Malamulo Akukonzekera Kukhazikitsa Mapazi a Inshuwalansi
Kuda nkhaŵa za kukhazikika kwa msika wa inshuwalansi yaumoyo (payekha ndi kusinthanitsa) wakhala akuwombera kwa kanthawi. Ambiri a inshuwalansi adachokera ku mgwirizano kapena msika wina aliyense kumapeto kwa 2016, ndipo ndalama zowonjezera zothandizira zowonjezera zawonjezeka ndi pafupifupi 25 peresenti ya 2017 ( zopereka zothandizana nazo zikuwonjezereka kuwonjezeka kwapadera kwa anthu oyenerera ndalama omwe amagula chithandizo pazotsatizana, kotero kuti zikhale zomveka, malipiro sanawonjezeke ndi pafupifupi 25 peresenti kwa anthu ambiri omwe amagula zolinga zawo powasintha).
Pofuna kuthetsa nkhawa za msika, Dipatimenti ya Zaumoyo ndi Zaumunthu idapempha kusintha kwapakatikatikati mwa mwezi wa February, patatha masiku angapo mtsogoleri wa HHS Tom Price atatsimikiziridwa ndi Senate.
Chidziwitso cha kukonza malamulo ndikukhudza kugulitsa kwa msika kwa misika ya magulu ndi aang'ono. Kawirikawiri, misika ya magulu ang'onoang'ono akhala yosakhazikika. Koma msika wina m'madera ena unali pamphepete mwa kugwa kwa kumapeto kwa 2016, ndipo Humana adalengeza pa February 14 kuti adzatha kuchotsa kwathunthu inshuwalansi pamsika pamapeto kumapeto kwa 2017 (iwo panopa amapereka ndondomeko m'mayiko 11 ).
Pa April 13, HHS inamaliza malamulo awo ogulitsa malonda, makamaka monga momwe akufunira. Ena amagwiritsa ntchito malamulowa poyendetsa masewera a inshuwalansi, koma ena adanena kuti malamulo ena atsopano amachititsa kuti misika iwonongeke.
Ndikofunika kuzindikira kuti monga inshuwalansi akulenga ndalama zawo ndi ndondomeko za 2018, iwo amavomereza mobwerezabwereza kuti zinthu ziwiri zofunika kwambiri zomwe zikuthandizira kugulitsidwa kwa malonda ndizokakamiza kukakamizidwa kwa ACA payekha , komanso kusowa kwachinsinsi potsata ndalama chifukwa chogawana ndalama zothandizira .
Zonsezi sizinayankhidwe ndi malamulo ogulitsira msika, ndipo zochita za Administration za Trump zathandiza kuti phindu la msika liwonongeke m'madera awiriwa.
Kodi Msika Wolimbitsa Msika Udzakhudza Bwanji Inshuwalansi Yanu ya Umoyo?
Anthu amene amapeza inshuwalansi ya umoyo kuchokera kwa abwana ambiri (m'mayiko ambiri, amatanthawuza antchito 50 ), Medicaid , kapena Medicare sadzakhudzidwa ndi kusintha komwe HHS yatha. Kusintha kumeneku kumagwiritsidwa ntchito pa msika wina aliyense, komwe ndi pafupifupi 7 peresenti ya anthu a ku United States, ngakhale kuti anthu amene amagwira ntchito kwa antchito ang'onoang'ono amatha kuona ndalama zowonjezera, komanso ndalama zochepa.
1. Anthu omwe amagula inshuwalansi yawo yowonjezera, kutsegulidwa kwa 2018 kudzakhala kofupikitsa kuposa zaka zapitazo.
Asanayambe kulamulira msika, nthawi yowunikira 2018 idakhazikitsidwa kutsatira ndondomeko yomweyi yomwe idagwiritsidwa ntchito pa 206 ndi 2017 (November 1 mpaka January 31). Koma pofika chaka cha 2019, ndondomekoyi inali kuyamba kuyamba nthawi yolembera, kuyambira pa 1 Novemba ndi kutha kumapeto kwa December 15. HHS yasankha kusinthana nthawi yolembera chaka chakale, ndikuyamba kugwiritsira ntchito kumapeto kwa 2017 (chifukwa chodziwika bwino mu 2018), mmalo modikira mpaka kugwa kwa 2018.
