Uma uzama ukukhetha uhlelo lwakho lwezempilo noma uqhathanise izinhlelo zomshuwalense wezempilo e-United States, udinga ukuqonda uhlelo lwe-metal-tier. I- Care Affordable Act imisa indlela izinhlelo zezempilo ezibaluleka ngayo. Kusukela ngo-2014, wonke amahlelo ompilo omuntu ngamunye nezinhlelo ezincane kufanele ahlangane nesinye sezigaba ezine: ithusi, isiliva, igolide noma i-platinum (kunezinye izinhlelo eziyingozi ezithengiswa emakethe ngayinye ).
I-metal tier ikutshela inani le- actuarial yecebo lempilo. Yindlela elula yokuqhathanisa ukubaluleka kwesinye uhlelo lwezempilo komunye ukuze ungatshela ukuthi iyiphi ipulani ekunika i-bang iningi lebhokisi lakho. Zonke izinhlelo zezempilo ezisezingeni elifanayo lezinsimbi zinezilinganiso ezifanayo, nakuba zingashintsha ngamaphesenti ambalwa amaphesenti.
Yini Okubaluleke Ngayo?
Inani le-actuarial plan liyakutshela ukuthi yimaphi amaphesenti wezindleko zokunakekelwa kwezempilo ukuthi uhlelo lomshuwalense wezempilo kulindeleke ukuthi ukhokhele abahlomulile. Ipulani elinenani le-actuarial lama-60% kulindeleke ukuthi likhokhe cishe amaphesenti angama-60 ezindleko zokunakekelwa kwezempilo kwabazuzi bayo. Abazuzi bezinhlelo bazokhokha amanye amaphesenti angu-40 ezindleko zabo zokunakekelwa kwezempilo ngendlela yokunciphisa imali , ukuqinisekiswa kwezimali nokukhokhwa kwemali .
Inani le-Actuarial libalwe ohlelweni lwezempilo lonke (ngokususelwa "ezingeni elijwayelekile" labantu) hhayi ngamalungu athile.
Ngakho-ke, ngokwesilinganiso kuwo wonke ababhalisile bezempilo, inani le-actuarial lichaza iphesenti yezindleko zokunakekelwa kwezempilo ezizokhokhwa nguhlelo. Kodwa-ke, iphesenti yezindleko zakho zokunakekelwa kwezempilo uhlelo lokukhokhela luzohlukahluka ngokuthi usebenzisa kanjani umshuwalense wakho wezempilo.
Izibonelo
Isibonelo, ake sithi uhlelo lwakho lwezempilo lunenani lama-80 elingu-actuarial, okusho ukuthi liluhlelo lwegolide.
Uma usebenzisa umshuwalense wakho wezempilo kuphela unyaka wonke, mhlawumbe ukuvakashela umtholampilo wokunakekelwa okuphuthumayo ngenxa yecala lomkhuhlane, ungathola ukuthi uhlelo lwakho lwezempilo alukhokha lutho nakwezindleko zakho zokunakekelwa kwempilo ngonyaka. Uma ngabe awuzange uhlangabezane ne-deductible yakho ngonyaka, cishe uzophela ukukhokha isikweletu sakho esiphuthumayo. Imali oyikhokhileyo izokwenziwa ngokubheka imali yakho. Kulesi simo, ngokuqinisekile uhlelo lwakho lwezempilo alukhokhelanga amaphesenti angu-80 ezindleko zakho zokunakekelwa kwezempilo. Ukhokha amaphesenti angu-100 ezindleko zakho zokunakekelwa kwezempilo.
Kodwa-ke, kuwo wonke ubulungu bepulani, amacala ngabanye afana nesibonelo ngenhla angalinganiselwa ngamacala lapho uhlelo lwezempilo lukhokhisa iningi lemithetho egcwele yelungu. Isibonelo, umuntu otholakala enomdlavuza futhi ephela nge $ 400,000 ezinyangeni zezokwelapha zonyaka uyokhokha imali engamaRandi angu-7,350 kuphela ekunakekelweni kwenethiwekhi ngo-2018 . Uhlelo lwe-inshuwalense yezempilo luzokhokha konke, okuzobe kungamaphesenti angaba ngu-98 omthethosivivinywa.
Futhi amanye amalungu angaguli ngaso sonke isikhathi phakathi nonyaka uyozuza ukuthi izinhlelo ze-ACA-ezihambisanayo zikhokha amaphesenti angu-100 omthethosivivinywa ngezinsizakalo zokunakekelwa kokuvikela ezifana nezivivinyo zonyaka kanye nokulawulwa kokuzalwa.
Labo bantu abazange bakhokhele izindleko zabo zokunakekelwa kwempilo ngonyaka.
