphandle kokuba umshwalense ephuma emakethe phakathi nonyaka (lokhu akuvamile, kodwa kwenzeke-ezinye ze- ACA CO-OPs baphoqeleka ukuba bavale phakathi nonyaka ngonyaka ka-2015 no-2016). Kodwa ngonyaka olandelayo, ama-insurers 'rankings esilinganisweni samanani angagubha nxazonke, njengoba abanye bomshuwalense bephakamisa amanani abo ngaphezu kwamanye, kanti abanye banciphisa amanani abo kusukela ngonyaka owodwa kuya olandelayo.
Kodwa inkokhelo eqondayo ukuqonda ukuthi imali yakho yokukhokhela i-premium isekelwe emalini eyakukukhokhela ukuthenga uhlelo lokulinganisa.
Ungasebenzisa leyo nsizakalo ukuthenga noma yiluphi uhlelo lwezinsimbi zensimbi ekushintsheni. Awudingi ukuthenga uhlelo lokubheka, kepha imali yakho yokusizakala izoba yinani elifanayo, kungakhathaliseki ukuthi uluphi uhlelo olukhethayo (imali yakho yokukhokhela imali elandelayo emva kokusizakala izohluka kakhulu, kuye ngokuthi yiliphi uhlelo oyikhethayo).
Amazinga asekelwe kuHulumeni Wezinzuzo Zempilo Eyisisekelo
Olunye uhlobo lwepulani lokubonisa uphawu luhlelo lwesithenjwa esifundazweni ngasinye sokunquma ukuthi yiziphi izinzuzo ezihlanganiswa izinhlelo zamanye amaqembu nezinhlelo ezincane kuhulumeni. Wonke amahlelo amasha omuntu ngamunye namancane kumele ahlanganise izinzuzo eziyishumi zezempilo ezidingekayo ze-ACA (kunenye indlela yokuhlinzekwa kwamazinyo / imibono yabantwana, kodwa ezinye izinzuzo eziyisishiyagalolunye ezibalulekile zezempilo kufanele zihlanganiswe kuzo zonke izinhlelo ze-ACA ezihambisanayo nezinhlelo ezincane).
Futhi ngenkathi izinhlelo eziningi zeqembu zingadingeki ukumboza izinzuzo zezempilo ezibalulekile, azikwazi ukuphoqelela ama-maximums wenzuzo yonyaka noma yokuphila kunoma yiziphi izinzuzo ezibalulekile zezempilo abazitholayo.
Ngakho kubalulekile ukucacisa okubaluleka njengenzuzo ebalulekile yezempilo. I-ACA ichaza ngokushaywa ngamabomu, ngokugcina uhlaka lwezinzuzo eziyishumi zempilo ezidingekayo kumaphuzu e-bullet angalingana nengxenye yekhasi. Umthetho waphinde wathi uMnyango wezeMpilo kanye noHulumeni lwabantu (HHS) uzobe unomsebenzi wokuqinisekisa ukuthi ukuhlinzekwa "kuzolingana nokulingana kwezinzuzo ezinikezwe ngaphansi kohlelo lomqashi olujwayelekile.
Ukusuka lapho, uhulumeni wesifundazwe washiya i-HHS ukulungisa imininingwane. I-HHS nayo yenza umsebenzi ngamunye ngokuqoka uhlelo lokubheka oluzosetshenziselwa uhlelo lokubhekisela kwamapulani amasha omuntu ngamunye kanye nezincane kuleso simo. Ngo-2012, i- HHS yanyathelisa uhlu lwe-FAQ mayelana nezinhlelo zokukhomba , ukusiza ukuthi zihambisane nenqubo, futhi isiqondiso esengeziwe sanyatheliswa ngo-2015 . Amazwe avunyelwe ukukhetha uhlelo lwazo lokubheka kusukela kwesinye sezinketho ezine ezilandelayo ("okukhulu kakhulu" kunqunywe ngokusekelwe ekubhaleni):
- Enye yezinhlelo ezintathu zezinhlelo ezincane kunazo zonke kuhulumeni
- Enye yezinhlelo ezintathu zokuhlomula ezempilo zomsebenzi wesifundazwe (ukuhlinzekwa okuhlinzekwa abasebenzi bezwe)
- Enye yezinhlelo ezintathu eziphezulu zokuhlomula ezempilo ezisebenzayo zikahulumeni (izinketho ze-FEHBP ezinikezwe abasebenzi basezentela)
- Uhlelo olukhulu lwe-HMO olungelona oluMedicaid oluhlinzekwe emakethe yezohwebo.
