Mafotokozedwe Awiri Osiyana a Benchmark Plan
Kuyambira zaka zochepa zothandiza Care Act (ACA) zinakhazikitsidwa, mawu akuti "ndondomeko ya zizindikiro" agwiritsidwa ntchito kwambiri. Koma amagwiritsidwa ntchito kufotokoza mbali ziwiri zosiyana kwambiri ndi malamulo, zomwe zingasokoneze ogula. Kawirikawiri, nkhani yanu idzakulolani kuti mudziwe tanthawuzo lomwe likufotokozedwa, malinga ngati mukumvetsetsa mitundu yonse ya ndondomeko zofanana.
Mapulani a zizindikiro amatanthauza:
- Ndondomeko ya siliva yodzikweza-yachiwiri pamsinkhu uliwonse, pamsika wa inshuwalansi, OR
- Ndondomeko yomwe boma lirilonse likugwiritsira ntchito pofotokozera mapindu okhudzana ndi thanzi labwino m'madera omwewo.
Awa ndi malingaliro awiri osiyana, koma onsewa ali ndi dzina lomwelo, lomwe lingayambitse chisokonezo. Tiyeni tiwone momwe mtundu uliwonse wa ndondomeko ya zizindikiro zimagwirira ntchito.
Ndondomeko Yachilidi Yopanda Ndalama Pakati pa Kusintha
Kwa anthu omwe ali oyenerera ndalama za ACA's premium (malipiro a msonkho wapamwamba) , ndalama zothandizira zimachokera pa kusunga ndalama zowonjezera ndalama zachiwiri-phindu pazomwe ndalamazo zatsimikiziridwa kale . Ndondomeko yachiwiri-yotsika mtengo imatchedwa ndondomeko ya zizindikiro.
Ndondomekoyi imasiyanasiyana kuchokera kumadera osiyanasiyana, kuyambira chaka chimodzi kupita kwina kuchokera pamene chiwerengero chake chikuyendetsedweratu ndi mtengo wake wofanana ndi mapulani ena a siliva omwe akupezeka m'deralo.
Kotero mkati mwa boma, pangakhale mapulani angapo osiyana siyana ngati boma liri ndi malonda ogulitsa inshuwalansi omwe amasiyana kuchokera kumalo amodzi kupita ku lina, kapena pangakhale dongosolo limodzi lomwe limagwirizira malo otchulidwa mu dziko lonse, ngati boma liri limodzi insurer kapena mabungwe ambiri omwe ali ndi inshuwalansi omwe ali ndi mtengo wogwirizana kudera lonseli.
Panthawi yolembera kuti aliyense adziwe malonda (November 1 mpaka 15 December), ogula amatha kuona zomwe mtengo wa ndondomekoyi idzakhala wa chaka chomwe chikubwera. Adzawonanso ndalama zomwe angapeze-ngati alipo-olembetsa adzalandira ndalama zothandizira, potsata kuchuluka kwa mapulani omwe angapereke kwa omwe akulembetsa, mtengo wa ndondomeko yomwe akufuna kugula, ndi ndalama zawo za phindu lawo zomwe amayembekezera kuti azilipira ndondomeko ya chiwerengero; masamu omwe akufotokozedwa apa).
Ndondomekoyi ingaperekedwe ndi kampani ina ya inshuwalansi kuyambira chaka chimodzi mpaka chapakati, popeza kuti inshuwalansi amasintha mitengo yawo pachaka. Mitengo imayikidwa pa chaka, choncho ndondomeko yachitsulo kudera lomwe siidzasintha mpaka chaka chotsatira pokhapokha ngati inshuwalansi ikuchoka msika pakati pa chaka (ichi ndi chosowa, koma chachitika-zina za ACA CO-OPs anakakamizika kutseka chaka cha 2015 ndi 2016). Koma chaka chotsatira, mabungwe a inshuwalansi pa mtengo wa mtengo akhoza kusungunuka, monga ena a inshuwalansi amaletsa mitengo yawo kuposa ena, ndipo ena amachepetsa ndalama zawo kuchokera chaka chimodzi kupita kutsogolo.
