Medicare

Uhlolojikelele lwe-Medicare Eligibility and Benefits

I-Medicare wuhlelo lombuso olunikeza ukunakekelwa kwezempilo kubahlali abadala kanye nabantu abaneziphene ezifanelekayo. Izakhamuzi zaseMelika ezisemthethweni ezihlangabezana nezidingo zeminyaka yobudala kanye / noma ukukhubazeka zingase zifaneleke. Uhlelo luhlangabezana nezidingo ezingaphezu kwezigidi ezingama-56 zaseMelika. Ngama-baby boomers angama-10 000 aneminyaka engu-65 ubudala nsuku zonke ngo-2030, inani labantu aseMedare liyaqhubeka likhula.

Ngomthetho uMongameli uLyndon Johnson ngo-1965, uM Medicare ekuqaleni wayephethe izingxenye ezimbili kuphela. Ebhekwa njengeMyriy Medicare, Ingxenye A kanye neNgxenye B ihlinzekelwe ukunakekelwa kwezibhedlela eziyisisekelo kanye nezindleko zeziguli ngokulandelana. Kusukela ngaleso sikhathi, lolu hlelo luye lwasakazeka ukuze luhlanganise "izingxenye" ​​eziningi futhi, ngaleyo ndlela, izinzuzo eziningi. Ukuqonda izingxenye zikaMedare kanye nokuthi basebenza kanjani ndawonye kuzokusiza ukuba ubhalisele i-Medicare ngendlela ezokwenza ukwandisa ukunakekelwa owutholayo.

• Ukuthi Imithi Yenzani Futhi Ayifuni Inhliziyo Yakho

• Ukubhalisa Okuvulekile Nokubhaliswa Okukhethekile Ungayishintsha Amapulani KaMedare

I-Medicare Ingxenye A: Ukuhlinzekwa kwezibhedlela

Ukuhlala esibhedlela kungabiza. Ngo-2011, isilinganiso sokuhlala esibhedlela sabiza u-$ 12,600 kubantu abaneminyaka engama-65 no-84 ubudala. Ngenxa kaMedare, uhulumeni wakhokhela u-$ 11,900 imali kulabo abahlala khona.

Ingxenye A yi-inshuwalense yakho yesibhedlela. Ikhokhela izindleko zasesibhedlela, ukunakekelwa kwezingane zokubeletha , indawo yokuhlengikaza abanekhono ehlala , indawo yokuvuselela ihlala, ngisho nezinsizakalo ezithile zokunakekelwa kwezempilo ekhaya. Ungacabangi lokhu kusho ukuthi konke kuzokhokhwa esikhathini eside. I-Medicare inezimiso eziqinile ezikhawulela ukuthi kuzokwenzeka nini lezi zinsizakalo, uma kunjalo.

I-Medicare Ingxenye B: Ukuhlinzeka Ngokwempilo

Iningi lokunakekelwa kwezempilo oyothola kuyoba ngesilungiselelo sesipiliyoni, okushiwo esibhedlela.

Lokhu kungase kube ehhovisi lika-clinic, i-laboratory, indawo ye-radiology noma yinani lezindawo . Ngisho noma isevisi inikezwa kahle esibhedlela, njengokuthola i-X emnyangweni we-radiology esibhedlela, uMedare akawubheki ukunakekelwa esibhedlela ngaphandle kokuthi ungenwe isifo esibhedlela.

Ingxenye B ingumshwalense wakho wezokwelapha. Ihlanganisa izinsizakalo ezihlukahlukene zezokwelapha kuhlanganise nokuvakasha kukadokotela, ukugibela kwe-ambulensi , umdlavuza kanye nezinye izivivinyo zokuvimbela, ukuhlinzeka ngesifo sikashukela, imishini yokwelapha ehlala isikhathi eside, izifundo ze-imaging, ukuhlolwa kwelabhorethri, imithi elinganiselwe , imithi , ukuvakashelwa kahle , nokuningi.

I-Medicare Ingxenye C: Medicare Advantage

I-Medicare Advantage , eyayaziwa ngokuthi i-Medicare + Choice, iyindlela ehlukile ku-Original Medicare eyongezwe ohlelweni ngo-1997. Ungakhetha i-Original Medicare (Izingxenye A no-B) noma Ingxenye C. Uhulumeni akakakuvumeli ukuba bobabili .

Izinhlelo ze-Medicare Advantage zinikezwe izinkampani zomshuwalense ezizimele ezisayine izivumelwano nezinhlaka zikahulumeni.

Lezi zinhlelo ziyavumelana ukumboza yonke into eyenziwa yi-Original Medicare kodwa inganikeza ngamasevisi angeziwe.

Ngo-2016, abantu abangaphezu kwezigidi ezingu-18 baseMelika bakhetha ama-Medicare Advantage amapulani phezu koMdokotela we-Original ukuze baqiniseke ukuthi bahlinzekelwe ukunikezelwa kwezinsizakalo ezidingayo. Izinhlelo ze-Medicare Advantage ziza ngezindleko ezengeziwe kubazuzi abavame ukukhokhwa amaphrimiyamu aphezulu ngaphezulu kunabo ababezokwenza ku-Original Medicare.

