Inshuwalansi ya Mankhwala Ovomerezeka

Zachidule za Inshuwalansi ya Mankhwala Osokoneza Bongo

Mankhwala osokoneza bongo ndi mbali yaikulu ya dongosolo lathu lachipatala. Magazini ya American Medical Association (JAMA) inanena kuti 59 peresenti ya anthu a ku America amagwiritsa ntchito mankhwala osachepera amodzi mu 2011-2012. Kotero ngakhale ngati simukugwiritsa ntchito mankhwala a nthawi yaitali kuti mupepetse matenda aakulu, mwayi ndi wabwino kwambiri kuti mufunikira mankhwala tsiku ndi tsiku.

Ndipo malamulo omwe anthu amawatenga akukwera mtengo kwambiri, pamlingo umene umakhala wotsika kwambiri padziko lonse lapansi (izi sizatsopano zatsopano; nkhani ya Health Health kuyambira 1990 inanena kuti ndalama zomwe zimagwiritsidwa ntchito pa ndalama ndizo zina mwazinthu zowonongeka mwakuya kwa mabanja okalamba m'ma 70s ndi m'ma 80s).

JAMA inanena kuti kuyambira chaka cha 2013, ndalama zogwiritsira ntchito mankhwala osokoneza bongo ku United States zinali zopitirira kawiri za mayiko ena otukuka, ndipo anawerengera 17 peresenti ya "chithandizo chonse chaumoyo waumwini." Malingana ndi 2015 Milliman Medical Index, mtengo wa mankhwalawa unakwera ndi 13.6 peresenti kuyambira 2014 kufikira 2015, chomwe chinali chachikulu chomwe chikuchititsa kuti pakhale kuchuluka kwa ndalama za chithandizo chaumoyo panthawi imeneyo.

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Mwachionekere, kulipira mankhwala osokoneza bongo ndi gawo lalikulu la ndondomeko ya inshuwalansi ya thanzi. Koma kufalitsa kwa mankhwala osokoneza bongo kwasintha kwambiri pazaka makumi angapo apitayo. Kulemba kwalembedwa kwa nthawi yaitali kwakhala kovuta pazinthu zambiri za inshuwalansi zaumoyo, koma pa msika wina kumayambiriro kwa zaka za 2000s, ena ogulitsa amayamba kusunthira ku zolinga zomwe sizinalembedwe mankhwala, kapena kuti ndi mankhwala okhawo omwe amapezeka. Kumayambiriro kwa chaka cha 2013, malinga ndi kafukufuku wa HealthPocket, ndi 82 peresenti yokha ya malonda yomwe imapezeka pamsika wogulitsa mankhwala osokoneza bongo, kuphatikizapo ndondomeko zokhala ndi "malire ochepa".

Kusintha kwa zaumoyo ndi mankhwala ovomerezeka

Pamene Ntchito Yabwino Yothandizira Padzikoli inalembedwa, olemba malamulo ankadziŵa kuti mankhwala oyenera a mankhwalawa amayenera kuikidwa pamakonzedwe onse, popeza zotsatira zachuma ndi zachipatala zosakhala ndi zolembera za mankhwala zingakhale zodabwitsa.

Mankhwalawa ndi chimodzi mwa zinthu zofunika kwambiri za thanzi la ACA, zomwe zikutanthauza kuti zakhala zikugwiritsidwa ntchito pazinthu zonse zatsopano zaumoyo kuyambira m'chaka cha 2014. Magulu akuluakulu (m'mayiko ambiri, amatanthauza antchito 51, ngakhale Ochepa amati , amatanthawuza antchito osachepera 101) sali oyenera kubisa zofunikira zaumoyo zofunikira za ACA kupatulapo chisamaliro chodziletsa , koma magulu ambiri a magulu akukonzekera kale kale mankhwala osokoneza bongo asanayambe kukhazikitsidwa, ndipo apitiriza kuchita zimenezo.

Kodi Inshuwalansi ya Umoyo Imapanga Bwanji Zolemba Zake?

Pali kusiyana kwakukulu potsata njira zaumoyo zomwe zimaphatikizapo mankhwala osokoneza bongo. Pali zinthu zitatu zomwe zimagwiritsidwa ntchito:

• Makope a malamulo omwe amayamba nthawi yomweyo. Mwachitsanzo, ndondomeko ikhoza kulipira madola 10 / $ 25 / $ 50/30% pa mankhwala a chigawo 1 / Tier 2 / Tier 3 / Tier 4, opanda deductible kapena kugawana mtengo wina .

