Ukuthi uhlelo lwakho lwezempilo luhlanganisa kanjani ukunakekelwa okuhlukahlukene kuxhomeke ekuklanyeni uhlelo
Kusho ukuthini uma ukunakekelwa kwempilo "kungabandakanyi kusuka ekudonseni" noma "kungaphansi kwe-deductible"? Lona umbuzo abanye abafundi abaye waba nawo ekuphenduleni ukuhlaziywa kweSikhwama se-Commonwealth Fund yamaphrojekthi wezempilo adayiswa emazweni asebenzisa i-Healthcare.gov.
Kulula ukubona ukuthi lokhu kungadideka kanjani, ngoba "ngaphandle" kuyigama elisetshenziselwa ukuchaza izinsizakalo ezingahlanganiswa nhlobo ngehlelo lempilo (kusho, isibonelo, ukwelashwa kokungabi nabantwana kumazwe angawadingi) .
"Akuhambisani ne-deductible" = ukhokha kancane
Kodwa uma insizakalo ingekho ngaphansi kwe-deductible, kusho ukuthi empeleni uthole ukuthengwa kangcono kwalowo nsizakalo. Okunye okuwukuthi insizakalo kufanele ibe ngaphansi kwe-deductible, okusho ukuthi uzokhokha inani eligcwele ngaphandle kokuthi ngabe usuvele uhlangabezane ne-deductible yakho yonyaka.
Ukucacisa, "intengo egcwele" kusho ngemuva kokususwa kwesisetshenziswa senethiwekhi. Ngakho uma umshayeli okhokhelwa njalo ebiza u-$ 250, kodwa inkampani yakho yomshuwalense wezempilo iye yaxoxisana nesamba esingu-$ 150, "inani eligcwele" lisho ukuthi uzokhokha u-$ 150.
Ukuqonda konke lokhu, kubalulekile ukuqonda igama elisetshenziselwa ukuchaza izinhlelo zezempilo . I-Copay ayiyona into efanayo nokuqinisekiswa kwezimali. I-Deductible ayiyona into efana ne-out-of-pocket esiphezulu (okungaba ngaphezulu kuka-$ 6,850 kumuntu oyedwa ngo-2016, futhi ephakeme ngo-$ 7,150 ngo-2017 ). Amaphrimiyamu awabalwa ezindleko zakho ezingaphandle (nakuba kufanele uwafake lapho wenza izibalo ukuqhathanisa izinhlelo).
Kubalulekile futhi ukuqonda izinzuzo ezibalulekile zezempilo ezithintekayo kuMthetho wezokwelapha, ezihlanganiswa yizinhlelo zezempilo zeqembu ngalinye nezincane ezinsukwini eziphumelelayo zikaJanuwari 2014 noma kamuva. Uma uthola ukwaziswa ngaphansi kweqembu elincane noma uhlelo olulodwa olungakhulumi noma lukhulu, ukwelashwa okuwela ngaphansi kwesambulela kwesinye sezibonelelo zezempilo ezibalulekile kuhlanganiswa uhlelo lwakho.
Kodwa "ukumbozwa" kusho ukuthi izinzuzo zakho zohlelo lwezempilo ziyasebenza. Ukuthi lezo zinzuzo zisebenza kanjani kuxhomeke ekuklanyeni kwecebo lakho:
- Kungase kungadingeki ukhokhe noma yini (lokhu kuyoba yinkinga yokunakekelwa kokuvikela).
- Noma kungenzeka ukuthi ukhokhe i-copay (imali ephathekayo ehlelwe ngaphambilini yi-plan yakho - mhlawumbe i-$ 25 noma i-$ 50 noma i-$ 100, kuye ngokuthi ukwelashwa okukhulunywa ngayo).
- Noma kungenzeka ukuthi ukhokhe inani eliphelele lokwelashwa (uma ungahlangabezane ne-deductible yakho okwamanje).
- Noma kungenzeka ukuthi ukhokhe iphesenti yezindleko (ukuqinisekisana).
