Yazi kahle ngezinketho zakho zokushintshanisa
Uma uthenga umshuwalense wakho wezempilo, kungenzeka ukuthi wezwe ngezinhlelo ezihleliwe, kuye ngokuthi uhlalaphi. Eziningana zomshuwalense wempilo yomshuwalense wezempilo zivele zinikeza izinhlelo ezihleliwe ngezinga elithile. Kodwa uma ukubhaliswa okuvulekile kuqala ngoNovemba 1, izinhlelo eziqinisekisiwe zizotholakala okokuqala emazweni asetshenziselwa ukushintshaniswa kwe-federally, ne-start of "Izinqumo Ezilula".
Ukusetshenziswa Kokusebenza Kusebenza Kanjani?
Hlela ukusimiswa yilokho okuzwakalayo. Izikhombandlela zibekwa ngokwemigomo ethile yokubika, futhi zonke izinhlelo ezihlelekile kumele zinikeze ukulandelwa okufanayo kulezo zici zalolu hlelo.
I-Healthcare.gov igxila izinhlelo ezilungisiwe ze-2017, nakuba ukuhlanganyela kuyoba okuzikhethela, okungenani ekuqaleni. Lapho uMnyango WezeMpilo Nezinsizakalo Zomuntu ushicilela ama-Benefit and Payment Parameters ngo-2017, babeka imininingwane yezinhlelo eziyisithupha ezihleliwe zezinhlelo ezizokwazi ukuhlinzeka ngezinkampani (imininingwane ekhasini 309 leParagraf Benefit and Payment Parameters ). Kakhulu ngangokunokwenzeka, i-HHS isebenze ukugcina uhlelo olulinganiselwe luklama okufana namapulani asevele anikezwe ngo-2015.
Kulabo abathwali abasebenzisa ukushintshaniswa kwe-federally (okusho, i-Healthcare.gov), kuzoba khona ukhetho oluhlelekile lwepulani ngalinye lamazinga wezethusi, isiliva, negolide, kanye nezinhlelo ezintathu ezenziwe ezihleliwe ezihlelekile ezingeni lesiliva kubantu bafanelekele ukuxhasa ngemali yokwabelana ngemali .
Ukushintshaniswa kwe-federally-run ngeke kube nomklamo we-HSA ofanelekayo we-design ku-2017, nakuba izinhlelo ze-HSA-ezifanelekayo zizobe zitholakala ukuthengwa phakathi kwamacebo angekho amisiwe azotholakala.
Ngezinhlelo ezihleliwe zokukhetha okulula, izici eziningi zokwaziswa kuzoba okufanayo kungakhathaliseki ukuthi yimuphi umshwalense wempilo yomshwalense ohlinzeka uhlelo.
Isibonelo, zonke izinhlelo zesiliva eziqinisekisiwe ku-exchange federalally-run exchange zizoba nama-dollar angu-3 500 ama-dollar, amahhovisi angama-$ 30 angama-dollar aqala ukuvakashela ama-copays, kanye nama-copays angu-$ 15 / $ 50 / $ 100 wegama lomkhiqizo / kuyoba ngamaphesenti angu-40 ngezinhlelo zesiliva ezilinganiselwe).
Lapho abathengi bangena kwi-Healthcare.gov lokhu kuwa ( ukubhaliswa okuvulekile kuqala ngoNovemba 1 ), bazobona izinhlelo ezilula zokukhetha eziboniswa ngokucacile phakathi kwezinketho ezikhona; ukushintshanisa sekuzibophezele ukwenza kube lula ngabantu ukuthi banqume ukuthi yiziphi izinhlelo ezihleliwe futhi ezingekho.
Izinhlelo Eziqinisekisiwe Zihluke Kanjani?
Nakuba izinhlelo ezihleliwe zenza ukuqhathanisa ama-apula kuya ku-apula kulula kakhulu, usadingeka uqaphele imininingwane yepulani. Izinhlelo zingahlukahluka kwezinye izindawo ezingakhulumi ngokuqondile ngemikhombandlela yokuhlelwa kwepulani. Amanethiwekhi omhlinzeki kanye namafomula (izinhlu zezidakamizwa ezihlanganisiwe) nazo zizohluka kakhulu kusuka kwelinye icebo ukuya kwelinye.
