Ukuthi i-Out-of-Pocket Maximum isebenza kanjani

I-Out-of-Pocket Max: Indlela Esebenzayo Nendlela I-ACA Ilawula Ngayo

Umshuwalense wezempilo ngaphandle kwe-pocket esiphezulu yinani elikhulu lemali okumele uyikhokhele ezindlebeni zokunakekelwa kwempilo unyaka ngamunye, ucabanga ukuthi uthola ukunakekelwa okuhlanganiswe uhlelo lwakho lomshuwalense futhi usebenzise izibhedlela ezisenkundleni kanye nodokotela.

Ngemuva kokuba ukhokhe ngokwanele ekudonsheni kwamakhokhelo , ukhokha imali futhi uxhumano lwemali ukuze ufinyelele ekuphumeni kwakho kwepokhethi , inkampani yakho yomshuwalense wezempilo ikhokhela yonke enye inethiwekhi yakho, ukunakekelwa kwempilo okudingekayo ngokwezempilo okusele kulowo nyaka.

Kodwa, akusebenzi ngaso sonke isikhathi ngaleyo ndlela. Nakuba isikhulu esingaphandle kwe-pocket senzelwe ukunciphisa ingozi yakho yezezimali uma unezindleko zokunakekelwa kwempilo ephakeme , ibonisa inkampani yakho yomshuwalense wezempilo engozini enkulu yezezimali. Ngakho, izinkampani zomshuwalense wezempilo zakha amasu okudala ukuze kuncishiswe leyo ngozi. Lezi zindlela zidala ukudideka ngalokho okubaluleke ekubhekeleni kwakho okuphezulu kwe-pocket, lokho umshwalense wakho wezempilo okhokhela khona ngemuva kokuwufinyelela, nokuthi umkhawulo wakho ongaphandle kwe-pocket uqobo kangakanani.

Ukuthi Ngokuvamile I -Out-Of-Pocket Inkulu Isebenza Kanjani

Ake sibone isibonelo: Une-deductible ye $ 1,000, u-coinsurance wamaphesenti angu-20, nomkhawulo ongaphandle kwe-$ 5,000 ngonyaka.

Uphula i-ankle yakho. Uyiswa ekuhlinzekeni ngalobo busuku. Isayithi lakho lokuhlinzeka litheleleke. Ungene esibhedlela iminyaka emibili, ube nokuhlinza kabili, futhi uthole ama-antibiotics e-IV ekhaya ngokunakekelwa kwezempilo kwamanye amasonto amathathu.

Nakhu ukuthi izikweletu zakho zizofakwa kanjani ngaphandle kokuphuma kwepokhethi ngokuphambene ne -out-of-pocket esiphezulu se $ 5,000:

• Isikweletu sakho segumbi lesiphuthumayo singama $ 4,000.
  Ngaphandle komkhawulo ongaphandle kwe-pocket, ukhokha imali eyi-$ 1,000 ekhishwe futhi i-$ 600 ekuqinisekisweni kwezimali.
  Ngomkhawulo ongaphandle kwe-pocket, ukhokhela imali efanayo engu-R1 000 futhi u-$ 600 ekuqinisekisweni kwezimali.
  

• Isikweletu sakho esibhedlela singama- $ 40,000.
  Ngaphandle komkhawulo ongaphandle kwe-pocket, ukhokha u-$ 8,000 we-coinsurance (amaphesenti angu-20).
  Ngomkhawulo ongaphandle kwe-pocket, ukhokha u-$ 3,400 kuphela. Ufinyelele ukuphuma kwakho kwepokhethi futhi uyeka ukukhokha (inani lama-$ 5,000 livela ku-$ 1000 yakho ekhokhelwa imali, imali engu-$ 600 yokuvakashelwa kwe-ER, kanye no-$ 3,400 imali yokukhokhela isikweletu sebhedlela).
  
