Imithethonqubo Yenzelwe Ukuzinzisa Amakethe Omshwalense
Ukukhathazeka mayelana nokuzinza kwemakethe yomshuwalense wezempilo ngamunye (kokubili kanye nokushintshaniswa kwezimali) sekulokhu kugijima isikhathi eside. Abaningi bomshuwalense baphuma emakethe noma yonke imakethe ekupheleni kuka-2016, futhi amaphrimiumende angaphambi kokubambisa enyuke ngamaphesenti angu-25 ngo-2017 ( ukuxhaswa ngemali ekukhulumeni kwakhula kwaze kwaba nzima ukukhuphuka kwamaholo amaningi abantu abafanelekayo abathengisa ukuthengiswa kokushintshaniswa; ngakho-ke ukuba kucace, ama-premium awazange akhuliswe ngamaphesenti angu-25 kubantu abaningi abathenga izinhlelo zabo ekushintsheni).
Ukubhekisisa ukukhathazeka kwemakethe, uMnyango wezeMpilo kanye noHulumeni lwaMuntu uhlongoze uchungechunge lwezinguquko phakathi no-Febhuwari, emva kwezinsuku ezimbalwa uNobhala weHHS uTom Price uqinisekiswe yiSenate.
Isaziso sokwenziwa komthetho okuhlongozwayo simayelana nokuqiniswa kwemakethe ezimakethe zeqembu ngalinye namancane. Ngokuvamile, izimakethe zeqembu ezincane zizinzile. Kodwa imakethe ngayinye kwezinye izifundazwe yayisemgodini wokuwa phansi ngasekupheleni kuka-2016, kanti uHumana wamemezela ngoFebruwari 14 ukuthi bazophuma ngokuphelele emakethe yomshuwalense wezempilo womhlaba wonke ekupheleni kuka-2017 (okwamanje banikela ngamalungiselelo ngabanye emazweni angu-11 ).
Ngo-Ephreli 13, i-HHS yaqedela imithethonqubo yokuqiniswa kwemakethe, ikakhulukazi njengoba ihlongozwayo. Abanye abathintekayo babethembise imithethonqubo njengesinyathelo esihle sokumisa imakethe yomshuwalense, kodwa abanye bathi ezinye zezimiso ezintsha zizobangela ukuba amanye emakethe ahlasele.
Kubalulekile ukuphawula ukuthi njengabaqashi abakha amazinga kanye nezinhlelo zabo ngo-2018, baphinda baqaphele ukuthi izici ezimbili ezibaluleke kakhulu ezifaka emakethe ekuqedeni ukuqinisekiswa komthetho yi-ACA, futhi ukungabi nokuqinisekiswa ngokwezimali ngokuqhubekayo ukuze uthole ukwabelana ngezindleko .
Ayikho yalezi zinkinga ezibhekiswe emithethweni yokuqiniswa kwemakethe, futhi izenzo zikaHulumeni zeTrump zenze iqhaza ekumakethe emakethe ezindaweni ezimbili.
Imithetho Yokusimamisa Imakethe Iyothinta Umshwalense Wakho Wezempilo?
Abantu abathola umshuwalense wabo wezempilo kusuka kumqashi omkhulu (ezindaweni eziningi, lokho kusho abasebenzi abangu-50 + ), i- Medicaid , noma i- Medicare ngeke ithinteke yizinguquko ezenziwe uHHS. Izinguquko zisebenza kakhulu emakethe ngayinye, lapho kungamaphesenti angaba ngu-7 ebantwini base-US, nakuba abantu abasebenzela abaqashi abancane bangabona izindleko ezingaphezulu kwe-pocket, futhi mhlawumbe amaphrimiyamu aphansi.
