Umgodi we-donut, noma igebe lokuhlanganisa, ingenye yezingxenye eziphambene kakhulu ze-Medicare Part D izidakamizwa zemithi yezidakamizwa kanye nokukhathazeka kubantu abaningi abajoyine uhlelo lweMithi D. Izindaba ezinhle ukuthi zihamba kancane futhi ngo-2020, uzokhokha amaphesenti afanayo angu-25 ngezidakamizwa ozikhokhela uma uhlangabezana ne-deductible yakho (uma unayo).
Ukushaya iDonut Hole
Nakuba wonke ama-drug adcription plans kufanele achaze igebe lokuhlanganisa ezincwadini zabo kanye nokukhangisa, kubhekana nokushaqeka kwabhalisile abaningi lapho behamba ngokungazelelwe ngokwenza amakhophi akho noma bakhokhele amaphesenti angu-25 ezindleko zezidakamizwa ekukhokheni amaphesenti amakhulu uma befaka idokhumenti umgodi.
Kodwa-ke, akuwona wonke umuntu oseMedare uzofaka igebe lokuhlanganisa futhi uma ufaneleka ukuthola usizo oluthe xaxa ekukhokheni izindleko zakho ze-Medicare Part D, ngeke ungene emgodini wokunikezela.
Indlela iDonut Hole esebenza ngayo
Lona uhlelo olujwayelekile lwe-Part D lwezidakamizwa oludingekayo yi-Medicare ngo-2018:
- Uma ujoyina uhlelo lwezidakamizwa lweMedric Medicine, kufanele ukhokhele ku-$ 405 yokuqala yezindleko zakho zezidakamizwa, ngokuya ngecebo lakho. Lokhu kwaziwa ngokuthi i- deductible . Amanye amapulani ayinayo i-deductible.
- Ngesikhathi sesigaba sokuqala sokuqala (emva kokudonswa kwemali , ngemuva kokuthola ukuthi le plan is deductible), ukhokha imali yokukhokha noma i- coinsurance , futhi uhlelo lwakho lwezidakamizwa zeCandelo D lukhokhela isabelo salo semithi ngayinye ehlanganisiwe kuze kube yilapho inani lakho elihlangene (kufaka phakathi i-deductible yakho) lifinyelela $ 3,750.
- Uma wena kanye nohlelo lwakho lweDis D D izidakamizwa usebenzise amaRandi ayizigidi ezingu-3,750 ukuze uthole izidakamizwa ezihlanganisiwe, uzobe usemgodini we-donut (njengoba inani lemali oyikhokhela ngayo libalwa futhi, ngeke usebenzise lokhu okuningi emzimbeni ongaphandle kwe-pocket kubiza ngesikhathi ufinyelela umgodi we-donut). Ngaphambi kuka-2011, kwadingeka ukhokhe izindleko ezigcwele zemithi yakho yesidakamizwa ngenkathi kugodi lomnikelo. Kodwa-ke, kusukela ngo-2011, isaphulelo saqala ukusebenza ezindlebeni zezidakamizwa ngenkathi kubhalisiwe ku-hole. Ngo-2018, awukhokheli amaphesenti angaba ngu-35 wezindleko zemithi ebizwa ngokuthi igama lomuthi ngesikhathi sokungena emgodini we-donut, futhi amaphesenti angu-44 wezindleko zemithi ejwayelekile.
- Umgodi we-donut uyaqhubeka kuze kube yilapho inani lakho eliphelele lokuphuma ephaketheni lifinyelela ku-$ 5,000. Leli nani lemali elingenayo i -pocket lonyaka lihlanganisa imali yakho yokudonswa kwemali , ukukhokhwa kwemali , nokukhokhiswa kwezimali , futhi kufaka phakathi isaphulelo somkhiqizi ngezidakamizwa ozithola ngesikhathi sokungena (ngakho-ke noma ukhokha amaphesenti angu-35 wezindleko zomkhiqizo -Izidakamizwa zamagama ngenkathi emgodini we-donut ngo-2018, amaphesenti angama-85 ezindleko zesidakamizwa kubalwa ngokwezindleko zakho ezingaphandle kwe-pocket, okukusiza ukuba uphume emgodini we-donut ngokushesha).