• Dokotala wotchedwa deductible yemwe ndi wosiyana ndi mankhwala ochotsera mankhwala, pambuyo pake amagwiritsidwa ntchito malinga ndi mankhwala osokoneza bongo. Mu bungwe la Benefit ndi Payment Parameters la 2018, HHS inanena kuti mapulani omwe akukonzekeretsa mu 2018 adzaphatikizapo mankhwala osokoneza bongo ndi mankhwala omwe amagawidwa chifukwa cha ndalama, "kuwonetsera kuti zonsezi zimagwiritsidwa ntchito pa QHPs pamagulu awa kufalitsa. " Mwa kuyankhula kwina, kukonza ndondomekoyi kwakhala kofala kale pamakonzedwe ogulitsidwa pamsika. Pogwiritsa ntchito ndondomeko zomwe HHS yanena kuti izi zichitike mu 2018, ndondomeko zasiliva zikanakhala ndi madola 500 a madokotala omwe adzalandira mankhwalawa, kuphatikizapo madola 3,500 a madokotala.
• Mgwirizano wa mankhwala ovomerezeka wogwiritsidwa ntchito, wogwiritsira ntchito mankhwala kapena ndalama zothandizira ndalama zomwe zimagwiritsidwa ntchito pokhapokha mutagwiritsidwa ntchito. Mapulani a HSA sangathe kupereka zopindulitsa zina kupatula chithandizo choletsa chithandizo chisanafike, kotero kuti mapulaniwa adzangotenga zomwe mwalemba pambuyo mutapereka ndalama zanu pachaka.

Madera ena atha kukhazikitsa malamulo oletsa momwe polojekiti yaumoyo ingafunire anthu kuti azilipira mankhwala apadera, pofuna kuyesa mankhwala omwe angakwanitse kwa anthu omwe ali ndi chikhalidwe chomwe chingathe kuchiritsidwa ndi mankhwala okwera mtengo kwambiri.

Koma ngakhale ngati dziko lanu silili, ndipo mukulipilira ndalama zochuluka mtengo wa mankhwala okwera mtengo pamwezi uliwonse, dziwani kuti ndondomeko yanu yathandizira inshuwalansi idzalipiritsa ndalama zanu zapadera pokhapokha ngati mutatulutsa -m-thumba lalikulu pa chaka. Kuchokera nthawi imeneyo, mankhwala anu adzalumikizidwa mokwanira kwa chaka chotsalira.

Zonse Zokhudzana ndi Malamulo

The formulary ndi mndandanda wa mankhwala zomwe dongosolo lanu labwino lidzaphimba. Pogwiritsa ntchito mankhwalawa, magulu azaumoyo amagawaniza mankhwala osokoneza bongo, ndipo mankhwala osokoneza bongo amatha kukhala pa Gawo 1 ndipo mankhwala okwera mtengo kwambiri ali mu Gawo 4, 5, kapena 6, malinga ndi momwe pulaniyi yapangidwira.

Mankhwala osokoneza bongo amatha kukhala mankhwala apadera , kuphatikizapo jekeseni ndi biologics . Kwa mankhwalawa, wogula kawirikawiri amayenera kulipira peresenti ya mtengo (mwachitsanzo, ndalama zothandizira osati ndalama ), pokhapokha ngati malamulo a boma ali ndi kapu pazofunika za mankhwala osokoneza bongo.

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Muzitsogozo zotsimikiziridwa ndi HHS ndi olamulira a boma, a inshuwalansi a zaumoyo ali omasuka kuti apange zolemba zawo zokha ndikuzisintha ngati pakufunika nthawi.

Pansi pa ACA, pulani ya formulary iyenera kutsekula kwambiri

• mankhwala osachepera m'madera onse a US Pharmacopeia ndi kalasi
• chiwerengero chomwecho cha mankhwala mu gawo lirilonse ndi kalasi monga ndondomeko yachitsulo yosankhidwa ndi boma
• Mapulani azaumoyo amafunikanso kukhala ndi komiti ya mankhwala ndi mankhwala (P & T) omwe amayenera kutsimikizira kuti formulary ndi yochuluka.

Choncho, ngakhale gulu lonse la mankhwala likuphimbidwa, izi sizikutanthauza kuti mankhwala enieni adzakonzedwa ndi ndondomeko iliyonse, kapena ndi mapulani alionse m'deralo. Pali njira yodandaulira yomwe ilipo , komabe, ngati inu ndi dokotala mukukhulupirira kuti ndi kofunikira kuti mugwiritse ntchito mankhwala omwe sali pa dongosolo lanu labwino.

Mankhwala ndi Mankhwala Osokoneza Bongo

Mosiyana ndi malonda a inshuwalansi zaumwini, Choyamba Medicare (Medicare Mbali A ndi B) sichikuyimira mankhwala osokoneza bongo. Mu 2003, Congress inadutsa HR1, Medicare Prescription Drug, Improvement, ndi Modernization Act ya 2003. Lamulo linakhazikitsa pulogalamu yatsopano- Medicare Part D -thandizidwe kuwona mtengo wa mankhwala ovomerezeka kwa a Medicare olembetsa.

