Phindu lenileni ndilo kuchuluka kwa kuchuluka kwa ndalama zothandizira zaumoyo zomwe zimaperekedwa ndi ndondomeko ya inshuwalansi ya umoyo. Zakhala zofunikira kwambiri chifukwa Chachikulu Chachizolowezi Care Act chinagwiritsidwa ntchito, chifukwa kutsatira malamulo a ACA kumafuna kuti magulu aumoyo ndi magulu ang'onoang'ono azitha kukhala ndi mapepala apadera malinga ndi momwe akufunira.
Lingaliro lokhalo liri losavuta mokwanira: Ndondomeko ya thanzi imabweretsa gawo lina la ndalama zothandizira zaumoyo, ndipo ndondomeko zimapereka mpumulo.
Koma ndizofunikira kumvetsetsa kuti chiwerengero cha actuarial sichiwerengedwera pazomwe zilipo. M'malo mwake, amawerengedwa pa chiwerengero cha anthu omwe ali ndi chiwerengero cha anthu . Mwa kuyankhula kwina, ngati dongosolo lina liri ndi chiwerengero cha 70 peresenti, ilo lidzalipira 70 peresenti ya ndalama zowonjezera zaumoyo kupyola muyezo wonse wa chiwerengero. Komabe, sizingapereke ndalama zokwana 70 peresenti ya mtengo uliwonse wa olembetsa .
Ndondomeko imodzi, Chokha Chokhazikika, Zotsatira Zosiyana Kwambiri kwa Anthu Athu
Mwachitsanzo, ganizirani ndondomeko yokhala ndi madola 2,500 okwana madola 2,500 komanso ndalama zokwana madola 5,000, zomwe zimangotenga ntchito zothandizira zisanafike. Tiyeni tiwone kuti Bob ali ndi chithandizo pansi pa ndondomekoyi, ndipo chithandizo chake chokha chachipatala chaka chonse ndi ulendo wopita mwamsanga pazitsulo zingapo pamene akudula dzanja lake. Chifukwa cha kuphweka, tidzanena kuti ndalama zothandizira mwamsanga ndi $ 1,500.
Izi ndi zochepa kuposa za deductible, choncho Bob ayenera kulipira $ 1,500. Mwa kuyankhula kwina, iye amalipiritsa 100 peresenti ya ndalama zake zothandizira zaumoyo kwa chaka-ndipo inshuwalansi yake yabweza 0 peresenti (poganiza kuti sanalandire chisamaliro chilichonse chodziletsa).
Tsopano tiyeni tione Alan, yemwe ali ndi chithunzi pansi pa dongosolo lomwelo. Alan amapezeka kuti ali ndi khansa mu February, ndipo amatsutsa ndondomekoyi yapamwamba pamwezi womwewo.
Pakutha kwa chaka, inshuwalansi ya inshuwalansi ya Alan yalipira madola 240,000 kuti asamalire, ndipo Alan adalipira madola 5,000 (ndalama zake zowonjezera). Pa nkhani ya Alan, inshuwalansi yake yadzipiritsa 98 peresenti ya ndalama zake, ndipo Alan wapereka 2 peresenti ya ndalamazo.
Koma Alan ndi Bob onse ali ndi ndondomeko yomweyi, ndipo chifukwa cha chitsanzo ichi, tidzanena kuti ndi ndondomeko ya siliva , zomwe zikutanthawuza kuti zili ndi phindu la makumi asanu ndi limodzi. Kuyang'ana pazifukwa izi, zikuonekeratu kuti payekha, pali kusiyana kwakukulu potsata za ndalama zomwe aliyense amayendera zomwe zili ndi ndondomeko ya thanzi, chifukwa zimadalira kuchuluka kwa chisamaliro chomwe munthu aliyense amafunikira chaka. Koma mwachidule, pamadera osiyanasiyana, zomwe Bob ndi Alan ali nazo zimaphatikizapo pafupifupi 70 peresenti ya ndalama.
ACA ndi Actuarial Value
Pansi pa malamulo a ACA, zonse zatsopano (zogwirizana ndi January 2014 kapena zapitazo) zolinga za gulu limodzi ndi zing'onozing'ono zimayenera kukwaniritsa chimodzi mwa zitsulo zinayi zamatabwa, zomwe zimagawidwa malinga ndi chidziwitso chodziwika bwino (cholembera kuti mapulani oopsa , omwe sagwirizana ndi chitsulo Mipingo yamagulu, imaloledwa pa msika wina aliyense, koma ingagulidwe ndi anthu osakwanitsa zaka 30, kapena omwe ali ndi vuto lopulumutsidwa ndi udindo wa ACA payekha ).
