Kungani Ngidinga Umshwalense Wezempilo?
Kubalulekile ukuthola umshuwalense wezempilo wena namalungu omndeni wakho oseduze. Umshuwalense usiza ukukuvikela ezindlebeni zokunakekelwa kwempilo ephakeme, ikakhulukazi lezo ezihlobene nezimo zezokwelapha ezingapheli noma isidingo sokwelashwa.
Kufanele uthole umshuwalense wezempilo ngesizathu esifanayo sokuthi unomshuwalense wezimoto noma umshuwalense wabanikazi - ukuvikela imali yakho kanye neholo lakho .
Kodwa udinga umshuwalense wezempilo ukuqinisekisa ukuthi uzofinyelela ekunakekelweni kwezempilo okubiza kakhulu uma futhi uma udinga. Ngezibhedlela ezamukela i-Medicare (iziphi izibhedlela eziningi), umthetho wesifundazwe udinga ukuba bahlole futhi baqiniseke noma ubani ovelela eminyangweni yabo ephuthumayo, kuhlanganise nowesifazane osebenza ngokusebenzayo. Kodwa ngaphesheya kokuhlolwa nokuzinza emnyangweni ophuthumayo, akukho mfuneko yokuthi izibhedlela zihlinzeke ukunakekela abantu abakwazi ukukukhokhela. Ngakho ukuntuleka komshuwalense wezempilo kungaqeda kube yisithiyo esibalulekile ekutholeni ukunakekelwa.
Ngithola kanjani umshuwalense wezempilo?
Ngokuya ngobudala bakho, isimo somsebenzi, nesimo sezimali, kunezindlela eziningi ongathola umshuwalense wezempilo, kuhlanganise:
- Umshuwalense wezempilo ohlinzekwa ngumqashi. Izinkampani ezinkulu e-US zidingeke ukuba zinikeze umshuwalense wezempilo ongabizi njengenzuzo yomsebenzi, futhi abaqashi abaningi abancane banikeza ukukhokhelwa kwabasebenzi babo. Kungenzeka ukuthi kuyadingeka ukuthi ukhokhe ingxenye ethile ye- premium yenyanga , noma izindleko zemshuwalense wezempilo, ikakhulukazi uma ungeza umndeni wakho ohlelweni lwakho.
- Umshuwalense wezempilo oyithenga wedwa. Uma uziqashile noma usebenzela inkampani encane enganikezi umshuwalense wezempilo, kuzodingeka uyithenge ngokwakho. Ungayithola ngemali yomshuwalense wezempilo embusweni wakho, noma ngokuqondile kusuka kunkampani yomshuwalense, kodwa uxhasomali lwe-premium (ukwehlisa inani okufanele ukhokhele ngokubambisana kwakho) kanye nezinsizakalo zokwabelana ngezindleko (ukwehlisa inani okufanele ukhokhe uma udinga ukunakekelwa kwezokwelapha) zitholakala kuphela uma uthola ukusakazwa kwakho nge-exchange.
- Umshuwalense wezempilo ohlinzekwa nguhulumeni. Uma uneminyaka engama-65 noma ngaphezulu, ukhubazekile, noma ungenayo kancane noma ungenayo imali, ungase ufanelekele umshwalense wezempilo okhokhelwa uhulumeni, njenge- Medicare ne- Medicaid .
Uma ungenayo umshuwalense wezempilo noma umshuwalense wezempilo okwanele, uzoba nesibopho sokukhokha zonke izikweletu zakho zokunakekelwa kwempilo. Isivikelo Sokubekezela Nokunakekelwa Kwezinkinga (ACA), esasungulwa ngoMashi 2010, siqinisekisa ukuthi iningi labantu baseMelika linokuthola umshwalense wezempilo ongabizi.
Kukhona okunye okuhlukile kulokho, noma kunjalo. Ezinye ziwumphumela weziphambeko zomklamo ku-ACA, kufaka phakathi ukuhloswa komndeni nokuthi ukuxhaswa kwe-premium kubanjwe ngamaphesenti angu-400 ebuningi bobuphofu, okuholela ekutheni abantu abangaba nemali engenayo ingenakulungiswa ukutholakala okungenakugwenywa kwabanye abantu abanemali engenayo nje kuphela. Kodwa ezinye ziwumphumela wemithethonqubo, izinqumo zenkantolo, nokuphikisana ne-ACA, okufaka phakathi igebe lokubhekela iMedicaid elikhona emazweni angu-18 abenqaba ukwamukela izimali zikahulumeni zokwandisa iMedicaid.
Ngimkhetha kanjani uhlelo lwezempilo?