Lapho izindleko zabo bonke ababhalisile bezinqunywe ekupheleni konyaka, uhlelo oluzobaluleka ngamaphesenti angu-80 luzokhokhela cishe amaphesenti angu-80 ezindleko zokunakekelwa kwezempilo kubo bonke abahlomulayo.
Ukubalwa kwamaxabiso okungokoqobo akubandakanyi amaphrimiamu omshwalense wezempilo noma izinto uhlelo lwezempilo alumbozi. Isibonelo, uma umshuwalense wakho wezempilo ungaboni ukuhlinzwa kwesisindo, izindleko zokuhlinzwa kwesisindo ngeke zifakwe uma zikhuphuka nenani lecebo lempilo.
I-Metal Tiers ihlobene kanjani ne-Value?
- Izinhlelo zezempilo zeBronze-tier zenani elikhulu cishe ngamaphesenti angu-60
- Izinhlelo zezempilo zesiliva zenani elikhulu cishe ngamaphesenti angu-70
- Izinhlelo zezempilo ze-Gold-tier zinenani lama-80%
- Izinhlelo zezempilo zePlatinum-tier zinenani lama-90%
Ngokusebenzisa isistimu yensimbi, abantu abangaqondi kahle ukuthi i-actuarial value isebenza kanjani ngokuqonda ukuthi i-gold-tier plan inikeza izinzuzo eziningi kunecebo le-bronze-tier (kodwa njengoba kuchazwe ngezansi, abantu abanemali etholakalayo abakhetha isiliva isingapheli ukuthola izinzuzo zegolide noma ze-platinum, ngenxa yenkxaso ye -ACA eyanciphisa izindleko ezingaphandle kwe-pocket ).
Kufanele Ngikhethe I-Bronze, Isiliva, Igolide noma i-Platinum?
Yenza isinqumo sakho se-metal tier ngokulinganisela ukuthi uzimisele kangakanani ukukhokhisa ama-premium nokuthi unesidingo esingakanani sokuthenga. Izinhlelo eziphakeme kakhulu zinamaprimiyamu aphezulu, kodwa bakhokhela iphesenti ephakeme yezindleko zakho zokunakekelwa kwempilo kunamaphesenti aphansi, amanani aphansi.
Ngayinye yalezi zihloko ezansi ngezansi zihlanganisa izigaba ukuthi ubani okufanele azicabangele nokuthi ubani okufanele agweme leyo nsimbi ensimbi. Uma ukhetha uhlelo lwezempilo, uma usuqedile uhlelo lwe-iron tier, qiniseka ukuthi awusilo ohlwini lwabantu okufanele bawugweme leso sivumelwano.
- Uhlelo lweBronze-Luyini?
- Uhlelo lweSiliva-Luyini?
- Uhlelo lwegolide-Luyini?
- Uhlelo lwePlatinum-Luyini? (phawula ukuthi izindawo eziningi azikho izinhlelo zeplatinum ezitholakalayo)
Ukufaneleka kwakho kwezinsizakalo zikahulumeni kungathinta ukhetho lwakho lwezinsimbi zensimbi. Uma ufanelwe uxhaso lokwabelana ngezindleko zikahulumeni (aka, ukunciphisa ukwabelana ngezindleko, noma i-CSR) ukukusiza ukuthi ukhokhe izinkampani zakho zokudonswa, ama-copays, nokuqinisekiswa kwemali, ngeke uthole umxhaso uma ungathengi uhlelo lwezempilo lwe-silver-tier usebenzisa ukushintshwa komshuwalense wezempilo wombuso wakho. Ukuze ufunde kabanzi mayelana nezinsizakalo, funda, " Ngingayithola Yini Usizo Lokukhokhela Umshwalense Wezempilo? "
Uma ufanelekile ukuthola usizo lwemali yokwabelana ngezindleko futhi uthengisa uhlelo lwesiliva, ungaphetha ukuthola ukuvakasha okulingana necebo legolide noma iplatinum, ngentengo yesiliva sesiliva. Ngakho kubalulekile ukunaka imininingwane yepulani ngalinye elitholakalayo, kunokuba nje ucabange ukuthi lelo zinga elilodwa lensimbi lizoba yindlela engcono kunazo zonke.
Futhi kwenye i-twist ephikisanayo, i-premium yezinhlelo zegolide kwezinye izindawo, kwabanye ababhalisile, empeleni kuncane kunezikhwama zezinhlelo zesiliva, kusukela ngo-2018. Lokhu kungenxa yokuthi Ulawulo lweTrump lume ukubuyisela izinkampani zomshuwalense ngezinkokhelo ze-CSR ngasekupheleni kwesikhathi 2017, kanye nabashuwalense emazweni amaningi bangeze izindleko ze-CSR kumaprimiyamu okuhlela isiliva. Lokhu kuholele ekusizeni okukhulu okuyinhloko kwezinye izindawo, futhi izindleko zezinga lensimbi ezingalandeli amaphethini alindelekile (okungukuthi, ukumboza kangcono ukuthi kubiza kakhulu). Ungafunda kabanzi mayelana nokuthi lokhu kusebenza kanjani lapha , kodwa iphuzu lokuthatha izinkampani ukuthi uma uthola imali eyinzuzo, ungathola ukuthi uhlelo lwegolide alubiza kakhulu kunecebo lesiliva, futhi ungathola ukuthi uhlelo lwebhusi alubizi kakhulu.
