Izinhlelo eziningi zezempilo zidinga kokubili ukudonswa nokubambisana . Ukuqonda umehluko phakathi kwe-deductible kanye ne-coinsurance yingxenye ebalulekile yokwazi ukuthi uzokwenzenjani uma usebenzisa umshuwalense wakho wezempilo.
I-Deductible kanye ne-coinsurance yizinhlobo zemali yomshuwalense wemali yomshuwalense wezempilo ; ukhokha ingxenye yezindleko zokunakekelwa kwezempilo, futhi uhlelo lwakho lwezempilo lubeka ingxenye yezindleko zokunakekela kwakho.
Zihlukile endleleni abasebenza ngayo, ukuthi kufanele ukhokhe kangakanani, futhi uma kufanele ukhokhe.
Yini eDeductible?
I-deductible yinani elilinganiselwe okhokha unyaka ngamunye ngaphambi kokuba umshwalense wakho wezempilo uphelele ngokugcwele (uma kwenzeka ku- Medicare Part A- ngoba ukunakekelwa kwesineke-i-deductible isebenza "izikhathi zokuzuzisa" kunokuba unyaka). Uma usukhokhele imali yakho yokudonswa, uhlelo lwakho lwezempilo luqala ukuthatha isabelo salo semali yezinkokhelo zezempilo. Nakhu ukuthi kusebenza kanjani.
Unayo imali engu-$ 2,000. Uthola umkhuhlane ngoJanuwari bese ubona udokotela wakho. Ibhilidi kadokotela liyi $ 200. Unesibopho kulo lonke umthethosivivinywa ngoba awukhokhelanga imali yakho kulo nyaka (ngalesi sibonelo, sicabanga ukuthi uhlelo lwakho alukho i- copay yokuvakashelwa ihhovisi, kodwa kunalokho, libala amacala okukhishwa kwakho) . Ngemuva kokukhokha imali ekhokhwa idokotela engu-$ 200, unayo i-$ 1,800 eyashiywe ukuhamba nge-deductible yakho ngonyaka.
Ngo-Mashi, uwela futhi uphule ingalo yakho.
Umthethosivivinywa u-$ 3,000. Ukhokha u-$ 1,800 walowo mthethosivivinywa ngaphambi kokuthi uhlangabezane ne-deductible yakho yonyaka ka-$ 2,000 (i-$ 200 kusuka kokwelashwa komkhuhlane, kanye no-$ 1,800 wezindleko zengalo ephukile). Manje, umshuwalense wakho wezempilo ukhalela futhi usize ukhokhe lonke imali.
Ngo-Ephreli, uthola ukukhishwa kwakho kususiwe. Umthethosivivinywa u-$ 500.
Njengoba usuvele uhlangabezane ne-deductible yakho yonyaka, akudingeki ukhokhe noma yikuphi ekubhekaneni ne-deductible yakho. Umshwalense wakho wezempilo ukhokhelwa ngokugcwele kulo mthethosivivinywa.
Kodwa-ke, lokhu akusho ukuthi umshuwalense wakho wezempilo uzokhokha lonke umthethosivivinywa futhi akudingeki ukhokhe noma yini. Ngisho noma usuqedile ukukhokha imali yakho yonyaka, ungase udingeke ukukhokha imali noma imali yokukhokhela imali.
Kuyini ukuqinisekiswa?
I-Coinsurance enye uhlobo lokubelana ngezindleko lapho ukhokha khona ingxenye yezindleko zokunakekelwa kwakho, futhi umshuwalense wakho wezempilo ukhokhela ingxenye yezindleko zokunakekela kwakho. Ngesiqiniseko sokukhokha, ukhokhela inani elilinganiselwe, iphesenti ngalinye lokukhokhelwa kwezempilo. Nakhu ukuthi kusebenza kanjani.
Ake sithi udinga ukukhokhela u-30% wezinkokhelo zemithi yemithi yokwelashwa. Ugcwalisa imithi kadakamizwa ebiza imali eyi-$ 100. Ukhokha u-$ 30 walowo mthethosivivinywa; umshuwalense wakho wezempilo ukhokhela u- $ 70.
Njengoba ukuqinisekiswa kwemali kuyinani lezindleko zokunakekelwa kwakho, uma ukunakekelwa kwakho kubiza kakhulu, ukhokha okuningi. Isibonelo, uma unesiqiniseko sokukhokhela u-25% sokubhedlela futhi isikweletu sakho esibhedlela singama-$ 40,000 uzothola u-$ 10,000 ukuqinisekiswa kwezimali-kuze kube yilapho uMthetho Wokunakekelwa Onganakekelwayo ushintshe uhlelo lwethu lomshwalense.
Izindleko ze-Coinsurance zalowo mkhulu azivunyelwe ngaphandle uma unesipiliyoni sempilo eningi.
Wonke amapulani angewona amancane kumele athole izindleko zomuntu ngamunye eziphuma ngaphandle (okufaka amadokhumenti, ama-copays, kanye ne-coinsurance) okungaphezu kwanoma yikuphi umuntu ongaphandle kwe-pocket owedlula lowo nyaka. Ngo-2016, lokho kungu- $ 6,850. Ngo-2017, kungu-$ 7,150.
I-Deductible vs Coinsurance-Zihluke Kanjani?
