Umshwalanse we mpilo

Uhlolojikelele Lwezinhlelo Zomshuwalense Wezempilo

Kungenzeka ukuthi une-umshuwalense wezempilo-amaphesenti angaba ngu-11 kuphela aseMelika angagunyazwa. Kodwa uma ungenalo ulwazi usebenzisa uhlelo lwakho lomshuwalense wezempilo ngokuthola ukwelashwa okuphawulekayo, kungenzeka ukuthi awukakhokhanga kakhulu imininingwane yokufaka kwakho. Futhi uma kudingeke ukuthi uzothengise ngokwakho noma ukhethe phakathi kwezinketho eziningana ezinikezwe umqashi wakho, kungenzeka ukuthi uthola ukukhetha okuphazamisayo noma okudidekayo.

Kungakhathaliseki ukuthi utholaphi umshuwalense wakho wezempilo, kubalulekile ukuqonda igama elisetshenziselwa ukuchaza izinqubomgomo kanye nokufakaza futhi ukwazi ukuqhathanisa izinhlelo. Ukwazi ukuthi uhlelo lwakho lusebenza kanjani-ngaphambi kokuba uludinge ukuyisebenzisa-lubalulekile; awufuni ukuhlunga imininingwane yokwaziswa kwakho ngenkathi uhlezi egumbini lesibhedlela.

Ungayitholaphi Usizo?

Cishe ingxenye yabantu baseMelika bathola umshwalense wabo wezempilo kumqashi.

• Ingabe Wena Nomngane Wakho Kufanele Uhlukanise Izinhlelo Zomshuwalense Wezempilo?

• Uma Umshwalense Wezempilo Ulahla Ukumboza Ukuvakashelwa kwe-ER

Cishe ingxenye yesithathu yabantu base-US inomsebenzi ngaphansi kweMedicaid noma i- Medicare futhi cishe amaphesenti ayisithupha anikezwa ukuthengwa emakethe ngayinye-kufaka phakathi ukushintshaniswa nokushintshaniswa kwamanye amazwe.

Usizo ngokukhethwa kwepulani, ukubhalisa, nokusebenzisa ukufaka kwakho kutholakala njalo, kungakhathaliseki ukuthi uthola kuphi ukufaka kwakho. Uma umqashi wakho enika umshuwalense wezempilo, ungabi namahloni ngokubuza imibuzo. Uma kunomnyango wemithombo yabasebenzi enkampanini yakho, ukukusiza uqonde izinzuzo zakho yingxenye yomsebenzi wabo.

Uma usebenzela umqashi omncane ongenalo iqembu elizinikezele labasebenzi, bangakuqondisa ezinsizeni ezingakusiza, kuhlanganise nomphathi womshuwalense wezempilo, umthengisi owasiza umqashi ukhetha ukukhokhelwa, umshwalense wezempilo omncane ukushintshanisa, noma inkampani yenkampani yesithathu / izinzuzo ezikhokhelwa ngumqashi.

Noma kunini uma uqinisekisa izinzuzo noma idatha yesimangalo, cela imininingwane ngokubhala ukuze wazi ngokuqinisekile ukuthi ulwazi luqondile.

Endabeni yokuthenga umshuwalense wakho wezempilo, abadayisi bayatholakala ukuze banikeze usizo ku-intanethi, ngefoni, noma kumuntu-futhi akukho sikweletu kumasevisi abo. Abathengisi bangakusiza uqhathanise izinhlelo ku- off and off the exchange . Uma wazi ukuthi ufuna ukusebenzisa inkokhelo yomshuwalense wezempilo, kukhona abahamba ngezimoto nabeluleki bokubhalisa abaqinisekisiwe abatholakala ukukusiza ukuba ubhalise. Ukuze uthole ukushintshaniswa kuhulumeni wakho, ungaqala ku-Healthcare.gov bese ukhetha isimo sakho. Uma usesimweni esinokushintshaniswa kwayo, uzoqondiswa kuleyo sayithi.

Uhlelo lwe-Medicaid noma lwe- Child Health Insurance (CHIP), i-agency yakho yombuso ingakusiza ukuba uqonde izinzuzo ezikhona kuwe, uma kufanelekile, futhi ikusize ngenqubo yokubhalisa. Ungakwazi futhi ukubhalisa kwi-Medicaid noma i-CHIP ngokusebenzisa ukushintshwa komshuwalense wezempilo kuzo zonke izimo.