Choncho anthu amene amagula inshuwalansi yawo ya umoyo (mwachitsanzo, iwo sapeza kuchokera kwa abwana kapena pulogalamu ya boma monga Medicare kapena Medicaid) adzakhala ndiwindo laling'ono kuti asankhe dongosolo la 2018. Lidzakhala pa November 1, 2017, ndi kutha pa December 15, 2017.
Izi zikutanthauza kuti palibe ndondomeko yomwe idzasinthidwe pambuyo pa chaka choyamba, kotero sipadzakhalanso mpata wosintha mapulani mu Januwale ngati malipiro anu akusintha zinyama mumakhala osamala. Zidzakhala zofunikira kwambiri kumvetsera mwatsatanetsatane malingaliro ndi mapulani omwe mumalandira mu Oktoba / November kuchokera ku kampani yanu ya inshuwalansi kapena kusinthanitsa, ndipo pangani ndondomeko isinthe isanafike pa 15 December.
Pambuyo pake, pulani ndondomeko ndi kulembetsa kumene kungakhale kotheka ngati muli ndi zofunikira .
Izi sizidzasintha kalikonse pazenera zowonjezera zowonjezera za inshuwalansi kapena Medicare.
2. Anthu omwe amalembetsa malingaliro awo kunja kwa kutsegulidwa akuyenera kupereka chitsimikiziro cha zofunikira, ndipo kuyenerera kwa nthawi yolembera yapadera kudzakhala koletsedwa nthawi zina.
ACA ndi malamulo otsatila amalola anthu okhala ndi zosiyana zosiyanasiyana kuti athe kulembetsa mwachindunji (komanso nthawi zambiri, kunja kwa kusinthana ), mosasamala nthawi ya chaka.
Izi zimakhala zomveka, ndipo ndi momwe inshuwalansi yothandizira olemba ntchito imathandizanso. Ngati munthu asiya ntchito yake ndikutaya mwayi wothandizira inshuwalansi ya bwana mu June, sangayembekezere kuyembekezera mpaka January kuti adzalandire. Ndipo ngati mwana wabadwa mu April, sikungakhale kwanzeru kukakamiza banja kuti lidikire mpaka atsegule kuti apeze chithandizo kwa mwanayo.
Kotero choyenerera chimachititsa nthawi yapadera yolembetsa (SEP), pomwe wopemphayo ali ndi masiku 60 kuti alembepo pulogalamu yatsopano. Koma pakhala pali mikangano yambiri yozungulira ma SEP. Pali nkhawa kuti anthu akhoza "kusewera" pulogalamuyi poyerekezera kuti akusowa chithandizo pamene akusowa chithandizo chamankhwala, ndipo mabungwe a inshuwalansi awona kuti ndalama zowonetsera ndalama ndizopambana kwa anthu omwe amalembetsa pa SEP kusiyana ndi anthu omwe kulembetsa pa nthawi yolembetsa.
Koma kumbali ina ya ndalama, ogulitsa ogulitsa akuwonetsa kuti anthu ochepa okha omwe ali oyenerera ndi omwe ali oyenerera kulembetsa, ndipo amafuna umboni wa choyenerera akhoza kulepheretsa olembetsa bwino kuti athe kumaliza. Izi zinawonekera pakadali pano patsiku lovomerezeka lovomerezeka la SEP kuti HealthCare.gov yakhazikitsidwe mu 2016.
Pakati pa anthu omwe ali ndi zaka 55-64, 73 peresenti inapereka umboni wa choyenera. Koma pakati pa olembapo a zaka 18 mpaka 24, ndi 55 peresenti yokha yomwe inapereka umboni wa choyenera. Izi zimabweretsa chipinda cha insureds omwe ali ndi zaka zapamwamba, zomwe zimagwirizana ndi ndalama zowonjezera.
Boma la Obama Administration HHS linali likukonzekera pulogalamu yoyendetsa ndege, kuyambira m'chilimwe cha 2017, pamene 50 peresenti ya ogwira ntchito HealthCare.gov (osankhidwa mwachisawawa) ayenera kupereka chitsimikizo choyenerera kuti ntchitoyi isanathe.
Koma malamulo atsopano a HHS amasintha kuti 100 peresenti. Kuyambira mwezi wa June 2017, HealthCare.gov onse omwe amalembetsa kulembetsa kunja kwa olembetsa adzayenera kupereka chitsimikiziro cha zofunikira kuti ntchitoyi isanagwiritsidwe ntchito.