- Uma ukusetshenziswa kwezidakamizwa zakho kufinyelela ku-$ 5,000, igebe lokuhlanganisa liphela futhi uhlelo lwakho lwezidakamizwa lukhokha kakhulu izindleko zemithi yakho ehlanganisiwe isikhathi esisele sonyaka. Khona-ke uzobe unesibopho sokukhokha imali encane (i-$ 3.35 noma i-$ 8.35, kuye ngokuthi ngabe lesi sidakamizwa siyisigameko noma igama lomkhiqizo oyithandayo noma igama lomkhiqizo ongakhethi) noma ukuqinisekiswa kwemali (amaphesenti amahlanu ezindleko), noma yikuphi okuhle. Leli zinga, uma ukhokha kuphela ingxenye encane kakhulu yezindleko zakho zezidakamizwa, uyaziwa ngokuthi ukusabalalisa inhlekelele .
Izindleko ezichazwe ngenhla zifaka nje izindleko zemithi yokwelapha. Azibandakanyi i-premium yenyanga oyikhokhela uhlelo lwezidakamizwa.
Ukuhlinzeka Kungahlukana Ngokuya Ngecebo Lakho
Kubalulekile ukuqonda ukuthi uhlelo lwakho lweMithi yeDakamizwa ye-Part D lungase luhluke ohlelweni olujwayelekile lwe-Medicare kuphela uma uhlelo lunikeza inzuzo engcono. Isibonelo, uhlelo lwakho lungasusa noma linciphise inani le-deductible. Futhi uhlelo lwakho lungakhokhela imishanguzo yegama elijwayelekile noma elikhethwe igama lomkhiqizo kugebe lokuhlanganisa.
Ukuguqulwa kwezeMpilo kanye ne-Medicare Ingxenye D
Isigaba 3301 soMthetho Wokunakekelwa Okungenakusiza , osayinwe ngomthetho ngo-Mashi 23, 2010, senza izinguquko ku-Medicare Part D ukunciphisa izindleko zakho zokuphuma ngaphandle uma ufinyelela emgodini we-donut, kufaka phakathi:
- Ngonyaka ka-2010, uma ngabe unayo izindleko kwigebe lokuhlanganisa, kufanele uthole imali engu-$ 250 ekhokhelwa yi-Medicare.
- Kusukela ngo-2011, uma ufinyelela emgodini we-donut, wanikezwa isaphulelo sama-50% ngezindleko eziphelele zamadakamizwa egama lomkhiqizo ngenkathi kugebe.
- I-Medicare yaqala ukukhishwa kwezaphulelo ezengeziwe ngezindleko zombili izidakamizwa nemithi ejwayelekile, kusukela ngo-2012 kuya phambili. Kusukela ngo-2018, ukhokha amaphesenti angu-35 ezindleko zemithi yegama lomkhiqizo ngenkathi emgodini we-donut, futhi amaphesenti angu-44 wezindleko zemithi ejwayelekile.
Ngo-2020, kunokuba ukhokhe amaphesenti angu-100 ezindleko zemithi yakho yesidakamizwa, umthwalo wakho wemfanelo uzoba ngamaphesenti angu-25, kungakhathaliseki ukuthi igama lomkhiqizo noma umuthi ojwayelekile.
Izibonelo ze-Medicare Part D
Ukuze uqonde kangcono ukuthi izidakamizwa ezingaphezu kwemithi zingakubiza kanjani ku-Medicare D, nansi ezinye izibonelo:
UCharley Smith
UCharley Smith uthatha imithi emithathu yokwelapha ukucindezeleka kwegazi eliphezulu kanye ne-cholesterol ephezulu. Le mithi izomkhokhela u-$ 1,200 ngo-2018. UCharley uyashintsha ohlelweni lwezidakamizwa lwe-Medicare olunomvuzo ophansi futhi unikeza inzuzo ejwayelekile yemithi yezidakamizwa, kuhlanganise ne-deductible futhi ayikho isidakamizwa sokufaka izidakamizwa emgodini we-donut.
Yilokho imishanguzo yakhe yokwelapha izobiza ngecebo alikhethile:
- UCharley uzokhokha imali engama-$ 405 .
- Uzokhokhela amaphesenti angama-25 (uxhumano lwezimali) wezindleko zemali yakhe esele ($ 1200 - $ 405 = $ 795). Izindleko zakhe ezengeziwe ezingaphandle kwesikhwama phakathi nalesi sikhathi sokuqala sizobe ngu- $ 199 . (Amaphesenti angu-795 x 25 = $ 199).
