I-State ngayinye inezinhlelo zayo futhi ihlukile
https: // www. / i-actuarial-value-yakho-yezempilo-umshuwalense-4147819 Ngenxa yomthetho wokunakekelwa okunganakekelwa kahle, osayinwe ngomthetho ngo-March 2010 nguMongameli Obama, umbuso ngamunye unomshwalense wempilo yomshwalense. Ukuhwebelana kwaba khona ukuze kusetshenziswe ngo-Okthoba 2013, futhi baye bakhonza kusukela njengengosi yokuthenga abantu ngabanye, izinhlelo zomshuwalense wezempilo emakethe (imakethe ngayinye inikeza abantu abadinga ukuthenga umshuwalense wabo ngoba abanakho ukufinyelela ukusakazwa kumqashi noma uhlelo lukahulumeni njengoMedare).
Abanye abantu abakufanelekela i- Medicaid nabo bangabhalisa ngezingxoxo, nakuba lokhu kuxhomeke esizathu sokuthi lowo muntu ufanelekile, njengoba ukubhaliswa kusetshenziselwa ngokuhlukile kubantu abafanelekile ngokusekelwe kuphela kwimali engenayo, ngokuhambisana nalabo abakufanelekayo nabo kuxhomeke kwezinye izici, njengokukhulelwa noma ukukhubazeka.
Futhi iqembu elincane lihlela amabhizinisi amancane atholakale ngokuhwebelana, nakuba leyo ngxenye yemakethe yabo ibangele abambalwa ababhalisile, futhi uhulumeni wesifundazwe umemezele ngoMeyi 2017 ukuthi ngeke besasebenza uhlelo lokubhalisa amabhizinisi amancane (asetshenziswe emazweni angu-33 kusukela ngo-2017) ngemuva kokuphela kuka-2017. Esikhundleni salokho, kusukela ngo-2018, amabhizinisi amancane kulawo mazwe aqondisa ngqo ngokusebenzisa izinkampani zomshuwalense noma ngosizo lomthengisi, futhi akhokhe imali yesikweletu kubanini bomshuwalense esikhundleni sokwenza izinkokhelo ze-premium nge-exchange.
I-Exchanges I-Portals Portals
Kubalulekile ukuqonda ukuthi ukuhwebelana kuyisigcawu sokuthenga kuphela.
Uma uthenga umshuwalense wezempilo nge Covered California, isibonelo (ukushintshaniswa kombuso e-California), Covered California akuyona inkampani yakho yomshuwalense. Esikhundleni salokho, inkampani yakho yomshuwalense izoba i-Health Net noma i-Blue Shield, noma i-Anthem noma yimuphi omunye umshwalense wangasese ohlinzeka nge-Covered California.
Nakuba umshuwalense wezempilo unzima kakhulu kunamathikithi ezindiza, cabanga ngokushintshaniswa njengendlela yesikhulumi efana neTravelocity noma i-Expedia. Ibonisa wena izinketho zomshuwalense endaweni yakho futhi ikuvumela ukuba uthenge okufunayo. Kodwa njengoba nje indiza yakho izohlinzekwa yizindiza ozikhethayo-hhayi nge-Travelocity noma i-Expedia-umshuwalense wakho wezempilo uzohlinzekwa ngumshuwalense wangasese, hhayi ngokushintshaniswa.
Amazwe anelungelo lokwenza ukuhwebelana noma ukuthembela kuhulumeni wase federal ukudala i-exchange for them. Amanye ama-hybrid exchanges angabambisana phakathi kukahulumeni nombuso, noma ukushintshaniswa kombuso okusebenzisa ipulatifomu yokubhalisa yaseFrance (HealthCare.gov). Ngo-2018, kunezingxoxo ezingu-12 ezisebenza ngokugcwele, ezithengiswayo zikahulumeni eziyisihlanu ezisebenzisa i-HealthCare.gov ngokubhalisa, ukuhwebelana kwezinhlaka eziyisithupha zombuso, kanye nokuhwebelana okungama-28.
Futhi ukucacisa elinye iphuzu lokuthi ngezinye izikhathi lidala ukudideka, amagama "exchange" kanye "marketplace" asetshenziswa ngokungafani. Kodwa igama elithi "imakethe" lisetshenziswa kabanzi ngokujwayelekile. Ngakho-ke lapho ukushintshaniswa komshuwalense wezempilo noma imakethe kubhekisela ngqo kwi-portal esifundeni ngasinye abantu abangasebenzisa ukuqhathanisa okukhethwa kukho okuhlukahlukene futhi babhalise, igama elithi "imakethe yempilo yomshuwalense wezempilo" lisebenza ngokubanzi, futhi lingabandakanya izinhlelo zokushintshanisa kanye nomqashi- izinhlelo ezixhasiwe kanye nezinhlelo ezizukulukazi nezikhulu.
