Uhlelo lwezempilo lwebhesi luhlobo lomshwalense wezempilo okhokhela, ngokwesilinganiso, amaphesenti angama-60 ezindleko zokunakekelwa kwezempilo ezijwayelekile (kodwa lokhu kuyinto ephakathi kwabo bonke ababhalisile-iphesenti yezindleko zakho ukuthi lolu hlelo luhlanganisa luyohluka kakhulu kuye ngokuthi udinga ukunakekelwa okuningi kwezokwelapha phakathi nonyaka, noma kungabi nhlobo nakakhulu). Ababhalisile bakhokhela amanye amaphesenti angu-40 ezindleko zabo zokunakekelwa kwezempilo ngokugcwele ngemali yokukhokhwa kwemali , ukuqinisekiswa kwemali , nokunciphisa imali .
Ukunqunywa ukuthi uhlelo luhambisana nezinga lobhedu lokubheka lusekelwe ekubalukeni kwe-actuarial, kuchazwe lapha ngokuningiliziwe . Izinhlelo ze-bronze ziyatholakala kokubili izimakethe zempilo yomshuwalense wezempilo ngabanye nabezincane, ngokushintshaniswa noma okungekho emthethweni.
Ukuqhathanisa kanjani izinhlelo
Ukwenza kube lula ukuqhathanisa ukuthi uthola kangakanani inani lemali oyisebenzisayo kuma- premium yomshuwalense wezempilo, ama- Care Affordable Care amazinga okulinganisa amanani wezinhlelo zempilo ngabanye nezincane ezinamathenda amane. Lezi zingxenye zethusi, isiliva, igolide ne-platinum.
Zonke izinhlelo zezempilo zesigaba esinikeziwe zinikeza inani elifanayo eliphelele, nakuba zingashintsha ngaphakathi kwebanga elingu-2 / -2 de minimus (ububanzi bukhuphukele ku- + 2 / -4 ngo-2018, futhi izinhlelo zethusi zine-widim minus ububanzi be + 5 / -4; lokhu kwakuyingxenye yomthetho wokuqiniswa kwemakethe ukuthi i-HHS iphelile ngo-Ephreli 2017).
Ngezinhlelo ze-bronze-tier, isilinganiso samanje se-actuarial cishe ngamaphesenti angu-60.
Kodwa ngebanga elingavumelekile, ibanga le-2018 elinamanani angama-actuarial amaphesenti angu-56 kuya kumaphesenti angu-65 ayobhekwa njengezinhlelo zethusi. Ngakho-ke nakuba izinhlamvu zezinsimbi ze-ACA zenza usizo ngokwenza kube lula ukwenza ukuqhathanisa okuvamile phakathi kwamacebo, kubalulekile ukubheka ukuphrinta okuhle, njengoba izinhlelo ezimbili zethusi zingaba nemiklamo ehlukene kakhulu yokuhlomula namazinga okufakaza.
Yeka Ukuthi Kusho Ukuthini
Inani, noma inani lamanje , likutshela ukuthi yiliphi iphesenti lezindleko zokunakekelwa kwempilo okuzobekwa kulindeleke ukuthi limboze wonke umuntu ojwayelekile. Lokhu akusho ukuthi wena, ngokwakho, uzoba namaphesenti angama-60 angu-60 ezindleko zakho zokunakekelwa kwezempilo ezikhokhelwa uhlelo lwakho lwezethusi. Kuye ngokuthi usebenzisa kanjani umshuwalense wakho wezempilo, ungase ube nezindleko zakho ezikhokhelwayo ezingaphansi kuka-60.
Umuntu obhekene nezindleko zokunakekelwa kwempilo ephakeme ngokusobala uzokhokha imali engaphansi kwamaphesenti angama-40 ezindleko eziphelele ngoba uhlelo lokuphuma ngaphandle kwepokhethi luzokwenyusa inani elikhokhelwa yilungu. Ngakolunye uhlangothi, umuntu ophethe izindleko eziphansi kakhulu angalindela ukukhokha ngaphezulu kwamaphesenti angama-40 ezindleko, ngoba angeke ahlangabezane ne-deductible yonyaka. Lokhu kuchazwa ngokuningiliziwe lapha .
Izindleko zokunakekelwa kwempilo ezingekho ngaphansi kwezimali azicatshangwa uma kunquma inani lezempilo. Izindleko ze-out-of-network nazo azibalwa, futhi futhi izindleko zokwelashwa ezingangeni ezigabeni zezinzuzo ezibalulekile zezempilo ze -ACA.
Okuzokhokhwa
Kuzodingeka ukhokhe izinkokhelo zenyanga zonke ohlelweni lwezempilo. Kuzodingeka futhi ukhokhe ukwabelana ngezindleko ezifana nokudonswa kwemali, ukuqinisekiswa kwezimali, kanye nama-copay uma usebenzisa umshwalense wakho wezempilo.
Uhlelo lwebhonasi izinyanga zamakhomishana zenyanga zonke zivame ukuba zishibhile kunezinhlelo eziphakeme kakhulu ngoba izinhlelo zethusi zilindele ukukhokha imali encane kumabhilidi akho okunakekela impilo. Uthola lokho okukhokhayo.