Kunezici eziningi okufanele uzicabangele lapho ukhetha umshuwalense wezempilo. Lezi zici zingase zihluke uma ukhetha omunye wezinketho eziningi zokuhlela umqashi noma ukuthenga umshuwalense wakho wezempilo.
Yenza umsebenzi wesikole ngaphambi kokuba uthenge inqubomgomo yomshuwalense wezempilo! Qinisekisa ukuthi uyazi ukuthi uhlelo lwakho lomshuwalense wezempilo luzokhokhela ... nokuthi ngeke luni.
Umshuwalense Wezempilo Oxhaswe Ngumqashi
Uma umqashi wakho enikezela umshuwalense wezempilo, ungase ukwazi ukukhetha phakathi kwezinhlelo eziningi zemishwalense yempilo. Ngokuvamile, lezi zinhlelo zihlanganisa uhlobo oluthile lwezinhlelo zokunakekelwa okuphethwe , njengenhlangano yokugcinwa kwezempilo (HMO) noma inhlangano ehlinzekwayo yokuhlinzeka (PPO). Uma ukhetha i-HMO, uhlelo luzokhokhela kuphela ukunakekelwa uma usebenzisa udokotela noma isibhedlela kuhlelo lenethiwekhi. Uma ukhetha i-PPO, uhlelo luvame ukukhokha ngaphezulu uma uthola ukunakekelwa kwezempilo ngaphakathi kwenethiwekhi yepulani.
I-PPO izoqhubeka ikhokha ingxenye yokunakekelwa kwakho uma uphuma ngaphandle kwenethiwekhi, kodwa kuzodingeka ukhokhe ngaphezulu.
Umqashi wakho anganikeza ngezinhlelo ezahlukene zezempilo ezibiza okungenani noma ngaphansi kuye ngokulinganiselwa kwezindleko ezingaphandle kwe-pocket onayo unyaka ngamunye. Lezi zindleko zingabandakanya ikhodiyali njalo uma ubona udokotela wakho noma uthole i-prescription egcwalisiwe kanye nokudonswa konyaka , okungukuthi ukhokhela ngezinsizakalo zokunakekelwa kwezempilo ekuqaleni konyaka ngaphambi kokuba umshwalense wakho wezempilo ukhawule.
Ngokuvamile, uhlelo oludinga ukuthi usebenzise umhlinzeki wenethiwekhi, lunokukhishwa okukhulu, futhi ama-copayments aphezulu ayoba nama-premium aphansi. Ipulani evumela ukuthi usebenzise noma yimuphi umhlinzeki, unezinzuzo eziphansi, futhi amakhophi amancane azoba nezinkokhelo eziphakeme.
Uma usencane, ungenayo isifo esingapheli, futhi uphile impilo enempilo, ungase ucabange ukhetha uhlelo lwezempilo olunezinzuzo eziphezulu zokukhokha kanye ne-copayments, ngoba awunakudinga ukunakekelwa futhi ama-premium akho ngenyanga angase abe ngaphansi.
Uma usukhulile futhi / noma unesifo esingapheli, njengesifo sikashukela, esidinga ukuvakashelwa odokotela abaningi nemithi kadokotela, ungase ucabange uhlelo lwezempilo olunokudonswa okuphansi nokukhokhwa kwama-copayments. Ungakhokha inyanga ngayinye ngesabelo sakho se-premium, kodwa lokhu kungase kukhishwe izindleko ezingaphansi kwe-pocket unyaka wonke. Hlanganisa izinombolo ukuze ubone ukuthi ungalindela kangakanani ukukhokha izindleko ezingaphandle kwe-pocket (qaphela inani eliphakeme lapha, uma ucabanga ukuthi uzodinga ukunakekelwa okuningi kwezokwelapha), bese ufaka lokho ama-premium aphelele ukuze ukwazi ukuqhathanisa izinhlelo eziningi. Awufuni nje ukucabanga ukuthi uhlelo olubizayo (noma, kuye ngokuthi isimo, uhlelo oluphansi) luzosebenza kangcono.
Ukuze ufunde kabanzi mayelana nezinketho zakho zezempilo, hlangana nommeleli womnyango wakho wemithombo yabantu noma ufunde izinto ezinikezwe uhlelo lwezempilo. Uma bobabili wena nomlingani wakho / umlingani usebenza ezinkampanini ezinikezela umshuwalense wezempilo, kufanele uqhathanise ukuthi inkampani ngayinye inikeza ini futhi ukhethe uhlelo oluvela kunkampani ehlangabezana nezidingo zakho. Nokho, qaphela ukuthi izinkampani ezithile zifaka inkokhelo uma umlingani wakho efinyelela ohlelweni lomqashi wakhe kodwa wanquma ukungenelelwa ohlelweni lwakho esikhundleni salokho. Nakhu okunye mayelana nokufakwa nokuphuma kwe-inshuwalense yezempilo kwabashadile .
