Max-Pocket Max: Momwe Ikugwirira Ntchito ndi Momwe ACA Imayendetsera Icho
Ndalama ya inshuwalansi yowonjezereka ndi ndalama zambiri zomwe muyenera kulipirira pa mtengo wa chithandizo chaumoyo wanu chaka chilichonse, poganiza kuti mumalandira chisamaliro chomwe chikugwiritsidwa ntchito ndi inshuwalansi yanu ndi kugwiritsa ntchito zipatala ndi madokotala.
Mutapereka malipiro okwanira, mutengapo ndalama komanso ndalama zothandizira kuti mupeze ndalama zowonjezera, kampani yanu ya inshuwalansi ya zaumoyo imabwereketsa zina zonse mu intaneti, zofunikira zaumoyo zoyenera pa chaka chonsecho.
Koma, sizimagwira ntchito nthawi zonse. Ngakhale kuti ndalama zowonongeka zapadera zimakonzedweratu kuti mukhale ndi mavuto azachuma mukakhala ndi chithandizo chamankhwala chambiri , zimawonetsa kampani yanu ya inshuwalansi kuti ikhale ndi ngozi zambiri. Choncho, makampani a inshuwalansi a zaumoyo amapanga njira zowonetsera pofuna kuchepetsa ngoziyi. Njirazi zimayambitsa chisokonezo pa zomwe zimafunika pazomwe mumatulutsira, zomwe inshuwalansi yanu imabweza pambuyo poti mwakwanitsa, ndi malire anu otani omwe ali kunja.
Momwe Zomwe Zimakhalira Pakati Pazokha Zimagwira Ntchito
Tiyeni tione chitsanzo: Muli ndi ndalama zokwana madola 1,000, ndalama zothandizira ndalama zokwana 20 peresenti, ndi malire a $ 5,000 pachaka.
Iwe umathyola chiuno chako. Mumatengedwa kupita ku opaleshoni usiku womwewo. Malo anu opaleshoni amatenga kachilomboka. Muli chipatala kwa milungu iwiri, chitani opaleshoni iwiri, ndipo mupeze ma antibayotiki achinayi panyumba kudzera kuchipatala kwa milungu itatu.
Pano pali momwe ngongole zanu zingagwiritsire ntchito mopanda malipiro apamwamba poyerekeza ndi ndalama zokwanira madola 5,000:
- Ndalama yanu yam'chipinda chachangu ndi $ 4,000.
Popanda malire a kunja, mumalipiritsa $ 1,000 ndalama zokwana madola 600 mu ndalama.
Ndi malire a kunja, mumalipira ndalama zokwana madola 1,000 $ ndipo ndalama zokwana madola 600 mu ndalama.
- Ndalama yanu ya chipatala ndi $ 40,000.
Popanda malire, mumalipira $ 8,000 ndalama (20 peresenti).
Ndi malire opanda pake, mumalipira $ 3,400 okha. Mwafika pamtunda wanu wapamwamba ndipo mumasiya kulipira (ndalama zokwana madola 5,000 zimachokera ku $ 1000 ndalama zanu, $ 600 ndalama zothandizira maulendo a ER, ndi $ 3,400 ndalama za chipatala). - Ndalama zothandizira kunyumba kwanu ndi $ 3,000.
Popanda malire a kunja, mumalipiritsa $ 600 ndalama.
Ndi malire a kunja, simukulipira kalikonse. Inshuwalansi wanu wa zaumoyo amalipira ndalama zonse za chisamaliro cha umoyo wanu kunyumba chifukwa mwafika kale pamtunda wapamwamba. - Ndalama zonse za bulu wanu wosweka ndi $ 47,000.
Popanda malire a kunja, mumalipira $ 10,200; wanu inshuwalansi akulipira $ 36,800.
Ndi malire a kunja, mumalipira $ 5,000; wanu inshuwalansi amalipira $ 42,000. - Mukusowa chithandizo chamankhwala ambiri kumapeto kwa chaka.
