Uhlolojikelele Womshuwalense Wezidakamizwa Osemthethweni
Izidakamizwa zemithi ziyingxenye ebalulekile yesistimu yethu yokunakekelwa kwezempilo. I- Journal ye-American Medical Association (JAMA) ibike ukuthi amaphesenti angu-59 aseMelika asebenzisa okungenani umuthi owodwa wokugulisa ngo-2011-2012. Ngakho-ke ngisho noma ungasebenzisi imithi yesikhathi eside ukuphatha isifo esingapheli, amathuba amnandi kakhulu ukuthi uzodinga imithi njalo emva kwesikhathi.
Futhi imithethonqubo abantu abayithathayo iya ngokuya ebiza kakhulu, ngesilinganiso esikude kakhulu sokukhuphuka kwamanani emali (lokhu akuyona into entsha; isihloko sezeMpilo kusukela ngo-1990 sibonisa ukuthi izindleko zemithi ziphakathi kwezindleko zokunakekelwa kwezempilo ezisheshayo ezisheshayo emakhaya asebekhulile kuma-70s no-80).
I-JAMA ibike ukuthi kusukela ngo-2013, ukusetshenziswa kwezidakamizwa zomuthi we-anti-capita e-United States kwakungaphezu kokuphindwe kabili kwezinye izizwe ezimbusiwe, futhi kwafaka amaphesenti angu-17 "amasevisi okunakekelwa kwempilo yomuntu wonke." Ngokusho kwe-2015 Milliman Medical Index, izindleko zemigomo yanda ngamaphesenti angu-13,6 kusukela ngo-2014 kuya ku-2015, okuyinto eyimbangela eyinhloko yokushayela ukwanda kwezindleko zokunakekelwa kwezempilo ngaleso sikhathi.
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Yini Engavunyelwe Ngayo Imali Yezokwelapha Emkhokhweni Wentela Yakho?
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Indlela Yokulondoloza Izidakamizwa Ngezinhlelo Zikahulumeni
Ngokusobala, ukukhokhela izidakamizwa zemithi kuyisici esibalulekile somshwalense wezempilo omningi. Kodwa ukuthengiswa kwemithi kadokotela kuye kwavela kakhulu eminyakeni embalwa edlule. Ukusabalala kwe-prescription kuye kwaba yinto evamile ngaphansi kwemigomo yomshuwalense wezempilo yangasese, kodwa emakethe ngayinye ekuqaleni kwawo-2000, abanye abathwali baqala ukushintshwa emiphakathini engazange ifake imiyalelo nhlobo, noma ngabe kuphela izidakamizwa ezivamile. Ekuqaleni kuka-2013, ngokusho kohlaziyo lwe-HealthPocket, amaphesenti angu-82 kuphela amapulani atholakala emakethe ngayinye ahlanganisa izidakamizwa ezibhalwe phansi, futhi lokhu kwakuhlanganisa izinhlelo "ezinomkhawulo wokufinyelela."
Ukuguqulwa kwezeMpilo kanye nezidakamizwa zokubhaliswa
Ngesikhathi uMthetho Wokunakekelwa Okungenakusiza wawubhalwe, abameli besazi ukuthi ukufakwa kwezidakamizwa ezidakamizwa kwakudingeka kufakwe kuzo zonke izinhlelo, njengoba imiphumela yezezimali kanye nezokwelapha yokungabi nokubhaliswa kwezidakamizwa kungaba nzima kakhulu.
Ngakho izidakamizwa zemithi zingenye yezinzuzo zezempilo ezidingekayo ze-ACA, okusho ukuthi zihlanganiswe kuzo zonke izinhlelo ezintsha zezempilo zeqembu ngalinye nezintsha ezincane kusukela ngo-2014. Izinhlelo eziningi zeqembu (emazweni amaningi, lokho kusho okungenani abasebenzi abangu-51, nakuba abambalwa bathi , kusho okungenani abasebenzi abangu-101) abadingeki ukuba baqaphele izinzuzo zezempilo ze-ACA ngaphandle kokunakekelwa kokuvikela , kodwa iningi lamacembu amakhulu livele libheke izidakamizwa ezidokotela ngaphambi kokuba i-ACA iqale ukusebenza, futhi ziqhubeke zenza kanjalo.