Koma chotsatira chotsatira kuti mumvetsetse ndikuti ndalama zanu zowonjezera ndalama zimachokera ku ndalama zomwe zingakugulitseni kuti mugule ndondomekoyi.
Mungagwiritse ntchito ndalamazo kuti mugule ndondomeko iliyonse yachitsulo mumasinthanidwe. Simusowa kuti mugule ndondomekoyi, koma ndalama zanu zowonjezera zidzakhala zofanana, mosasamala kanthu za ndondomeko yomwe mumasankha (misonkho yanu yothandizana nayo idzakhala yosiyanasiyana, malingana ndi dongosolo lomwe mumasankha).
Miyezo yochokera ku boma Yofunika Kwambiri Zaumoyo Zaumoyo
Ndondomeko ina ya ndondomekoyi ndilo ndondomeko yowunikira ndondomeko iliyonse m'madera onse kuti adziwe zomwe amapindula ndi mapulani a gulu limodzi ndi aang'ono. Magulu onse atsopano ndi magulu ang'onoang'ono ayenera kubisa zofunikira zaumoyo khumi ( ACA) zofunikira zaumoyo (pali njira zina zowunikira za mano / masomphenya, koma zina zisanu ndi zitatu zofunika kwambiri zaumoyo ziyenera kuphatikizidwa kuzinthu zonse za ACA zomwe zimagwirizana ndi gulu limodzi).
Ndipo ngakhale kuti magulu akuluakulu sakuyenera kubwereza ubwino wathanzi, sangapangitse kuti phindu la pachaka kapena phindu la moyo wawo likhale lopindulitsa pazinthu zonse zofunika zaumoyo zomwe zimaphimba.
Choncho nkofunika kufotokoza zomwe zimafunika ngati chithandizo chofunikira cha thanzi. ACA imawafotokozera ndi zikwapu zadala mwadala, kusunga ndondomeko ya zofunika khumi zaumoyo zofunika ku zipolopolo zomwe zingagwirizane ndi theka la tsamba. Lamuloli linanenanso kuti Dipatimenti ya Zaumoyo ndi Zaumoyo (HHS) idzayenera kuonetsetsa kuti kulumikizidwa kungakhale "kufanana ndi kuchuluka kwa zopindula zoperekedwa pogwiritsa ntchito ndondomeko ya ntchito.
Kuchokera kumeneko, boma la federal linasiyira HHS kuti lifotokoze tsatanetsatane. HHS, inachitanso kuti boma lirilonse likhale ndi ndondomeko yofanana yomwe idzagwiritsidwe ntchito ngati ndondomeko yowonetsera magulu atsopano ndi magulu ang'onoang'ono m'mayiko amenewo. Mu 2012, HHS inalembetsa mndandanda wa FAQs zokhudzana ndi ndondomeko zowonetsera , kuthandiza zotsatila ndikutsatila ndondomekoyi, ndipo zowonjezera zowonjezera zinafalitsidwa mu 2015 . Mayiko analoledwa kutenga ndondomeko yawo yofanana ndi imodzi mwa njira zinayi zotsatirazi ("zazikulu" zatsimikiziridwa malinga ndi kulembetsa):
- Chimodzi mwa mapulani atatu a gulu laling'ono kwambiri m'dzikolo
- Mmodzi mwa akulu atatu omwe akugwira ntchito za umoyo wogwira ntchito zaumoyo (chithunzi choperekedwa kwa antchito a boma)
- Imodzi mwa maudindo atatu akuluakulu a ogwira ntchito kuntchito (Health FEO) zomwe zimaperekedwa kwa ogwira ntchito ku federal)
- Mapulani aakulu kwambiri omwe sanali a Medicaid HMO amaperekedwa msika wogulitsa.
Lingaliro linali kuti njira iliyonse yomwe angasankhe idzapereka chitsimikizo cholimba, ndipo sizingatheke kuti ikhale yopatsa mafupa chifukwa chakuti ikuperekedwa kwa ogwira ntchito za boma kapena kuti idzasankhidwa ndi malonda ambiri kuti atsimikizire antchito awo.
