Lapho Izinkampani Zomshwalense Zinezandla Ephezulu
Okungaxhunyiwe kufanele kube lula, kungabi namandla, futhi kube nzima. "Ukuguqulwa okungahlelekile" kwe-Medicare, noma kunjalo, akunandaba neze. Lena yinkambiso ephikisanayo eyabamba abahlomuliyo abazi. Abanimshuwalense abangasese banabhange ngokuthi awuqondi uhlelo ngoba bakucindezela emiphakathini engafuneki ye-Medicare Benevantage.
Ukuze uqonde indlela inqubo esebenza ngayo, okokuqala kudingeka uqonde ukuthi ukubhalisa okuzenzakalelayo kusebenza kanjani, ngubani ofanelekayo, nokuthi kungani ungase ukhethe ukukhetha uhlelo lwe-Medicare Advantage phezu kwe-Original Medicare .
Yazi amalungelo akho bese ubeka emuva ukuzikhethela ezandleni zakho.
Umehluko phakathi kwe-Medicare yokuqala kanye neMedyare Advantage
I-Medicare yokuqala yabizwa kanjalo ngoba yayingumuthi we-Medicare owaqala ukuqala emuva ngo-1965. Lokhu kufaka phakathi Ingxenye A , umshuwalense wembhedlela ohlanganisa ukunakekelwa kwabagulayo kanye nokunakekelwa esibhedlela, neNgxenyana B , umshuwalense wezokwelapha ohlanganisa izindleko zakho zokwelapha kanye nokuhlala kokubona .
Ingxenye C, eyaziwa nangokuthi i-Medicare Advantage, noma kunjalo, ingenye ye-Original Medicare. Ihlanganisa zonke izingxenye ze-A no-B kodwa zingafaka izinsizakalo ezingeziwe kwimenyu yayo yokufakazela ukuthi i-Original Medicare ayifuni. Kuye ngezidingo zakho zezokwelapha, ungakhetha ukwelapha uhlelo lwe-Medicare Advantage esikhundleni se-Original Medicare kodwa ugcine engqondweni ukuthi awukwazi kokubili kokubili.
Izindleko-ezihlakaniphile, lindele ukukhokha ngaphezulu kwe-Medicare Advantage.
Abaningi baseMelika bathola Ingxenye A mahhala. Okusho ukuthi, uma wena noma oshade naye esebenze amahora angama-40 emisebenzini ekhokhiswa intela, izinkokhelo zakho zenyanga ze-Part A zizoba mahhala. Wonke umuntu ukhokhela izinkokhelo ze-Part B, inani le dollar elihluka ngokusho kweholo lakho.
I-Medicare Advantage izinhlelo zinezikhwama zodwa.
Nakuba uhlelo lwakho lwe-Medicare Advantage lukhokhela izinsizakalo zakho zeNgxenye B, usadingeka ukhokhe izinkokhelo zenyanga ze-Part B.
Ukubhalisa Okuzenzakalelayo Nezokuphepha Komphakathi
Ukubhalisa ngokuzenzekelayo ku-Medicare ne-Social Security kuyahambisana. Abantu abathola ngokugcwele izinzuzo zokuvikeleka kwezenhlalakahle bazobhaliswa ngokuzenzakalelayo ku-Original Medicare uma befaneleka. Lokhu kungenzeka ngesikhathi sokuqala sokubhalisa lapho uphendukela eminyakeni engu-65 ubudala noma ngemuva kokuba usuMshuwalense Wokukhubazeka Kwezenhlalakahle (SSDI) izinyanga ezingu-24.
Uma ufaka phakathi nezinyanga ezintathu zokuqala ze-Period yokuqala yokubhalisa, izinzuzo zakho zeMedricare zizoqala usuku lokuqala lwenyanga yokuzalwa kwakho kwezinsuku ezingu-65. Uma usebenza engxenyeni yesibili yoHlelo LokuQala Lokubhalisa, izinzuzo zakho zizoqala ezinyangeni ezingu-3 (ngenyanga engu-1 uma usebenza ngenyanga yakho yokuzalwa, ezinyangeni ezingu-2 uma usebenzisa inyanga ngemuva kwenyanga yakho yokuzalwa noma ezinyangeni ezingu-3 uma sebenzisa izinyanga ezimbili kuya kwezingu-3 emva kwenyanga yakho yokuzalwa). Endabeni ye-SSDI, izinzuzo zeMediare zizoqala ngenyanga ye-25 yenzuzo yakho yokukhubazeka.