Ngakho-ke nakuba ungase uqhathanise izinhlelo ezintathu zesiliva ezilinganiselwe ukuthi bonke banezindleko ezifanayo zokuphuma kwezidakamizwa, uzodinga ukubheka ama-formularies yenkampani ngayinye ukuze unqume ukuthi ihlanganisa yini isidakamizwa esithile oyidingayo, futhi uma ngakho-ke, yimuphi umuthi wesiguli osebenzayo.
Ngezinhlelo ezilula zokukhetha ukuthi i-Healthcare.gov iyaqala ngo-2017, inethiwekhi eyodwa kuphela yomhlinzeki ivunyelwe uhlelo ngalunye, ngakho ngeke kube khona izinhlelo zokuxhumana zenethiwekhi phakathi kwezinketho ezihlelekile. Kodwa amanethiwekhi ngokwawo azohluka kusuka kwelinye icebo kuya kwelinye.
Akukhona yini izinhlelo zezempilo ezivele ziqinisekisiwe?
I-Care Affordable Act isivele ilethe izinga elithile lokulinganisa emakethe yomshuwalense wezempilo ngabanye, ngokusungulwa kwezigaba zezinsimbi zezinhlelo zezempilo . Zonke izinhlelo zomshuwalense wezempilo ngezinsuku eziphumelelayo zikaJanuwari 2014 noma kamuva-kuhlanganise nezinhlelo ezithengiswa ngaphandle kwezokuhwebelana-ezifanelekile noma ezihlelweni lwezinsimbi noma zibe uhlelo oluyingozi.
Ngenxa yokuthi zonke izinhlelo ezintsha zezempilo zenziwe ngethusi, isiliva, igolide, i-platinum, noma inhlekelele, kulula kakhulu ukuba abathengi baqhathanise ama-apula nama-apula kunangaphambi kuka-2014. Kodwa ukuhlukaniswa kwezinga lensimbi kunqunywa ngokubaluleka kwe-actuarial (AV) lohlelo . Futhi akuyona isilinganiso esivame ukusho okuningi kubathengi ngabanye. Ama-bronze amapulani ane-AV engamaphesenti angu-60 (empeleni ububanzi, kusukela kumaphesenti angu-58 kuya kumaphesenti angu-62; amaphesenti angu-+/- amaphesenti angu-2 asebenza kuwo wonke amazinga wokuhlukanisa), izinhlelo zesiliva zine-AV yezingxenye ezingu-70, izinhlelo zegolide ezine-AV Amaphesenti angu-80, nezinhlelo ze-platinum zine-AV ezingamaphesenti angama-90.
Ngakho-ke, kungalindelwa ukuthi isamba sesiliva sikhokhele cishe amaphesenti angu-70 ezindleko zokunakekelwa kwezempilo okuphelele kuwo wonke umuntu ojwayelekile. Kodwa lokho kuphakathi, kuhlanganise nabantu abanokuncane kakhulu kokusebenzisa imali, kanye nabantu abangase badinge ukunakekelwa okungamamitha ayizigidi ngonyaka.
Umuntu onenkinga encane yokunakekelwa kwempilo angase akhokhe iningi noma ukunakekela kwakhe konke phakathi nonyaka, ngokuya ngesakhiwo sakhe sokuhlela (okungukuthi, uma une-$ 3,000 esetshenzisiwe futhi esebenzisa kuphela imali eyi-$ 1,000 yokunakekelwa kwezempilo okusebenza kuyo, d akhokhele izindleko ezigcwele). Ngakolunye uhlangothi, umuntu obhekene nezindleko zokunakekelwa kwezempilo afinyelele ku-dollar ayizigidi ngonyaka uyokhokha ingxenye encane yezindleko zakhe, ngoba uhlelo lwakhe lwezempilo luzokhokha amaphesenti angu-100 ezindleko zakhe ngemuva kokushaya okuphezulu kwe-pocket uhlelo lwakhe.
