Kungani umuntu efuna ukuba nomshwalense ongaphezu kweyodwa? Kuxhomeke ukuthi ubani ocela. Ungase ufune ukufakwa okwengeziwe ukuze uqinisekise ukuthi uthola zonke izinsizakalo zezempilo ozidingayo. Ngakolunye uhlangothi, i-Medicare kanye nezinye izinkampani zomshuwalense, zinesithakazelo esinikeziwe. Uma unezinhlelo ezingaphezu kweyodwa zezempilo, bangakwazi ukushintsha umthwalo wokukhokha kwenye ihlangothi.
Ungakhathazeki. Omunye uhamba ngezinyathelo zomthethosivivinywa, futhi uma nje wonke umuntu ehamba ngokulandela uhlelo, akufanele ube nguwe. Udinga ukuqonda ukuthi ngubani ozokhokha kuqala nokuthi ngubani, uma kukhona, uzokhokha izindleko ezisele. Yilapho i-Medicare Secondary Payer iqala khona.
Kungani Ungase Ufune Ngaphezu Kokuthi Imithi Yanikeza
I-Medicare inikeza ukunakekelwa kwempilo engaphezu kwezigidi ezingama-56.8 zaseMelika, kodwa lokho akusho ukuthi kuhlanganisa konke okudingayo. Cabanga ngalezizinto ezijwayelekile uM Medicare akushiya ukuthi ukhokhele ephaketheni:
- I-Acupuncture
- Ukunakekelwa ngenkathi uhambo lwangaphandle ngaphandle kokungavamile
- Izinsizakalo ze-Chiropractors ngaphandle kokulungisa ukuxoshwa komgogodla
- I-lens iso elungisa (amalensi okuxhumana noma ama-eyeglass)
- Ukunakekelwa kokugcina (ukugeza, ukugqoka, indlu yangasese)
- Amazinyo
- Ukunakekelwa kwezinyawo
- Izinsiza zokuzwa
- Ukunakekelwa kwekhaya lokunakekelwa isikhathi eside
- Ukuthutha okungahambi okuphuthumayo okungekho okungajwayelekile
- Imithi eminingi, amavithamini, nezithako
- Imithi ye-prescription ngezigaba ezithile
- Ukuhamba ngezinyosi ezimpumputhe
Lokhu akulona uhlu oluphelele, yiqiniso, akumangazi ukuthi abanye abantu baphishekela ezinye izidingo zezempilo ukuze bagcwalise igebe. Ngenkathi kunezinketho zeMedricare Supplement Plans, eyaziwa nangokuthi izinhlelo ze-Medigap , ukusiza ukufaka izindleko ze-Medicare ngaphandle kwezindleko (i- copayments, u-coinsurance, kanye ne-deductibles ), lezi zinhlelo azange zeneze izinzuzo ezengeziwe zezempilo ekufundeni kwakho.
Esikhundleni salokho, abantu abaningi baphendukela komunye umshuwalense njengamacebo ezempilo axhaswe ngumqashi, izinzuzo zezempi, nezinzuzo zokuthatha umhlalaphansi ukuze uthole ukuthenga okudingayo.
I-Medicare kanye nezinhlelo zezempilo ezixhasiwe
Isikhathi sokuthatha umhlalaphansi sezinhlalakahle zezenhlalakahle esetshenziselwa ukuba neminyaka engama-65 ubudala, ubudala obufanayo ukuthi ufanelekile ku-Medicare . Konke kwashintsha ngo-1983 lapho iCongress idlulisela umthetho ukwandisa iminyaka yobudala yokuthatha umhlalaphansi ngokusekelwe ngosuku lwakho lokuzalwa. Kubantu abazalwa phakathi kuka-1943 no-1954, iminyaka yokuthatha umhlalaphansi manje isineminyaka engu-66 ubudala. Isikhathi sokuthatha umhlalaphansi sikhula kancane kancane sibe neminyaka engaphezu kwengu-67 ubudala kulabo abazalwa emva kuka-1960. Ukuthatha umhlalaphansi ngaphambi kwalesi sikhathi esibekiwe kuzoholela ekubeni uthole izinkokhelo ezincane ezivela kwi-Social Security.
Umphumela wokuphela wukuthi abantu abaningi basebenza isikhathi eside ukukhulisa imali yabo yokuthatha umhlalaphansi. Ukusebenza kubanika ukufinyeleleka ekunakekelweni kwezempilo ngokusebenzisa abaqashi babo ukuthi bangakhetha ukuqhubeka bebodwa, baqhubeke bese bebhalela iMedare, noma bakhansele futhi baphinde bafake uM Medicare.