• Isikweletu sakho sokunakekelwa kwempilo ekhaya si $ 3,000.
  Ngaphandle komkhawulo ongaphandle kwe-pocket, ukhokha imali engu-$ 600 yezimali.
  Ngomkhawulo ongaphandle kwe-pocket, awukhokhi lutho. Umshwalense wakho wezempilo ukhokhela zonke izindleko zokunakekelwa kwempilo yakho ekhaya ngoba usuvele ufinyelele ekuphumeni kwepokhethi.
  
• Izindleko eziphelele zezinyosi zakho eziphukile ziyi $ 47,000.
  Ngaphandle komkhawulo ongaphandle kwe-pocket, ukhokha u- $ 10,200; umshwalense wakho ukhokha u- $ 36,800.
  Ngomkhawulo ongaphandle kwe-pocket, ukhokha u-$ 5,000; umshwalense wakho ukhokha u- $ 42,000.
  
• Udinga izinsizakalo zokunakekelwa kwezempilo ngaphezulu konyaka.
  Ngaphandle komkhawulo ongaphandle kwe-pocket, uzokhokha imali engama-20%.
  Ngomkhawulo ongaphandle kwe-pocket, awukhokhi lutho.

Imithetho Eyi-Out-Of-Pocket Ehluke Ngokuphawulekayo Ngaphambi Konyaka ka-2014

Umkhawulo wakho ongaphandle kwe-$ 5,000 ulondoloze imali eningi, kodwa kubiza inkampani yakho yomshuwalense wezempilo njengoba nje ikulondolozile. Ngaphambi koMthetho Wokunakekelwa Okungenakuthengekayo waqala ukulawula imingcele ye-out-of-pocket, abanye abahlinzeki bomshuwalense bezempilo basebenzisa amasu ahlukene okugcina izindleko zabo (kanye nama-premium) aphansi ngangokunokwenzeka.

Lezi zilungiso zishintshe ngaphezulu kwezindleko zokunakekelwa kwezempilo kuwe: ukhokha ngaphezulu, futhi bakhokhela kancane. Abashuwalense basebenzisa amasu amathathu ayisisekelo yokwenza lokhu, akekho okuvunyelwa ukuthi aphinde avunyelwe, ngenxa ye-ACA:

1. Inqubo yokuqala yenza kube nzima kuwe ukuba ufinyelele umkhawulo ngokungazibizi zonke izindleko zakho ekuphumeni okukhulu kwepokhethi. Umshuwalense kungenzeka ukuthi unqume ukuthi angayikhokhisi eyodwa noma ngaphezulu kwalokhu kumkhawulo:
   • Deductible
   • I-Copayments
   • Ukuqinisekiswa kwezidakamizwa
   • Ukuqinisekisa ukuhlolwa
   • I-Coinsurance yokunakekelwa kwe- out-of-network
   Ake sithi imithetho yezinhlelo zakho zezempilo ayikakhokhisi imali ekhishwayo ekubhekaneni ne-out-of-pocket yakho esiphezulu. Uma unayo imali engu-$ 1,000 futhi u-$ 5,000 ongaphandle kwe-pocket esiphezulu, ubuzokhokha imali engu-$ 6000 ngaphambi kokuba umshwalense wakho aqale ukuqoqa amaphesenti angu-100 ezindleko. Ucwaningo lwango-2013 lwe-HealthPocket lubonise amaphesenti angu-38 wemiphakathi yezempilo eyithengiwe ngasese ayizange ikhokhelwe imali ekhishwayo ekubhekaneni ne-out-of-pocket maximum.
   

1. Enkambeni yesibili, umshuwalense akazange akhokhe amaphesenti angu-100 ezindleko zakho zokunakekelwa kwezempilo ngemuva kokufinyelela umkhawulo wakho wokuphuma ngaphandle.
   
   Isibonelo, uhlelo lwezempilo lungase ludinge ukuthi uqhubeke ukhokhela ikhophi njalo uma ubona udokotela noma ngabe usuvele ufinyelele ekuphumeni kwepokhethi. Kulesi simo, ukufinyeleleka okuphezulu kuzokuvikela ekukhokheleni imali yonke yonyaka, kodwa hhayi ekukhokheni ama-copays.
   