I-Medicare Ingxenye D: Ukuhlinzekwa kwezidakamizwa zemithi

I-US Census Bureau ibike ukuthi imithi ejwayelekile yaseMelika igcwaliswe ngo-12.2 ngo-2013. Leyo nombolo yenyuka yaba nemigomo engu-27.8 ngonyaka kulabo abangaphezu kweminyaka engama-65 ubudala. Kulula ukubona ukuthi izindleko zemithi yesidakamizwa ngokushesha zingangeza kanjani.

Ingxenyana D isingeniso sezidakamizwa esayinwe ngomthetho ngo-2003 ngaphansi kukaMongameli uGeorge W. Bush kodwa saqala ukusebenza ngonyaka ka-2006. Ngokufanayo neMedricare Advantage, lezi zinhlelo ziqhutshwa izinkampanini zomshuwalense wangasese kepha kumele zihlangabezane neziqondiso ezijwayelekile ezibekiwe nguhulumeni wesifundazwe. Uhlelo ngalunye luzoba nemithi ehlukile ye- formulary futhi umhlomulo ngamunye weMedare kufanele anqume ukuthi yikuphi uhlelo oluhambisana nezidingo zabo.

Akekho uhlelo oluhlanganisa yonke imithi.

Izinhlelo ze-Medicare Supplement: Medigap

Kulabo abafuna ukufakwa okwengeziwe, i-Medicare Supplement Plan, eyaziwa nangokuthi uhlelo lwe- Medigap , ingaba yinto okufanele icatshangelwe. Lezi zinhlelo aziyona ingxenye esemthethweni yohlelo lwe-Medicare, nakuba amaCenter for Medicare kanye neMedicaid Services (CMS) afanisa lokho abakufaka khona. Izinhlelo ze-Medigap zifanayo kuwo wonke amazwe ngaphandle kweMassachusetts, Minnesota, naseWisconsin.

Izinhlelo ze-Medigap empeleni azifaki izinzuzo ezengeziwe emkhakheni wakho we-Medicare. Lokho abakwenzayo kusiza ukukhokha izindleko ukuthi uMagare ushiya etafuleni, njengama-deductibles, u-coinsurance, kanye ne-copayments. Bangase baze bafake isikhalazo uma uhamba phesheya. Lezi zinhlelo zinikezwa ngabashuwalense abazimele futhi zingasetshenziswa kuphela ngokubambisana ne-Original Medicare, hhayi izinhlelo ze-Medicare Advantage.

Nini Ukubhalisa ku-Medicare

Isikhathi sokuQala sokuQala (IEP) se-Medicare siqala izinyanga ezintathu ngaphambi bese siphela izinyanga ezintathu emva kokuzalwa kwakho kwe-65. Abantu abasemshuwalense wokukhubazeka kokuphepha kwezenhlalakahle (SSDI) bafanelekile ku-Medicare ngenyanga ye-25 yezinzuzo ze-SSDI futhi babhalise ngokuzenzakalelayo ohlelweni ngo-Social Security.

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Abanye abantu bangase bafaneleke isikhathi sokubhalisa esikhethekile esekelwe emlandweni wabo wokuqashwa noma omunye umshwalense wezempilo.

Kukhona isikhathi sokubhalisa esivulekile njalo ngonyaka kubantu abafuna ukuguqula ukukhishwa kwabo kwe-Medicare. Ingabe ufuna ukushintsha kusuka ku-Original Medicare kuhlelo lwe-Medicare Advantage noma ngokuphambene nalokho? Noma ufuna ukushintsha kusuka ohlelweni olulodwa lweMedare Medicine ukuya kwesinye? Lesi yisikhathi sokwenza. Isikhathi sokubhalisa esivulekile senziwa njalo ngonyaka kusukela ngo-Okthoba 15 kuya kuDisemba 7.

Akuwona wonke umuntu okufanele abhalisele zonke izingxenye ze-Medicare, kodwa ukungabhalisi ngesikhathi kungadla isisindo ngemali ekhokhelwa isikhathi eside uma ukhetha ukubhalisa kamuva. Izimali zokugcina ze-Part A zingadlulela iminyaka, kepha Ingxenye B kanye neNgxenye D izijeziso ezisheshayo zingadla uma nje unayo iMedare. Mayelana nerekhodi, ukukhetha uhlelo lweMeditore Advantage esikhundleni seMithi Yempilo yangempela ngeke ikukhiphe ekukhokheni izigwegwe zeNgxenye A neyengxenye B.

Imali Engakanani Imali Ebiza

I-Medicare ivame ukubizwa ngokuthi imithi yomphakathi, kodwa ayiyona mahhala. Yize kungase kube okungabizi kakhulu kunamapulani omshuwalense wangasese, abaningi baseMelika bazama ukuthola ukunakekelwa kwempilo. Kulabo abahlangabezana nezimfuneko ezithile zefa kanye nezenzuzo, kunezinhlelo ze- Medicare zokugcina imali ezingasiza ekugcineni izindleko phansi.