Popanda malire a kunja, mutha kulipira ndalama zokwana 20 peresenti.
Ndi malire a kunja, simukulipira.
Mipukutu Yotuluka M'mizere Yambiri Imakhala Yosiyana Kwambiri Pambuyo pa 2014
Mphotho yanu ya $ 5,000 yanu inakupulumutsani ndalama zambiri, koma inagula kampani yanu inshuwalansi monga momwe idakupulumutsani. Pambuyo pa Ntchito Yopanda Thandizo Lisanayambe, anayamba kukhazikitsa malire, ena a inshuwalansi amagwiritsira ntchito njira zosiyanasiyana kuti asamalire ndalama zawo (komanso malipiro).
Kusintha uku kunasintha kwambiri mtengo wa chisamaliro chanu chaumoyo pa inu: mumalipira zambiri, ndipo amalipira zochepa. Ogwiritsira ntchito amagwiritsa ntchito njira zitatu zoyenera kuchita izi, palibe zomwe zimaloledwa, chifukwa cha ACA:
- Njira yoyamba inakulemetsani kuti mufikire malire mwa kusawerengera ndalama zonse zomwe mumagwiritsa ntchito kuti mupite kumalo osungira. Wothandizira inshuwalansi angakhale atasankha kuti asakwerenge chimodzi kapena zambiri mwazimenezi:
- Deductible
- Mipukutu
- Kulimbikitsana kwa mankhwala osokoneza bongo
- Kulimbikitsidwa kwa mayesero
- Kulimbikitsana kwa chisamaliro cha kunja kwa intaneti
- Mu njira yachiwiri, inshuwalansiyo sadalipire ndalama zokwanira 100 zazomwe mumagwiritsa ntchito pathanzi lanu mutatha kufika malire anu.
Mwachitsanzo, ndondomeko yaumoyo ikhoza kufunsa kuti mupitirize kulipira copay nthawi iliyonse mukamuwona dokotala ngakhale mutakhala kale kufika pamtundu wapamwamba. Pachifukwa ichi, kufika pamlingo waukulu kumakutetezani kuti muthe kulipira ndalama kwa chaka chonse, koma osati kubweza ndalama za copays.
Phunzirani kusiyana pakati pa copays ndi coinsurance .
Ndondomeko zina zaumoyo sizinagwiritsidwe ntchito mankhwala osokoneza bongo osagwiritsa ntchito mankhwala osokoneza bongo. Pankhaniyi, muyenera kupitiriza kupereka malipiro anu ngakhale mutatha kufika malire anu. Ngati mutakhala ndi ndalama zokwanira 30 peresenti ya mankhwala osokoneza bongo, ndipo mudali mankhwala osokoneza bongo omwe amawononga ndalama zokwana madola 30,000 pachaka, mumalipira madola 9,000 pa mankhwalawa ngakhale mutakhala ndi ndalama zokwana madola 5,000. - Njira yachitatu imapanga miyeso yosiyana-siyana yamagulu a inshuwalansi. Chitsanzo chofala kwambiri chinali ndi chiwongoladzanja chachikulu cha mankhwala osokoneza bongo komanso mankhwala osiyana ndi ena onse.
Mutatha kuika malire a mankhwala osokoneza bongo , inshuwalansiyo inapereka ndalama zokwana 100 peresenti ya ndalama zanu, koma munapitiriza kupereka malipiro anu osagwiritsa ntchito mankhwala. Pambuyo pofika pamtundu wapamwamba kwambiri pazinthu zina zonse , inshuwalansi inapereka ndalama zoposa 100 peresenti za mankhwala osamalidwa ndi mankhwala, koma munapitiriza kulipira ndalama zanu pokhapokha ngati mutakumananso ndi zina zoterezi, thumba lalikulu la mankhwala.
