Ukukhokhwa Kwezokwelapha ku-Medicare, Medicaid, ne-Tricare

Ukuqonda izinsisekelo zemiphakamiso yomshuwalense wezempilo kanye nabakhokhisi kwenza abasebenzi basehhovisi lezokwelapha bakwazi ukuxhumana ngokuphumelelayo neziguli mayelana nezinzuzo zabo zomshuwalense wezempilo futhi baxoxe ngemininingwane ye-akhawunti yesiguli nabamele inkampani yomshuwalense. Uma unesithakazelo sokuba umthengisi wezokwelapha, nansi isifundo ku-Medicare, Medicaid, Tricare, nakwabanye abakhokha.

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Ukuqonda Medicare

Kubalulekile ukuqonda izidingo zokukhokhisa zeMedare ezingaba nzima kakhulu. Cabanga ngokuya ezifundweni zemicimbi namathuba. Abahlinzeki kumele baqinisekise ukuthi labo abathintekayo ukulungiselela nokuhambisa izimangalo zikaMedare bayazazi iziqondiso neziqondiso ezifanele zokuhambisa.

Kunezingxenye ezine eziyisisekelo ze-Medicare Program:

1. I-Medicare Ingxenye A: I- Medicare Ingxenye A yiyingxenye ye-Medicare ukuthi iningi labantu akudingeki likhokhele ngokuthi umshuwalense wesibhedlela. I-Medicare Ingxenye A ibizwa ngokuthi umshuwalense wesibhedlela ngoba isiza ukukhokhela ukunakekelwa kwesiguli esitholwa esibhedlela esibhedlela, isifo esibhedlela esibucayi, indawo yokuhlengikaza enekhono (SNF), ukunakekelwa kwezempilo nokunakekelwa kwezempilo.
2. I-Medicare Ingxenye B: I- Medicare Part B ingxenye ye-Medicare ebizwa ngokuthi umshuwalense wezokwelapha. Ingxenye B ihlanganisa izinsizakalo eziningi ezingagciniwe yiNgxenye A njenge-Physician Visits, Outpatient Treatments, Ukunakekelwa Okuvimbelayo, Izinto zokwelapha, Izinsizakalo ze-Ambulance, njll.
3. I-Medicare Ingxenye C: I- Medicare Part C nayo yaziwa nangokuthi i-Medicare + Ukukhetha kodwa ibizwa ngokuthi yi-Medicare Advantage Plans. Izinhlelo ze-Medicare Advantage zivumela abahlomuli beMedare ukuba babhalise kumshuwalense wezempilo wangasese noma uhlelo lokunakekelwa olulawulwa olukhethiweyo. Kunezinhlobo ezihlukahlukene zamasu okukhetha kusuka kulolu hlelo lwezinsizakalo ezivame ukuhlanganiswa ngaphansi kweMederal Medicine.
4. I-Medicare Ingxenye D: Le ngxenye yohlelo lwe-Medicare iyinzuzo ye-Prescription Drug Benefit. Ukutholakala kwezidakamizwa kutholakala kuphela nge-Medicare Advantage Plans.

Okuningi

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Ukuqonda iMedicaid

I-Medicaid ihlale ikhokha isenzo sokugcina . Lokhu kusho ukuthi iMedicaid ihlale ikhokha ekugcineni lapho kukhona khona izinhlelo zomshuwalense wezempilo. Abamukeli kuyadingeka ukuthi bahlale benolwazi mayelana nolwazi lomshuwalense wezempilo.

Abahlinzeki nabo banomthwalo wokwazisa i-Medicaid yomshwalense wenkampani yangaphandle abayithola ngayo kanye nokwazisa iMedicaid nganoma yiziphi izinkokhelo zomphakathi ezitholayo egameni lomamukeli.

I-medicaid ilawulwa ngokombuso, ngakho-ke, isifunda ngasinye sinemfuno yaso yokukhokha. Abaqashi kumele baxhumane nohlelo lwe-Medicaid esimweni sabo ukuze bathole ulwazi oluthile lokukhokha.

Okuningi

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Ukuqonda Ukulinganisa

I-TRICARE, ingxenye yeNhlelo Yempilo Yezempi, uhlelo lokunakekelwa kwezempilo kumalungu asevisi asebenzayo, asethathe umhlalaphansi kanye nabalindi kanye nemindeni yabo. Kunezindawo ezine ezihlukene zendawo ezihlinzeka ngezinsizakalo kubazuzi be-TRICARE:

• North
• ENingizimu
• West
• Ngaphandle kwezwe

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Ukuqonda Abanye Abakhokhi

Ukuba nokuqonda okuyisisekelo kohlobo ngalunye lomshwalense kuzonciphisa izinkinga zokufaka izimangalo nokuqoqa izinkokhelo. Kunezinhlobo ezimbili ezinkulu zezinhlelo zomshuwalense wezempilo:

• Umshuwalense Wesikweletu : Izinhlelo zomshuwalense wokukhokhela izinkokhelo zenza inkokhelo ehhovisi lezokwelapha esekelwe imodeli yokukhokhela imali.
• Izinhlelo Zokunakekelwa Ezokuphatha : Ukuphatha izinhlelo zokunakekelwa zifuna ukuphatha izindleko zokunakekelwa kwezempilo kwamalungu ayo ngokuhlela nokuhlela ukunakekelwa ngenethiwekhi yabanogada, ochwepheshe kanye nezibhedlela. Kunezinhlobo ezine zezinhlelo zokunakekelwa eziphathisiwe:
  • Izinhlangano Zokulondoloza Impilo (ama-HMO)
  • Izinhlangano Zokuhlinzeka Ezikhethiwe (ama-PPOs)
  • Izinhlangano Ezihlinzeka Ngaphandle (EPOs)
  • Izinhlelo zePoint-of-Service (POS)