Kuphela eNew York naseMinnesota Kuye Kwaqalwa BHPs
Isigaba 1331 soMthetho Wokunakekelwa Okungenakusiza ukuvumela isimo ukuthi senze uhlelo lwezempilo oluyisisekelo (BHP) ukuze luhlinzekwe ngempilo kubantu abahola okuningi ukuze bafanelekele iMedicaid, kodwa abasafuna usizo olwedlula i-ACA. Noma yiliphi izwe lingasungula i-BHP, kodwa kuphela eNew York naseMinnesota okwenze kanjalo.
Izindleko ze-BHP zihlanganiswa ngemali yezimali kahulumeni kanye nesifundazwe, kuhlangene nama-premiums aphansi futhi ukwabelana ngezindleko kumalungu.
I-ACA idinga nje i-BHP ukuqinisekisa ukuthi amalungu akudingeki akhokhe ngaphezulu amaphrimiyamu nokwabelana ngezindleko abazokhokha ngaphansi kwepulani lezempilo elifanele (ikakhulukazi, uhlelo lwesibili lwezindleko zesiliva ngokwemigomo yeprimium, kanye ne-platinum noma i-plan plan yegolide-kuye ngokuthi imali engenayo-ngokwezindleko ze-out-of-pocket) ekushintsheni, kepha ukubhalisa kwi-BHPs eNew York naseMinnesota kunezindleko eziphelele kakhulu kunalokho abazokwazi ukukwenza ngezempilo.
Ubani Okufanelekile Ukuhlinzekwa Kwempilo Eyisisekelo?
Izinhlelo Zezempilo Eziyisisekelo zikhethwa yizizwe. Kodwa uma kusetshenziswe, ukufaneleka kufanele kuchazwe kumbhalo we-ACA:
- Iningi labantu liyakwazi ukuthola ukukhishwa kwe-BHP uma kunemali engenayo phakathi kwamaphesenti angu-133 (ngokwenzayo, yizingamaphesenti angu-138 ngezinga elingenakuthola engenayo) kanye namaphesenti angu-200 wezinga lobuphofu elisemthethweni. Ngohlelo lwe-2018, umkhawulo ongenhla wokuthola umuntu oyedwa ngu-$ 24,120. Njengoba i-ACA ibhalwa, abantu abanenzuzo engenayo ngaphansi kwamaphesenti angu-133 ebuningi bobubha kulindeleke ukuba bahlinzekwe nge-Medicaid, ngakho-ke umbiko we-BHP uzokhipha lapho i-Medicaid ishiya khona. Kodwa-ke, kunamazwe angu-19 anqatshelwe ukwandisa iMedicaid, okuholela ekungeneni kwe-18 kubo (abantu abaningi abanenzuzo engaphansi kwezinga lobuphofu abavunyelwe ukukhokhelwa kwe- premium ku-exchange). Kodwa yilokho kuphela okushiwo yi-BHP futhi kwandise iMedicaid.
- Ukwethula ngokusemthethweni abafuduki abangakaze base-US okungenani iminyaka emihlanu bayakufanelekela ukukhishwa kwe-BHP uma benemali engenayo engaphansi kwamaphesenti angu-133 obukhulu bobuphofu. Lokhu kungenxa yokuthi abahambeli bamuva abakufanelekeli i-Medicaid (ngisho nasesimweni esandise iMedicaid) kungakhathaliseki ukuthi bayitholaphi , baze bavele ngokomthetho e-US okungenani iminyaka emihlanu.
Izizwe ezimbili ziye zasungula izinhlelo zezempilo eziyisisekelo
Amabandla amabili-eNew York naseMinnesota-asungula izinhlelo zezempilo eziyisisekelo.
I-New York
I-BHP yaseNew York ibizwa ngokuthi i-The Essential Plan, futhi yatholakala ekuqaleni kuka-2016. Izingcaphuno ze-Essential Plan kanye nezindleko ziyatholakala lapha futhi lapha . Awekho amaphrimiyamu abhalisa ngenzuzo engenayo kuze kube ngamaphesenti angu-150 wezinga lobuphofu, ngaphandle uma befuna ukwengeza ukuhlinzekwa kwamazinyo nokubona. Labo abanenzuzo engenayo phakathi kuka-150 no-200 wamaphesenti wezinga lobuphofu bakhokhela u-$ 20 / ngenyanga ukuze bafinyelele.
