Yini Enquma Izinkokhelo Zakho Nalokho Okumaphakathi Kwamanye amazwe aseMelika
Ingxabano enkulu yamuva mayelana nokuguqulwa kwezempilo e-US igxile ezindlekweni zomshuwalense wezempilo, okungenakho ukukhokhela kwabaseMelika abaningi.
Kodwa-ke, Ukuvikelwa Kweziguli kanye Nokunakekelwa Okunakekelwa Ngokwempilo kusayinwe ngomthetho ngo-Mashi 23, 2010, ikakhulukazi ikheli lokuthola umshuwalense wezempilo futhi liqinisekisa ukuthi bonke abaseMelika abadinga ukukhokhelwa bazokwazi ukuthola umshwalense wezempilo.
Akucaci ukuthi lo mthetho uzothinta kanjani izindleko zemshuwalense wezempilo, ikakhulukazi amaprimiyamu kanye nezindleko zangaphandle. Kungenzeka ukuthi izindleko zizoqhubeka zanda ukwakhiwa okuzayo.
Ingakanani umshuwalense wezempilo oyokukhokhela kuncike eminyakeni yakho, isimo sempilo yakho (ukuthi unempilo noma unempilo), kuphi ezweni ohlala kulo, imali oyihola, nesimo sakho somsebenzi.
Kunezindlela eziningi ongazithola umshuwalense wezempilo, futhi lezi zinganquma ukuthi uzokhokha malini. Lokhu kufaka:
Umshuwalense wezempilo ohlinzekwa ngumqashi. Izinkampani eziningi ezinkulu nezinkampani zase-US zinikeza umshuwalense wezempilo njengenzuzo yomsebenzi. Abaningi baseMelika abanomshwalense wezempilo bakuthola enkampanini abayisebenzelayo.
Umshuwalense wezempilo oyithenga wedwa. Uma uziqashile noma usebenzela inkampani encane enganikezi umshuwalense wezempilo, kuzodingeka uthenge umshwalense.
Umshuwalense wezempilo ohlinzekwa nguhulumeni. Uma uneminyaka engama-65 noma ngaphezulu, ukhubazekile, noma ungenayo kancane noma ungenayo imali, ungase ufanelekele umshwalense wezempilo okhokhelwa uhulumeni, njenge-Medicare ne-Medicaid.
Yini Imali Yomshuwalense Wezempilo?
Kunezinto eziningi ezinquma ukuthi umshwalense wakho wezempilo uzokubiza kangakanani ngenyanga ngayinye.
Izinkokhelo
I-premium yinkokhelo yenyanga yonke ekhokhelwa inkampani yomshuwalense noma uhlelo lwezempilo lokuhlinzeka ngempilo, kuhlanganise nokukhokhela izinsizakalo ezihlobene nempilo ezifana nokuvakashelwa odokotela, ukuvakasha izihambi kanye nemithi.
Uma unomshwalense ohlobene nomsebenzi, umqashi wakho ukhokhela i-premium yenyanga. Cishe, inkampani yakho izofuna ukuthi ukhokhe ingxenye ethile ye-premium yenyanga, ezokwehliswa kusuka ekukhokhweni kwakho. Uma usebenza ngokweqile noma uthenge umshuwalense wakho wezempilo , ukhokha yonke i-premium yenyanga.
Kungakhathaliseki ukuthi uthola umshuwalense wezempilo emsebenzini noma uthenge umshuwalense wakho, i-premium yakho ingase ibe ephakeme noma ephansi kuye ngokuthi yiliphi uhlobo lomshwalense oyikhethayo. Izindleko ezinezindleko eziphezulu ezivela ngaphandle ( izindleko zokubambisana, ukukhokhelwa kwemali, kanye nokukhokha imali) ngokuvamile ziba nama-premium aphansi kanye nezinhlelo ezinezindleko eziphansi ezingaphandle kwe-pocket zinamaprimiyamu aphezulu. Futhi, uhlelo lwezempilo (olufana ne- HMO ) oludinga ukuthi usebenzise inethiwekhi odokotela nezibhedlela ngokuvamile lunomvuzo ophansi. Futhi uzokhokha ngaphezulu umshuwalense wezempilo ohlanganisa amalungu omndeni wakho.
Uma uzithenga umshuwalense wangasese (noma amanye amalungu omndeni), ama-premiums akho azoba ngaphezulu nakakhulu uma ukhona, uma usebenza ngokweqile emsebenzini "onobucayi" (njengomshayeli wendiza), noma unesimo sezempilo esingapheli (njengohlobo lwesifo sikashukela 2 noma umfutho wegazi ophezulu)
Izindleko ezingaphandle kwe-Pocket
Izindleko ezingaphandle kwezezimali yizo ozikhokhela ngezinsizakalo ezihlobene nezempilo ngaphezulu nangaphezulu kwe-premium yakho yenyanga. Kuye ngecebo lakho lempilo, lezi zindleko zingabandakanya i-deductable, i-co-inshurensi yonyaka, kanye ne-copayments yokuvakashelwa udokotela kanye nemithi yokudokotela.