1. Kubantu abathengisa umshwalense wabo wezempilo, ukubhaliswa okuvulekile ngo-2018 kuzoba mfushane kunekadlule.
Ngaphambi kokubusa kokumaketha emakethe, isikhathi sokubhalisa sika-2018 sivuliwe ukulandela isimiso esifanayo esasetshenziswa ngo-206 no-2017 (Novemba 1 kuya kuJanuwari 31). Kodwa ukuhlinzeka ngo-2019, uhlelo lwaluzoqala ukusebenzisa isikhathi esifushane sokubhalisa, kusukela ngoNovemba 1 futhi kuphelile ngoDisemba 15. UHHS uye wakhetha ukushintshela esikhathini esifushane sokubhalisa ngonyaka odlule, futhi uqale ukuyisebenzisa ekupheleni kuka-2017 (ukufakwa kokusebenza okuphumelelayo ngo-2018), esikhundleni sokulinda kuze kube sekupheleni kuka-2018.
Ngakho-ke abantu abathengisa umshwalense wabo wezempilo (okungukuthi, abawutholi kumqashi noma ohlelweni lukahulumeni njengoMedare noma iMedicaid) bayoba nefasitela elifushane ukuze bakhethe uhlelo ngo-2018. Luzoqala ngoNovemba 1, 2017, futhi iphele ngoDisemba 15, 2017.
Lokhu kusho ukuthi akukho luhlelo olushintsha emva kokuqala konyaka, ngakho ngeke kube khona ithuba lokushintsha izinhlelo ngoJanuwari uma ukuguqulwa kwakho kwe-premium kuyakuthola uqaphe. Kuzobaluleke ngokukhethekile ukuthi uqaphele noma iyiphi i-premium kanye nohlelo lokushintsha izaziso ozitholayo ngo-Okthoba / Novemba kusuka enkampanini yakho yomshuwalense noma ukushintshaniswa, futhi wenze uhlelo luguqulwe ngaphambi komhlaka-15 Disemba.
Ngemuva kwalokho, hlela izinguquko kanye nokubhaliswa okusha kuzokwenzeka kuphela uma unomcimbi ofanelekayo .
Lokhu ngeke kushintshe noma yini mayelana namawindi okubhalisa avulekile okwamanje kumshuwalense wezempilo oxhaswe ngumqashi noma i-Medicare.
2. Abantu ababhalisela izinhlelo zokushintshaniswa ngaphandle kokubhaliswa okuvulekile kuzomele banikeze ubufakazi bokuthi kufaneleke, futhi ukufaneleka kwezikhathi ezikhethekile zokubhalisa kuzovinjelwa kwezinye izimo.
I-ACA nemithethonqubo elandelwayo ivumela abantu abanezimo ezihlukahlukene ezifanelekayo ukuba babhalise ngokubambisana nge-exchange (futhi ezimweni eziningi, ngaphandle kwezingxoxo kanye ), kungakhathaliseki ukuthi unyaka wonyaka.
Lokhu kunengqondo, futhi yindlela umshwalense oxhaswe ngayo umqashi osebenza ngayo futhi. Uma umuntu eyeka umsebenzi wakhe futhi elahlekelwa ukufinyelela kumgomo womshuwalense wempilo oxhaswe ngumqashi ngoJuni, akalindelekile ukuba alinde kuze kube nguJanuwari ukuba abe nokufaka okusha. Futhi uma umntwana ezalwa ngo-Ephreli, bekungeke kube umqondo ukuphoqa umndeni ukuba ulinde kuze kufike ukubhalisa okuvulekile ukuze uthole ukuhlinzekwa kwengane.
Ngakho isenzakalo esifanele sifaka isikhathi sokubhalisa esikhethekile (SEP), lapho umfakisicelo ephethe izinsuku ezingu-60 ukuze abhalisele uhlelo olusha. Kodwa kube nokuphikisana okukhulu okuzungezile ama-SEP. Kukhona ukukhathazeka ukuthi abantu bangase "badlale" ohlelweni ngokuzenza sengathi banesidingo sokunakekelwa kwezokwelapha, futhi abahlinzeki besikhwama baye baqaphela ukuthi izindleko zesilinganiso semali ziphakeme kubantu ababhalisa ngesikhathi se-SEP ngokuphambene nabantu bhalisa ngesikhathi sokubhalisa okuvulekile.
