Indlela Izinkampani Zomshuwalense Ezizimele Zithatha Imali Kuhulumeni
Ungase ungacabangi iphiniki, kepha uhulumeni wesifundazwe uyaqiniseka. Izinkampani zomshuwalense ezizimele zingase zenze inzuzo kuhulumeni uma zikunikeza lokho okubonakala sengathi "okukhululekile" kwezinsizakalo zokunakekelwa ekhaya. Uma uke waba nokuhlolwa kweengozi yaseMedare ekhaya, ungafuna ukwazi ukuthi inkampani yakho yomshuwalense ingasebenzisa kanjani ulwazi lwakho lwezempilo.
Umehluko phakathi kwe-Medicare yokuqala kanye neMedyare Advantage
I-Medicare yasekuqaleni yilokho oye waziwa njengoMedare.
Kwaba khona ngeziNguquko zoHlelo lwezeMpilo ka-1965 futhi unikezela umshuwalense wesibhedlela (Ingxenye A) kanye nomshuwalense wezokwelapha (Ingxenye B) . Ngo-2006, i-Medicare Part D yanezelwa njengengxenye yokuzikhethela ye-Medicare ehlinzekwa ngezidakamizwa ezidakamizwa .
Lokho kuchaza izingxenye A, B, no-D, kodwa kuthiwani ngeNgxenye C?
Yilapho i-Medicare Advantage iqala khona. I-Medicare Part C, i-Medicare Advantage (eyayingumuthi we-Medicare + Choice), ingenye ye-Original Medicare . Uhlelo lwe-Medicare Benevantage lungakwazi noma alufaki izinzuzo ze-Part D zokubheka.
Wonke ama-Medicare Advantage amapulani ahlanganisa ukuthi yiyiphi ingxenye ye-Part A ne-Part B kodwa kodwa, uma ikhetha, ikunikeze amasevisi angeziwe. Kungani? Ngoba esikhundleni sokuphathwa nguhulumeni, lezi zinhlelo ziqhutshwa izinkampani zomshuwalense wangasese.
Indlela uHulumeni Kahulumeni Osebenza Ngayo Izinkampani Zomshwalense Zomuntu
Kungani inkampani yomshuwalense yangasese ingafuna ukubhalisa abantu ku-Medicare?
Ngencazelo, abazuzi bazoba iminyaka engu-65 nangaphezulu noma uma bebancane, bayoba nokukhubazeka okwesikhathi eside . Kungakhathaliseki ukuthi ubukeka kanjani, basengozini ephakeme yokuba nezinkinga ezingelapheki zezokwelapha ezingase zidingeke ukusetshenziswa kwemali eminingi.
Izinkampani ezenzelwe inzuzo zangena ebhizinisini le-Medicare ngoba uhulumeni wesifundazwe ubakhokhela ukukwenza.
Uhulumeni ubakhokhela imali "ngayinye" ngenyanga ngayinye ukukunakekela. Lokhu kusho ukuthi kunezinga elijwayelekile elikhokhelwa uhulumeni kumuntu ngamunye obonisa uhlelo lweMederal Benevantage. Inani lemali yenkampani yomshuwalense ibuyiselwa, noma kunjalo, ikhuphuka nayo yonke imithi yezokwelapha okungenayo. Lokhu kusekelwe emkhatsini wokubalwa kweMedare yokuhlola izingozi.
Indlela Ukuhlolwa Kwemithi Yezokwelapha Kusebenza Kanjani
Kuyinto enesithakazelo esihle kakhulu somshuwalense ukuthola irekhodi lezokwelapha elibhalwe kahle elibalula izimo eziningi zezokwelapha ezingapheli ngangokunokwenzeka. Ngale ndlela, bangathola amaphuzu aphezulu okuhlolwa kweengozi yeMedare kanye nemali eyengeziwe yezimali.
Umbuzo uwukuthi noma empeleni bazoyisebenzisa yini imali eyengeziwe ukuze bakunakekele noma uma bekhetha ukubopha lawo madola esikhundleni salokho.
Eqinisweni, abaqinisekisi bangezimele abanakho ukufinyelela ngqo kumarekhodi akho ezokwelapha. Amarekhodi wezokwelapha aqinisekiswe yisikhungo sakho sokunakekelwa kwezempilo, hhayi inkampani yomshuwalense. Umshwalense angabona kuphela izifo ezikhokhwa odokotela bakho nabanye abahlinzeki bezempilo. Kalula, kungase kube khona imininingwane ephawulwe eshadini lakho lezokwelapha elingakhokhiwe ohlelweni.
Ukuze ukwandise izinga labo lokuhlola ingozi ye-Medicare, umshwalense wakho angase afune ukuthumela udokotela wakhe ekhaya lakho ukuze athole lolo lwazi.
Abakwazi ukuthembela kolwazi olunikezwe ucingo. Ukuze ulwazi lubaleke emkhakheni wokuhlola ubungozi we-Medicare, kumele kube nokuhlangana ubuso nobuso nomhlinzeki wezokwelapha.
Ukuhlola kwangaphakathi kwekhaya
Inkampani yakho yomshuwalense ingase ikufinyelele kuwe ukuvakashelwa ekhaya ngokuzithandela. Kungabhalwa ngokuthi ukuvakashelwa ngokomzimba noma ukuhamba kahle ngonyaka. Kungakhathaliseki ukuthi, bayakhuthaza inkonzo njengendlela yokuqinisekisa ukuthi amaklayenti abo anempilo ngangokunokwenzeka futhi ephephile emakhaya abo. Kungcono nakakhulu, bayinikeza mahhala.