Inhloso yomshwalense wempilo yomshuwalense ukwenza umshuwalense wezempilo uphelele futhi kulula ukuyithenga.
Ukuxhaswa kwe-Premium kanye Nezinsizakalo Zokukwabelana Ngezindleko: Kutholakala Kokushintshaniswa kuphela
I-ACA ihlanganisa ukuxhaswa kwe-premium (izikweletu zentela zama-premium) kanye nokuxhaswa kwemali yokwabelana (izindleko zokwabelana ngezindleko) ukwenza ama-premium angabizi kakhulu futhi wehlise izindleko ezingaphandle kwamanye amazwe abanye abangabhalisa. Lezi zinsizakalo zisekelwe emalini engenayo futhi zitholakala kokubili ababhalisile abaphansi nabangaphakathi.
Zombili izinhlobo zoxhaso zitholakala kuphela uma uthenga ukuthengiswa kwakho ngokushintshaniswa. Ngisho noma uhlelo olufanayo olufanayo luyatholakala ngaphandle kokushintshaniswa (ngqo kusuka enkampanini yomshuwalense), kuzodingeka ukhokhe inani eligcwele uma uthenga noma yikuphi ngaphandle kokushintshaniswa.
Futhi nakuba izimali ezisezingeni eliphezulu zokunciphisa izindleko ziqedwe ekupheleni kuka-2017, izinzuzo zokunciphisa izindleko eziqhubekayo ziqhubeka zitholakala kubhalisile abathengisa izinhlelo zesiliva ekushintshaneni futhi abanomvuzo wabo ngaphakathi kwemikhombandlela yokufaneleka yezinzuzo zokunciphisa izindleko (okungukuthi, ezingamaphesenti angaba ngu-250 ezingeni lobuphofu, futhi ezingaphansi kwezingu-100 zezinga lobuphofu emazweni azange azandise iMedicaid, noma amaphesenti angama-139 ebuningi bobuphofu emazweni asandise iMedicaid).
Ubani Ongasebenzisa Ukuhwebelana?
Zonke izakhamuzi zase-US nezakhamuzi ezisemthethweni ezingaboshwa futhi ezingakufanelekeli i- Part A Medicare ezingenayo i-premium, zifanelekile ukuthenga uhlelo lwezempilo ekushintsheni kuhulumeni abahlala kuwo. Abafuduki abangenayo imibono abangeke bakwazi ukubhalisa ngokubambisana, ngisho nangaphandle kwezibonelelo ze-premium .
Amabhizinisi amancane angabuye athenge ukuthengiswa ekushintsheni; emazweni amaningi, lokhu kunqunyelwe amabhizinisi anabasebenzi abafika ku-50 , nakuba kunezimbalwa ezimbalwa (iCalifornia, iColorado, eNew York neVermont) lapho amabhizinisi anabasebenzi abangaba ngu-100 angasebenzisa ukushintshaniswa ukuze bavikeleke. Qaphela ukuthi kumazwe asebenzisa ukushintshaniswa kwebhizinisi elincane le-HealthCare.gov, ukushintshaniswa akusekho ukubhalisa, futhi esikhundleni salokho amabhizinisi abhalisa ngokuqondile nabanomshwalense.
Ngenxa ye-Grassley Amendment ku-ACA, iCongress kanye nabasebenzi bayo kuyadingeka ukuthi bathole ukukhokhelwa ekushintsheni. Ukuhlangabezana nale mfuneko futhi uqinisekise ukuthi iCongress kanye nabasebenzi abazange balahlekelwe iminikelo yabo ye-premium yomqashi, uhulumeni wadala umsebenzi owavumela iCongress kanye nabasebenzi ukuba babhalise izinhlelo zeqembu elincane ngokusebenzisa ukushintshaniswa kombuso esifundeni sase-Columbia (DC Health Link) . I-DC Health Link ibike ngo-Ephreli 2017 ukuthi cishe abangaba ngu-11 000 beqembu labo ababhalisile bezinhlangano zeCongress nabasebenzi bazo.
I-One-Stop Yokuthenga Nesisetshenziswa Sokwaziswa
Inzuzo enkulu yomshwalense wempilo yomshuwalense ukukwenza kube lula kuwe ukuqhathanisa izinketho bese ubhalisa ohlelweni lwezempilo. Ezinye zezindlela ukuhwebelana okukhuthaza ukukhetha nokuncintisana kubandakanya:
- Izinketho zokuhlela ezempilo ekhompyutheni yakho zihlelwe kuwebhusayithi egcinwe nguhulumeni wakho noma uhulumeni wesifundazwe. Kule sayithi, ungafunda ngezinzuzo zezinhlelo zezempilo nezindleko, bese ubhalisa.