Kodwa ngakolunye uhlangothi lwemali, abathengi bomthengi bakhombise ukuthi bambalwa kakhulu abantu abafanelekayo be-SEP ababhalisa ekubhaliseni, futhi kudinga ubufakazi bokuthi umcimbi ofanelekayo ungabangela ababhalisile abaphilile ekuqedeni inqubo. Lokhu kwacaca ngezinga elithile ngemuva kokuqinisekiswa kokufaneleka kwe-SEP okuqinisekisiwe ukuthi i-HealthCare.gov yaqala ukusebenza ngo-2016.
Phakathi kwabafakizicelo abaneminyaka yobudala engama-55 kuya ku-64, amaphesenti angu-73 afaka ubufakazi bokuthi kukhona umcimbi ofanelekayo. Kodwa phakathi kwabafakizicelo abaneminyaka engama-18-24 ubudala, amaphesenti angu-55 kuphela abafaka ubufakazi bokuthi kufanele kube khona umcimbi. Lokhu kuholela echibini lama-insureds aneminyaka ephakeme ephakathi, ehambisana nokunyuka kwezindleko zezempilo.
I-Obama Administration HHS ibihlele uhlelo lokushayela, kusukela ehlobo lika-2017, lapho amaphesenti angu-50 abafaka isicelo se-HealthCare.gov (okukhethwe ngokungahleliwe) kuzomele anikeze ubufakazi bokuthi umcimbi ufanelekile ngaphambi kokuba isicelo sabo sigcwaliswe.
Kodwa umthethonqubo omusha we-HHS ushintshe ukuthi kube ngamaphesenti angu-100. Kusukela ngo-June 2017, yonke i-HealthCare.gov ebhalisa abangabhaliswa ngaphandle kokubhaliswa okuvulekile kuyodingeka banikeze ubufakazi bomcimbi ofanelekayo ngaphambi kokuba isicelo sabo singacutshungulwa.
Ngaphezu kwalokho, imithetho emisha yenza ukunciphisa ukufinyelela kuma-SEP kwezinye izimo:
- Umshado uzocatshangwa nje njengomcimbi ofanelekayo uma okungenani umlingani oyedwa usevele enesibalo esincane esibalulekile (noma ehlala ngaphandle kwe-US noma ensimini yase-US ngaphambi komshado).
- Uma umuntu esevele ebhalisile ohlelweni enomntwana noma engumntwana, umzali uvinjelwe ekungenizeni ingane ohlelweni olukhona, noma ukubhalisa ingane yedwa kunoma yikuphi uhlelo olutholakalayo (uma, ngenxa yezizathu ezithile, ingane ingeke ibe khona eyongezwe ohlelweni, umzali angakwazi ukubhalisela kwelinye uhlelo esilinganisweni esifanayo sensimbi , kanye nengane). Umuntu ongaqinisekisiwe futhi onomntwana noma othole umntwana usevumelekile ukubhalisa, kanye nengane, kunoma yiluphi uhlelo olukhona. Kodwa umuntu osevele ekhona akavunyelwe ukusebenzisa ukuxhomeka komuntu othembekile njengethuba lokushintsha ukushicilela kwakhe okukhona kuhlelo olusha.
- Abantu abalahlekelwe ukukhokhelwa kokungakhokhwa kwe-premium ngesikhathi esithile sonyaka kuzodingeka bakhokhele amaphrimiyamu abo abedlule ngaphambi kokuba bakwazi ukubhalisa-ngesikhathi se-SEP noma ukubhaliswa okuvame ukuvulwa-kuhlelo oluvela kumshuwalense ofanayo (noma omunye umshuwalense ngaphansi kwenkampani efanayo yomzali). Ngokuvamile bazokhokhwa amaphrimiyamu angadluli isikhathi esingaphezu kwezinyanga ezintathu zokuqashwa, ngoba abengekho kwi-hook yama-premium uma uhlelo luphelile ngenxa yokungakhokhwa kwe-premium. Uma abantu abakule nkinga babhalisa kabusha, umshwalense uyavunyelwa ukusebenzisa izinkokhelo zabo ezintsha ze-premium ebhalansi labo elidlule.