Zonke lezo zindlela zibalwa ngokuthi "zimboziwe." Ezinye izinhlelo zezempilo zakha ngendlela ehlela ngayo ukufaka kwabo (isb., Uhlelo olungenayo i-deductible, kodwa i-copay eyi-$ 5,000 yezibhedlela). Kodwa kungakhathaliseki ukuthi uhlelo lwakho lwakhiwe kanjani, inani eliphelele olikhokhela izinsizakalo ezihlanganisiwe kulo lonke lizobalwa ekuphumeni kwakho kwepokhethi. Kungaba yinoma yikuphi ukuhlanganiswa kwama-copays, deductible, nokuqinisekiswa kwemali, kepha uma usuhlangabezane ne-out-of-pocket esiphezulu yonyaka, uhlelo lwakho lwezempilo luzokhokha 100% kwanoma yiziphi izinkonzo ezihlanganisiwe zonyaka osele (inothi ukuthi uma shintshela ohlelweni oluhlukile phakathi nonyaka, ukuphuma kwakho kwepokhethi kuqala ngaleyo plan).
I-Copays = izindleko ezincane ngesikhathi senkonzo
Uma uhlelo lwakho lwezempilo lunemisebenzi ehlukahlukene ehlanganisiwe kepha engaphansi kokudonswa, kusho ukuthi uzokhokha kancane kulokhu kunakekelwa kunokuba ngabe ngabe insizakalo ingaphansi kokudonswa.
Uma ngabe kuncike ku-deductible, uzokhokha inani eligcwele le nsizakalo, ucabanga ukuthi awukaze uhlangabezane ne-deductible yakho (uma usuvele uhlangabezane ne-deductible yakho, uzokhokha noma yi-percentage yezindleko - ukuqinisekiswa kwezimali-noma akukho lutho, uma ngabe usuvele uhlangabezane ne-out-of-pocket yakho esiphezulu).
Kodwa uma le nsizakalo ingekho ngaphansi kwe-deductible, ngokuvamile uzoba necala le-copay esinqunyiwe ngaphambi kwentengo ephelele. Qaphela ukuthi ezinye izinsizakalo - ezifana nokunakekelwa kokuvimbela, nakwezinye izinhlelo, izidakamizwa ezivamile - azikho ngaphansi kwe-deductible noma i-copay, okusho ukuthi akudingeki ukhokhe noma yini ekunakekeleni (zonke izinhlelo ezingenalutho ukumboza ukunakekelwa kokuvimbela ngaphandle kokwabelana ngezindleko, okusho ukuthi isiguli asikhokheli lutho ngalokhu kunakekelwa - sigcwele amaphrimiyamu akhokhelwe ukuthenga uhlelo).
Isibonelo sidinga amazwi angu-1,000
Ngakho ake sithi uhlelo lwakho lwezempilo lunama-dollar angu-$ 35 ukuze ubone udokotela oyinhloko yokunakekelwa kodwa ubala ukuvakashelwa kochwepheshe okubhekiswe ekudonseni. Unayo imali engu-$ 3,000 ekhishiwe futhi u-$ 4,000 ongaphandle kwe-pocket esiphezulu. Futhi isilinganiso senani lomthengisi oxoxisana nenethiwekhi yenkampani yomshuwalense wezempilo ngu-$ 165.
Ake sithi uvakashelwa kathathu ku-PCP yakho phakathi nonyaka, futhi ukuvakashelwa kokubili kumchwepheshe. Izindleko zakho eziphelele zokuvakashelwa kwe-PCP ngu-$ 105, futhi izindleko zakho eziphelele zokuvakashelwa kochwepheshe zifika ku-$ 330 kusukela ukhokhela inani eligcwele.
Kuleli phuzu, ukhokhe imali engu-330 ku-deductible yakho, futhi ukhokhe u-$ 435 ekuphumeni kwakho okuphezulu. ($ 330 kanye no-$ 105).
Manje ake sithi usengozini ngaphambi kokuphela konyaka, bese ugcina esibhedlela ngesonto. Amacala okugula asebenza ku-deductible, futhi uhlelo lwakho lukhokha u-80% ngemuva kokukhokha imali ekhishweyo kuze kube yilapho usuhlangabezane ne-out-of-pocket yakho esiphezulu.