Kuwonjezera pamenepo, malamulo atsopano amachepetsa kupeza mwayi wa ma SEP nthawi zina:
- Ukwati uyenera kuonedwa ngati woyenerera ngati wokondedwa mmodzi anali kale ndi zofunikira zochepa (kapena amakhala kunja kwa US kapena gawo la US asanakwatirane).
- Ngati munthu atalowerera kale m'ndondomeko ali ndi mwana kapena amulera mwana, kholo limangophatikizapo kuwonjezera mwanayo ku dongosolo lomwe likupezekapo, kapena kulemba mwanayo yekha pa pulani iliyonse yomwe ilipo (ngati, chifukwa chache, mwanayo sangakhale kuwonjezeredwa ku ndondomeko, kholo likhoza kulowetsa mu dongosolo lina lachitsulo , limodzi ndi mwanayo). Munthu yemwe sali wotsimikiziridwa ndipo ali ndi mwana kapena atenga mwana akadali woyenera kulembetsa, pamodzi ndi mwanayo, mu dongosolo liripo. Koma munthu yemwe ali ndi kalembedwe saloledwa kugwiritsa ntchito kuwonjezera kwa wodalirika ngati mpata wosintha zomwe akupezekapo panjira yatsopano.
- Anthu amene amalephera kulandira malipiro awo pa nthawi inayake pachaka ayenera kulipira malipiro awo apitako asanayambe kulembetsa-panthawi ya SEP kapena olembetsa nthawi zonse-mu dongosolo kuchokera kwa inshuwalansi yemweyo (kapena wina inshuwalansi pansi pa kampani yofanana ya kholo). Kawirikawiri iwo amapereka ndalama zowonjezera kale kuposa miyezi itatu yowunikira, popeza sali pa ngongole ya ndalama zowonjezereka pokhapokha ndondomeko itatha chifukwa chosalipira malipiro. Ngati anthu akulembedwanso, wothandizirayo amaloledwa kugwiritsa ntchito malipiro awo atsopano ku malipiro awo akale.
3. Kuyambira mu 2018, padzakhala zambiri zogwirizana ndi kuchuluka kwa ndalama zimene mipangidwe yathanzi iyenera kuchitika. Izi zingachititse kuti ndalama zowonjezera zikhale zochepa, koma zapamwamba zowonjezereka ndi zopereka. Zingathenso kutanthauza thandizo laling'ono la ndalama zopambana.
Pansi pa ACA, mipangidwe yatsopano ya thanzi laling'ono ndi yaing'ono iyenera kukhala imodzi mwazitsulo zamkuwa: bronze, siliva, golide, kapena platinamu (mapulani oopsa amapezekanso kwa ena olembetsa). Ndondomeko yachitsulo yachitsulo imatsimikiziridwa ndi mtengo wake wamtengo wapatali (AV), womwe ndi chiwerengero cha kuchuluka kwa ndalama zothandizira zaumoyo zomwe ndondomeko ya thanzi lidzalipira, poyerekeza ndi chiwerengero chonse cha anthu. Mapulani a zitsulo ali ndi AV ya 60%, mapulani a siliva ali ndi 70 peresenti, mapulani a golide ali ndi 80 peresenti, ndipo mapulani a platinum ali ndi 90 peresenti.
Koma zikanakhala zovuta kwa makampani a inshuwalansi kuti apange mapulani omwe amawombera nambalayi (pre-ACA, panalibe zofunikira za AV, choncho asungitsi sanafunikire kudandaula za kugunda pachindunji cha AV). Kotero malingaliro azaumoyo amaloledwa kugwiritsa ntchito mtundu wa AV kusiyana ndi kuchuluka kwa chiwerengero. Pakali pano, mndandanda uli ndi +/- 2. Choncho ndondomeko ya siliva ikhoza kukhala ndi AV yomwe imakhala pakati pa 68 ndi 72 peresenti (mapulani a bronze ali ndi minimus yawo, yomwe ilipo -2 / + 5).
Pansi pa malamulo atsopano a HHS, kuyambira mu 2018, malo ololedwa ndi -4 / + 2, zomwe zikutanthauza kuti ndondomeko ya siliva ikhoza kukhala ndi AV kulikonse pakati pa 66 ndi 72 peresenti (chifukwa cha ndondomeko zamkuwa, +5).