3. Kusukela ngo-2018, kuzoba nokunye okuningi ngokwemaphesenti wezindleko zokuthi amapulani ezempilo afanele afake. Lokhu kungabangela amaphrimiyamu aphansi, kodwa ama-deductibles aphezulu kanye nama-copays. Kungase kusho nezinsizakalo ezincane zokukhokhelwa kwe-premium ezenzakalweni.
Ngaphansi kwe-ACA, wonke amahlelo ompilo omuntu ngamunye namancane amancane kufanele ahlangane namazinga amane ensimbi: ithusi, isiliva, igolide, noma i-platinum (izinhlelo eziyingozi nazo ziyatholakala kwabanye ababhalisile). Izinga lensimbi lensiza lithathwa yi- value actuarial (AV), okuyisilinganiso sephesenti yezindleko zokunakekelwa kwempilo ukuthi uhlelo lwezempilo luzokhokha, lubekwe kuwo wonke umuntu ojwayelekile. Ama-bronze amapulani ane-AV engamaphesenti angama-60, izinhlelo zesiliva zine-AV ezingamaphesenti angama-70, izinhlelo zegolide ezine-AV ezingamaphesenti angu-80, kanti izinhlelo ze-platinum zine-AV ezingamaphesenti angu-90.
Kodwa kuyoba yinselelo ezinkampanini zomshuwalense wezempilo ukuklama izinhlelo ezithinte lezo zinombolo ngokuqondile (pre-ACA, kwakungenayo imfuneko ye-AV eqinisekisiwe, ngakho-ke ama-insurers akudingeki akhathazeke ngokushaya i-AV target). Ngakho izinhlelo zezempilo zivunyelwe ukusebenzisa uhla lwe-AV esikhundleni sephesenti eliqondile. Okwamanje, ububanzi buyi-+/- 2. Ngakho-ke uhlelo lwesiliva lungaba ne-AV ephakathi kwamaphesenti angu-68 kuya kwangu-72 (izinhlelo zethusi zinebanga lazo elincane, okwamanje zibekwe ku -2 / + 5).
Ngaphansi kwemithetho emisha ye-HHS, kusukela ngo-2018, ibanga elivumelekile li--4 / + 2, okusho ukuthi uhlelo lwesiliva lungaba ne-AV noma yikuphi okuphakathi kwamaphesenti angu-66 kuya kwangu-72 (ngezinhlelo zethusi, uhla oluvunyelwe ngu -4 / +5).
Ngakho mayelana nezinhlelo abazozilungiselela ukuhlinzekela ngo-2018, izinkampani zomshuwalense zivunyelwe ukwandisa izindleko ezingaphandle kwe-pocket ( deductibles , copays , coinsurance ), ngoba ngeke kudingeke zimboze inani elikhulu lezindleko ezijwayelekile. Lokhu kusho ukuthi ama-premiums angase ahle kancane, kodwa inani abantu okufanele bakhokhe uma badinga ukunakekelwa kwezempilo liyokhula (phawula ukuthi ukwehla kwe-premium kuhlobene nokuthi ngabe bebengabikho yini kulolu shintsho; amaprimiyamu amaningi ayoqhubeka evuka ngo-2018, mhlawumbe ngempela ikakhulukazi ngenxa yeminye imakethe engaqiniseki ukuthi ikhona, kuhlanganise nokungabi khona kokucaca mayelana nokuthi izinsizakalo zokwabelana ngezindleko zizoqhubeka zixhaswa ngemali).