   Funda umehluko phakathi kwama-copay no-coinsurance .
   
   Ezinye izinhlelo zezempilo zingabandakanyi ukukhokhelwa kwezidakamizwa zemithi yesiguli okuvela ngaphandle kwe-pocket esiphezulu. Kulokhu, kuzodingeka uqhubeke nokukhokha isabelo sakho sezindleko zemithi kadokotela ngisho nangemva kokuba ufike emkhawulweni wakho wokuphuma ngaphandle. Uma unesiqiniseko sokubambisana ngamaphesenti angu-30 ngezidakamizwa, futhi ubekudakamizwa ephezulu ebiza nge-biologic ebiza kakhulu ama-dollar angu-30 000 ngonyaka, uzokhokha u-$ 9,000 kulowo muthi noma ngabe unezigidi ezingu-5,000 ezingaphandle kwepokhethi.
   
2. Inqubo yesithathu yakha ama-maximum ahlukene aphuma ngaphandle kwezingxenye zezingxenye ezahlukene zempilo yomshwalense wakho wezempilo. Isibonelo esivame kakhulu sine-out-of-pocket esiphezulu semithi yesidakamizwa kanye ne-out-of-pocket ehlukile kunazo zonke ezinye izinto.
   
   Ngemuva kokuthi ufinyelele umkhawulo ongaphandle kwezikhwama zezidakamizwa , umshwalense wafaka amaphesenti angu-100 wezindleko zemigomo yakho, kodwa waqhubeka nokukhokha isabelo sakho sezindleko ezingekho izidakamizwa. Ngemuva kokuthi ufinyelele esiphezulu se-pocket esiphezulu kuzo zonke ezinye izinto , umshuwalense uhlanganise amaphesenti angu-100 ezindleko zakho zokunakekelwa kwezempilo okungewona izidakamizwa, kodwa waqhubeka ukhokhela isabelo sakho sezindleko zemithi ngaphandle kokuthi ubuye uhlangabezane ne-out-of- isikhwama esiphezulu semithi.
   
   Inkampani yomshuwalense wezempilo ayizange ifake amaphesenti angu-100 okunakekelwa kwezempilo kuze kube yilapho usufinyelele kokubili umkhawulo ongaphandle kwamapokhethi. Uma umkhawulo ngamunye wawuyi $ 5,000, ukhokhe u-$ 10,000 ngaphambi kokuthi uhlelo lwezempilo luqale ukukhokhela amaphesenti angu-100.

I-Affordable Care Act & Out-Of-Pocket Maximum

Akukhona kuphela ukuthi amasu okunciphisa ingozi adidliza abathengi, kodwa futhi ashiya abantu bazizwa sengathi baphathwe kabi. Ngemuva kwakho konke, uma ngabe ube nokukhululeka okungaphezulu kwe-$ 5,000, kungani kufanele ukhokhe imali engu-9 000 ye-out-of-pocket ukuze uthole imithi kadokotela ehlanganiswe uhlelo lwakho lwezempilo? Abomthetho baphendule ukukhathazeka komthengi ngokulawula umshwalense wezempilo ngaphandle kwemiphakathi.

I- Care Affordable Act yenza amaphuzu angaphandle kwe-pocket alula kakhulu. Ibeka umkhawulo wokuthi okungakanani okungaphezulu kwe-pocket kungenziwa unyaka ngamunye. Kudinga ukuthi ama-deductibles, ama-copays, kanye no-coinsurance bonke bathole ukuhlonishwa emkhawulweni ongaphandle kwe-pocket. Lesi sidingo sikhipha inqubo ye-one one-insurers yezempilo.

