Medicare mwayi mapulani amabwera mu mitundu iwiri yofunikira
Medicare Mapulani Mapulani, kapena Medicare Part C, amapereka thandizo la Medicare m'malo mwa Medicare wamba. Mapulaniwa amalola odwala kusankha ndondomeko yomwe ingapangitse kusinthasintha komwe akufunikira kuti zigwirizane ndi zosowa zawo. Izi zikhoza kukhala zodabwitsa chifukwa ambiri omwe amapindula ndi Medicare ali ndi ndalama zokwanira.
Medicare Zopindulitsa Mapulani Opindula Opindulitsa
Medicare Zopanga Mapulani Makampani ayenera kutsatira malamulo omwewo omwe amalamulira pulogalamu ya Medicare. Mankhwala a Medicare ndi mabungwe apagulu kapena apadera kuti apereke zosankha zosiyanasiyana zaumoyo zomwe zimapindulitsa zomwe Medicare Part A ndi Part B zikuphimba.
- Medicare Part A imatchedwa inshuwalansi ya chipatala chifukwa imathandiza kulipira chisamaliro chimene wodwala amalandira kuchipatala chachipatala, chipatala chodziwika bwino, malo osungirako anamwino (SNF), hospice, ndi chisamaliro chaumoyo.
- Medicare Part B ndi gawo la Medicare wotchedwa mankhwala inshuwalansi. Gawo ili la Medicare ndilolandira kwa odwala kamodzi akafika msinkhu wa zaka 65, ndipo amalipidwa mwezi uliwonse. Gawo B limapereka ntchito zambiri zomwe sizinalembedwe ndi Gawo A.
Mitundu ya Mankhwala Opatsa Thandizo - Gawo C
Pali mitundu inayi ya madongosolo a Medicare Advantage omwe opindula angasankhe. Izi zimasiyanasiyana ndi momwe operekera amalipilira, komanso copays ndi zina zofunika kwa odwala.
1. Ntchito Yothandizira Zaumoyo kapena Mapulani a HMO
Medicare HMO ikukonzekera kugwira ntchito mofanana ndi chisamaliro choyang'anira HMO ndondomeko. Makhalidwe omwe amawonekera kwambiri ndi dongosolo la HMO ndi njira yake yobwezera. Ofesi ya zamankhwala imalandira malipiro enieni, pamwezi pamwezi. Ndalamayi imakhalabe yofanana mosasamala kuti ndi angati omwe amachezera wodwalayo ali, mtengo wa ndalama zomwe amapeza, kapena ngakhale atalandira chisamaliro konse. Zizindikiro zina za HMO ndi:
- Ochepa kwa othandizira pa intaneti pokhapokha pazidzidzidzi
- Zowonjezera zimafunika kuti muwone katswiri
- Udindo wam'mbuyomu ndi wofunika kuntchito zina
- Mamembala alibe mapepala osokonekera komanso ochepa
2. bungwe loperekera okondedwa kapena mapulani a PPO
Mankhwala a Medicare PPO ali ofanana ndi chisamaliro choyang'anira PPO Plans. PPOs amalipira njira yothandizira. Maulendo a maofesi, ma test lab, X-ray, kapena mautumiki ena amadzipidwa payekha malinga ndi malipiro. Njira yolipira imeneyi imalola ofesi yachipatala kulandira malipiro apamwamba pa gawo lililonse la chisamaliro. Zina ndizo:
- Othandizira a-in-network ndi otuluka pa Intaneti amaloledwa, koma odwala amalipira zochepa pamene ogwiritsira ntchito pa intaneti amagwiritsidwa ntchito
- Palibe kutumizidwa kuti upeze katswiri
- Udindo wam'mbuyomu ndi wofunika kuntchito zina
- Mamembala angakhale ndi udindo wopereka ndalama, ndalama zothandizira ndalama komanso ndalama zothandizira ndalama
- Amapereka zowonjezera phindu poyerekeza ndi mankhwala a Medicare, pa mtengo wapadera
- Zimaphatikizapo kupitirira kwapakati pa mthumba
3. Mapulani Apayekha-Kwa-Utumiki kapena PFFS
Chinthu chofunika kwambiri kudziwa za Medicare PFFS ndondomeko ndikuti amalola anthu ogwira ntchito kuti azikhala ndi ndalama zokwanira 15 peresenti pazomwe amapereka ndalamazo . Mapulani a PFFS amagwira ntchito mofananamo ndi ndondomeko zopereka malipiro.
Ndondomeko za inshuwalansi zopanda malipiro zimapereka malipiro ku ofesi ya zachipatala pogwiritsa ntchito ndalama zothandizira. Mulipira-kwa-utumiki, ofesi ya zamalonda imalipidwa ndalama zokhazikitsira mtundu uliwonse kapena gawo la utumiki woperekedwa. Maulendo a maofesi, ma test lab, X-ray, kapena mautumiki ena amadzipidwa payekha malinga ndi malipiro. Njira yolipira imeneyi imalola ofesi yachipatala kulandira malipiro apamwamba pa gawo lililonse la chisamaliro.
Mipingo Yopadera Yapadera kapena SNP
Mipanga ya Mipingo Yowonjezera Yowonjezera imayang'ana opindula omwe amakhala ndi matenda, matenda, kapena matenda ena. Ubwino ndi ochepa kwa odwala omwe:
- Khalani ndi vuto lachilombo kapena lolepheretsa monga HIV / Aids, shuga, matenda a maganizo, congestive mtima kulephera (CHF), kungotchula pang'ono
- Khalani ku nyumba yosungirako okalamba kapena kulandira chisamaliro kunyumba
- Landirani madalitso onse a Medicare ndi Medicaid
Zimanyamula
Malangizo a Medicare Advantage nthawi zina amasokonezeka ndi mapulani omwe amasamalidwa ndi ogwira ntchito ku ofesi ya zachipatala. Ambiri mwa mapulaniwa amaperekedwa kudzera m'ma makampani akuluakulu a inshuwalansi monga:
- Aetna
- AARP
- United Health Care
- Blue Cross Blue Shield
- WellCare
Ndikofunika kudziwa madongosolo a Medicare Advantage m'deralo komanso momwe mungaperekere zodzitetezera kuti muteteze malipiro ochedwa.