Imiphakamiso Yomshuwalense Wezempilo Imigomo Yemiqulu Yemfihlo
Kukhona ukuhlukahluka okubanzi mayelana nokuthi izinhlelo zezempilo zihlanganisa kanjani izidakamizwa zemithi. Kunezinhlelo ezintathu ezijwayelekile zokuhlomula okungahle kusetshenziswe izinhlelo:
- I-Copay yezimiso eziqala ngokushesha. Isibonelo, uhlelo lungakhokhisa u-$ 10 / $ 25 / $ 50/30% wezidakamizwa ze-Tier 1 / Tier 2 / Tier 3 / Tier 4, kungekho-deductible noma enye ukwabelana ngezindleko .
- I-prescription deductible ehluke ekudonseni kwezokwelapha, emva kwalokho ama-copay asebenza ngokuya ngesidakamizwa sezidakamizwa. Ku-Benefits and Payment Parameters ehlongozwayo ngo-2018, i-HHS yaphawula ukuthi izinhlelo ezihleliwe ezihlongozwayo ngo-2018 zizobandakanya ama-deductibles ezidakamizwa zezokwelapha nezidakamizwa zezinhlelo zesiliva, "kubonisa ukujwayelekile kwesakhiwo sokwabelana ngezindleko ku-QHPs kula mazinga ukuhlanganisa. " Ngamanye amazwi, lo mdwebo wepulani usuvele ujwayelekile kakhulu kumacebo athengiswa emakethe ngayinye. Mayelana nezinhlelo eziqinisekisiwe uHHS eziye zahlongozwa ngo-2018, izinhlelo zesiliva zizoba nemithi engu-$ 500 yemithi ekhishiwe, ngaphezu kwemali engamaRandi ayizigidi ezingama-3 500.
- I-medical / prescription edidiyelwe ehlukanisiwe, ne-copay copays noma i-coinsurance esebenza kuphela emva kokuthola imali ephelele. Izinhlelo ze-HSA-ezifanelekayo azikwazi ukuhlinzeka ngezinzuzo ngaphandle kokunakekelwa kokuvikela ngaphambi kokuthi kukhishwe imali, ngakho lezo zihlelo zizohlanganisa kuphela imiyalelo ngemuva kokukhokha imali yakho yokukhishwa konyaka.
Amanye amazwe asebenzise imikhawulo yokuthi uhlelo lwezempilo lungadinga amalungu ukuba akhokhe kanjani izidakamizwa ezikhethekile, ngomzamo wokugcina imithi engabizi kubantu abanezimo ezingaphathwa kuphela ngezidakamizwa ezibiza kakhulu.
Kodwa noma ngabe isimo sakho asikho, futhi unamathela ekukhokheni iphesenti enkulu yezindleko zemithi eqolo kakhulu njalo ngenyanga, yazi ukuthi uhlelo lwakho lomshuwalense wezempilo luzokhokha amaphesenti angu-100 emithi yakho yesidakamizwa uma usuhlangabezane nokuphuma kwakho -of-pocket esiphezulu sonyaka. Kusukela ngaleso sikhathi kuya phambili, izidakamizwa zakho zizohlanganiswa ngokugcwele kulo lonke usuku.
Konke Mayelana Ne-Formularies
I- formulary yiluhlu lwezidakamizwa ezizobekwa isicwangciso sakho sezempilo. Ngaphakathi kwe-formulary, izinhlelo zezempilo zihlukanisa izidakamizwa zibe yizigaba ezintathu, kanti izidakamizwa ezibizayo kakhulu ziyiNyathelo 1 futhi izidakamizwa ezibiza kakhulu ziyi-Tier 4, 5, noma 6, kuye ngokuthi uhlelo lwakhiwe kanjani.
Izidakamizwa eziphezulu zivame ukuba izidakamizwa ezikhethekile , kuhlanganise nezinjectjectables kanye ne- biologics . Kulezi zidakamizwa, umthengi ngokuvamile kufanele akhokhe iphesenti yezindleko (okungukuthi, u- coinsurance kunokuba i-copay ), ngaphandle uma imithethonqubo yombuso inesikhwama sezindleko zemithi ekhethekile.