Umshwalense weMpilo ngamunye
Uma uziqashile, umqashi wakho akahlinzeki umshwalense wezempilo okwanele, noma awuqinisekisiwe futhi awufanelekeli uhlelo lomshwalense wezempilo kahulumeni, ungathenga umshuwalense wezempilo ngokwakho.
Ungathenga umshuwalense wezempilo ngqo kusuka kunkampani yomshuwalense wezempilo, njenge-Anthem noma i-Kaiser Permanente, ngokusebenzisa i-agent yomshuwalense omelela inkampani yomshuwalense, noma nge- exchange yomshuwalense wezempilo esifundazweni sakho. Xhumana nommeli wakho womshuwalense ongakwazi ukukusiza uthole umshuwalense wezempilo ohambisana nezidingo zakho.
Njengoba izindleko ngokuvamile ziyisici esibaluleke kakhulu lapho ukhetha uhlelo lwezempilo, izimpendulo zakho kule mibuzo elandelayo zingakusiza ukuthi unqume ukuthi iyiphi inqubo oyithenga.
- Ngakanani imali ekhokhwa ngenyanga (ngemva kwanoma yikuphi ukukhokhelwa kwe-premium esebenzayo, uma uvumelekile owodwa. Ngo-2018, izinsizakalo zitholakala kubantu abathola imali engu-$ 48,240, nasemndenini wabahlanu abafinyelela ku-$ 115,120).
- Ngingakanani okufanele ngikhokhe ngaphambi kokuba uhlelo lwezempilo lukhawule?
- Kungakanani i-copay yokuvakashelwa kukadokotela nemithi yokwelashwa?
- Uma ngikhetha i- PPO , ngabe ngizokhokha malini uma ngisebenzisa odokotela noma izibhedlela ngaphandle kwenethiwekhi ye-PPO?
- Yikuphi okungcono kakhulu okumele ngikhokhe ekukhokhweni kwe-out-of-pocket uma ngiqeda ukudinga ukondliwa okuningi? Lokhu kufakwe kuzo zonke izinhlelo ze-ACA-ezivumelanisiwe ku- $ 7,350 kumuntu oyedwa ngo-2018 .
- Ingabe uhlelo lwezempilo lunomuthi wezidakamizwa ohlanganisa imithi engiyisebenzisayo?
- Ngabe udokotela wami enethiwekhi yomhlinzeki wezempilo?
Qaphela izinhlelo ezingavumelani ne-ACA-Compliant Plans
Zonke izinhlelo zempilo ezinkulu zezokwelapha ngezinsuku eziphumelelayo zikaJanuwari 2014 noma kamuva zidingeka zihambisane ne-ACA. Lokhu kusebenza kuwo wonke amazwe, futhi kusebenza kumacebo athengiswa ngaphakathi kwezokushintshaniswa kanye nezinhlelo ezithengiwe ngqo ezinkampanini zomshuwalense wezempilo.
Kodwa kunezinketho eziningi zezinhlelo ezingekho ezihambisana ne-ACA. Futhi ngezinye izikhathi lezo zinhlelo zithengiswa ngamasu okungaqondakali, okuholela abathengi ukuba bakholelwe ukuthi bathenga umshuwalense wezempilo wangempela, uma empeleni bengenalo.
Uma ubheka izinhlelo zesikhashana esifushane , izinhlelo ezilinganiselwe zokuhlomula, izithasiselo zengozi, izinhlelo zokugula ezibucayi, izinhlelo zokwehliswa kwezokwelapha, noma olunye uhlobo lwepulani elingavumelani, uzofuna ukukhokha ngokucophelela ukuphrinta okuhle, futhi qinisekisa ukuthi uyaqonda ukuthi uyini ngempela ukuthenga. Qaphela ukuthi lezi zinhlelo akudingeki zimboze izinzuzo zezempilo ze-ACA ezibalulekile, akudingeki ukumboze izimo ezikhona ngaphambili, zinganciphisa izinzuzo zakho eziphelele ngonyaka noma ngaphezulu kwesikhathi sakho sokuphila, futhi ngokuvamile unolwazi olude lokungabikho okufakiwe .
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services. Umthetho Wezokwelapha Eziphuthumayo Nomthetho Wezabasebenzi.
> Imindeni yase-USA. Izinkombandlela zeNtshonalanga Yezobuhlwempu Zokunquma Ukufaneleka Kwama-Medicaid, I-CHIP, kanye Nezinsizakalo Ezingxenyeni.