Kuyindlela enhle yokumaketha, futhi abadala abaningi bayayithanda. Uthola ihora lokubhekana nesidakamizwa ngenduduzo yendlu yakho uma uhlale unesikhathi esinqunyiwe ehhovisi likadokotela.
Udokotela ovakashelayo uhlola imithi yakho, umlando wakho wezokwelapha, umlando wakho womndeni, umlando wakho wezenhlalakahle, futhi wenza ukuhlolwa okusemzimbeni okulula kufaka phakathi isheke segazi . Nakuba lo dokotela engakuniphatheli noma anikeze imithi yakho, lonke ulwazi oluqoqwe luzokwabiwa nodokotela wakho wokunakekela oyinhloko. Okubaluleke nakakhulu, inkampani yomshuwalense, idatha eqoqwe ingasetshenziselwa ukuthuthukisa amaphuzu akho wokuhlola ingozi.
Ingabe lokhu okuvakashelwa empeleni kukwenza ngcono izinga lokunakekelwa umuntu othola ngokuhamba kwesikhathi? Lokho akutholakali ukuthi kuyindaba. Lokho aboniswe ukukwenza, noma kunjalo, ukuthuthukisa ukwethembeka kwamalungu ohlelweni lomshwalense olunikeziwe. Ngaphezu kwalokho, ziye zanda ngokweqile ukusetshenziswa kwemali ku-Medicare.
Izindleko Zeqiniso Zezokwelapha Ezizuzayo
Kungakhathaliseki ukuthi uhamba yini kumuntu wokuqala weMederal Medicare noma umuthi we-Medicare Advantage, usesekhoneni lokukhokhela izinkokhelo ze-Part A ne-Part B kuhulumeni. Ngokuthakazelisayo, iningi labantu lingathola ama-Premium awo e- Part A mahhala . Uma ukhetha uhlelo lwe-Medicare Advantage, ungase ukhokhe intela yanyanga zonke enkampanini yomshuwalense. Izinhlelo ezimbalwa kakhulu ze-Medicare Benevantages zitholakala ngaphandle kwe-premium, nakuba zikhona ezimbalwa.
Ngisho noma ngabe i-Medicare ingozi yakho isiphezulu, uhlelo lwakho lwe-Medicare Advantage luzokwenzela okufanayo. Inkampani yakho yomshuwalense ibamba imali eyengeziwe kodwa leyo mali ayifakwe kuwe. Le nkampani ibhekana nayo futhi ekugcineni inqume ukuthi ingayisebenzisa kanjani.
Kulinganiselwa ukuthi izinhlelo zeMedricare Advantage zandisa kakhulu uhulumeni cishe u-$ 70 billion kusukela ngo-2008 kuya ku-2013 ngokusekelwe ezigabeni ezingenakulungiswa ze-Medicare zodwa. Uma lo mkhuba uqhubeka, i-solvency ye-Medicare (isikhathi esingakanani i-Medicare Trust Fund izohlala isikhathi eside) ingaba yingozi.
Umbuzo usalokhu: Ingabe i-Medicare Advantage iyonke inzuzo ekubonweni kwezindleko? Ngonyaka ka-2012, i-Commonwealth Fund yathola ukuthi amaphesenti angu-75 e-Medicare Advantage amapulani asebenzisa okuningi ekunakekeleni kukaMdokotela weMvelo. I-Medicare Advantage ihlela ngamanye amadolobha, kodwa-ke, yayiphumelele ekugcineni izindleko eziphansi kuneMederal Medicine.
Singakwazi yini ukunikeza i-Medicare izinkampani zomshuwalense uma ziqhubeka nokubeka inzuzo phambi kwabantu?
> Imithombo:
> Ingabe Imithi Yokuthola Imithi Engazuzi Ngaphansi Kwemithi Yendabuko? Iwebhusayithi ye-Commonwealth Fund. http://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less. Ishicilelwe ngoJanuwari 28, 2016.
> I-Medicare Advantage Plans isebenza kanjani? Iwebhusayithi ye-Medicare.gov. https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/how-medicare-advantage-plans-work.html.
> Medicare Inzuzo. Iwebhusayithi kaHenry J. Kaiser Family Foundation. http://kff.org/medicare/fact-sheet/medicare-advantage/. Ishicilelwe ngoMeyi 11, 2016.
> Shulte F, uDonald D, Durkin E. Kungani Imithi Imali Yokuthola Izindleko Ezikhokhelwa Abakhokhi Billion Ngaphezu Kwakufanele. Isikhungo Sobulungiswa Bomphakathi. https://www.publicintegrity.org/2014/06/04/14840/why-medicare-zizuzisayo-zizinto- abathengisi-billions-more-it-should. Ishicilelwe ngo-Juni 4, 2014.
> Ukuqonda Ukulungiswa Kwemingcipheko Emkhakheni Wezokwelapha. I-website ye-Better Medicare Alliance. http://bettermedicarealliance.org/sites/default/files/Understanding_Risk_Adjustment_in_Medicare_Advantage_February_2016.pdf. Kushicilelwe ngo-February 2016.