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Izidakamizwa Ezijwayelekile: Ngingazigcina E-Walmart nakwezinye izitolo ezinkulu?
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Umshuwalense wezeMpilo: Izidakamizwa zikaGeneric Zikusiza ukuthi Ugcine Imali kwimigomo
Ngaphakathi kwemihlahlandlela eyenziwe yi-HHS kanye nabalawuli bezwe, abahlinzeki bezempilo bayakhululekile ukuthuthukisa ama-formularies abo futhi bavumelane nabo ngokudingekayo ngokuhamba kwesikhathi.
Ngaphansi kwe-ACA, i-formulary yepulani kufanele ihlanganise okuningi
- okungenani umuthi owodwa kuzo zonke izigaba ze-US Pharmacopeia kanye nesigaba
- inombolo efanayo yezidakamizwa esigabeni ngasinye kanye nekilasi njengendlela yezinhlelo zokubheka ezikhethiwe nguhulumeni
- Izinhlelo zezempilo kudingeka futhi zibe nekomidi lekhemisi nelashwa (P & T) elibhekene nokuqinisekisa ukuthi ifomula liphelele ngokwanele.
Ngakho-ke noma zonke izigaba zomuthi ezijwayelekile zihlanganiswa, lokho akusho ukuthi imithi ethize iyohlanganiswa yizo zonke izinhlelo, noma ngisho nanoma yimaphi amacebo endaweni ethile. Kukhona inqubo yezikhalazo ezitholakalayo , kodwa, uma wena nodokotela wakho ukholelwa ukuthi kubalulekile ukuba usebenzise izidakamizwa ezingekho kwifomula yakho yezempilo.
I-Medicare & Izidakamizwa Zokubhalisa
Ngokungafani nezinhlelo zomshuwalense wezempilo wangasese, i- Original Medicare (i-Medicare Parts A ne-B) ayifuni izidakamizwa zemithi. Ngo-2003, iCongress yadlula i-HR1, i-Medicare Prescription Drug, I-Improvement, kanye ne-Modernization Act ka-2003. Umthetho wadala uhlelo olusha- Medicare Part D-ukusiza ukumboza izindleko zemithi ekhishwa ngamagciwane e-Medicare ababhalisile.
Ukuze uthole ukukhokhelwa kwemigomo, Medicare ababhalisa kudingeka badingeke ngasese. Kunezindlela ezimbalwa zokuthola ukukhishwa kwesidakamizwa uma usufanelekile ku-Medicare:
- i- Medicare Part D kuphela, i- Medicare Part D , yokusetshenziswa kwezidakamizwa , okungasetshenziswa ngokuhambisana ne-Original Medicare
- uhlelo lwe- Medicare Advantage olubandakanya i-Part D yokubhaliswa kwezidakamizwa (lezi zihlelo ze-Medicare Advantage zibizwa ngokuthi i-MAPD)
- Ukuthengiswa okungeziwe kumqashi noma umqashi womlingani wakho
I-Medicare Part D ine-" hole hole " lapho ababhalisile ekuqaleni babephethe amaphesenti angu-100 ezindleko zabo zezidakamizwa. Umthetho Wokunakekelwa Onganakekelwayo wawubandakanya ukuhlinzekwa ukuvala umgodi we-donut; leyo nqubo iqhutshwa kancane kancane, futhi umgodi we-donut uzoshabalala ngo-2020.
Izidakamizwa ze-Medicaid & Prescription
Kuzo zonke izimo, i-Medicaid ihlanganisa izidakamizwa zemithi. Uma ubhaliswe ku-Medicaid (kufaka phakathi abantu abaqala ukufaneleka ngenxa yendlela yokwandiswa kwe-Medicaid ), imiyalelo yakho izohlanganiswa ngokugcwele noma ngama-copay amancane.