Kubuye kusho ukuthi izinsizakalo ze-premium zingase zibe ezincane kakhulu kunokuba ngabe ngabe zingekho ngaphandle kwalolu shintsho, ngoba zisekelwe ezindlebeni zesipiliyoni sesiliva esiphansi-izindleko (endaweni yokuhlola) endaweni ngayinye. Uma uhlelo lwesiliva oluphansi-oluphansi kakhulu olulodwa olune-AV lwamaphesenti angama-66, luzobe lubiza ngezansi kunezinye izinhlelo zesiliva nge-AV yamaphesenti angu-68 noma ngaphezulu. Futhi uhlelo lokuhlelwa kwamanani aphansi oluthile luhunyushwa ezinsizeni ezincane.
4. Ama-insurers avunyelwe ukusebenzisa amaphrimiyamu amasha kumanani adingekayo esidlule.
Ngaphansi kwemithetho yangaphambilini, uma uhlelo luphelile ngenxa yokungakhokhwa kwama-premium, lowo muntu angakwazi ukubhalisa ohlelweni olufanayo ngesikhathi sokubhaliswa okuvulekile, noma ngesikhathi sokubhalisa esikhethekile, kungekho mphumela omubi. Ukukhokhwa kwe-Premium kuzoqala ngosuku olusha olusebenzayo, futhi inkampani yomshuwalense ayivumelekile ukuthi idinga ukuthi umuntu akhokhele amaphrimiyamu akhe adlule avela ohlelweni langaphambilini.
Imithethonqubo emisha inikezela izinkampani zomshuwalense kangcono ukuqoqa amaprimiyamu adingekayo esikhathini esidlule uma umuntu ekhetha ukuphinde abhalise ohlelweni oluvela kumshuwalense ofanayo oye waqeda ukukhokhelwa ngaphambi kokukhokhwa kwama-premium (noma umshuwalense oyingxenye yeqembu elilawulwayo elifanayo, noma inkampani yomzali). Amaphrimiyamu akhokhelwa kuhlelo olusha angasetshenziswa kuma-premium ekhokhelwa esikhathini esedlule kusukela ezinyangeni ezingu-12 ezedlule, futhi abanikezeli besikhwama bavunyelwe ukwenqaba ukwenza inqubomgomo entsha kuze kube yilapho imali ekhokhelwa khona ngonyaka odlule ikhokhwe.
Amaphrimiyamu omuntu odlulile esikhathini esidlule ngokuvamile azoba izinyanga ezintathu ukuya kwezinyanga ezintathu, ngoba amaprimiyamu adingekayo esikhathini esidlule awaqhubeki ukuqhubeka ngemva kokuthi uhlelo luphelile ngenxa yokungakhokhwa kwama-premium.
Abantu bangakwazi ukuzungeza lolu shintsho ngokubhalisa ohlelweni oluvela kumshuwalense ohlukile, kodwa kwezinye izifunda, kukhona umshuwalense owodwa ohlinzeka izinhlelo ekushintsheni. Kulawo mazwe, noma ubani obanjelwe ukukhokhela imali engekho ukukhokhwa kwemaliyamuyamu kungase kube ngaphansi kokukhokhela izinkokhelo emuva kokuthi avunyelwe ukubhalisa ohlelweni olusha.
> Imithombo:
> ACAsignups.net. Isilinganiso Esingaqinisekisiwe Sokuhamba Kwezimakethe Zezimakethe Zezimakethe, 2017. Kuqedile ngo-Okthoba 27, 2016.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi , ukuvikelwa kwabagulayo kanye nomthetho wokunakekelwa okwethenjelwa; Ukuqiniswa Kwemakethe . NgoFebruwari 15, 2017.
> UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi, ukuvikelwa kwabagulayo kanye nomthetho wokunakekelwa okwethenjelwa; Ukuqiniswa Kwemakethe, Umthetho Wokugcina. Ngo-Ephreli 13, 2017.
> Humana. I-Humana > Iyaqhubeka Ukwakha Isu Lokufakazela Ukuqeda Ukuhlanganiswa Kwempahla nge-Aetna; Inikeza Isiqondiso sezezimali sika-2017; Ukwazisa izinhlelo zokuThuthukiswa koMnotho. Ngo-February 14, 2017.
> Kaiser Family Foundation. Ukuphepha Kwezempilo Kwempilo Yonke Yabantu, 2015.