Uma ufanelekile ku-Medicare, ungasebenzisa Uhlelo lwakho loMsizi woMshuwalense wezeMpilo njengoHulumeni.

Kukhona nabathengisi ezweni lonke abasiza abahlomulo ukuba babhalise izinhlelo ze-Medicare Advantage noma ukufakwa kwesinye isikhathi se-Medicare yase-Original.

Izinqumo, Izinqumo, Izinqumo

Kwezinye izimo, izinketho zakho zezinhlelo zingalinganiselwe, njengokungathi umqashi wakho unikeza uhlelo olulodwa kuphela. Kodwa abantu abaningi banezinketho ezimbalwa uma kuziwa ekukhetheni umshuwalense wabo wezempilo. Umqashi wakho anganikela ngezinhlelo eziningi ngezinga elihlukile lokungena kanye nama-premium yenyanga. Uma uthenga umshuwalense wakho wezempilo, ungakhetha kusuka kunoma yikuphi uhlelo olutholakala emakethe ngayinye endaweni yakho (noma ukushintshaniswa, nakuba izinsizakalo ze-premium zitholakala kuphela ekushintsheni).

Uma ufanelekile ukubhalisa ku-Medicare, uzoba nokukhetha ukukhetha uhlelo lwe- Medicare Advantage noma ukunamathela kuMdokotela Wokuqala kanye nokunquma ukuthi ungayifaka yini nge- Medigap ne-Part D yokubhaliswa kwemithi.

Kuzo zonke izinhlobo zokuhlanganisa ezinye i-Medicaid / CHIP, izinyanga zokubhalisa ezivulekile zonyaka ziyasebenza. Izinkathi zokubhalisa ezikhethekile, noma kunjalo, ziyatholakala uma uhlangabezana nezenzakalo ezithile zokuphila ezifanelekayo, njengokulahlekelwa okungahambisani nokuqashwa noma umshado.

Akukho ukulingana komuntu oyedwa-uma kuziwa kumshuwalense wezempilo. Uhlelo oluzokwenza kangcono kuwe luncike ezintweni ezihlukahlukene:

1. Unayo izimo ezikhona ngaphambili? Lokhu akusekho inkinga ngokwekutholakala kokutholakala njengoba uMthetho Wokunakekelwa Ongenakusiza ongenqatshelwe ukubhaliswa kwezokwelapha kusukela ngo-2014. Kodwa ngokuqinisekile kuyoba yisici ngokukhetha i-plan, ngoba izinzuzo, ukukhishwa kwe-pocket, ukuhlanganiswa kwezidakamizwa (formulary), futhi inethiwekhi yomhlinzeki iyahlukahluka kakhulu kusuka kwelinye icebo kuya kwelinye.
   
   Uma ilungu elilodwa lomndeni wakho linemibandela ekhona noma ulindele izindleko ezibalulekile zezokwelapha ngonyaka ozayo, ungase uthande ukucabangela ukubhalisa umndeni ngamapulani ahlukene, ngokubambisana okunamandla kelungu lomndeni okulindeleke ukuthi udinga ukunakekelwa kwezempilo ngaphezulu ngesikhathi ngonyaka.

2. Ingabe uthatha noma yikuphi imithi kadokotela? Qinisekisa ukuhlola amafomula wezinhlelo zezempilo ozicabangayo. Ungathola ukuthi uhlelo olulodwa lubandakanya izidakamizwa zakho ezingeni eliphansi kunamanye noma ukuthi ezinye izinhlelo azifihli imithi yakho nhlobo. Izinhlelo zezempilo zihlukanisa izidakamizwa ezihlanganisiwe zibe yizigaba, ngokuvamile ezibizwa ngokuthi iNqanaba 1, iNqanaba lesi-2, iNqanaba lesi-3, no-4.
   
   Izidakamizwa eziNgceni 1 zibiza kakhulu, kuyilapho labo abasemkhakheni we-4 beyizidakamizwa ezikhethekile. Izidakamizwa eziNgceni 4 zivame ukuhlanganiswa ne-coinsurance (ukhokha iphesenti yezindleko) ngokuphambene ne-copay flat rate. Njengoba kunikezwe isitatimende esiphezulu semithi ekhethekile, abanye abantu baqeda ukuhlangabezana nokuhleleka kweplanethi yabo ekuqaleni konyaka uma badinga izidakamizwa ezibizayo ze-Tier 4. Nokho, abanye bathi, basebenzise imingcele yezigulane zesiguli sezidakamizwa ezikhethekile.
   