Uhlelo lwakho lwezempilo oluxhaswe ngumqashi lungambopha oshade naye nabathembele kulo , kanti i-Medicare ikufaka wena wedwa. Lezi zinhlelo zingase zihlanganise nezinsizakalo ezithi uM Medicare azikho. Uma ufanelekile isikhathi sokubhalisa esikhethekile , ungase ukwazi ukufaka isicelo sokubhalisa ku-Medicare ngaphandle kokubhekana nezijeziso ezisheshayo uma ekugcineni ubhalisa.
Lokhu kungakusindisa amadola amaningi ngoba ngeke kudingeke ukhokhe i-premium yamapulani amabili ahlukene.
Uma unayo kokubili Medicare kanye nohlelo lwempilo oluxhaswe ngumqashi, i-Medicare izokhokha kuqala kuphela ezimweni ezithile. Isinqumo sisekelwe eminyakeni yakho, kungakhathaliseki ukuthi unesifo sokuqeda isiteji sokugcina (ESRD) noma esinye ukukhubazeka , nokuthi bangaki abantu abasebenzela umqashi wakho.
Uma ungahlangabezane ne-Medicare yokukhokha kuqala, uhlelo lwakho lwezempilo oluxhaswe ngumqashi luzokhokhwa esikhundleni. Lokho abangakhokheli kuyobe sekukhokhiswa ku-Medicare. I-Medicare izokhokhela izinsizakalo zokunakekelwa kwezempilo ezingavame ukuzimboza uma nje zibabona njengezidingo zempilo.
| I-Medicare izokhokha kuqala | I-Medicare izokhokha okwesibili |
|---|---|
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I-Medicare ne-COBRA
Ngenxa yoMthetho Wokuhlanganiswa Kwemali Yezokuhlaziywa Kwezimali Ze-Omnibus (COBRA) ka-1985 ungaqhubeka nohlelo lwakho lwezempilo oluxhaswe ngumqashi ngemuva kokushiya umsebenzi wakho. Umthetho udinga ukuthi abaqashi abasebenzi abangu-20 noma ngaphezulu bahlinzekele ukufinyelela okuqhubekayo ohlelweni lwabo lwezempilo isikhathi esithile, ngokuvamile izinyanga ezingu-18, ngemuva kokuba umsebenzi wakho uphele ngendlela yokuqeda noma ukuyeka. Ubude besikhokhelo se- COBRA singanwetshwa kuze kube yizinyanga ezingu-36 uma izimo ezithile zifinyelelwa.
I-Medicare ne-COBRA babe nobuhlobo obunzima. Uma usuvele une-COBRA uma ubhalisa ku-Medicare, ukukhishwa kwakho kwe-COBRA cishe kuzophela ngosuku ozobhalisa ngalo ku-Medicare. Uma usuvele une-Medicare uma ufaneleka ku-COBRA, uvunyelwe ukubhalisa ku-COBRA.
Uma unesi-COBRA futhi uba yi-Medicare-kufanelekile ngaleso sikhathi, unesinqumo esibalulekile sokwenza. Ukubhalisa ku-Medicare kusho ukuthi uzolahlekelwa yizinzuzo zakho ze-COBRA, noma ngabe uzokwazi ukuqhubeka nokwaziswa komngane wakho nomlingani. Uma ukhetha ukubambezeleka ukubhaliswa eMedare, qaphela ukuthi uzobhekana nezinhlawulo eziseduze uma ekugcineni ubhalisa. Izinzuzo ze-COBRA azikufanelekeli isikhathi sokubhalisa esikhethekile nge-Medicare.
| I-Medicare izokhokha kuqala | I-Medicare izokhokha okwesibili |
|---|---|
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Imbuyiselo ye-Medicare noMsebenzi
Inxephezelo yomsebenzi isebenza kancane ngokuphambene nalokho uhlelo lwakho lwezempilo oluxhaswe ngumqashi. Isivumelwano esivunyelwe nguhulumeni phakathi kwakho nomqashi wakho othi awusoze ubafakaze uma nje befaka izindleko zakho zokwelashwa nganoma yikuphi ukulimala emsebenzini. Uma wamukela izinzuzo zesinxephezelo sesebenzi, awukwazi ukufuna umonakalo wokujeziswa walokho kulimala. Uma unqabela lezo zinzuzo, ungafakazela ukulimala njengobuhlungu nokuhlupheka.