Choncho pokonza zolinga zawo za 2018, makampani a inshuwalansi amaloledwa kuwonjezera ndalama zowonongeka ( zoperekedwa , ndalama zothandizira ndalama , ndalama zothandizira ), chifukwa sangafunikire kufotokozera kuchuluka kwa chiwerengero cha ndalama zonse. Izi zikutanthawuza kuti malipiro amatha kuchepa pang'ono, koma ndalama zomwe anthu ayenera kulipira pamene akusowa chithandizo chamankhwala zikhoza kuwonjezeka (onani kuti kuchepa kwapayimenti kumayenderana ndi zomwe sakanakhala akusintha izi; malipiro onse adzalowera mu 2018, mwinamwake ndithu zovuta chifukwa cha zovuta zina za msika zomwe zilipo, kuphatikizapo kusowa kwachindunji pambali ngati ndalama zothandizira ndalama zidzapitilizidwa kudalitsidwa).
Zimatanthauzanso kuti kupereka ndalama zowonjezereka kungakhale kochepetsetsa pang'ono kusiyana ndi kukanakhala kopanda kusintha kumene, chifukwa chakuti zimachokera ku mtengo wa ndondomeko yamtengo wapatali wa siliva (ndondomeko yachitsulo) m'dera lililonse. Ngati ndondomeko ya siliva yapamwamba kwambiri ndi imodzi yomwe ili ndi AV ya 66 peresenti, idzakhala yotsika mtengo kuposa mapulani ena a siliva ndi AV ya 68% kapena kuposa. Ndipo ndondomeko yachitsulo cha mtengo wapansi imatanthawuzira kuzing'ono kochepa.
4. Inshuwalansi amaloledwa kugwiritsa ntchito malipiro atsopano kwa ndalama zomwe zapita kale.
Pansi pa malamulo apitalo, ngati ndondomeko idathetsedwa chifukwa chosalipira malipiro a ndalama, munthuyo akhoza kulembanso pulogalamu yomweyi panthawi yolembera, kapena pa nthawi yolembera, popanda zotsatira. Ngongole yoyamba idzayambira pa tsiku latsopano, ndipo kampani ya inshuwalansi sichiloledwa kuti munthuyo abwezere malipiro awo omwe apita kale.
Malamulo atsopano amapatsa makampani a inshuwaransi ndalama zambiri kuti asonkhanitse malipiro apitalo ngati munthuyo akufuna kusankha kulembetsa mapulani kuchokera kwa inshuwalansi yemweyo yemwe anathetsa chithandizo choyambirira cha kulipira malipiro (kapena inshuwalansi omwe ali mbali ya gulu lomwelo, kapena kampani ya kholo). Ndalama zomwe zimaperekedwa pa ndondomeko yatsopanoyi zingagwiritsidwe ntchito ku malipiro apitalo kuchokera kumapeto kwa miyezi khumi ndi iwiri yapitayi, ndipo a inshuwalansi amaloledwa kukana ndondomeko yatsopanoyi mpaka mapepala omwe aperekedwa kuchokera chaka chotsatira adalipidwa.
Mphoto yam'mbuyomu ya munthu iyenera kukhala ya miyezi itatu kapena itatu yokha, popeza kuti malipiro apitawo sapitilirabe pokhapokha ndondomeko yothetsera msonkhanowu yatha.
Anthu akhoza kuyandikira kusintha kumeneku polembera ndondomeko yochokera kwa inshuwalansi wina, koma muzinthu zina, pali mphotho imodzi yokha yoperekera malingaliro. M'mayiko amenewo, aliyense amene chithandizo chake chatsekedwa kuti asapereke malipiro amatha kulipira kubweza malipiro asanaloledwe kulembetsa dongosolo latsopano.
> Zotsatira:
> ACAsignups.net. Avereji Yosasinthidwa Mwini Msika Wamtunduwu Mapiri, 2017. Anamalizidwa pa October 27, 2016.
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu, Chitetezo cha odwala komanso chithandizo chamankhwala chamtengo wapatali; Msika Ukukhazikika . February 15, 2017.
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu, Chitetezo cha odwala komanso chithandizo chamankhwala chamtengo wapatali; Kulimbitsa Msika, Lamulo Lomaliza. April 13, 2017.
> Humana. Humana > Akupitiriza Kumanga Zomwe Zimayendera Pambuyo Kuthetsa Mitundu ndi Aetna; Amapereka Malangizo a Financial 2017; Adzalengeza Mapulani a Kugwiritsa Ntchito Zigawo Zambiri. February 14, 2017.
> Kaiser Family Foundation. Health Insurance Inshuwalansi ya Total Population, 2015.