Ngaphansi kwe-The Essential Plan, ibhalisa ngemali engenayo kuze kube ngu-150% wezinga lobuphofu ($ 18,090 kumuntu oyedwa ngo-2018) awunayo i-copays noma enye ukwabelana ngezindleko zezinsizakalo eziningi, nakuba kunama-copay amancane ama-$ 3 emithi yokwelashwa. Labo abanenzuzo engenayo ngaphezu kwamaphesenti angu-150 ebunini bobuphofu banamakhophi amaningi ezinsizakalo, nakuba kungekho deductible futhi inani elilinganiselwayo lokubiza izindleko liphansi kakhulu kunokuba libe seluhlelo lwangasese ngokusebenzisa iNew York State Health (ukushintshwa kombuso eNew York).
Izinzuzo ze-Essential Plan zihlinzekwa ngabanomshwalense abazimele abenza isivumelwano ne-New York. Kunezinkampani eziyishumi nambili zomshuwalense ezithatha iqhaza ohlelweni, nakuba iningi linikeza uhlelo olubalulekile ezindaweni ezimbalwa zombuso ( leli shidi libonisa lapho umshwalense ngamunye enikeza khona Uhlelo Olubalulekile).
Izakhamuzi zaseNew York zingabhalisela i-The Essential Plan ngeNew York State Health. Ukushintshaniswa kunquma ukufaneleka kwe-Medicaid, I-Essential Plan, kanye nezinhlelo zempilo ezifanele (noma ngaphandle kwezibonelelo ze-premium), kuye ngokwemali engenayo nezinye izinto ezifanele.
Kusukela ngoDisemba 2017, kwakukhona abantu abangaba ngu-720 000 ababhalisile ku-The Essential Plan ka-2018.
Minnesota
I-BHP yaseMinnesota ibizwa ngokuthi i-MinnesotaCare, futhi ibe uhlelo lwezempilo oluyisisekelo kusukela ngo-2015 (MinnesotaCare uhlelo oluye eMinnesota kusukela ngo-1992, kodwa lwaguqulwa lwaba yi-BHP ngaphansi kwemihlahlandlela ye-ACA kusukela ngoJanuwari 2015, usuku lokuqala oluvunyelwe ngaphansi kwesifundazwe imithetho).
Isifingqo se-MinnesotaCare coverage siyatholakala lapha. Abantu abangaphansi kweminyaka engu-21 abakhokhi ukwabelana ngezindleko, kodwa kunama-copays abhalisile abaneminyaka engu-21 nangaphezulu, kanye ne-deductible ye-$ 2.95 ngenyanga (imali ekhokhwayo kuphela okufanele ikhokhwe uma udinga usizo lwezokwelapha phakathi nenyanga).
Izinkokhelo ze-MinnesotaCare zisekelwe emalini engenayo, futhi zingaba ngaphezulu kwamaRandi ayi-80 / ngenyanga ngomuntu ngamunye kulabo abanezinkokhelo ekupheleni kokuphezulu kwebanga lokufaneleka (amaphesenti angu-200 ebunini bobuphofu, okungama-$ 24,120 kumuntu oyedwa, no-$ 49,200 umndeni wezingane ezine; inothi lokuthi umndeni wezingane ezine nalesi sigaba semali engenayo uzofanelekela eNigeriaCare kubazali, kodwa izingane zizofanelekela i-Medicaid uma zineminyaka engu-18 noma encane).
Njengoba kunjalo eNew York, Minnesota izinkontileka nabashuwalense abazimele ukunikeza izinsizakalo ngaphansi kohlelo lwezempilo oluyisisekelo. Kusukela ngo-2017, kunezinkampani eziyisikhombisa zomshuwalense ezinkontileka zikahulumeni ukuhlinzeka nge-MinnesotaCare. Izakhamuzi zaseMinnesota zingabhalisela i-MinnesotaCare nge-NNure, ukushintshaniswa kombuso. Ukushintshaniswa kwenza ukufaneleka kwemigomo ye-Medical Assistance (Medicaid), MinnesotaCare, kanye nezinhlelo zempilo ezifanelekile (noma ngaphandle kwezibonelelo ze-premium), kuye ngokwemali engenayo nezinye izinto ezifanele.
Kusukela ngoNovemba 2017, kwakunabantu abangaba ngu-93 000 ababhalise eMinnesotaCare ngo-2018.
IziNhlelo Zempilo Eziyisisekelo Zixhaswe Njani?