- Uma unokufinyelela okulinganiselwe ku-inthanethi, ukushintshanisa kunganikeza izinsiza ukuze uthole ulwazi nokubhalisa ngezinto ngeposi nakwezindawo ezikhethwe umphakathi emphakathini wakho; kunabantu abasesebenziseka-muntu abatholakala kulo lonke izwe ngesikhathi sokubhaliswa okuvulekile ngonyaka ngamunye ukuze kube lula ukubhaliswa kubantu abakhetha ukubhekana ubuso nobuso.
- Ukuze uvumele ukuqhathaniswa okulula kwamacebo, ukuhwebelana kufanele kusebenzise ifomu elijwayelekile, izincazelo, nezinto zokuthengisa. Ungabhalisa ku-intanethi, ngokomuntu, ngeposi noma ngocingo.
- Isikhungo socingo ukuze kuqinisekiswe umsebenzi omuhle wamakhasimende
Izinzuzo zeZempilo
Uma uthenga umshwalense ngokushintshanisa, uzokwazi ukukhetha ukuhlinzeka ngezempilo okungcono kakhulu wena nomndeni wakho. Ngamanye amapulani ezempilo atholakalayo ahlanganisa isethi ebalulekile yezinzuzo ezihlinzeka ngezinsizakalo zokunakekelwa kwezempilo eziphelele ngamazinga ahlukene okwabelana ngezindleko.
Futhi, izindleko zakho zonyaka ezingaphandle kwezindleko (amadokodo, ama-copayments, kanye ne-coinsurance) anqunyelwe inani elibekwe uhulumeni wesifundazwe unyaka ngamunye. Ngo-2018, ukukhishwa kwepokhethi enkulu kumuntu oyedwa kungu-$ 7,350 umuntu oyedwa, futhi u-$ 14,700 umndeni. Izinhlelo zingaba nemikhawulo engaphandle kwezimpahla ezingaphansi kwalezi zimali, kodwa hhayi ngaphezu kwazo.
Zonke izinhlelo ezithengiswa ekushintshaneni zihambisana nenye yezigaba ezinhlanu ezilandelayo :
- Uhlelo lweBronze: Ihlanganisa isilinganiso samaphesenti angama-60 wezindleko zezinzuzo ezibalulekile zezempilo kubantu abajwayelekile.
- Uhlelo lweSiliva: Ihlanganisa isilinganiso samaphesenti angu-70 wezindleko zezinzuzo ezibalulekile zezempilo kubantu abavamile.
- I-Gold Plan: Ihlanganisa isilinganiso samaphesenti angu-80 ezindleko zezinzuzo zezempilo ezibalulekile kubantu abavamile.
- Uhlelo lwePlatinum : Ihlanganisa isilinganiso samaphesenti angama-90 ezindleko zezinzuzo zempilo ezibalulekile kubantu abalinganiselwe.
- Uhlelo oluyingozi: Ihlanganisa isilinganiso samaphesenti angu-60 wezindleko zezinzuzo zezempilo ezibalulekile kubantu abajwayelekile, futhi kubandakanya ukunakekelwa kwehhovisi eliyinhloko kanye nokunakekelwa kokuvikela ngaphambi kokudonswa. Konke okunye kusebenza ku-deductible, futhi kuhlanganiswa kuphela ngemva kokuhlangana. Izinhlelo ezimbi zitholakala kuphela kulabo abaneminyaka engama-30 noma kulabo abafanelekela ukukhululwa kanzima emthethweni wokuthenga
Qaphela ukuthi emazweni amaningi, kukhona uhla lwe-minimis engu -4 / + 2 oluvunyelwe ngesiliva, igolide, nezinhlelo ze-platinum, futhi uhla lwe-minimis -4 / + 5 oluvumelekile lwezinhlelo zethusi. Ngakho-ke uhlelo lwegolide lukwazi ukumboza phakathi kwamaphesenti angu-76 no-82 amaphesenti wezindleko ezijwayelekile, futhi uhlelo lwebhusi lukwazi ukumboza phakathi kuka-56 no-65 wamaphesenti wezindleko.
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services. Ikusasa le-SHOP: I-CMS ihlose ukuvumela amabhizinisi amancane kuma-SHOPs esebenzisa i-HealthCare.gov Ukuzivumelanisa okuningi uma ubhalisa ku-Healthcare Coverage. Ngo-May 15, 2017.
> Amasevisi e-Medicare naseMedicaid Services. Isikhungo Sokwaziswa Komthengi kanye Nokuqapha Umshuwalense. Ukuhluka kwesilinganiso sikaHulumeni. Juni 2, 2017.
> UMnyango WezeMpilo Nezinsizakalo Zabantu, Ukuvikelwa Kweziguli kanye Nokunakekelwa Kwezinkinga Ezithintekayo, Ukuqiniswa Kwemakethe . Ngo-Ephreli 13, 2017.
> I-Federal Register, Isivikelo Sokugula kanye Nomthetho Wokunakekelwa Okungathintekiyo; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2018; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi olusetshenzisiwe futhi oluhlelekile. NgoDisemba 22, 2016.