I-enductible iphela, kodwa ukuqinisekiswa kwemali kuqhubekela phambili futhi kuqhubeke (kuze kube yilapho ushaya i-out-of-pocket yakho esiphezulu).
Uma usuhlangabezane ne- deductible yakho yonyaka, awukhokhwa noma yiziphi ezinye izinkokhelo ezidonswayo kuze kube ngonyaka ozayo (noma, esimweni se-Medicare Part A, kuze kufike isikhathi sakho esilandelayo). Ungase udingeke ukhokhe ezinye izinhlobo zokwabelana ngezindleko ezifana ne-copayments noma i-coinsurance, kodwa i-deductible yakho yenziwa ngonyaka.
Uzoqhubeka nokukhokhela u-coinsurance njalo uma uthola izinsizakalo zokunakekelwa kwezempilo. Isikhathi sokubambisana kwezezimali kuphela lapho ufinyelela khona inqubomgomo yakho yomshuwalense wezempilo engaphandle kwepokhethi. Lokhu akuvamile futhi kwenzeka kuphela uma unezindleko zokunakekelwa kwempilo kakhulu.
I-deductible ihleliwe, kodwa imali yezinkokhelo iyashintsha .
I-deductible yakho iyinani elinqunyiwe, kodwa imali yakho yezimali iyinani eliguquguqukayo. Uma unemali engu-$ 1,000 ekhishiwe, kuseyizinkulungwane zama-$ 1,000 kungakhathaliseki ukuthi ibhilikhithi likhulu kangakanani. Uyazi uma ubhalisa ohlelweni lwezempilo ngqo ukuthi uzokhipha imali engakanani.
Nakuba uzokwazi ukuthi isilinganiso sakho sephesenti ye-coinsurance nini uma ubhalisa ohlelweni lwezempilo, ngeke ukwazi ukuthi imali oyikhokhelwa yinoma iyiphi insizakalo ethile kuze kube yilapho uthola leyo nsizakalo kanye nomthethosivivinywa. Njengoba u-coinsurance yakho iyinani eliguquguqukayo, iphesenti le-bill, imali ephakeme kakhulu yesikweletu, yiyona okhokha ngayo imali. Lokhu kwenza u-coinsurance akuphephe amandla kuwe ngoba kunzima kakhulu kwisabelomali. Isibonelo, uma unayo imali engu-$ 20,000 yokuhlinzekwa, ukuqinisekiswa kwakho kwe-30% kuzoba ngu-$ 6,000 (kodwa futhi, izindleko zakho eziphelele ngaphandle kwezezimali angeke zidlule u-$ 7,150 ngo-2017).
Deductible vs Coinsurance-Zifana kanjani?
Ukhokha ingxenye yezindleko zokunakekelwa kwezempilo.
I-Deductible kanye ne-coinsurance kokubili kwehla inani lemali uhlelo lwakho lwezempilo olukhokhela ukunakekelwa kwakho ngokukwenza ukhethe ingxenye yethebhu. Lokhu kuzuzisa uhlelo lwakho lwezempilo ngoba bakhokhela kancane, kodwa futhi ngenxa yokuthi awuncane amathuba okuthola izinsizakalo zokunakekelwa kwezempilo uma kungadingeki ukhokhele enye imali yakho kulowo mthethosivivinywa.
Khokha ngesilinganiso esinqunyiwe, hhayi isilinganiso esivamile.
Izinhlelo eziningi zezempilo zixoxisana izaphulelo ezivela odokotela nakwezinye abahlinzeki bezempilo emkhakheni wabo wenethiwekhi . Kokubili ukukhishwa kwakho kanye nokubambisana kwakho kutholakala ngesilinganiso esinqunyiwe, hhayi ngesilinganiso esivamile.
Isibonelo, ake sithi izinga elijwayelekile le- scan ye- MRI yi-$ 500. Uhlelo lwakho lwezempilo luxoxisana nesilinganiso esincishisiwe se $ 350. Uma uthola i-MRI, uma ungakabi nokuhlangabezana ne-deductible yakho, ukhokha imali engu-350 ye-MRI. Leyo $ 350 idalwe ku-deductible yakho ngonyaka. Uma uhlangabezane ne-deductible yakho kakade kodwa kufanele ukhokhwe imali engu-20%, ufanele u-$ 70 (okungama-20% wezinga lokuncishiswa kwe-$ 350.)
Iphutha elivamile lokukhokha lwenzeka lapho abahlinzeki bezempilo bekhokha imali yezinkokhelo ngesilinganiso esivamile kunesilinganiso esinqunyiwe . Lephutha liholela ekukhokha okungaphezu kwalokho okumele ukwenze, ngakho kabili hlola izikweletu nezitatimende ozithola kumhlinzeki wakho wezempilo kanye nenkampani yakho yomshuwalense.
Kubuyekezwe nguLouise Norris.
> Imithombo:
> UMnyango WezeMpilo Nezinsizakalo Zabantu, Ukuvikelwa Kweziguli kanye noMthetho Wokunakekelwa Kwezinkinga, Isaziso Sokuzuza Nezikhawulelo Zokukhokha Zonyaka ka-2016 .
> UMnyango WezeMpilo Nezinsizakalo Zabantu, Ukuvikelwa Kweziguli kanye Nokunakekelwa Okunakekelwa Kwezimali, Isaziso Sokuzuza Nezikhawulelo Zokukhokha Zonyaka ka-2017.