   Uma ubhalisa ku-Medicare, ungasebenzisa ithuluzi lokuthola uhlelo lwe-Medicare lapho uqala ukubhalisa futhi unyaka ngamunye ngesikhathi sokubhalisa okuvulekile. Kuzokuvumela ukuthi ufake imigomo yakho futhi ikusize ubone ukuthi yiluphi uhlelo oluzosebenza kahle kakhulu.

• Umshuwalense wezeMpilo kanye nezimo eziPhambi kokuqala: ACA, HIPAA, & Admin Admin

• Kwenzekani Uma Udinga Bobabili I-Medicare ne-Medicaid

1. Ingabe okwamanje uthola ukunakekelwa kwezokwelapha kudokotela othile noma esibhedlela? Amanethiwekhi omhlinzeki ayahluka kusuka kwesinye isithinteli kuya kwesinye, ngakho qhathanisa uhlu lomhlinzeki ngezinhlelo ezihlukahlukene ozicabangayo. Uma umhlinzeki wakho engekho kwinethiwekhi, ungase ukwazi ukusebenzisa lowo mhlinzeki kodwa ngezindleko eziphezulu ezingaphandle kwe-pocket noma kungenzeka ukuthi awunakho ukuhlanganisa ngaphandle kwenethiwekhi nhlobo.
   
   Kwezinye izimo, kuzodingeka uthathe isinqumo sokuthi ukugcina umhlinzeki wakho wamanje kufanelekile ukukhokhela amaphrimiamu omshwalense wezempilo. Uma ungenalo ubuhlobo obusungulwe kahle nodokotela othize, ungathola ukuthi ukukhetha uhlelo olunenethiwekhi encane kungabangela amaphrimiyamu aphansi.

2. Ingabe ulindele noma yikuphi ukunakekelwa kwezokwelapha okubizayo ngonyaka ozayo? Uma wazi ukuthi unokuhlinzwa okuzayo, isibonelo, noma uhlela ukuba nomntwana, cishe kuyoba nengqondo ukukhokha amaphrimiyamu aphezulu ekuhwebeni kwecebo ngenomkhawulo ophansi ongaphandle kwepokhethi. Khumbula ukuthi ungathola inani elingcono kusuka ohlelweni elinomkhawulo ophansi ongaphandle we-pocket, kungakhathaliseki ukuthi uhlelo lufuna ukuthi ukhokhele izinsizakalo ngabanye ngaphambi kokuhlangana nomkhawulo ongaphandle kwepokhethi.
   
   Isibonelo, uma wazi ukuthi uzodinga ukuguqulwa kwamadolo, uhlelo oluphelele lwemali engu-$ 3,000 lungaba yinani elingcono kunecebo elinomkhawulo we-$ 5,000 ongaphandle kwepokhethi. Ngisho noma uhlelo lokugcina luhlinzeka ngama-copays okuvakashelwa udokotela, uhlelo lwangaphambili lubonisa ukuthi udokotela wakho uvakashele ekudonseni.
   
   Ekugcineni kuyoba yindlela engcono yokukhokha izindleko ezigcwele zokuvakasha kwakho udokotela uma wazi ukuthi yonke imali yakho yokusebenzisa ngempilo emisebenzini ehlanganisiwe iyophela uma ushaya u-$ 3,000 ngonyaka. Ukukhokha i-copay-esikhundleni sezindleko ezigcwele-ukuhambela kukadokotela kunenzuzo esikhathini esifushane. Kodwa kubantu abazodinga ukunakekelwa okukhulu kwezokwelapha, i-cap esiphelele ekusebenzeni kwemali ephuma ngaphandle ingase ibe yinto ebaluleke kakhulu.

3. Ingabe uhamba okuningi? Ungase uthande ukucabangela i-PPO enenethiwekhi ebanzi kanye nokuthunyelwa okuqinile kwe-network. Lokhu kuzobiza kakhulu kune-HMO encane-inethiwekhi, kodwa ukuguquguquka okunikezwayo ngokukuvumela ukuthi usebenzise abahlinzeki ezindaweni eziningi kungase kuwufanele. Uma ubhalisa ku-Medicare, izinhlelo zakho zokuhamba cishe zizokwenza i-Original Medicare-nokuhlanganisa ukufakwa kwezinto ezengeziwe-ukhetho olungcono kunomuthi we-Medicare Advantage, kusukela i-Medicare Advantage inomkhawulo wamanethiwekhi omhlinzeki.