Ukuze uhlale esibhedlela, kuzodingeka ukhokhele u-$ 2,670 ngamacala okukhishwa (imali engu-$ 3,000 engaphansi kwe $ 330 ukuthi usuvele ukhokhele ukuvakashelwa ochwepheshe). Khona-ke kuzodingeka ukhokhe ama-20% wezindleko ezisele kuze kube yilapho inani lemali ozolikhokhela unyaka selifinyelele ku-$ 4,000. Njengoba ubukade ukhokhela amakhophi ama-PCP amathathu angama $ 105, uzokhokha imali engu- $ 895 kuphela ekukhokhweni kwe-coinsurance yokuhlala esibhedlela ukuze ufike ekuphumeni kwepokhethi.
Nakhu ukuthi izibalo zizobukeka kanjani uma zonke zisho futhi zenziwa:
- U-$ 330 + $ 2,670 = $ 3,000 ohlangene naye
- I-$ 105 (ama-copays) + $ 895 (ukukhokhelwa kwezimali) = enye i-$ 1,000 emalini wonyaka
- $ 3,000 + $ 1,000 (deductible plus zonke ezinye izindleko zangaphandle) = $ 4,000
- I-$ 4,000 i-out-of-pocket esiphezulu kuhlelo lakho, okusho ukuthi noma yiziphi ezinye izinkonzo ezihlanganisiwe zonyaka wonke zizobe zigcwele ngokugcwele uhlelo lwakho lomshuwalense wezempilo, ucabanga ukuthi uhlala ohlelweni olufanayo kulo lonke unyaka.
Uma uhlelo lwakho lwezempilo lubekwe ngaphansi kokuvakashelwa kwe-PCP ku-deductible, ngabe ukhokhele inani eliphelele kulabo kanye (ake sithi US $ 115 ngamunye). Uma kunjalo, ngabe usufike ku-$ 675 emalini akhokhiswayo ngaphambi kokuhlala esibhedlela ($ 345 ukuvakashelwa kwe-PCP, kanye no-$ 330 ukuvakashelwa ochwepheshe). Uzobe usuphelile u-$ 4,000 ofanayo ezindleko ezingaphandle kwe-pocket emva kokuhlala esibhedlela.
Kodwa uma ingozi ingakenzekanga futhi ungakapheli esibhedlela, izindleko zakho zonyaka zizobe ziphakeme kakhulu kuhlelo lokuvakashelwa kwe-PCP ngokwe-deductible ($ 675, esikhundleni se-$ 435). Uma ugcina ukuhlangana nokuphuma kwakho kwepokhethi okwedlulele konyaka, akusho ukuthi udaba olulodwa noma olunye. Kodwa uma ungapheli ukuhlangabezana nokuphuma kwakho kwe-pocket esiphezulu, uzovame ukukhokha kancane uma uhlela inezinsizakalo ezingahambisani ne-deductible.
Isifingqo
Ungethuki uma uthola ukuthi izinsizakalo azikho ngaphansi kwe-deductible. Uma nje zihlanganiswa uhlelo lwakho, lokhu kusho ukuthi uzokhokha kancane kulawo masevisi kunokuba ungathanda uma ngabe ungaphansi kwe-deductible.
Uma unesifo esingelapheki, esibi kakhulu esidinga ukwelashwa okubanzi, kunethuba elihle lokuthi uzohlangana nokuphuma kwakho kwe-pocket okungaphezulu konyaka kungakhathaliseki ukuthi uhlelwe kanjani, futhi cishe uzothola ukuthi uhlelo nge-ephansi ye-pocket esiphezulu kuyoba nenzuzo kuwe, naphezu kokuthi izofika nge-premium ephezulu.
Kodwa uma uphilile futhi ungapheli ukuhlangabezana nezinhlelo zakho eziphuma ngaphandle kwepokhethi - noma ngisho ne-deductible - enezinzuzo ezingekho ngaphansi kwe-deductible nje kusho ukuthi inkampani yakho yomshuwalense wezempilo izoqala ukukhokhela ingxenye kokunakekelwa kwakho ngokushesha kunokuba ngabe ngabe ngabe zonke izinsizakalo zingaphansi kwe-deductible (ngoba lokho kusho ukuthi kuzodingeka ukhokhe intengo egcwele kuze kube yilapho kukhishwa imali - okungeke kwenzeke nhlobo ngonyaka onikeziwe).
Lokho kusho ukuthi, izinsizakalo ezingaphezulu ezikhishwe kwi-deductible, ama-premium aphakeme kakhulu.