I-Deductible : I-deductible yimalini okufanele uyikhokhe ngaphandle kwe-pocket ngonyaka ngonyaka ngezinyathelo ezihlobene nempilo ngaphambi kokuba umshwalense wakho uqale ukukhokha. Ama-Deductibles avamile kuma- PPOs ngezinsizakalo zokunakekelwa kwezempilo ezitholwa ngaphandle kwenethiwekhi ye-PPO. Uma une-Medicare, cishe kuzodingeka ukhokhe imali ekhokhelwa izinsizakalo zezokwelapha kanye nokwehlukaniswa okuhlukile kwemithi ngaphansi kwe- Medicare Part D.
I-Coinsurance : Enye umshuwalense wezempilo udinga ukuba ukhokhe iphesenti yezindleko zemisebenzi ehambisana nempilo ngemuva kokuhlangabezana nokukhishwa kwakho kwonyaka. Lokhu kwaziwa ngokuthi yi-coinsurance futhi kaningi kuwu-20% walokho uhlelo lwakho lwezempilo oluvuma.
Isibonelo, uMnu. Jones unenhlelo lempilo yomndeni ene-$ deductible yonyaka we-$ 500 kanye no-20% wezimali. NgoFebhuwari, umkakhe nezingane ezimbili baqashelwa. UMnu. Jones ukhokhela udokotela ngalezi zinsizakalo, okubiza ama-dollar angu-510. Ngo-Mashi, omunye wabantwana wagula futhi izindleko zokuvakasha ehhovisi kwakuyi $ 50. Kusukela kutholakale imali ekhishwe yonyaka, uhlelo lwezempilo lukhokhela udokotela u-$ 40 (80%) noMnu Jones bakhokhela udokotela u-$ 10 (20%).
Ikhophiyayment : Ikhophi yokukhokha iyimali ephathekayo, noma inani elibekiwe okufanele ukhokhele ngensizakalo ethile ephathelene nempilo. Ama-copayments ajwayelekile kakhulu kumalungiselelo okunakekelwa okulawulwa (njenge-HMOs kanye nama-PPOs) nasemiphakathini yezidakamizwa ezifana ne-Medicare Part D.
Isibonelo, ama-copayments ajwayelekile angama-$ 20 ukuze uvakashele udokotela, u-$ 50 ukuze uvakashele igumbi lokuphuthumayo, bese ufika ku-$ 10 kuya ku-$ 40 ukuze uthole imithi kadokotela (kuncike uma imithi yakho yodakamizwa noma umuthi wegama lomkhiqizo ).
Iyini Umshuwalense WaseMelika Okhokhela Umshwalense Wezempilo?
Lo ngumbuzo obunzima ukuphendula. Abantu abangaphezu kwezigidi ezingama-85 baseMelika bathola umshuwalense wezempilo ngohulumeni, kuhlanganise ne-Medicare, Medicaid, izinzuzo zabase-veterans, kanye nempi (kokubili umsebenzi osebenzayo nabahlala emakhaya). Njengamanje, abangaphezu kwezigidi ezingu-45 baseMelika abanayo umshuwalense wezempilo.
Abaningi baseMelika abanomshuwalense wezempilo bakuthola kumqashi wabo futhi abangaphezu kuka-26.5 million baseMelika bahlanganiswa ngamapulani ahlukene athengwe ngqo kusuka kwinkampani yomshuwalense.
Embikweni (Umshwalense Wezempilo Ngamanye Nonyaka 2009: Uhlolo Oluphelele Lwezinkokhelo, Ukutholakala, Nezinzuzo) olwenziwe ngomphakathi ngo-Okthoba 2009, Izinhlelo Zomshuwalense Wezempilo eMelika (iqembu lezokuhweba elimele izinhlelo zezempilo) linikeze olunye ulwazi olunikeza umqondo walokho umshuwalense wezempilo izindleko zenqubomgomo lapho kuthengwa umuntu.
- Ngokwesilinganiso, i-premium yonyaka yayiyi $ 2,985 kumuntu oyedwa kanye no-$ 6,328 emndenini.
- I-premium yaminyaka yonke ihluke kusuka kumbuso kuya kumbuso. Isibonelo, i-premium yepulani lempilo yomndeni eNew York yayiyi $ 13,296, kanti uhlelo olufanayo e-Iowa lwaluyi $ 5609.
- Amaphrimiyamu wonyaka wezinhlelo zezempilo ayehlukene kakhulu kuye ngokuthi ngabe ukukhishwa kwonyaka kwaba phezulu noma okuphansi. Isibonelo, izinhlelo zomndeni ezingenayo i-deductible zinezigidi eziyinkulungwane zama $ 12686 ngonyaka, kuyilapho izinhlelo zonyaka odalwe u-$ 10,000 zinezigidi ezilinganiselwa ku-$ 5380 ngonyaka.