I-ACA idinga ukuthi izinhlelo zezempilo zikhokhele amaphesenti angu-100 ezindleko zokunakekelwa okuvela kubanikezeli be-inthanethi kulo lonke unyaka uma sekufinyelelwe umkhawulo ongaphandle kwe-pocket. Lesi sidingo susa inqubo yesibalo ezimbili.

Ngo-2017, izinhlelo zezempilo ezingenakulinganiswa nazo azikwazi ukutholakala ngezindleko ezingaphandle kwe-pocket ezingaphezu kuka-$ 7,150 kumuntu oyedwa, noma i-$ 14,300 emndenini (futhi umkhawulo ngamunye ongaphandle kwe-pocket kumele ungene emiphakathini yempilo yomndeni , ngakho-ke eyodwa ilungu lomndeni angeke lidingeke ukuthi likhokhe ngaphezu kwama-$ 7,150).

Ngo-2018, le mikhawulo izokhula ibe ngu-$ 7,350 umuntu ngamunye futhi i-$ 14,700 emndenini. Njengoba kunjalo ngaso sonke isikhathi, izinhlelo zezempilo zizokwazi ukukwazi ukuphuma ngaphandle kwezimpahla ezingaphansi kwezibalo (futhi eziningi zizoba), kodwa hhayi ngaphezu kwazo.

I-ACA iphinde isungule uxhasomali lwempilo yomshuwalense wezempilo olwehlisela ukuphuma kwe-pocket esiphezulu kubantu abafanelekile ngezindlela ezinesizotha, futhi lokho kuzoqhubeka nokusebenza ngo-2018.

Insizakalo kanye neningi lama-ACA ekuvikeleni abathengi aqala ngoJanuwari 1, 2014. Nokho, ezinye izinhlelo zezempilo zeqembu elikhulu azidingeki zihambisane kuze kube yilapho kusetshenzwa uhlelo lokuqala kusukela ngoJanuwari 1, 2015 (uma behlinzeka ngokwaziswa ngokwezokwelapha nokwelashwa ngokwehlukile, bavunyelwe ukuba babe nemingcele ehlukile ye-pocket ngo-2014). Futhi amacebo amakhulu akudingeki ahambisane nayo yonke imithetho ye-ACA, ngakho-ke bangaqhubeka nokusebenzisa imithetho yabo yakudala mayelana nama-maximum angaphandle kwe-pocket. Ezizweni ezisazobavumela ukuba zikhona, izinhlelo eziyinhloko zingase ziqhubeke nokusebenzisa ama-maximum awo angaphandle kwe-AC-AC, kepha izinhlelo ezizobe zikhulu kumele ziqede ngasekupheleni kuka-2018.

Ngizivikela Kanjani?

Ungazitholi ukukhathazeka ngoba ukuvikelwa komthengi kukhona. Kukhona ezinye izindleko ozothola ukuzibophezela ngokukhokha ngemuva kokuhlangana okuphezulu kwe-pocket. Lokhu kufaka:

• Izinto ezihlelelwe uhlelo lwakho lwezempilo aludingekile kwezokwelapha.
• Isabelo se- balance-billed kanye nokwabelana ngezindleko zokunakekelwa kwempilo kwe- out-of-network .
• Izinto ezingahlanganiswa uhlelo lwakho lwezempilo njengohlinzekwa ngezimonyo.
• Ukwabelana ngezindleko zezinto ezingabhekwa njengezinzuzo ezibalulekile zezempilo. Lezi zinzuzo ezingekho ezibalulekile ziyadingeka ukuthi uhlelo lwakho lwezempilo aludingeki ukuhlinzeka kepha lukhetha.
• Imishanguzo yakho yomshuwalense wezempilo.

Uhlelo ngalunye lwezempilo luhlinzeka ngesifingqo seziNzuzo nokuPhepha noma isichazamazwi sePulani Incazelo echaza ukuthi yini umkhawulo ongaphandle kwe-pocket kanye nalokho okwenziwe futhi ongawutholi khona. Qaphela lokhu uma uqhathanisa izinhlelo ngesikhathi sokubhalisa okuvulekile, noma uma uthengisa umshuwalense wezempilo . Ungabiza futhi uhlelo lwakho lwezempilo bese ucela.