Pofuna kufotokozera malamulo, Medicare olembetsa ayenera kukhala ndi chinsinsi. Pali njira zochepa zopezera kufotokozedwa kwa madokotala mukalandira Medicare:

• mankhwala a Medicare Part D Kukonzekera kwa Mankhwala Osokoneza Bongo , omwe angagwiritsidwe ntchito polemba ndi Original Medicare
• Ndondomeko ya Medicare Yophatikizapo yomwe ikuphatikizapo gawo la mankhwala D (Medicare Advantage plans) amadziwika kuti MAPD)
• Zowonjezeredwa kufalitsa kuchokera kwa abwana kapena abwana a bwana

Medicare Part D ili ndi " dzenje " pamene olembetsa poyamba anali ndi ndalama zokwana 100 peresenti ya ndalama zawo. Ndalama Zopindulitsa Zophatikizapo zikuphatikizapo ndondomeko yotsekera dzenje; Ndondomekoyi ikukhazikitsidwa pang'onopang'ono, ndipo dzenje lidzatha pofika 2020.

Medicaid & Prescription Dawa

M'mayiko onse, Medicaid imaphatikizapo mankhwala osokoneza bongo. Ngati mwalembetsa ku Medicaid (kuphatikizapo anthu omwe adangokhalira kulandira thandizo chifukwa cha kukula kwa Medicaid ), malamulo anu adzakwaniridwa mokwanira kapena ndi mapepala ochepa kwambiri.

Komabe, kwa anthu omwe ali ovomerezeka ku Medicaid ndi Medicare , Medicaid anasiya kulemba mankhwala osokoneza bongo mu 2006, pamene Medicare Part D inayendetsedwa. Ovomerezedwa awiriwa amalandira zolemba zawo kudzera mu Medicare Part D (m'malo mwa Medicaid), koma Pulogalamu Yowonjezera Yowonjezera imalipira malipiro ndi magawo ambiri omwe akugawira mtengo pa dongosolo la mankhwala.

Mapulani Otsatsa Mankhwala Osokoneza Bongo ndi Mapulani Okhazikika

Ngati muli pa mapologalamu aakulu omwe sali ndi mankhwala osokoneza bongo, kapena ngati simukulimbikitsidwa, pali mitundu yosiyanasiyana ya mankhwala osungiramo mankhwala osokoneza bongo komanso mapulani osokonekera pamsika. Iwo akhoza kuperekedwa ndi makampani a inshuwalansi, pharmayi, opanga mankhwala osokoneza bongo, kapena mabungwe othandizira / ubungwe monga AARP.

Ngati mukuganiza za dongosololi, werengani bwino kusindikizidwa mosamala kwambiri. Dziwani kuti ndi ndondomeko yowonjezera, mutha kupereka ndalama zochuluka kwa mankhwala osokoneza bongo, choncho kumbukirani kuti ngati zipangizo zamalonda zimati "mpaka 60 peresenti," sizikutanthauza kuti mudzapeza 60 peresenti pa mtengo wa mankhwala alionse omwe mungawafunire.

Mapulani osokoneza bongo sayenera kuwerengera ngati ACA, kotero ngati simukuvomerezedwa ndipo muli ndi inshuwalansi ya mankhwala kapena ndondomeko yotsika mtengo, mukanakhalabe pachikole cha chilango cha ACA, mukuganiza kuti ndinu osataya.

Chidziwitso Chochokera

Malemba ndi okwera mtengo, ndipo kufotokozera mokwanira kungathandize kusiyanitsa mankhwala anu ndi kuchita popanda.

Ngati mukuvutikira kulipira malamulo anu, pali mapulogalamu othandizira mankhwala omwe angakuthandizeni. Ngati mwasokonezeka ndi zomwe mumapindula kapena zosankha zomwe mungapeze, funsani gulu la HR wanu, kapena kwa wogulitsa kapena woyendetsa ndege amene angakuthandizeni kufanizitsa mapulani osiyanasiyana. Chonde musamve ngati mukuyenera kuziganizira nokha; Thandizo likupezeka kumudzi wanu.

> Zotsatira:

> Congress.gov. Medicare Mankhwala Oletsedwa Mankhwala, Kupititsa patsogolo, ndi Modernization Act wa 2003. 108th Congress (2003-2004).

> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu, Chitetezo cha odwala ndi ndalama zothandizira pa ntchito, HHS Zindikirani Zopindulitsa ndi Zopereka Zowonjezera za 2018 . 9/6/2016.

> Girod, Christopher S., Weltz, Scott A., Hart, Susan K., 2015 Mwezi wa Zamankhwala wa Mamiliyoni, May 19, 2015.

> Kantor, Elizabeth D., MPH; Rhem, Colin D., PhD, MPH; Haas, Jennifer S., MD, MSc; Chan, Andrew T., MD, MPH; Giovannucci, Edward L., MD, ScD. Mmene Mungagwiritsire Ntchito Mankhwala Osokoneza Bongo Pakati pa Akuluakulu ku United States Kuchokera mu 1999-2012. Magazini ya American Medical Association , November 3, 2015, Vol. 314, No. 17.

> Kesselheim, Aaron S., MD, JD, MPH; Avorn, Jerry MD; Sarpatwari, Ameet, JD, PhD. Mtengo Wapamwamba wa Mankhwala Osokoneza Bongo ku United States. Magazini ya American Medical Association , August 23/30, 2016, Vol. 316, No. 8.