Nakuba izinhlelo ezingaphansi kwezinga elifanayo lesimbi zine-AV efanayo, ukucaciswa okuqondile kungashintsha kakhulu kusuka kwelinye icebo kuya kwelinye. Isibonelo, kuvamile ukubona izinhlelo zesiliva ngamadeductibles avela ku $ 1,500 kuya ku-$ 4,500. Abanye banama- copay ekuvakashelweni kwehhovisi , kanti abanye abakwenzi. Abanye banesidumbu esiphezulu se-pocket sokuvulwa , kanti abanye banama-caps aphansi angaphandle kwe-pocket. Ngamafuphi, kunezindlela eziningi ezahlukene ukuthi uhlelo lungakwazi ukufeza i-AV ngaphakathi kwesinye sezigaba ezenzelwe izinhlelo zezinga lensimbi.
Ngakho-ke nakuba abathengi abanciphisa ukusesha kwabo ezingeni elilodwa lensimbi bazobe beqhathanisa izinhlelo ukuthi zonke zinikeza inani elifanayo elifanayo, zingase zithole ukuthi inqubo yokuqhathaniswa kwepulani ingaba yinkimbinkimbi, ikakhulukazi lapho kunezinqwaba zomshuwalense wezempilo ezithintekayo.
Ukwethulwa kwemiklamo yezinhlelo ezihleliwe kuwumzamo wokwenza inqubo yokuqhathaniswa kwepulani inembile, futhi ingasiza ekunciphiseni ukusabalalisa kwezinhlelo zokuhlela ezibandlulula.
Amazwe Asevele Akhona Izilungiselelo Ezibekiwe
Izifunda eziningana sezivele zinezinhlelo ezilinganisiwe ekushintshaneni kwabo. Uhlelo lokuhlelwa kwepulani luhlukahluka kusuka kumbuso kuya kuhulumeni, kodwa ukugxila okuphelele ekugciniwe ukugcina ama-deductibles, ama-copays, u-coinsurance, kanye nezindleko ezingaphandle kwe-pocket ezifanayo kuzo zonke izinhlelo eziqinisekisiwe ezingeni elikunikezwayo. Ngakho-ke, zonke izinhlelo zesiliva eziqinisekisiwe ekushintshaneni kwe-Oregon zizoba ne-$ 2,500 ezidonswayo ngabanye ngonyaka ka-2017 futhi ihhovisi lika-$ 35 lokunakekelwa okuyisisekelo livakashele ama-copays.
Uhlelo oluningi oluhlelekile luklama ukunakekelwa kwezilwane zangaphandle kanye nama-copays, kunokuba kusetshenziswe kulokhu kukhishwe. Iningi lichaza ngezinhlelo ezihleliwe zepulani futhi zivumela abathwali ukuba banikeze izinhlelo ezingekho ngaphansi kwazo:
- E- California , ukushintshaniswa kuvumela kuphela abathwali ukuba banikeze izinhlelo ezihleliwe.I-Covered California-exchange-run exchange-ayivumeli ukuthengiswa kwezinhlelo ezingaqinisekisiwe, futhi kakhulu ekusekeleni ukwethulwa kwezinhlelo eziqinisekisiwe kumazwe asebenzisa impilo .gov esikhundleni sokuzikhandla.
- I-New York idinga inshuwalense yezempilo ukuthi inikeze okungenani uhlelo olulodwa oluqinisekisiwe ezingeni ngalinye lensimbi, nakuba izinkampani zomshuwalense nazo zivunyelwe ukuba zinikeze izinhlelo ezintathu ezingekho eziqinisekisiwe. Amaphesenti angu-61 abantu ababhalise ngeNew York State State of Health ngo-2015 akhethiwe izinhlelo ezihleliwe.
- UMassachusetts usungula izinhlelo zomshuwalense wezempilo ozimele ngonyaka ka-2010, futhi ziyaqhubeka zitholakala ngokushintshaniswa kombuso, eMassachusetts Health Connector. Kodwa abathwali abathengisa izinhlelo emashini aseMassachusetts nabo banenketho yokunikeza izinhlelo ezingekho ngaphansi kwazo.