Zitsulozi zimapangidwa ngati mkuwa, siliva, golide, ndi platinamu. Ndondomeko zamkuwa zamtengo wapatali zimakhala pafupifupi 60 peresenti, ndondomeko zasiliva 70 peresenti, mapulani a golide 80 peresenti, ndipo platinamu amapanga 90 peresenti. Chifukwa zimakhala zovuta kwa inshuwalansi kupanga mapulani omwe ali ofunika kwenikweni, ACA imalola macheza a +/- 2. Izi zikutanthauza, mwachitsanzo, kuti ndondomeko ya siliva ikhoza kukhala ndi chiwerengero cha 68 peresenti mpaka 72 peresenti, ndipo ndondomeko ya golide ikhoza kukhala ndi phindu lokhazikika pakati pa 78 peresenti ndi 82 peresenti.
Mu December 2016, HHS inamaliza lamulo lomwe limalola mapulani a bronze (omwe ali ndi phindu pafupifupi 60 peresenti) kuti akhale ndi 2 / + 5, kuyambira mu 2018 (mwachitsanzo, pakati pa 58 peresenti ndi 65 peresenti).
Kenaka mu April 2017, HHS inakhazikitsa malamulo ogulitsa malonda omwe amalola kuti minimis ipitirire mpaka -4 / + 2 kwazinthu zasiliva, golidi, ndi platinum, ndi kupititsa patsogolo njira yatsopano yazitsulo zamakonzedwe a bronze ku -4 / + 5 .
Pansi pa malamulo atsopano, ogwira ntchito mu 2018:
- Ndondomeko zamkuwa zimatha kukhala pakati pa 56 peresenti ndi 65 peresenti.
- Ndondomeko ya siliva ikhoza kukhala ndi ndalama zokwana 66 peresenti ndi 72 peresenti.
- Zolinga za golide zikhoza kukhala zogwirizana pakati pa 76 peresenti ndi 82 peresenti.
- Zolinga za Platinum zikhoza kukhala ndi mfundo zabwino pakati pa 86 peresenti ndi 92 peresenti.
Kuwerengera Zowona Zowona: Ndi EHB Zomwe Zili M'kati
Boma la federal linapanga pulogalamu ya actuarial valuator-yomwe imasinthidwa chaka ndi chaka -kuti maburitsi amagwiritsa ntchito kudziwa momwe ntchitoyo ikufunira chaka chotsatira (pano ndifotokozera 2017 actuarial value calculator).
Ntchito zokha zomwe zimaonedwa kuti ndizofunikira zothandiza zaumoyo (EHBs) ndizowerengedwa. Ogwirizanitsa amaloledwa kubisa zina zowonjezera, koma izi sizikugwirizana ndi kufunika kwa dongosolo.
Kuonjezera apo, kuwerengetsera kwapadera kumagwiritsidwa ntchito pazowonjezera mauthenga, kotero kufotokozera kwapadera komwe dongosolo limapereka-ngati kulikonse-sikuli mbali yokhudzidwa kwa momwe polojekiti ikuyendera.
Gulu Lalikulu ndi Anthu Omwe Akukhala ndi Ndondomeko Ali ndi Malamulo Osiyana
Zomwe amagwiritsa ntchito zimakhudza zoyenera zazitsulo zazitsulo ku ACA zimagwiritsa ntchito ndondomeko ya gulu limodzi ndi yazing'ono. Koma magulu akuluakulu amapanga ( m'mayiko ambiri, amatanthawuza antchito oposa 50, koma m'mayiko ochepa, amatanthawuza antchito oposa 100 ) ndipo mapulani omwe ali ndi inshuwalansi ali ndi malamulo osiyana.
Pogwiritsa ntchito ndondomeko yowonjezereka, cholinga chake ndi chakuti mapulaniwa amapereka mtengo wochepa, womwe umatanthawuza kuti ndiwo ndalama zokwana 60 peresenti ya ndalama zogulira anthu. Pali chiwerengero chochepa chomwe chikufanana ndi chiwerengero cha actuarial value chogwiritsiridwa ntchito pa mapulani a gulu limodzi ndi aang'ono, koma owerengera ali ndi kusiyana kwakukulu kosiyanasiyana .
