Momwe dongosolo lanu la thanzi likukhudzira chisamaliro chosiyana chimadalira dongosolo lokonzekera
Kodi zikutanthauzanji pamene chithandizo cha zaumoyo "chosachotsedwa ku deductible" kapena "chosadulidwa"? Limeneli ndi funso limene owerenga ena ali nalo poyankha kafukufuku wa bungwe la Commonwealth Fund posachedwapa la ndondomeko zaumoyo ogulitsidwa m'mayiko omwe amagwiritsa ntchito Healthcare.gov.
Zili zosavuta kuona momwe izi zikanasokoneza, popeza kuti "osatulutsidwa" ndigwiritsidwe ntchito pofotokoza ntchito zomwe sizinapangidwe konse ndi dongosolo la thanzi (titi, mwachitsanzo, chithandizo cha kusachiritsika m'mayiko omwe samafuna) .
"Osati pansi pa deductible" = mumalipira pang'ono
Koma pamene msonkhano sali pansi pa deductible, zikutanthauza kuti mwakhala bwino kulengeza kwa utumiki. Njira ina ndiyo kukhala ndi mwayi wogonjera ndalama, zomwe zikutanthawuza kuti mutha kulipilira mtengo wokwanira pokhapokha mutakhala kale ndi deductible yanu pachaka.
Kufotokozera, "mtengo wathunthu" umatanthawuza kuti kuchoka kwa malonda akugwiritsidwa ntchito. Kotero ngati katswiri wamalonda alipira $ 250, koma kampani ya inshuwalansi ya zaumoyo yayamba mtengo wa $ 150, "mtengo wathunthu" ungatanthauze kuti ukhoza kulipira $ 150.
Kuti tidziwe zonsezi, ndizofunika kumvetsetsa mawu omwe amagwiritsidwa ntchito pofotokoza mapulani azaumoyo . Copay si chinthu chimodzimodzi ngati kulimbikitsidwa. Deductible si chinthu chofanana ndi chiwongoladzanja chapamwamba (chomwe chingakhale chapamwamba kuposa $ 6,850 kwa munthu mmodzi mu 2016, ndipo chiposa $ 7,150 mu 2017 ). Ndalama sizimayikidwa mu ndalama zomwe mumakhala nazo (ngakhale muyenera kuziyika pamene mukuchita masamu kuti muzifaniziranso zolinga).
Ndikofunika kumvetsetsa zapadera zothandiza Care Act zomwe zimapindulitsa kwambiri zaumoyo, zomwe zimapangidwa ndi ndondomeko ya thanzi la gulu limodzi ndi laling'ono limodzi ndi masiku abwino a January 2014 kapena mtsogolo. Ngati muli ndi chidziwitso pansi pa gulu laling'ono kapena ndondomeko ya munthu omwe sanabalepo kapena agogo , chithandizo chomwe chimagwera pansi pa ambulera imodzi mwa zofunika zofunika zaumoyo chimapangidwa ndi dongosolo lanu.
Koma "kuphimbidwa" kumangotanthauza kuti mapulani anu azachuma amagwira ntchito. Momwe ubwino umenewo umagwirira ntchito umadalira mapulani anu:
- Mwina simukuyenera kulipira kalikonse (izi ndizo zowonetsera chithandizo).
- Kapena mungafunike kulipira copay (malipiro omwe akutsogoleredwa ndi dongosolo lanu - mwinamwake $ 25 kapena $ 50 kapena $ 100, malingana ndi chithandizo chomwe chikufunsidwa).
- Kapena mungafunikire kulipira mtengo wokwanira wa mankhwala (ngati simunakumanepo ndi deductible wanu pano).
- Kapena mungafunike kulipira peresenti ya mtengo (coinsurance).
Zosankha zonsezo zimakhala ngati "zophimbidwa." Zolinga zina zaumoyo zimalengedwa ndi momwe amapangidwira zolemba zawo (mwachitsanzo, ndondomeko yopanda deductible, koma ndalama zokwana $ 5,000 za hospitalization). Koma mosasamala momwe ndondomeko yanu yapangidwira, ndalama zonse zomwe mumalipirako pazinthu zophimbidwa chaka chonse zidzawerengera kuti muzithera. Zingakhale kuphatikiza kwa ndalama, ndalama, komanso ndalama zothandizira ndalama, koma mutakhala ndi ndalama zambiri pachaka, ndondomeko yanu ya thanzi idzapereka 100% yamtundu uliwonse wotsalira kwa chaka chotsalira (onani kuti ngati Sinthani dongosolo losiyana pakatikati pa chaka, chiwongoladzanja chanu chimayamba ndi dongosolo).
Copays = mtengo wochepa pa nthawi ya utumiki
Ngati ndondomeko yanu ya zaumoyo ili ndi mapulogalamu osiyanasiyana omwe sali okhudzana ndi deductible, zikutanthauza kuti mudzalipira zocheperapo kusiyana ndi momwe mungagwiritsire ntchito ngati ntchitoyo ikuperekedwa.
Ngati mutapatsidwa ndalama zowonjezera, mutha kulipira mtengo wonse wa ntchitoyo, poganiza kuti simunayambe mutapereka deductible yanu (ngati mutagwirizana kale ndi deductible yanu, mutha kulipira peresenti ya mtengo - coinsurance - kapena palibe nkomwe, ngati mutatha kale kukwaniritsa zowonjezera zanu).
