I-out-of-pocket esiphezulu izoba ngu-12,6% ephakeme kuneka-2014
Uma unesidingo sezempilo esivumelana noMthetho Wokunakekelwa Onganakekelwayo (ACA), ukuphuma kwakho kwepokhethi kungu-$ 6,850 ngo-2016. Uma unabantu abangaphezu kweyodwa uhlelo lwakho, umndeni ohlangene ongaphandle kwe-pocket ungaba ' t kudlula iRandi ayi-13,700, nakuba uhlelo kumele lube nomuntu omningi ongaphandle kwe-pocket okungenakudlula i-$ 6,850.
Kubalulekile ukuqonda ukuthi isiphakamiso esiphezulu sepulani sakho singase sibe ngaphansi kwalezi zimali ...
akukwazi nje ukuphakama (ngaphandle uma uhlela uhlelo olukhulu). Ngakho-ke ungase ube nenqubomgomo ene-$ 1,000 deductible kanye ne-out-of-pocket enkulu ye $ 4,000. Lokhu kungaphakathi kwemikhombandlela yemithethonqubo, futhi kuvamile, kuye ngokuthi izinga lensimbi le plan (izinhlelo zethusi zivame ukuba nezikhulu eziphezulu kakhulu ezingaphandle kwe-pocket - ngokuvamile ezingeni eliphakeme kakhulu - kuyilapho igolide neplatinum kuhlelwa babe nama-maximum aphansi kakhulu e-pocket, ngokuvamile aphansi kancane kunesilinganiso esiphezulu esingavunyelwe).
Ukuphakama okuphezulu kwe-pocket ngo-2017
NgoFebruwari 2016, uMnyango wezeMpilo kanye nezinsizakalo zabasebenzi (HHS) wakhiphe iziNzuzo zokuPhathwa kanye nokuPhawula ngo-2017 . Kulo, i-HHS ibhekane nezinkinga ezihlukahlukene, kufaka phakathi izikhwama ezingapheli.
Ngo-2017, i-HHS ibeke ukukhishwa kwe-pocket okungenani ku-$ 7,150 kumuntu ngamunye, futhi i-$ 14,300 emndenini (ama-maximum angaphandle ehlanganisiwe azobe esadingeka kumalungiselelo omndeni).
Futhi, kuzoba nezinhlelo eziningi ezitholakalayo ngezimiso eziphansi ezingaphandle kwe-pocket. Kodwa akukho amacebo amasha azokwazi ukuphuma ama-maximum angaphandle kwelizinga.
Ngombono, ukukhishwa kwe-pocket okwedlule ngonyaka ka-2014 - unyaka wokuqala amacebo ahambisana ne-ACA - ayengu- $ 6,350 umuntu ngamunye, futhi $ 12,700 ngomndeni.
Ngonyaka we-2017, ukuphuma okungaphandle kwe-pocket kuzokhuphuka ngo-12.6% kusukela ngo-2014.
Kungani i-out-of-pocket inyuke kakhulu ngonyaka ngamunye?
Ngokuyinhloko, kuyindlela yokugcina ama-premium esheke, nokuhambisana nokukhuphuka kwemali yezokwelapha. I-HHS isebenzisa ifomula efanisa isilinganiso samanje semali yomshuwalense wempesheni yeminyaka yonke ekhokhelwa umqashi ngezinhlelo ezixhaswe ngumqashi ($ 6,076 ngo-2016), kanye nesilinganiso semali yomshuwalense wempesheni yokukhokhela umqashi ngamunye ngonyaka wezi-2013 ($ 5,365).
Kulesi simo, sithatha u-6076 - 5365 = 711. Sithatha u-711 uhlukaniswe ngu-5365 ukubona ukukhushulwa kwamaphesenti ezinkampanini ezijwayelekile zokubhalisa ngezinhlelo ezixhaswe ngumqashi. Sithola u-0.1325256291, noma cishe ngo-13.25%.
Manje sithatha isisindo sokuqala esingaphandle kwe-pocket esasungulwa ngo-2014 ($ 6,350), futhi sikhulise ngo-13.25%. Siphelela ngo-$ 7191.
Kodwa kunamalungiselelo emthethonqubo odinga ukuthi i-HHS idonsele ku-$ 50 esiseduze, ngakho-ke umphumela wehlelwe ku-$ 7,150.