Kampani ya inshuwalansi ya inshuwalansi sinaphatikizepo 100 peresenti ya chisamaliro chanu mpaka mutakwanitsa malire onse awiri. Ngati malire onse anali $ 5,000, mudalipira madola 10,000 kuti ndondomeko yaumoyo isayambe kupereka 100 peresenti.
The Affordable Care Act & Out-Of-Pocket Maximum
Sikuti njirazi zowonongeka ndi zovuta zokhudzana ndi ogula, koma zinasiyitsa anthu kumverera ngati kuti anazunzidwa. Ndiponsotu, ngati mutakhala ndi ndalama zokwana madola 5,000, ndiye bwanji munayenera kulipira $ 9,000 kunja kwa mthumba mankhwala omwe adayikidwa ndi dongosolo lanu la thanzi? Ochita zamalamulo adayankha kuti wogulitsawo akukhumudwa mwa kulamulira malire a inshuwalansi.
The Affordable Care Act amapanga miyandamiyanda yosavuta kwambiri. Imaika malire pa kuchuluka kwa thumba lachikwama likhoza kukhala chaka chilichonse. Izi zimafuna kuti ndalama zotsalira, zopereka, ndi ndalama zothandizira ndalama zonse ziyamikiridwe kumapeto kwa malire a kunja. Chofunika ichi chimachotsa inshuwalansi ya thanzi 'njira yochepetsera chiopsezo cha nambala imodzi.
ACA imafuna kuti zogwiritsira ntchito zaumoyo zizilipira 100 peresenti ya ndalama zowonongedwa kuchokera kwa a-network operekera kwa chaka chonse pokhapokha malire a kunja kwa mthumba atakwaniritsidwa. Chofunikira ichi chimasokoneza njira nambala ziwiri.
Mu 2017, ndondomeko zathanzi zomwe sizinakhalepo kale sizingakhale ndi ndalama zokwanira madola 7,150 kwa munthu mmodzi, kapena $ 14,300 za banja (ndipo malire omwe ali kunja omwe ayenera kukhala nawo muzinthu za umoyo , monga amodzi Wachibale sangathe kulipira ndalama zoposa $ 7,150).
Mu 2018, malire awa adzawonjezeka kufika pa $ 7,350 payekha komanso $ 14,700 kwa banja. Monga momwe zilili nthawi zonse, mapulani azaumoyo adzatha kukhala ndi malire amtundu wapatali (pansi pano) ndipo ambiri sadzatero, koma osati pamwamba pawo.
ACA inakhazikitsanso ndalama zothandizira inshuwalansi zomwe zimachepetsanso ndalama zowonjezera kwa anthu oyenerera, ndipo izi zidzapitiriza kugwira ntchito mu 2018.
Ndalama zambiri komanso zoteteza ku ACA zinayamba pa January 1, 2014. Komabe, magulu ena a magulu akuluakulu a zaumoyo sankayenera kutsatira mpaka mapulani a zaka 1 kuyambira mu January 1, 2015 (ngati atapereka chithandizo chachipatala ndi mankhwala, iwo analoledwa kuti akhale ndi malire osiyana kunja kwa 2014 mu 2014). Ndipo ndondomeko zazikuluzikulu sizikuyenera kutsatira malamulo onse a ACA, kotero iwo akhoza kupitiriza kugwiritsa ntchito malamulo awo akale onena za miyendo yodula. M'mayiko omwe amavomerezabe kukhalapo, ndondomeko zazikuluzikulu zingathe kupitiliza kugwiritsa ntchito maulamuliro awo a pre-ACA, koma zolinga zazikuluzikulu ziyenera kuthera kumapeto kwa 2018.
Kodi Ndiziteteza Bwanji?
Musagwedezeke chifukwa chodandaula chifukwa chotetezera ogula alipo. Palibe ndalama zina zomwe mudzakhala nazo kuti muthe kulipira mutatha kukwaniritsa zowonjezera. Izi zikuphatikizapo:
- Zomwe moyo wako umasankha sizowonjezera zamankhwala.