Akukho lutho olungalungile mayelana nabanomshwalense bezempilo abazama ukunciphisa ingozi yabo uma nje benza ngaphakathi komthetho futhi banikeze incazelo ecacile yemigomo yenqubomgomo. Umthwalo wukuthi uqinisekise ukuthi uqonde ngokugcwele imithetho yecebo lakho lempilo. Udinga ukuqonda ukuthi ungakanani kangakanani ohlangothini lwezinyosi ngonyaka ukuze ukwazi ukubeka isabelomali ngendlela efanele futhi wenze amaphuzu okubhekana nesimo esibi kakhulu.

U-AHCA wawuzoshintsha kanjani imithetho?

I- American Health Care Act (AHCA) yadlulisela iNdlu ekuqaleni kukaMeyi . I-Senate ibhala inguqulo yabo siqu, kodwa ayizange ibe nokuphikisana noma ingxabano yomphakathi, ngakho asazi ukuthi ingakanani inkulumo yeNdlu abahlela ukuyigcina.

Kodwa iNdlu ye-Bill ye-bill izogcina imingcele ye-ACA ngaphandle kwe-pocket. Kodwa-ke, kuzovumela futhi izizwe ukuba zifune ukuxoshwa lapho zingakwazi khona ukuchaza kabusha lokho okubhekwa njengesizuzo sezempilo esibalulekile . Futhi imingcele ye-ACA ngaphandle kwe-pocket isebenza kuphela ezinsizeni zezempilo ezibalulekile. Ngakho-ke uma ngabe isimo sivuma, isibonelo, abahlinzeki bezempilo abahlinzeka ngamalungiselelo omakethe ngamunye angahlanganisi ukubeletha (ngokuhlenga kabusha izinzuzo zezempilo ezibalulekile futhi kungabandakanyi ukunakekelwa kokubeletha ohlwini), izindleko zokunakekelwa kokubeletha zizophuma ngokugcwele- of-pocket kwabazali abasha, futhi ngeke babheke ukuthi umshwalense wabo ungaphandle kwepokhethi.

I-Senate ingakwazi noma ingagcinanga ukuhlinzekwa okuvumela ukuthi izifunda ziphinde zenze kabusha izinzuzo ezibalulekile zezempilo, kodwa uma zenza, izokwenza buthakathaka ukuvikelwa okuhlinzekwa yi-ACA's cap kwizindleko eziphezulu ezingaphandle kwe-pocket.

_Imithombo:

_{Amasevisi we-Medicare neMediicaid Services, Amanothi Okunakekelwa Kokunakekelwa Kwamanani Asebenzayo Angenwe 18.}

_{UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi .} > Ukuvikelwa kwabagulayo kanye noMthetho Wokunakekelwa Ngezinkinga; Amazinga afana Nezinzuzo Zempilo Ezingundoqo, Inani Lokubuyekeza, Nokugunyazwa . Ngo-Februwari 25, 2013.

> I-Federal Register, Isiguli > Isivikelo > noMthetho Wokunakekelwa Okunganakwa; Isaziso se-HHS Isaziso seNzuzo kanye neMigomo yokukhokha ka-2018; Ukuchitshiyelwa kwezikhathi ezikhethekile zokubhalisa kanye nohlelo lwabathengi olusetshenzisiwe kanye nohlelo oluhlelekile >. NgoDisemba 22, 2016.

_{UMnyango WezeMisebenzi waseMelika. Imibuzo mayelana ne-Care Affordable Act Implementation Ingxenye XII. Februwari 20, 2013.}

_{UMnyango WezeMisebenzi waseMelika. Imibuzo ephathelene ne-Care Affordable Act Implementation (Ingxenye XVIII) kanye nokuqaliswa kwePhalamende yeMpilo Yengqondo, ngoJanuwari 9, 2014.}