Ngokweqile, umqondo wukuthi isilinganiso semali esiyi-premium esixhaswe ngabaqashi senyukile cishe ngo-13.25% kusukela ngo-2013 kuya ku-2016, ngakho-ke ama-maxum angaphandle kwe-pocket kumele akhule ngamaphesenti afanayo kusukela ngo-2014 kuya ku-2017 (ngoba aphansi, Ukwanda okuphumelelayo emaxukwini angaphandle kwe-pocket kungu-12,6% kuphela).
Ngalolu fomula, kungenzeka ukuthi ama-maximum angaphandle kwe-pocket anganqamuka kusukela ngonyaka owodwa kuya kwesilandelayo, uma amaphrimiyamu ajwayelekile axhasiwe oqashiwe enqaba. I-2017 iyoba ngumnyaka wesine kuphela wokuba nemingcele egunyaziwe ema-maxus angaphandle kwe-pocket (ngaphambi kuka-2014, abanikazi bomshuwalense babekhululekile ukubeka ama-maximum angaphandle kwe-pocket njengoba babona kufanelekile). Futhi nakuba ama-maximum angaphandle kwe-pocket akhule minyaka yonke kuze kube manje, akukho mthetho othi bazoqhubeka nokukwenza njalo ngonyaka.
Kuyini okushiwo yi-out-of-pocket maximum?
I-plan out-of-pocket esiphezulu (futhi ebizwa ngokuthi i-out-of-pocket) esiphezulu isamba esiphezulu isiguli okufanele siyikhokhise ngonyaka onikeziwe ngenqubo yokwelapha inethiwekhi ehlukaniswa njengezinzuzo zezempilo ezibalulekile.
Uma uthola ukunakekelwa ngaphandle kwenethiwekhi yakho yezinhlelo , ukukhishwa kwe-out-of-pocket kungaphezulu, noma kungenakulinganiswa.
Uma nje uhlala ku-inethiwekhi futhi uthola ukunakekelwa okuhlanganiswe ngaphansi kwepulani lakho lempilo, imali yakho yonke yonyaka izobekwa ngaphezulu kwe $ 6,850 ngo-2016. Lokhu kuhlanganisa inhlanganisela yakho
- i-deductible (inani okhokha ngaphambi kokuba iningi lezinzuzo likhishwe)
- ama-copays (imali encane okhokhayo ukubona udokotela, ugcwalise imithi kadokotela, vakashela ochwepheshe, uye egumbini lokuphuthumayo, njll), futhi
- u-coinsurance (iphesenti yesicelo sokukhokha ukuthi ukhokhe ngemuva kokuthi ukhokhe imali yakho, kodwa ngaphambi kokuba uhlangabezane nokuphuma kwakho kwepokhethi).
Akuwona wonke amaphuzu afaka zonke lezo zindawo ezintathu zokuchitha. Isibonelo, uhlelo lwezempilo oluphakeme olufanelekayo lwe- HSA olufanelekile lwe-HSA ngeke lufake ama-copays, kodwa luzokhipha imali futhi lungabi namali yezimali (kwezinye izimo, i-deductible kwi-HDHP yiyona ephelele ye-pocket ephezulu, kuyilapho amanye ama-HDHP azoba ne-deductible plus coinsurance ukuze afinyelele ngaphandle kwe-pocket esiphezulu).
Uma usufinyelele ekuphumeni okukhulu kwe-pocket konyaka, uhlelo lwakho lwezempilo luzokhokha 100% we-in-inethiwekhi yakho, izindleko ezihlanganisiwe zonyaka osele. Kodwa uma ushintsha amapulani phakathi nonyaka (ngenxa yomcimbi ofanelekayo obangela isikhathi sokubhalisa esikhethekile ), izindleko zakho eziphuma ngaphandle zizoqala ngecebo elisha. Futhi ngisho noma ugcina uhlelo olufanayo unyaka nonyaka, izindleko zakho ezingaphandle kwe-pocket zizoqala ngaphezulu ekuqaleni konyaka.
Imfuneko ye-ACA yokuthi izinhlelo zezempilo zithatha izindleko ze-pocket ezivela kumapulani ngabanye neqembu, kufaka phakathi izinhlelo eziningi zeqembu. Kodwa izinhlelo eziningi ezikhululekile zikhululekile, njengamanye amacebo amakhulu nezinhlelo ezincane zeqembu. Amapulani amaqembu amakhulu awadingeki ukuba agubungele izinzuzo zezempilo ze-ACA ezibalulekile , kodwa ngokwenza lokho, angeke adinge ilungu ukuthi likhokhise ngaphezulu kwezindleko ezingaphandle kwe-pocket kunomkhawulo wonyaka osebenzayo kulowo nyaka.