Kodwa-ke, kubantu abathandekayo -abafanelekayo eMedicaid neMediare , iMedicaid yeka ukufaka izidakamizwa ezidakamizwa ngo-2006, lapho i-Medicare Part D isetshenziswa khona. Abazuzi abafanelekayo ababili bathola imiyalelo yabo nge-Medicare Part D (kunokuba i-Medicaid), kodwa uhlelo losizo olwengeziwe lukhokha ama-premium kanye nokuningi kokwabelana ngezindleko zepulani lomuthi.
Izinhlelo Zama-Discount Drug Drug & Plani-Alone Plans
Uma usuhlelo oluhle kakhulu noma olunenqwaba yezinto ezingavumelani nezidakamizwa, noma uma ungaqinisekisiwe, kunezinhlobonhlobo zemigomo yomshuwalense wemithi yemithi yokwelapha kanye neyaphulelo emakethe. Zingenziwa izinkampani zomshuwalense, ama-pharmacy, abakhiqizi bezidakamizwa, noma izinhlangano zokugqugquzela / zobulungu njenge-AARP.
Uma ucabangela lolu hlobo lwepulani, funda ukuphrinta okuhle kakhulu ngokucophelela. Yazi ukuthi ngecebo lesaphulelo, ngokuvamile uzokhokha inani elikhulu ngezidakamizwa ezibiza kakhulu, ngakho khumbula ukuthi uma izinto zokuthengisa zisho "amaphesenti angaba ngu-60," lokho akusho ukuthi uzothola Amaphesenti angama-60 avela izindleko zanoma imuphi umuthi ongawudinga.
Amapulani e-drug-stand-alone ayibalo njengobuncane bokubambisana okubalulekile ngaphansi kwe-ACA, ngakho-ke uma ungaqinisekisiwe futhi unomshwalense wegciwane noma uhlelo lwesaphulelo, usazobe usenkonzweni yesigwebo se-ACA somuntu ngamunye, ucabanga ukuthi ukhona hhayi ukukhululeka.
Inothi Kusuka
Imigomo iyabiza, futhi ukutholakala ngokwanele kungenza umehluko phakathi kokukwazi ukukhokhela imithi yakho ngokufanele ukwenze ngaphandle.
Uma unzima ukukhokhela izinkombandlela zakho, kunezinhlelo zosizo lwezokwelapha ezingasiza. Uma udidekile mayelana nezinzuzo zakho noma izinketho zokufinyelela ezitholakalayo kuwe, finyelela eqenjini lomqashi wakho we-HR, noma kumthengisi noma umgijimi ongakusiza uqhathanise izinhlelo ezihlukahlukene. Sicela ungazifisi sengathi kufanele uzibone konke ngokwakho; Usizo luyatholakala emphakathini wakho.
> Imithombo:
> Congress.gov. I-Medicare Isidakamizwa Sezidakamizwa, Ukuthuthukiswa, noMthetho Wokuvuselelwa ka-2003. I-108th Congress (2003-2004).
> UMnyango WezeMpilo Nezinsizakalo Zabantu, Ukuvikelwa Kweziguli Nokunakekelwa Okunakekelwayo, I-HHS Isaziso Sokuzuza Nezikhawulelo Zokukhokha ngo-2018 . 9/6/2016.
> Girod, Christopher S., Weltz, Scott A., Hart, Susan K., Index wezigidi ze-2015, ngo-May 19, 2015.
> Kantor, Elizabeth D., MPH; Rhem, Colin D., PhD, MPH; Haas, Jennifer S., MD, MSc; Chan, Andrew T., MD, MPH; UGiovannucci, u-Edward L., MD, i-ScD. Amathrendi Wokusetshenziswa Kwedakamizwa Phakathi Kwabantu Abadala E-United States Kusukela ngo-1999-2012. I-Journal of the American Medical Association , ngoNovemba 3, 2015, Umqulu 314, No. 17.
> Kesselheim, Aaron S., MD, JD, MPH; Avorn, Jerry MD; Sarpatwari, Ameet, JD, PhD. Izindleko Eziphezulu Zokusetshenziswa Kwezidakamizwa E-United States. I Journal of the American Medical Association , Agasti 23/30, 2016, Vol 316, No. 8.