Ungasiza ngokwakho ukugcina imali ngezindleko zemithi kadokotela
Uma unesidakamizwa sokubhaliswa kwezidakamizwa izidakamizwa udokotela wakho uchaza, uzofuna ukujwayela inkampani yakho yomshuwalense, Medicare noma uhlelo lokukhokhiswa kwezidakamizwa ezikhokhelwa izidakamizwa okuthiwa i- formulary .
Isikhundla sezidakamizwa ohlelweni lokufaka amanani entela ye-formulary sizokwenza umehluko omkhulu ezindlebeni zakho zomuthi jikelele.
Iyini i-Formulary?
Umkhokheli wakho, noma ngabe inkampani yomshuwalense wangasese, i-Medicare, i-Tricare, i-Medicaid noma enye uhlelo igcina uhlu lwezidakamizwa ezizokhokha ngokuthi i-formulary yayo.
I-formulary yayo iqukethe izidakamizwa ezivamile, izidakamizwa zemithi futhi ngezikhathi ezithile izidakamizwa ezingaphezu kwe-counter (i-OTC) ezazisetshenziswa izidakamizwa zangaphambili kuphela. Isibonelo, i-Prilosec ne-Naproxen esetshenziselwa ukuthi ibe yilapha kuphela, kodwa kokubili manje izidakamizwa ze-OTC. Ezinye izinhlelo zokukhokhela zihlanganisa i-Prilosec ne-Naproxen emafomeni abo.
Yiziphi izinhlaka ze-Formulary?
Izigaba ziyiqembu lamazidakamizwa awela ngaphakathi kwencazelo kanye namaqembu okubiza:
- Isigaba 1 noma iTier I: Izidakamizwa zenqanaba 1 zivame ukuba nezidakamizwa ezivamile , izidakamizwa eziphansi kakhulu. Ngezinye izikhathi ezinye, izidakamizwa ezidayiswayo zenani eliphansi njalo zizowela kulo mkhakha, futhi. Izidakamizwa ze-Tier I zisithatha imali ephansi kakhulu ekhokhela, ngokuvamile i-$ 10 kuya ku-25.
- Isigaba sesi-2 noma iSigaba sesi-II: Isigaba II ngokuvamile sinezidakamizwa ngegama lomkhiqizo noma ama-generics abizayo. Uma kufanele uthathe umuthi wegama lomkhiqizo , umkhokheli wakho uyoba nomhlu lwezidakamizwa ezibizwa ngokuthi yizidakamizwa ezithandayo (ngoba izindleko zawo zingaphansi, kuchazwe ngezansi.) Le mikhiqizo ekhethiwe itholakala ku-Tier 2. Imithi yesigaba II isithatha inzuzo ephakathi -pay, ngokuvamile $ 15 kuya $ 50.
- Isigaba sesi-3: noma isiGaba sesi-III: Izindleko zemikhiqizo ebiza kakhulu, futhi ngokuvamile yinkampani yakho yomshuwalense ayifuni ukuba uthole imithi (ngoba izindleko zayo ziphakeme, kuchazwe ngezansi) nazo zibhekwa njengezingakhethi. Zitholakala ku-Tier 3. Izidakamizwa ze-Tier III ziyodla izindleko ezingaphezu kwezingxenye eziphansi, ngokuvamile ezikhokhelwa ama-$ 25 kuya ku-$ 75.
- Umzila wesi-4 noma u-Tier IV, obizwa nangokuthi izidakamizwa ezikhethekile: Lezi zidakamizwa zivame ukuvunyelwa imithi, futhi zibiza kakhulu ukuthi umkhokhi wakho ufuna ukudikibala imithi yomuthi. I-Tier IV iyisiqalo esisha, esetshenziswa okokuqala ngo-2009.
Isiqephu se-Tier IV sibonakala sibamba-konke okudinga izidakamizwa ezibizayo. Esikhundleni sokunikeza i-dollar co-pay ethile, abakhokhi bazokwabela amaphesenti, afana no-60%. Isibonelo, isidakamizwa se-chemo esabiza kakhulu, esithengiswa ku-$ 1,000 singabiza isiguli esingu-$ 600.