- Njengoba uCharley engakafiki emkhawulweni wokuqala wokukhishwa u-$ 3,750, ngeke angene emgodini we-donut.
I-Costare Part D icebo lakhe elizolinganiselwa ngonyaka lizobe libiza u-$ 405 (deductible) + $ 199 (isabelo sakhe samaphesenti angu-25 esikhwameni sakhe sokudla izidakamizwa) = $ 604 (plus amaphrimiyamu akhe ngenyanga ngenyanga ye-Medicare Part D plan) .
UMary Jones
UMary Jones uthatha imithi emithathu yokwelapha uhlobo lwakhe lwesifo sikashukela, umfutho wegazi ophakeme, ne-cholesterol ephezulu-zonke izidakamizwa zamagama. Le mithi izomkhokhela u-$ 4,500 ngo-2018. UMary wajoyina uhlelo lwezidakamizwa lweMedare oluhlinzeka ngemithi ejwayelekile yezidakamizwa , okubandakanya ukukhishwa kwemithi kanye nokungaxhunywanga kwemithi ejwayelekile emgodini we-donut.
Yilokho imishanguzo yakhe yemithi yokwelapha izobiza ngecebo elikhethile:
- UMary uzokhokha imali engama-$ 405 .
- Uzokhokhela amaphesenti angu-25 ezindleko zemithi yakhe yezidakamizwa ezilandelayo zamaRandi ayizigidi ezingu-3,345 (okungukuthi imali engu-$ 3,750 ayikho imali engu-$ 405 ekhishwe) kuze kube yilapho efika egazini lokuhlanganisa. Izindleko ezengeziwe ezingaphandle kwe-pocket phakathi nalesi sikhathi sokuqala sizoba cishe ngama- dollar ayi-836 (kusukela $ 3,345 izikhathi ezingu-25 = $ 836.25).
- Njengoba uMary wafinyelela kumaRandi ayizigidi ezingu-3,750 ekusetshenzisweni kwezidakamizwa ($ 405 + $ 3,345 = $ 3,750), uzongena emgodini we-donut. Ngaphambi kuka-2011, uMary wayezoba necala lamaphesenti angu-100 kulokhu. Kodwa-ke, njengoba yonke imithi kaMariya ibizwa ngamagama, kufanele nje akhokhe cishe ngamaphesenti angama-35 ezindleko zezidakamizwa ngenkathi emgodini we-donut. Udinga ukuqoqa enye imali engu-$ 1,250 ezindlini zodokotela ngaphambi kokuthi aphume emgodini we-donut, kodwa kokubili izindleko zakhe (amaphesenti angu-35 ezindleko zezidakamizwa) kanye nesaphulelo sama-50% esakhiwe ngumkhiqizi wezidakamizwa sizobalelwa ekufinyeleleni leyo $ 1,250. Ngakho ngenkathi lokho kuzothatha cishe amaRandi angu-1,470 izindleko zomuthi eziphelele ($ 1,250 ehlukaniswe ngamaphesenti angama-85), uMary uzokhokha imali engaba ngu-5 515 ephaketheni lakhe ngenkathi emgodini we-donut (amaphesenti angu-35 alezi $ 1,470).
Izindleko zikaMariya zonyaka odlule ezingaphandle kwezindakamizwa zemithi ebizwa nge-Medicare Part D zizoba yi-$ 405 (deductible) + $ 836 (isabelo sakhe samaphesenti angu-25 esibhekene nezidakamizwa ngaphambi kokuba umgodi we-donut) + $ 515 (okumele ayenze ukhokhe ngenkathi ungena emgodini we-donut) = $ 1,756 (plus ama-premium ayo ngenyanga ngenyanga ye-Plan Medicare Part D).
> Imithombo:
> Medicare.gov. Izindleko ku-Gap Yezokuphepha.
> Medicare.gov. Ukulondolozwa Kwezidakamizwa Ezengeziwe Ukuza Ngo-2020.
> Medicare.gov. Londoloza ezindleko zeDrug.
> Medicare.gov. Unyaka owedlule wezinhlelo zokudakwa kwezidakamizwa.
> U. Indlu yabamele. Ukuvikelwa Kweziguli Nokunakekelwa Okunakekelwa Ngokwezinkinga , Isigaba 3301 . Yenzelwe uMashi 23, 2010.