Koma ngati ntchitoyi sichigonjetsedwa ndi deductible, inu mumakhala ndi udindo wa copay yomwe yatsimikiziridwa m'malo mwa mtengo wathunthu. Zindikirani kuti ntchito zina - monga chithandizo chodziletsa, ndi zina, mankhwala osokoneza bongo - sali pansi pa deductible kapena copay, zomwe zikutanthauza kuti simusowa kulipira kalikonse pazinthu zosamalidwa (zolinga zonse zomwe sizinalipo Kuphimba chisamaliro chodziletsa popanda kugawana mtengo, zomwe zikutanthauza kuti wodwala sapereka kalikonse pa chisamaliro chimenecho - chimaphimbidwa ndi malipiro omwe amaperekedwa kuti agule dongosolo).
Chitsanzo chili ndi mawu 1,000
Kotero tiyeni tinene kuti dongosolo lanu la thanzi liri ndi madola $ 35 kuti muwone dokotala wa chisamaliro choyambirira koma amawerengera akatswiri omwe akuyendera ku deductible. Muli ndi ndalama zokwana madola 3,000 komanso ndalama zokwana madola 4,000. Ndipo mlingo wamakono wokhudzana ndi intaneti ndi kampani yanu ya inshuwalansi ya zaumoyo ndi $ 165.
Tiyerekeze kuti muli ndi maulendo atatu ku PCP yanu pachaka, ndipo awiri akuchezera kwa katswiri. Ndalama yanu yonse ya maulendo a PCP ndi $ 105, ndipo mtengo wanu wonse kuti maulendo apadera azibwera kumadola $ 330 chifukwa mumalipira mtengo wathunthu.
Panthawiyi, mwalipiritsa $ 330 kuti mutengere ndalama zanu, ndipo mudalipira madola 435 kuti mufike poti mutulutse. ($ 330 kuphatikiza $ 105).
Tsopano tiyeni tinene kuti muli mu ngozi pasanafike mapeto a chaka, ndipo mutha kuchipatala kwa sabata. Malamulo odwala matenda opatsirana amagwiritsidwa ntchito ku deductible, ndipo ndondomeko yanu imabereka 80% mutatha kulipira deductible mpaka mutakwaniritsa zochepa zanu.
Poti chipatala chikhalepo, uyenera kulipira madola 2,670 madola odzipatulira ($ 3,000 kupatula $ 330 kuti mwakhala mukulipirako kale kuti mukadzere alendo). Ndiye muyenera kulipira 20% mwazotsalira zotsalira mpaka ndalama zonse zomwe munalipirako chaka chinali atafika $ 4,000. Popeza mudalipira mapepala atatu a PCP okwana madola 105, muyenera kulipira $ 895 patsiku lachigulitsiro kuti chipatala chikhalepo mpaka kufika pamtunda.
Pano pali momwe masamu angayang'anire pamene zonse zinanenedwa ndikuchitidwa:
- $ 330 + $ 2,670 = $ 3,000 osakanikirana
- $ 105 (copays) + $ 895 (chitsimikizo) = $ 1,000 potsutsa kwa chaka
- $ 3,000 + $ 1,000 (deductible plus ndalama zina zonse) - $ 4,000
- $ 4,000 ndizopanda malipiro anu, zomwe zikutanthauza kuti ntchito zina zonse zokhudzana ndi chaka chonse zidzakwaniridwe ndi dongosolo la inshuwalansi ya umoyo wanu, poganiza kuti mukhale ndi dongosolo lomweli kwa chaka chonse.
Ngati ndondomeko yanu yaumoyo inayendera PCP maulendo a padera, mukanakhalapira mtengo wathunthu kwa iwo (tiyeni tizinena $ 115 payekha). Zikanakhala choncho, mukanakhala $ 675 pa milandu yomwe mumagwiritsira ntchito ndalamazo musanapite kuchipatala chanu ($ 345 pa maulendo a PCP, kuphatikizapo madola 330 okayendera akatswiri). Mukadakhala ndi ndalama zokwana madola 4,000 mu ndalama zowatuluka pakapita chipatala.
Koma ngati ngoziyo isanachitike ndipo simunapite kuchipatala, ndalama zanu zonse za chaka chikanakhala zapadera pazondomeko ndi maulendo a PCP pansi pa ndalama zokwanira ($ 675, osati $ 435). Ngati mutha kukwaniritsa zochepa zanu zapakati pa chaka, sizingakhale zovuta kapena ayi. Koma ngati simutha kumaliza kukwaniritsa zochepa zanu, mutha kulipira pang'ono pamene mukukonzekera ali ndi mautumiki omwe sali pansi pa deductible.
Chidule
Musawopsyeze pamene mupeza kuti mautumiki sali pansi pa deductible. Malingana ngati ataphimbidwa ndi ndondomeko yanu, izi zimangotanthauza kuti mudzalipira zochepa pazinthu zomwe mungachite ngati zikanakhala zochepa.
Ngati muli ndi matenda aakulu, omwe amafunikira chithandizo chamankhwala chokwanira, pali mwayi wabwino kuti mukwaniritse zowonjezereka zapadera kwa chaka mosasamala mapulani, ndipo mungapeze dongosolo ndi mtengo wapansi wotsika kwambiri udzakuthandizani, ngakhale kuti udzabwera ndi apamwamba kwambiri.
Koma ngati muli ndi thanzi labwino ndipo simutha kumaliza kukwaniritsa mapulani anu - kapena ngakhale deductible - kukhala ndi mapindu omwe sali pansi pa deductible kumangotanthauza kuti kampani yanu inshuwalansiyo imayamba kulipira gawo za chisamaliro chanu mofulumira kuposa momwe zingakhalire ngati ntchito zonsezo ziyenera kugonjetsedwa ndi deductible (chifukwa izo zikutanthauza kuti muyenera kulipira mtengo wonse mpaka deductible anakumana - zomwe sizingatheke konse mu chaka choperekedwa).
Izi zinati, ntchito zambiri zomwe siziperekedwa kuchoka ku deductible, zimakhala zowonjezereka.