Kungakhathaliseki indlela yokubhalisa okuzenzekelayo, izindleko zama-premium akho ngenyanga zikhishwa ngokushesha ku-Check Social Security check.
Uma ufuna uhlelo lwe-Medicare Advantage esikhundleni se-Original Medicare, kuzodingeka uthathe isinyathelo bese ubhalisela uhlelo.
Uma nganoma yisiphi isizathu unquma ukuthi awufuni ukubamba iqhaza ku-Medicare ngesikhathi sokubhalisa okuzenzekelayo, kuzodingeka uthathe isinyathelo futhi uphume. Qaphela kakhulu ekwenzeni lesi sinqumo. Ukunciphisa Ingxenye A izinzuzo nazo ziqeda izinzuzo zakho zokuvikeleka kwezenhlalakahle.
Abantu abangatholi ngokuzithandela izinzuzo zokuvikeleka kwezenhlalakahle kufanele bathathe isinyathelo futhi babhalise ku-Medicare ngokwabo. Okungenani kwakudingeka kufike ukuguqulwa okungapheli.
Ukuguqulwa kokuguqulwa okungahleliwe
Ukubhalisa okuzenzakalelayo manje kungathinta abantu abangatholi ngenzuzo izinzuzo ze-Social Security.
Ukuguqulwa kwamandla angenawo amandla kuzinkampani zomshuwalense ezizimele ezixhasa izinhlelo zeMedare Advantage. Uma ukhona ohlelweni lwezempilo olunikezwa yilezi izinkampani zomshuwalense ngesikhathi ufaneleka kuM Medicare, noma ngabe yiloluhlelo lwezempilo lwe- Care Act elinganakusiza noma uhlelo lwezempilo oluxhaswe ngumqashi, inkampani ingakufaka ngokuzenzekelayo kwenye yazo Izinhlelo ze-Medicare Advantage.
Ekuboneni kokuqala, lokhu kungase kuzwakale njengento enhle. Phela, inqubo ingasiza umuntu ofuna ukuhlala nenkampani efanayo yomshuwalense. Kungenza kube lula ukuphatha, ukuqeda isinyathelo enqubo, futhi ukusiza ukuqhubeka nokuqhubeka nenkampani. Kungase futhi kuvimbele izijeziso ezisheshayo ezingadala amakhulu ezinkulungwaneni zamaRandi ngaphandle kwezindleko zezikhwama zabantu abhalisela isikhathi se-Medicare.
Njengoba nje kunezinzuzo zokuguqulwa okungapheli, kunezimo eziyingozi.
- Izindleko. I-Medicare yasekuqaleni yikhotho yakho engabizi kakhulu, kodwa inkampani yangasese yomshuwalense ithatha ukuthi uzofuna ukukhokhela i-premium eyengeziwe inyanga ngayinye ohlelweni lwayo lwe-Medicare Advantage.
- Ukukhetha. Inkampani ikhetha uhlelo lwakho. Bangakhetha uhlelo olubi kakhulu ukushayela inzuzo, hhayi ngempela uhlelo olubiza kakhulu kuwe noma oluhlangabezana nezidingo zakho.
- Ukuhlanganisa. Ungacabangi uhlelo owawunalo ngaphambi kokuba ufanelekile ku-Medicare yiluhlelo ozoqhubeka ngalo ngaphansi kwe-Medicare Advantage. Ungase ulahlekelwe ukufinyelela kwabanye odokotela, amanethiwekhi esibhedlela, imithi, noma izinsizakalo ngokuya kwepulani le-Medicare Advantage elikhethiwe.