Indlela uhlelo ngalunye olwenza ngayo ukhokhe isabelo sakho sezindleko zakho zokunakekela impilo kuzohluka. Isibonelo, uhlelo olulodwa lwe-bronze lungase lube ne-$ 6,000 ephezulu ekudonshulwe ngokubambisana nge-coinsurance ephansi ye-10%. Uhlelo lwezethusi olunomncintiswano lungase lube ne-$ 4,000 ephansi ekhishwe ngokubambisana ne-coinurance ephakeme engamaphesenti angama-35 kanye ne-$ 45 copay ukuvakashelwa kwamahhovisi (wonke ama-ACA-ahambisana nezinhlelo zamacembu amancane anemikhawulo engaphezulu kwizindleko eziphelele ezingaphandle kwe-pocket ezisebenza kungakhathaliseki ukuthi Izinga lensimbi; akukho macebo angaba nomkhawulo ngamunye ngaphandle kwe-pocket-kufaka phakathi i-deductible, i-copay, ne-coinsurance-engaphezu kwama-$ 7,150 ngo-2017, noma i-$ 7,350 ngo-2018).
Izizathu Zokukhetha Uhlelo Lwebhondi
Ekukhetheni uhlelo lwezempilo, uma isici esibaluleke kunazo zonke kuwe siyi-premium yenyanga ephansi, uhlelo lwezempilo lwezethusi lungakhetha kahle. Uma ungalindele ukusebenzisa umshwalense wakho wezempilo okuningi noma uma ukwabelana ngezindleko eziphezulu kuhlelo lokubhedu akukukhathaleli, uhlelo lwezempilo lwebhesi lungalingana nalo mthethosivivinywa.
Uma uneminyaka engaphansi kwengu-30 futhi awufanelekile ukuthola izinsizakalo ze-premium, ungathola ukuthi uhlelo oluyingozi luhlinzekela i-premium yenyanga ephansi kakhulu, kanye nenani elincane elincane le-actuarial (amaphuzu enhlekelele awunayo i-actuarial value targets ngendlela yesimbi yensimbi amapulani enza; kumele abe nemigomo engaphansi kwamaphesenti angama-60, nakuba kufanele abuyele ukuvakashelwa okuyinhloko kathathu ngonyaka futhi ahambisane nemikhawulo efanayo ephezulu ngezindleko ezingaphandle kwamanye amazwe njengamanye amacebo).
Uma uneminyaka engaphezu kwengu-30, noma kunjalo, ngeke ukwazi ukuthenga uhlelo oluyingozi kumshwalense wezempilo ngaphandle uma unesitifiketi sokukhishwa kwemshuwalense wezempilo. Futhi izinsizakalo ze-premium azikwazi ukusetshenziselwa izinhlelo eziyingozi, okwenza kube ukhetho olubi kubantu abaningi abafanelekile ukuthola izinsizakalo ze-premium.
Izizathu Ukungakhethi I-Bronze Plan
Ungakhethi uhlelo lwezempilo lwe-bronze-tier uma ufuna uhlelo olukhokhela izindleko zakho eziningi zokunakekelwa kwezempilo. Uma ulindele ukusebenzisa umshuwalense wakho wezempilo okuningi, noma awukwazi ukukhokhela ama-copay aphezulu, u-coinsurance, kanye nama-deductibles, uhlelo lwe-bronze lungase lungabi luni.
Uma ufanelekile ukuthola izinsizakalo zokwabelana ngezindleko ngoba imali yakho engenayo ingamaphesenti angu-250 wezinga lobuphofu elisemthethweni noma eliphansi, ungathola kuphela izinsizakalo zokwabelana ngezindleko uma ukhetha uhlelo lwe-silver-tier. Ngeke uthole ama-subsidies-ukwabelana ngezindleko ozifanelekelayo uma ukhetha uhlelo lwebhusi.
Izinsizakalo zokwabelana ngezindleko zenza imali yakho yokubambisana, i-copays ne-coinsurance ephansi ukuze ukhokhe kancane uma usebenzisa umshuwalense wakho wezempilo. Empeleni, uxhasomali lokubelana ngezindleko luyokhulisa inani lepulani lakho lempilo ngaphandle kokuphakamisa amaphrimiyamu wenyanga. Kufana nokwenza ukuthuthukiswa kwamahhala kokubaluleka. Ngeke uthole ukuthuthukiswa kwamahhala uma ukhetha uhlelo lwebhusi.
> Imithombo:
> I-American Academy of Actuaries. Inani elibukeziwe labathengi bezempilo. Ngo-Ephreli 1, 2013.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Ukuvikelwa kwesineke kanye noMthetho Wokunakekelwa Kwezinkinga, Ukuqiniswa Kwemakethe . April 2017.
> I-Federal Register. Ukuvikelwa Kwabeziguli kanye noMthetho Wokunakekelwa Ongathintekiyo, Isaziso Sokuzuza Nezikhawulelo Zokukhokha ngo-2017. Mashi 8, 2016.
> 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.