Umqondo wukuthi noma yikuphi kwalokhu okukhethwa kukho kuzokwenza ukuthi kube nokutholakala okuqinile, okunamandla, futhi bekungeke kube khona ukuhlinzekela "amathambo angenalutho" njengoba behlinzekwa kubasebenzi bakahulumeni noma bekhethwe ngamabhizinisi amaningi okuqinisekisa abasebenzi babo.
Ngonyaka ka-201 kuya ku-2016, uhlelo lokubheka uhlelo lwaluyihlelo olunikezwa ngonyaka ka-2012 (kusukela ngaleso sikhathi lapho amazwe ebeka khona izinhlelo zabo zokubeka uphawu). Abanye babo kwakudingeka ukuba baxhaswe ukuze baqinisekise ukuthi bahlanganisa wonke ama-EHB, ngoba izinhlelo zazingakafiki ukuba zikwazi ukuhambisana ne-ACA ngo-2012. Ngonyaka we-2017 nangaphezulu, uhlelo lokulinganisa luhlelo olwenziwe ngo-2014. Cishe zonke lezi zizwe zikhethe ukuhlela amaqembu amancane njengendlela yokulinganisa. Imininingwane ecacisiwe yepulani yokukhethwa kwepulani lomhlaba ngamunye yokutholwa kwezitembu iyatholakala lapha.
Amakethe ngamunye nezinhlelo ezincane zezinhlelo ezihlinzekwa kuhulumeni kufanele zibandakanye ukufakwa "okulingana" nezinzuzo ezinikezwa uhlelo lokubheka okukhethwa nguhulumeni. Kukhona ukuqhubeka kombuso owodwa kuya kwesinye, njengoba i-ACA ichaza imingcele evamile ye-EHBs. Kodwa ukuhluka kohlelo lokubheka isimo sezwe kungani uzobona ezinye izinsizakalo-ezifana nokuphathwa kokwelapha-zihluke ngokuhlukile kusuka kumbuso kuya kwesifunda, ngokusekelwe kunoma yiziphi iziphathimandla ezisebenza kuhulumeni, noma ukungafani okuvela ohlelweni lokubheka komunye wombuso kuya kwesinye.
Ngo-Okthoba 2017, i-HHS yanyathelisa izinzuzo ezihlongozwayo nezinzuzo zokukhokhelwa ngo-2019, ezifaka izinguquko ezihlongozwayo ezihlobene nezinhlelo zokulinganisela ze-EHB. Uma kuqedile njengoba kuhlongozwa, kusho ukuthi kuzobe nokunye ukuguquguquka okunye okuqala kusukela ngo-2019, kufaka phakathi ukhetho lokuthola uhlelo lomunye umgomo wezwe njengalo, noma ukufaka izingxenye ezihlukene zezinhlelo ezihlukahlukene zokubeka uphawu lwamazwe ukuze zenze uhlelo lwazo lokubheka nge-hybrid. Ngaphezu kwalokho, uthi uzokwazi ukukhetha noma ukuklama uhlelo lokubheka amasha ngonyaka, kunokuthi aqhubeke nokusebenzisa uhlelo lokubonisa uphawu oluphelile ngo-2017.
Izwi elivela
Uma uzwa othile ekhuluma ngecebo lokubheka ngokuphathelene ne-ACA, umongo uzokuvumela ukuba ubone ukuthi yiluphi uhlobo lwepulani lokubheka oluxoxwe ngalo.
Ingabe bakhuluma ngecebo lesiliva eliphansi-eliphansi kunawo wonke elinikezwa emakethe ngayinye ngokushintshaniswa, noma mayelana nesiphakamiso esinikezwe isimo sokusebenza njengezinsizakalo eziyisisekelo lapho wonke amaqembu ahambisana ne-ACA-ahambisanayo isimo sisekelwe? Uma usuqaphela lokho, imininingwane engenhla izokusiza ukuba wenze umqondo wengxoxo.
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services. Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshuwalense. Izindinganiso zeZempilo Eziyisisekelo Ezibalulekile: Ukuqinisekisa Ikhwalithi, Ukulinganiswa Okungenakutholakala.
> Amasevisi e-Medicare naseMedicaid Services. Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshuwalense. Ukwaziswa Ngezinzuzo Zezempilo Eziyinhloko (EHB).
> Amasevisi e-Medicare naseMedicaid Services. Izinzuzo zezempilo ezibaluleke kakhulu: Uhlu lweMikhiqizo Emikhulu Eminye Eminye Emithathu Ngombuso . Ngo-Ephreli 8, 2015.
> House.gov. Umbhalo woMvikeli Weziguli kanye noMthetho Wokunakekelwa Kwezinkinga .
> Isevisi yangaphakathi yeNgeniso. Inqubo Yokuthola Imali 2017-36 .
> Kaiser Family Foundation. Izinhlelo Zobuningi Bamathuba Ezempilo (EHB), 2017.