4. Yini ukubekezela kwakho engozini? Ingabe ukhetha ukuchitha ngaphezulu ama-premium njalo ngenyanga ngokuhweba izindleko ezingaphansi kwezindleko? Ingabe ube ne- copay ehhovisi likadokotela-ngokuphambene nokukhokha konke okunakekelwayo kuze kube yilapho uhlangabezana nezinkokhelo zakho eziphakeme ezifanelekile? Ingabe unayo imali yokugcina imali engasetshenziselwa ukukhokha izindleko zakho zokunakekelwa kwezempilo uma ukhetha uhlelo nge-deductible ephakeme?
   
   Lezi imibuzo ezingenayo impendulo efanele noma engalungile, kodwa ukuqonda ukuthi uzizwa kanjani ngabo kuyisici esiyinhloko sokukhetha uhlelo lwezempilo oluzokunika inani elihle kakhulu. Ama-premium yenyanga azodingeka akhokhwe kungakhathaliseki ukuthi usebenzise ukunakekelwa kwezempilo okuyizigidi eziyizinkulungwane noma akekho. Kodwa ngaphesheya kwama-premium, inani ozolikhokhela unyaka wonke kuncike ekuhloleni kwakho nokuthi kunakekelwa kangakanani ukwelashwa.
   
   Zonke izinhlelo ezingenakubalwa zihlanganisa ezinye izinhlobo zokunakekelwa kokuvimbela ngaphandle kwenkokhelo-okusho ukuthi akukho kopay futhi awudingi ukukhokha imali yakho. Kodwa ngaphesheya kwalokho, ukuhlanganiswa kwezinye izinhlobo zokunakekelwa kungashintsha kakhulu kusuka kwelinye icebo kuya kwelinye. Uma ukhetha uhlelo nge-premium ephansi kakhulu, qaphela ukuthi izindleko zakho kungenzeka ukuthi ziphakeme uma futhi uma udinga ukunakekelwa kwezokwelapha.

5. Ingabe ufuna ukufaka isandla kwi- Akhawunti Yokulondoloza Impilo (HSA)? Uma kunjalo, kuzodingeka uqiniseke ukuthi ubhalisa kwi-High Deductible Health Plan (HDHP) okuyi-HSA-efanelekayo. Lezi zinhlelo zihlanganisa ukunakekelwa kokuvikela ngaphambi kokudonswa, kepha akukho okunye. Izinhlelo ze-HSA-ezifanelekayo zinezidingo ezincane zokudonswa kanye nemikhawulo ezindleko eziphezulu ezingaphandle kwe-pocket.
   
   Wena noma umqashi wakho angakwazi ukukhokhela i-HSA yakho futhi akukho "ukuyisebenzisa noma ukulahlekelwa". Ungasebenzisa imali ukukhokhela izindleko zezokwelapha nge-dollar engaphambi kwentela, kepha ungashiya imali ku-HSA bese uyivumela ukuba ikhule. Kuzoqala ukuphuma kusukela ngonyaka owodwa kuya kwesinye futhi kungasetshenziswa-ukungakhokhi intela-ukukhokhela izindleko zezokwelapha ezifanelekile ngisho noma ungenayo uhlelo lwezempilo olufanelekayo lwe-HSA.

Izwi elivela

Umshuwalense wezempilo kubalulekile kodwa futhi ungabangela ukukhathazeka futhi kube nzima. Kungakhathaliseki ukuthi unesimiso sikahulumeni, uhlelo lokuhlinzekwa olunikezwa umqashi wakho, noma inqubomgomo owathengile yona, ukuqonda okuqinile ukuthi umshuwalense wezempilo usebenza kanjani kuyokusiza kahle. Uma wazi ngokwengeziwe, kuzoba lula kuwe ukuqhathanisa izinketho zepulani futhi wazi ukuthi uthola inani elihle kakhulu kusuka ekuthungeni kwakho umshuwalense wezempilo. Futhi qiniseka ukuthi usizo luhlala lukhona uma unemibuzo.

> Imithombo:

> I-Gallup, Isilinganiso se-US Uninsured ku-11 Amaphesenti, aphansi kunayo yonke iminyaka engu-8,

> Kaiser Family Foundation, Ukuphepha Kwempilo Yomphakathi Wabantu Bonke, ngo-2014.