• Ingxenye A: Izinkokhelo zenyanga zonke zeNgxenye A zikhululekile kubantu abaye basebenza iminyaka engaphezu kwengu-40 (iminyaka engu-10) yomsebenzi okhokhelwa umuthi. Abashadile babo , futhi ngezinye izikhathi labo abashade nabo abafelokazi babo, nabo bayakwazi ukuthola amaholo akhokhelwayo mahhala. Labo abaye basebenza ngaphansi kwalokho bazokhokha amakhulu amaRandi njalo ngenyanga. Ngonyaka we-2016, lokho kungu-$ 226 ngenyanga ngenyanga engama-30-39 kuya ku-$ 411 ngenyanga ngemisebenzi engaphansi kwezingu-30. Ingxenye eyengeziwe Ingqikithi ihlanganisa imali eyi-$ 1,288 ekhishwe ngonyaka ka-2016 ukuze kube nokuhlala esibhedlela ngasinye, ukukhokhwa kwezimali kubhedlela kuhlala isikhathi esingaphezu kwezinsuku ezingama-60, futhi ukukopishwa kwezikhungo zokuhlengikaza abanamakhono kuhlala isikhathi esingaphezu kwezinsuku ezingu-20.
• Ingxenye B: Wonke umuntu ukhokhela izinkokhelo zenyanga ngenyanga yeNgxenye B, futhi uma uhola okuningi uyokhokha. I-Medicare ibheka ukubuyisa kwentela yakho engenayo kusukela eminyakeni emibili eyedlule ukunquma izindleko zama-premium akho. Kukhona isikhathi esisodwa sokudonswa ukukhokha njalo ngonyaka ngaphambi kokuba izinzuzo zakho zikhawule ($ 166 ngo-2016). Ngaphandle kokuhlolwa kokuvimbela ukuvimbela, ukwamukela ukuvakashelwa kweMedricare kanye nokuvakashelwa kokuhamba kahle kweminyaka kuyakhululekile uma udokotela wakho evumelana nesimiso semali yesigqirha sikaMedare . Kufanele ulindele ukukhokha ukuqinisekiswa kwephesenti engama-20 kunoma yiziphi izinsizakalo zeNgxenye B owamukelayo.
• Ingxenye C (Medicare Advantage) neNgxenyana D: Izinkokhelo, ama-deductibles, kanye ne-copayments ye-Medicare Advantage ne-Part D izinhlelo zizohluka ngokusekelwe yinkampani yomshuwalense wangasese enikeza lolu hlelo. Kodwa-ke, uma imali yakho engenayo idlula inani elithile, i-CMS idinga ukuthi ukhokhe imali eyaziwa njenge-Income-Related Monthly Adjustment Value (IRMAA) ngaphezu kwama premium akho e-Part D ngenyanga. Le nkokhelo izophinde ifakwe uma ukhona ohlelweni lwe-Medicare Advantage olubandakanya ukufakwa kwezidakamizwa zemithi. I-IRMAA ikhokhwa ngqo kuhulumeni, hhayi kwinkampani yomshuwalense yangasese ephethe uhlelo lwakho.

Ukuthola Usizo

I-Medicare uhlelo oluyinkimbinkimbi nemithetho nemigomo eguqukayo. Lokho kusho, kungase kubenzima ukukwazi ukuqhubeka. Ungase ufune ukubhalisa usizo lomsebenzi wakho wesikhwama sempilo yomshuwalense wezempilo uma unemibuzo noma ukukhathazeka mayelana nokukhishwa kwakho kweMedare. Lezi izinhlelo zokuzithandela ezithola imali evela kuhulumeni wesifundazwe ukukuqondisa. Ngaphandle kwalokho, ungaqasha ababonisi abazimele ukuze bakusize nganoma yiziphi izinkinga ongazithola.

> Imithombo:

> Medicare Inzuzo. Iwebhusayithi kaHenry J. Kaiser Family Foundation. http://kff.org/medicare/fact-sheet/medicare-advantage/. Ishicilelwe ngo-Juni 29, 2015.

> Medicare Ukubhalisa Dashibhodi. Amasevisi we-website ye-Medicare ne-Medicaid Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMSProgramStatistics/Dashboard.html. Kubuyekezwe ngo-June 2016.

> Imithi yokusebenzisa kanye nezindleko zokuguqula impilo. IMS Institute for Healthcare Informatics iwebhusayithi. http://www.imshealth.com/en/thought-leadership/ims-institute/reports/use-of-medicines-in-the-us-2013. Kushicilelwe ngo-Ephreli 2014

> Pfuntner A, Wier LM, Steiner C. Izindleko zeSibhedlela Zihlala e-United States, 2011. Isifinyezo se-HCUP # 168. I-Agency for Research and Health Quality . http://www.hcup-us.ahrq.gov/reports/statbriefs/sb168-Hospital-Costs-United-States-2011.pdf. Kushicilelwe ngo-December 2013.

> Iyini i-Medicare Supplement Insurance (Medigap)? Iwebhusayithi ye-Medicare.gov. https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html.