Nakuba ukhokhela izinkokhelo zepulani lakho lezempilo elixhaswe ngumqashi, izinkokhelo zempesheni yokukhokhela abasebenzi zikhokhwa ngumqashi wakho. Azikho izindleko kuwe. Ngemuva kokulimala, ubeka isimangalo futhi ukuhlolwa kwenzeka ukuze ubone ukuthi noma ukulimala kwakho kwaba yini umphumela wendawo yakho yokusebenzela.
Kungenzeka ukuthi isinxephezelo sesebenzi siphika isimangalo sakho noma siyihlanganisa kancane ngokusekelwe esimweni esandulele . Isibonelo, uma ubuhlungu obubuhlungu obungapheli kodwa ubuhlungu bakho emuva bulimala, kungase kube nzima ukuthola ukuthi umqashi wakho unomthwalo wemfanelo kangakanani kumpawu zakho. Imithi ye-Medicare kulesi sigaba ukwenza izinkokhelo zokuqala.
Inxephezelo yomsebenzi ingase ibuyisele izindleko zakho zezokwelapha ngenkathi zenzeka noma zinganikeza ukuhlala kwesikhathi esisodwa. Eminye yalezi zimali zingabekwa ku-Workers 'Compensation Medicare Setting Extension Plan (WCMSAA), ilungiselelo elihloswe ukugcina izimali zokwelashwa esikhathini esizayo kwanoma yikuphi ukulimala okubangelwa izinkinga zesikhathi eside. I-Medicare ngeke ikhokhe kuze kube yize izimali ku-WCMSAA ziphelile.
| I-Medicare izokhokha kuqala | I-Medicare izokhokha okwesibili |
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Imithi yezempilo kanye neMpilo yezempi
Uma ungumuntu omdala, ilunga lezinsizakalo ezisebenzayo, noma ilungu elithatha umhlalaphansi wezinsizakalo ezinjengeyunifomu ongase ube nelungelo lezinzuzo zezempilo ezivela ku-Veteran's Administration (VA) noma uhlelo olubizwa nge-TRICARE. Lezi zinzuzo zixhumanisa ne-Medicare ngendlela ehlukile.
Okokuqala futhi okubaluleke kakhulu, izinzuzo ze-VA zizohlanganisa kuphela ukunakekelwa okutholiwe kusikhungo esigunyaziwe se-VA.
Okwesibili, i-Medicare ngeke ikhokhele ukunakekelwa okukhokhelwa yi-VA izinzuzo futhi ngokufanayo. Ayikho inkinga yesikhokhelo sokuqala noma sesibili lapha.
Okwesithathu, i-TRICARE ne-Medicare basebenza kukhonsathi. I-Medicare yenza njengomkhokheli oyinhloko wezinsiza eziphethwe yiMedare futhi i-TRICARE ihlanganisa noma yikuphi ukunikezwa kwemithi ebizwa nge-Medicare noma imali yezimali eziphathelene nalawo masevisi. Uma insizakalo ingahlanganiswa ne-Medicare, i-TRICARE izosebenza njengomkhokhi oyinhloko.
Kuncike ekunakekeleni kwakho, kungenzeka ukuthi bobabili u-Medicare no-TRICARE babambe njengomkhokhi oyinhloko ngesikhathi esisodwa!
> Imithombo:
> I- Medicare Nezinye Izinzuzo Zempilo: Umhlahlandlela Wakho Wobani Oqala Uhulumeni. Amasevisi we-Medicare neMediicaid Services. https://www.medicare.gov/Pubs/pdf/02179-Medicare-Ukulungiswa-Izinzuzo-Payer.pdf.
> Medicare Ukubhalisa Dashibhodi. Amasevisi we-website ye-Medicare ne-Medicaid Services. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html. Kubuyekezwe ngo-July 2016.
> Medicare Secondary Payer. Amasevisi we-website ye-Medicare ne-Medicaid Services. https://www.cms.gov/Medicare/Ukulungiswa-Benefits-and-Recovery/Kuhle--Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Medicare-Secondary-Payer.html. Ibuyekezwe ngomhla ka-30 Januwari 2014.
> Imbuyiselo yabasebenzi. Amasevisi we-website ye-Medicare ne-Medicaid Services. https://www.cms.gov/Medicare/Ukulungiswa-U-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Amalungiselelo/WCMSA-Overview.html. Kubuyekezwe ngo-Ephreli 18, 2016.