Magulu akuluakulu komanso mabungwe omwe ali ndi ngongole sizinagwirizane ndi magulu a zitsulo zomwe zimagwira ntchito pamsika wamagulu ndi gulu laling'ono, kotero kuti pangakhale kusiyana kwakukulu kuchokera ku dongosolo limodzi kupita ku gulu limodzi ndi msika wogula okha. Zolingazi zimayenera kuwononga pafupifupi 60 peresenti ya ndalama zomwe anthu ambiri amawononga, koma akhoza kuikapo ndalama zonse zomwe zilipo pamtunda umenewo, popanda kupanga mapulogalamu awo kuti akhale oyenerera m'magawo ofunika kwambiri.
Zimapanga Zomwe Zimagwiritsidwa Ntchito Zomwe Zimakhala Zofunikira Kawirikawiri Zimakhala ndi Mapulani Osiyanasiyana
The actuarial value value calculator amalola olemba inshuwalansi kupanga mapangidwe apadera omwe onse amathera panthawi imodzimodziyo. Ichi ndi chifukwa chake mungayang'ane ndondomeko 10 zasiliva zosiyana siyana ndikuwona mapulani 10 osiyana kwambiri, ndi zosiyana siyana za deductibles , copays, ndi coinsurance .
Ndalama za inshuwalansi za ku California zimafuna kuti magulu onse payekha ndi magulu ang'onoang'ono akhale oyenerera , zomwe zikutanthauza kuti mkati mwazitsulo zinazake, zonse zomwe zilipo zimakhala zofanana ndi zomwe zimapindula kuchokera ku ndondomeko yina, ngakhale kuti onse ali ndi othandizira osiyanasiyana . Pali zigawo zina zambiri zomwe zimafuna mapulani ena ovomerezeka komanso zimapereka ndondomeko zosavomerezeka, ndipo HealthCare.gov inayambira ndondomeko zoyenerera (kuphatikizapo ndondomeko zosadziwika) mu 2017.
Koma kukonza ndondomeko si chinthu chofanana ndi chiwerengero chenicheni. Ngati boma kapena kusinthanitsa kumafuna zolinga kuti zikhale zofanana, zolinga zonse zomwe zilipo zidzakhala ndi phindu lenileni lomwe limagwiritsidwa ntchito poyendetsera masitepe (operekera ndalama, copays, coinsurance, out-of-pocket maximum, etc.). Izi zikusiyana ndi zofunikira zenizeni zenizeni, zomwe zimapangitsa kusiyana kwakukulu potsata ndondomeko zopindulitsa ndi zopindulitsa, ngakhale pazinthu zomwe zili ndi mtengo womwewo.
Kusiyanasiyana pakati pa mapulani omwe ali ndi mlingo umodzi wazitsulo ukhoza kuchitika ngakhale pamene zolinga ziri ndi mtengo womwewo weniweniwo (mwachitsanzo, mapulani awiri omwe ali ndi mapangidwe osiyana angapindule kwenikweni ndi 80 peresenti). Koma la de minimus limaloleza pa mlingo uliwonse wazitsulo-ndipo kukula kwa mtunda wa 2018-kumapitiriza kuonjezera kusiyana komwe kumaloledwa mu msinkhu umodzi umodzi wa zitsulo. Kwa 2018, ndondomeko yokhala ndi chiwerengero cha 56 peresenti ndi ndondomeko ya mkuwa, komanso momwemonso ndondomeko yokhala ndi ndalama zokwanira 65 peresenti. Mwachiwonekere, mapulani awiriwa adzakhala ndi mapangidwe opindulitsa kwambiri, koma onsewo angatengedwe ngati ndondomeko zamkuwa.
> Zotsatira:
> American Academy of Actuaries MV / AV Practice Note Working Group > Zomwe Zili Phindu ndi Zomwe Zikugwiritsidwa Ntchito Pogwiritsa Ntchito Chithandizo Chachidwi . April 2014.
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu. Chotsatira 2017 Actuarial Value Calculator Methodology . January 21, 2016.
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu. Chitetezo cha Odwala ndi Ntchito Yodalirika Yothandiza, Msika Wolimbitsa . April 2017
> Federal Register. Chitetezo cha Odwala ndi Zopanda Thandizo Labwino; Chidziwitso cha HHS cha Kupindula ndi Kulipira Malipiro a 2018; Kusinthidwa kwa Nthawi Zowonjezera Zapadera ndi Ogulitsa Ogwira Ntchito ndi Okhazikitsa Mapulani Pulogalamu. December 22, 2016.