Ngaphansi kwe-ACA, uhulumeni wesifundazwe uzohlinzeka ngezifundazwe ngezimali ze-BHP ezilingana namaphesenti angama-95 emali ukuthi uhulumeni wase-federal uzobe esebenzile ekusizeni imali eyinzuzo kanye nokunciphisa izindleko kuleso simo (kubantu abaphelela ekufanelekele iBHP esikhundleni kunezinhlelo zesiliva eziphansi kakhulu ezibiza imali ekushintsheni, ngezinsizakalo ze-premium kanye nokunciphisa izindleko).
Ngaphambi kuka-2015, i-MinnesotaCare yihlelo oluxhasiwe nguhulumeni olunikeza ukuhlinzekwa kubantu abangakufanelekeli i-Medicaid, futhi abenezimali ezingaphezulu kwamaphesenti angu-275 wezinga lobuphofu. Ukushintshela kwi-BHP kwakuzuzisa ngokwezimali ngokweMalika, njengoba kwavunyelwa ukuxhasa ngemali eyinhloko kunokuba ixhomeke ngokuphelele kwizimali zikahulumeni (abantu baseMinnesota abahola phakathi kuka-200 no-275 wamaphesenti wezinga lobuphofu manje sebesebenza ngezinhlelo zempilo ezifanelekile ngeNkambiso, njengoba I-ACA idinga ukuthi i-BHP ibe yi-cap yokufaneleka ku-200% wezinga lobuphofu).
Kwakuzuzisa ngokwezimali eNew York ukusetha i-BHP. Kusukela ngo-2001, iNew York yayinikeze ukunikezwa kwemali yaseMedicaid ekhokhelwa uhulumeni kubantu abavela kwamanje (abangazange bafanelekele ukuxhaswa ngeMedicaid okuxhaswe ngokuhlanganyela nguhulumeni wesifundazwe nesifundazwe, ngoba izimali zaseMedicaid zemali azikwazi ukusetshenziselwa ukumboza abafuduki abasanda kuvela e-US ngaphansi kweminyaka emihlanu). Njengoba ukusakazwa kwe-BHP kuyatholakala kulabo abavela kwamuva, ukushintshwa kweNew York kumodeli we-BHP kwakusho ukuthi kwakungasadingeki ukuba bathembele ngokuphelele kwizimali zikahulumeni ukumboza abafuduki abangenayo imali engenayo.
Isinqumo sikaHulumeni seTrump ngo-Okthoba 2017 sokuqeda ukusekelwa kwemali ehambisana nokunciphisa izindleko kuzonciphisa inani lemali yezimali ezenziwa yi-BHPs, kepha imali ephelele yezimali ze-BHPs iningi imali uhulumeni wase-federal ozoyisebenzisa ekusizeni imali eyinzuzo- imali eyobe isetshenziselwa ukunciphisa izindleko zenani eliyingxenye encane yenani. Ukuqedwa kwezimali zokunciphisa izindleko zokwabiwa kwemali kusekhona ukukhathazeka okukhulu kokubili eNew York naseMinnesota, nakuba bobabili abasezifundazweni beqhubeka nokuqhuba umsebenzi wabo we-BHP no-2018 kutholakala izakhamuzi ezifanelekile kanye nezinkomba ezifanayo zohlelo ezisetshenziswe eminyakeni eyedlule.
Ingabe amanye amazwe asungula ama-BHP?
Uhlelo lwe-BHP luyatholakala yonke indawo, kodwa akunakwenzeka ukuthi ezinye izifunda eziningi zizoqeda ukusetha eyodwa. Ngokuvamile, umbuso udinga ukwandisa iMedicaid futhi usungulwe umshuwalense wezempilo wakhe ukuze i-BHP ibe yindlela engokoqobo. Futhi ngenkathi izinhlelo zezempilo ezifanelekile ekushintsheni azizithembi nakancane kwizimali zikahulumeni, i-BHP ibeka uhulumeni esikhungweni sokubambisana ngemali engase ibe khona, uma imali yezimali engeke yanele (kokubili eNew York naseMinnesota bekufanele kuhlanganise ezinye izindleko ze-BHPs yabo, nokuqedwa kwezimali ezisezingeni likahulumeni ekunciphiseni izindleko zokwenza imali kuqhubekisela phambili okwandisa igebe phakathi kwalokho uhlelo olubiza nokuthi yini uhulumeni okhokhela yona).