Kungani Izidakamizwa Zibekwe Ezingxenyeni?
Lena yimpendulo yegama elilodwa kulowo mbuzo: imali.
Ukufakwa ohlwini kwezidakamizwa kuwumsebenzi wezinto ezimbili: izindleko zayo zangempela nezindleko zokuxoxisana nomkhokhi. Uma izidakamizwa zibiza kakhulu umkhokheli, i-upper tier, futhi nakakhulu iyobiza iziguli.
Izidakamizwa ezihlukene ekilasini ngalinye lesidakamizwa zihlelwe kumathanga ahlukene. Isibonelo, iklasi yezidakamizwa ezisiza abantu abane- GERD (isifo se-reflux ye-gastroesophageal) kuthiwa i-proton pump inhibitors, noma i-PPIs. I-PPI engabizi kakhulu i-generic, ebizwa ngokuthi i-omeprazole, futhi ihlala ilandelwa ku-Tier I. Ezinye ze- PPI ezinamazinga aphansi, njenge Prilosec noma i-Prevacid, zivame ukufakwa ohlwini ku-Tier II. Ama-PPI abiza kakhulu, afana ne-Aciphex noma i- Nexium , afakwe kuhlu ku-Tier III.
Ukusebenzisa isibonelo se-PPI ngenhla: Umkhokhi angase axoxisane nentengo yakhe nomkhiqizi noma umsakazo wezinye zezidakamizwa ezibiza kakhulu, njenge-Aciphex noma i-Nexium endaweni ephansi kakhulu. Uma benza lokho ngempumelelo, leso sidakamizwa saba "uphawu oluthandwayo," okuvame ukuthi luthi lube yisidakamizwa se-Tier II. Uma bengenakukwazi ukuyixoxisana ngokwanele, iyobekwa ku-Tier III futhi izobiza iziguli ngaphezulu, futhi.
Ingabe Bonke Abakhokhi Basebenzisa Amathrekhi Afanako?
Cha, bonke abakhokhayo abangezi uhlu lwezidakamizwa ezifanayo kumathrekhi afanayo. Njengoba kukhonjisiwe nje, isabelo somuntu okhokhelwayo sincike ezindlebeni zayo ezixoxiswene ngazo. Uma Umkhokhi A engakwazi ukuxoxisana ngentengo ephansi yomuthi othize onguchwepheshe kunama-negotiate ama-Payer B, khona-ke i-Payer A ingabhala lolo mkhiqizo ku-Tier II ngenkathi Umkhokhi B engayibhala ku-Tier III.
Ngingayithola Kanjani I-Formulary Yami Yomshwalense Wezempilo?
Noma yimuphi umkhokheli wezempilo uyokwenza ifomula yayo itholakale kuwe - ifuna ukuthi ube nayo futhi uyisebenzise. Kuzotholakala kalula kwiwebhusayithi yayo, noma ungabiza inombolo yesevisi yamakhasimende bese ucela ukuthi bayithumele kuwe.
Akuyona into engavamile kumkhokheli ukwenza izinguquko kwifomula yayo noma ukuhambisa isidakamizwa kusuka kwesinye isithathu kuya kwesinye. Uma uthatha isidakamizwa nsuku zonke noma njalo, ungaziswa uma ushintsho lwenzeka. Futhi, uzofuna ukuhlola kabili ngonyaka ngonyaka wokubhalisa okuvulekile, uma unethuba lokwenza izinguquko ohlelweni lwakho lokufaka, ukuze ubone ukuthi izidakamizwa zakho zishintshe isikhundla sayo kumfomu wokukhokha.
Ungayisindisa Kanjani Imali Ngokusebenzisa Ifomula Yakho?
Uma unokuqonda okuyisisekelo kwamakilasi ezidakamizwa kanye nemanani emithathu, ungasebenzisa nodokotela wakho ukhethe isidakamizwa esizokukhokhela okungenani. Buyekeza isigaba somuthi we-odokotela, bese uthola isikhundla salo kwifomula yakho yokukhokha ukuqinisekisa ukuthi uthola isidakamizwa oyidingayo ngenani lemali encane.