Kwa 2014 kupyolera mu 2016, ndondomekoyi inali ndondomeko yomwe inaperekedwa mu 2012 (popeza ndi pamene mayiko adakhazikitsa mapulani awo). Ena mwa iwo amayenera kuthandizidwa kuti athetse ma EHB onse, popeza mapulani anali asanafunike kukhala ACA-ovomerezeka mu 2012. Kwa 2017 ndi kupitirira, ndondomekoyi ndiyo dongosolo lomwe laperekedwa mu 2014. Pafupifupi mayiko onse adasankha mapulani ang'onoang'ono monga gulu lawo. Mapulani apadera a mapulani a ndondomeko ya ndondomeko ya boma alipo pano.
Msika waumwini ndi magulu ang'onoang'ono omwe amaperekedwa m'dzikolo ayenera kuphatikizapo kufotokozera "kofanana" ndi mapindu omwe aperekedwa ndi dongosolo lomwe boma linasankha. Pali kupitiriza kuchokera ku dziko lina kupita ku lina, monga ACA imafotokozera magawo onse a EHBs. Koma kusiyana pakati pa ndondomeko ya zigawo za boma ndi chifukwa chake mudzawona chithandizo china-chofanana ndi chithandizo cha kusabereka-chosiyana ndi boma ndi boma, pogwiritsa ntchito maudindo omwe amagwiritsidwa ntchito mu boma, kapena zosiyana kuchokera pa ndondomeko yofanana ya boma.
Mu Oktoba 2017, HHS inafotokozera zopindulitsa zomwe zimapindula ndi malipiro a chaka cha 2019, zomwe zinaphatikizapo kusintha komwe kumakhudzana ndi ndondomeko zofanana za EHB. Ngati kukwanilitsidwa monga kukonzedweratu, zidzatithandizanso kusintha kuchokera mu 2019, kuphatikizapo mwayi wokhala ndi ndondomeko yofanana ndi yomwe ilipo, kapena kuyika zigawo zosiyana siyana za ndondomeko zofanana zowonetsera ndondomeko yawo yowonongeka. Kuonjezera apo, likuti likhoza kusankha kapena kupanga mapulani atsopano chaka ndi chaka, m'malo moyenera kugwiritsa ntchito ndondomeko yomwe inakonzedweratu mu 2017.
Mawu Ochokera
Mukamamva wina akuyankhula za ndondomeko ya malire mogwirizana ndi ACA, nkhaniyi ikulolani kuti mudziwe mtundu wa ndondomeko ya zizindikiro zomwe mukukambirana.
Kodi akukamba za dongosolo la siliva lachiwiri-lopindulitsa lomwe limaperekedwa pa msika wina payekha, kapena za ndondomeko yomwe dziko lapatsidwa limapereka ndalama zothandizira kuti ACA yodzipereka ndi gulu laling'ono likonzekere boma likukhazikitsidwa? Mukazindikira kuti, mfundo zomwe zili pamwambazi zidzakuthandizani kumvetsetsa zokambiranazo.
> Zotsatira:
> Magulu a Medicare ndi Medicaid Services. Pulogalamu ya Odziwitsa Anthu ndi Kuyang'anira Inshuwalansi. Miyezo Yofunika Kwambiri Zaumoyo: Kutsimikizira Uli Wabwino, Wopindulitsa.
> Magulu a Medicare ndi Medicaid Services. Pulogalamu ya Odziwitsa Anthu ndi Kuyang'anira Inshuwalansi. Zambiri pa Zopindulitsa Zaumoyo Zaumoyo (EHB) Mapulani a Zowona.
> Magulu a Medicare ndi Medicaid Services. Zowonjezera Zaumoyo Zamtengo Wapatali: Mndandanda wa Zowonjezera Zoposa Zitatu Zamagulu Padziko . April 8, 2015.
> Nyumba.gov. Malemba a Chitetezo cha Odwala ndi Care Care Affordable Act .
> Mapulogalamu a Pakhomo la mkati. Ndondomeko ya Ndalama 2017-36 .
> Kaiser Family Foundation. Mapulani Ofunika a Health Benefit (EHB) Benchmark Plans, 2017.