Kodwa abantu kanye nemindeni enenzuzo engenayo kakhulu kakhulu kwi-Medicaid ifakwe kahle yi-BHPs. Ezingeni ezingenayo i-BHP, kukhona "umcibisholo" onamandla kakhulu ngokwemigomo yamaphrimiyamu kanye nokwabelana ngezindleko phakathi kwama-Medicaid nezinhlelo zangasese ekushintshaneni, ngisho nezinsizakalo ze-premium nokunciphisa ukwabelana ngezindleko kuhlelo lokuzimela ( izinzuzo zokunciphisa izindleko zisatholakala, naphezu kokuthi uhulumeni wesifundazwe akasasekhokhela izinkampani zomshuwalense ukuhlinzeka lezo zinzuzo).
Umuntu onesiNgisi se-Medicaid uyokhokha kancane noma angabikho kuma-premium, futhi ukwabelana ngezindleko kunomkhawulo kumanani amancane ngaphansi kwemithetho kahulumeni. Uma lowo muntu ethola imali encane futhi imali yakhe engenayo ikhula kusuka ku-$ 16,600 kuya ku-$ 16,700 (ngo-2017), uzolahlekelwa ukufaneleka kwe-Medicaid (ecabanga ukuthi usesesimweni esandise iMedicaid). Uma esesimweni ene-BHP futhi imali engenayo iphakama kakhulu ku-Medicaid, uzokwazi ukuthola ukufakwa kwe-BHP esikhundleni, lapho ezokhokhela khona i-premium ye-nominal (noma akekho nhlobo, eNew York, ngokusekelwe kumholo wakhe ), futhi izindleko zakhe ezingaphandle kwezepolitiki zizoqhubeka zizithoba.
Kodwa uma esesimweni ngaphandle kwe-BHP, kuzodingeka athenge uhlelo lwezempilo olufanele ekushintsheni. Kuncike lapho ahlala khona, angase afanelekele ukukhokhela imali eyinzuzo enkulu yokukhokha imali egcwele yeplani ye-bronze, kodwa lezo zindleko ziza nezindleko ezinkulu (ngokuvamile okungenani u-$ 6,500 ngo-2018, futhi ngokuvamile ziphakeme njengoba okuvunyelwe kakhulu-$ 7,350). Uma ekhetha kunalokho ukukhetha uhlelo lwesiliva (oluzohlanganisa ukunciphisa izindleko, futhi ngaleyo ndlela ube nezindleko ezingaphansi kwe-pocket), uzokhokha ngamaphesenti amathathu emali engenayo emahoyisini. Ngisho nezinzuzo zokunciphisa izindleko zokwenza imali, uzokhokha okuningi kuma-deductibles kanye nama-copays kunoma yiziphi ezimbili ze-BHP ezikhona zidinga ukubhalisa kwabo ukukhokha.
Ngamanye amazwi, ukusetshenziswa kombuso we-BHP kusiza ukubhebhethekisa umehluko phakathi kokuhlinzekwa kwemithi / izindleko kanye nokubhekwa kwezimali / izimali ezizimele, futhi kubangele izindleko zokunakekelwa kwezempilo ezingaphezulu eziphathekayo kubantu abathola imali engenayo kakhulu ekufanelekeni kweMedicaid. Kodwa ukusungula i-BHP kungase kudingeke ukuthi izwe lisetshenziselwe izimali zalo, futhi lizobandakanya ukuguqula abantu abakhona njengamanje njengabantu abaphephile (abanomsebenzi ngaphansi kwezinhlelo zempilo ezifanele) ohlelweni olusha, okungahle kudidelele izakhamizi zombuso nabahlinzeki bezokwelapha, futhi okungenzeka ziphazamise ngokuqhubeka nokunakekelwa.
> Imithombo:
> Imindeni yase-USA. Izinkombandlela zeNtshonalanga Yempofu.
> HealthCare.gov. Funda uMthetho Wokunakekelwa Onganakekelwayo. Ingxenye yesi-4, ukuguquguquka koMbuso ukuqala izinhlelo ezihlukile. Isigaba 1331 (ikhasi 93 lombhalo).
> UMnyango Wezisebenzi ZaseMinnesota. MinnesotaCare (Uhlelo Lokusebenza, Ukufaneleka, Izinzuzo, Ulwazi Lokufaka Isicelo).
> Isimo sezempilo saseNew York. Uhlelo olubalulekile.