- Esigodini saseColumbia , i-exchange-DC Health Link- yazisa izinhlelo ezihleliwe ngo-2016 , kodwa abathwali banokuguquguquka okukhulu ukuhlinzekela izinhlelo ezingekho ngaphansi kwe-aswell. Ukushintshaniswa kudinga kuphela ukuthi othwali bezinkampani banikeze uhlelo oluqinisekisiwe kunoma iyiphi iveli lessimbi lapho othwala abanikeza khona izinhlelo.
- Uhlelo lwe-Connecticut -Access Access CT-ludinga abathwali ukuba banikele okungenani uhlelo olulodwa lwegolide oluhlelekile, okungenani uhlelo olulodwa lwesiliva olufanele (okumele lube uhlelo oluphansi kunazo zonke lwesiliva umhlinzeki ohlinzeka), futhi okungenani izinhlelo ezimbili zethusi ezilinganiselwe, eyodwa okumele kube yi- HSA-ehambisanayo . Abathwali abathintekayo abavunyelwe ukuba basebenzise izidingo zesango lomsebenzi wezinhlelo zabo ezihleliwe; ababhalisile kumele bavunyelwe ukuvakashela ochwepheshe ngaphandle kokudluliselwa kudokotela odokotela bokuqala. Uma nje abathwali behlangabezana nezidingo zepulani ezihlelekile, banganikeza nezinhlelo ezimbili ezingekho ngaphansi kwe-platinum, futhi kuze kube nezinhlelo ezintathu ezingezona ezihleliwe kuzo zonke izigaba zethusi, zesiliva negolide.
- I-Oregon ekuqaleni yayinokushintshaniswa ngokugcwele kombuso, kepha manje isebenzisa i-Healthcare.gov njengesikhulumi sayo sokubhalisa. Umbuso wadala izinhlelo ezihleliwe ezigabeni zethusi, zesiliva negolide, kodwa izinkampani zomshuwalense ezihlinzekela ukukhokhelwa ekushintsheni zinganikezela nezinhlelo ezimbili ezingezona ezihlelekile kanye nezinhlelo ezimbili "ezintsha" ezingeni ngalinye lokufunda.
- Ukushintshaniswa kombuso kaVermont, Vermont Health Connect, kunezinhlelo ezenziwe nge-bronze, isiliva, igolide, kanye ne-platinum , kanye nezinhlelo ezingeziwe ezenziwe ngezinga le-bronze nesiliva ezihambisana ne-HSA. Abathwali ababili enkonzweni kahulumeni bahlinzeka ngezinketho ezingalungisiwe zepulani.
I-HHS yenza izinhlelo eziqinisekisiwe kakhulu zokuzithandela-zabathwali nabathengi-ngo-2017. Ngokuya ngokuthi izinhlelo ezikhethiwe ze-Simple Choice ziyatholakala kanjani, zingase zibe yinto edingekayo ekushintshaneni kwezemidlalo esikhathini esizayo.
Futhi nakuba abanye abagxeki bephikisana ngokuthi izinhlelo ezihleliwe zifakaza emisha emakethe yomshuwalense wezempilo, kufanele kuqaphele ukuthi cishe wonke ama-exchange-run exchange asebenzayo asevele anesimiso esivumelekile futhi avumela abathwali ukuba bathengise izinhlelo ezingekho eziqinisekisiwe.
> Imithombo:
> Ukufinyelela kwezeMpilo CT, Ukuncenga Abahlinzeki bezeMpilo UkuHamba iqhaza Emiphakathini Yezinketho zezeMpilo zeBhizinisi kanye / noma ezincane (SHOP) Izindawo zokuhweba, Uhlelo Lonyaka 2016 .
> Covered California, Izinkampani Zomshuwalense WezeMpilo kanye Namazinga Wokuhlela we-2016 .
> UMnyango WezeMpilo kanye Nezinsizakalo Zabantu, Ukuvikelwa Kweziguli kanye Nokunakekelwa Okunakekelwayo Okunakekelwayo, Isaziso Sezinzuzo Nezikhawulelo Zokukhokha ze-2017 https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-04439.pdf .
> State of Health of New York, Isimemo Nezimfuneko Ze-Insurer Certification and Recertification for Participation in 2016 .
> Oregon Division of Financial Regulation, Oregon Izinhlelo Zempilo Eziqinisekisiwe, Isifinyezo Sokuxhumana.