Indlela Ukuguquguquka Okungahleliwe Kusebenza
Amasevisi we-Medicare ne-Medicaid Services (i-CMS) adinga izinkampani zomshuwalense ukuba zifake isicelo semvume yokubamba iqhaza ekuguquleni okungapheli. Lokhu kuvumela uhulumeni ukuba aqondise le protocol ngezinga. Indlela edlala ngayo ezweni langempela, noma kunjalo, kuboniswe ukuthi kuyinkinga.
Umshuwalense kufanele anikeze isaziso sabaningi esibhalisiwe izinsuku ezingama-60 sokubhaliswa kwabo ohlelweni. Uma lowo muntu engaphumi, lokho ukubhalisa kusebenza ngokuzenzakalelayo. Inkinga ukuthi ukuthunyelwa kwe-imeyili evela kwenkampani yomshuwalense ekwazisa umzuzi waleqiniso kungase kungcwatshwe phakathi kokubulawa kweposi kusukela kwezinye izinkampani zomshuwalense ezikhuthaza izinhlelo zabo. Abadala baqala ukuthengiswa ngezinto zokuthengisa futhi badidekile ngamalungelo abo.
Umzuzi angase angazi ukuthi kuhlelo lweMedricare Advantage kuze kube yilapho bethola isimemezelo sokunakekelwa okwenziwa ngaphandle kwenethiwekhi noma bathola ikhadi le-Medicare Advantage nodokotela omusha wokunakekelwa okuyinhloko kulotshiwe.Umphumela wokuphela ube yizinkokhelo eziphezulu zezokwelapha futhi ukulahlekelwa kokuqhubeka kokunakekelwa kwabadala abaningi kakhulu.
Ukubamba kodwa Akusikho Isimiso Sokuguqulwa Okungahleliwe
Inkinga ngokuguqulwa okunamandla kungukuthi abazuzi banenketho yokuphuma ngaphandle kokungena ngemvume kulezi zinhlelo ze-Medicare Advantage. Kalula nje, ufakwa ohlelweni futhi unqunyelwe ukuwukhansela kunokuba unike inkululeko yokuyikhetha kuqala.
Izindaba ezinhle ukuthi i-CMS ifake isikhashana okwesikhashana izicelo ezivela kumashuwalense amasha omshwalense ofuna ukuhlanganyela ekuguquleni okungaqondakali. Izindaba ezimbi ukuguqulwa okungaxhunyiwe kusetshenziselwa izinhlelo ezivele zinikezwe imvume.
Yazi amalungelo akho futhi uhlale uphawula ukuthumela ama-mail kusuka kwinkampani yakho yomshuwalense engase iphathelene nokuguqulwa okungahambisani. Ufanelwe uhlelo oluhlangabezana nezidingo zakho, kokubili kwezokwelapha nangokwezimali. Uma ukuguqulwa okungenamthunzi kusebenza ngokuthanda kwakho, lokho kuhle! Uma kungenjalo, unganqikazi ukuphuma bese ukhetha uhlelo lwe-Original Medicare noma uhlelo oluthile lwe-Medicare Advantage, nenkampani yakho yamanje noma enye inkampani.
> Imithombo:
> Crochunis, M. Ukubhaliswa Kwamanye Abantu Ngokwemvume Yokuqala Ye- Medicare. Amasevisi we-website ye-Medicare ne-Medicaid Services. https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/HPMS_Memo_Seamless_Moratorium.pdf. Ishicilelwe ngo-Okthoba 21, 2016.
> I- Medicare Manual Managing Care: Isahluko 2 - Ukubhaliswa Nokuhlukunyezwa Kwemithi Ye-Medicare. Amasevisi we-website ye-Medicare ne-Medicaid Services. https://www.cms.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2016_MA_Enrollment_and_Disenrollment_Guidance_9-14-2015.pdf. Ibuyekezwe ngo-September 14, 2015.
> Ingxenye C-MEDICARE + UKUKHETHA Uhlelo: Ukufaneleka, ukhetho, nokubhalisa. Iwebhusayithi yokuPhatha kwezokuThuthukiswa komphakathi https://www.ssa.gov/OP_Home/ssact/title18/1851.htm.