Uma Zonke Izinhlelo Zisezingeni Elinganikeziwe Ziyizilinganiso Ezifanayo, Kungani Ungabheki Nabaphansi?
Nakuba wonke amalungiselelo athile anikeziwe azoba nenani elifanayo le-actuarial, azohluka ngezindlela ezithile. Thatha lezo zingxabano ziphendule lapho ukhetha uhlelo; khetha uhlelo olusebenza kahle ngesimo sakho.
Isibonelo, uhlelo olulodwa lwegolide lungase lube ne-deductible ye $ 1,500 kanye ne-coinsurance yamaphesenti angu-15. Enye iplani yegolide ingase ibe ne-low deductible ehlanganiswe ne-coinsurance ephezulu kanye ne-copays. Uma ungeke ukwazi ukukhokhisa imali enkulu ngaphambi kokuba umshwalense wakho wezempilo uphelele, ungase ukhethe lolu hlelo nge-deductible engezansi ngisho noma inama-premium aphakeme kakhulu. Uyazi ukuthi inani le-actuarial lazo zonke izinhlelo zegolide lifana ncamashi, ngakho-ke ukhetho lwakho lwenziwe ngokusekelwe endleleni ongathanda ukuyisebenzisa ngayo umshuwalense kunokuthi kungakanani okufanelekile.
Amanye amaphuzu okuqhathaniswa afaka inethiwekhi yezinhlelo zezempilo. Ingabe udokotela wakho in-network nazo zonke izinhlelo zezempilo oziqhathanisa nazo? Ingabe inethiwekhi ngayinye yabahlinzeki inkulu ngokwanele ukukunika ukukhetha kwabahlinzeki uma unquma ukuthi awuthandi udokotela othile noma esibhedlela futhi ufuna ukushintshela komunye?
Amafomula amakhemikhali adakamizwa (imithi ehlanganisiwe yezidakamizwa) izohlukahluka komunye umshwalense kuya kwenye. Ngakho-ke ungase ubheke izinhlelo ezintathu zesiliva ezihlukene, kodwa eyodwa kuphela ihlanganisa izidakamizwa ezithile ozithathayo.
Ingabe uhlelo olulodwa lunikeza inkululeko enkulu yokuzikhethela kunomunye? Ama-HMO ngokuvamile ngeke akhokhele ukunakekelwa okuphuma ngaphandle kwenethiwekhi . Noma kunjalo, ama- PPO azokhokha ukunakekelwa kwe-out-of-network, kodwa ngesilinganiso esingaphansi kunokuba ngabe uhlale ku-inethiwekhi. I-PPO ayitholakali kuzo zonke izindawo, kodwa uma itholakala, ijwayele ukuba phakathi kwezinketho ezibiza kakhulu. Ingabe uzimisele ukukhokha amaphrimiyamu aphezulu ohlelweni olukuvumela ukuba unakekele ngaphandle kwenethiwekhi uma ufisa? Noma ingabe ungakuyeka ukukhululeka lokho okukhethayo, kodwa ukhokhele amaphrimiyamu aphansi?
Ingabe izinga lekhwalithi yecebo elilodwa lingcono kunecebo eliphikisanayo? Ingabe amaphrimiyamu wecebo elilodwa aphansi kakhulu kunezinhlelo zokuncintisana ezinezici ezifanayo zekhwalithi?
Uma uhlela ukusebenzisa umshwalense wakho wezempilo okuningi, qhathanisa ama-maximum angaphandle kwamapulani. Uma uhlelo olulodwa lunesikhezulu esingaphansi kwesiphakheji kunamanye ama-plan athile, ungagcina imali ukhetha uhlelo ngezinga eliphansi elingaphandle kwepokhethi. Uzothola ulwazi oluthe xaxa mayelana nendlela le nqubo isebenza ngayo " Indlela Yokulondolozwa Ngomshwalense Wezempilo Uma Ufinyelela Ngaphandle Kokuphakama Kwesikhwama ."
> Imithombo:
> I-Federal Register, Amasevisi weMedicaid neMediicaid Services, uMnyango WezeMpilo kanye Nezinsizakalo Zabantu. Ukuvikelwa kwesineke kanye noMthetho Wokunakekelwa Kwezinkinga; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2018; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi olusetshenzisiwe futhi oluhlelekile. NgoDisemba 22, 2016.