- Gawo lolipira- malipiro ndi kugawana mtengo mtengo kwa chithandizo chamankhwala chatsopano .
- Zinthu zomwe sizinapangidwe ndi dongosolo lanu labwino monga opaleshoni yokongoletsa.
- Kugawana mtengo kwa zinthu zomwe sizinapangidwe kuti ndizofunikira phindu la thanzi. Zopindulitsa izi sizowonjezera zomwe mukuganiza kuti ndondomeko yaumoyo yanu siyiyenera kupereka koma imasankha.
- Inshuwalansi zanu za inshuwalansi.
Ndondomeko iliyonse ya zaumoyo imapereka Chidule cha Mapindu ndi Mapindu kapena ndondomeko yofotokozera Mapulani omwe amamvetsetsa zomwe malire omwe ali kunja kwa mthunzi ndi zomwe sizikutchulidwa. Zindikirani izi pamene mukufanizira mapulani panthawi yolembera, kapena mukakhala kugula inshuwaransi yaumoyo . Mukhozanso kutchula dongosolo lanu labwino ndikufunsa.
Palibe cholakwika pankhani za inshuwalansi zaumoyo akuyesera kuchepetsa chiopsezo chawo malinga ngati akugwira ntchito mwalamulo ndikupereka tsatanetsatane wa malamulo. Cholemetsa chiri pa inu kuti mutsimikizire kuti mumamvetsa bwino malamulo anu. Muyenera kumvetsetsa momwe mungakhalire pachikopa chaka chilichonse kuti mutha kupanga bajeti moyenerera ndikupanga zochitika zovuta kwambiri.
Kodi AHCA ingasinthe bwanji Malamulo?
American Health Care Act (AHCA) inadutsa Nyumbayi kumayambiriro kwa mwezi wa May . Senate ikulemba mavoti awo, koma sanakhale nawo kumvetsera kapena kutsutsana kwa anthu onse, kotero sitikudziwa kuchuluka kwa nyumba yomwe akukonzekera.
Koma Nyumbayi imayimitsa malire a ACA m'malo mwake. Komabe, izo zilolezanso kuti dziko lifunefune kuchoka komwe angathe kufotokozera zomwe zimaonedwa kuti ndizofunikira phindu la thanzi . Ndipo malire a ACA omwe ali kunja kwa mthumba amangogwiritsidwa ntchito pazothandiza zaumoyo zofunika. Choncho, ngati boma likuloleza, azinesi zothandizira kuti azipereka malonda omwe sakuphimba amayi (mwa kubwezeretsanso zopindulitsa zofunika zaumoyo komanso kuphatikizapo chisamaliro cha amayi pa mndandanda), mtengo wa chisamaliro chakumayi udzakhala kunja- wa-mthumba wa makolo atsopano, ndipo sakanakhoza kuwerengera ku ndondomeko yawo ya inshuwalansi yowonjezera mthumba.
Senate ikhoza kusunga kapena kusunga makonzedwe omwe amalola kuti boma libwezeretsenso phindu la thanzi labwino, koma ngati atero, lidzafooketsa chitetezo chomwe chimaperekedwa ndi kapu ya ACA pa mtengo wapatali.
Zotsatira:
Zigawo za Medicare ndi Medicaid Services, Zopindulitsa Care Act Maphunziro FAQs Anakhazikitsa 18.
Dipatimenti ya zaumoyo ndi zithandizo zaumunthu . > Kuteteza Odwala ndi Zopanda Thandizo Labwino; Miyezo Yogwirizana ndi Zofunikira Zaumoyo Zaumoyo, Zofunika Kwambiri, ndi Kuvomerezeka . February 25, 2013.
> Federal Register, Patient > Chitetezo > ndi Chachikulu Chachidwi Chalamulo; Chidziwitso cha HHS cha Kupindula ndi Kulipira Malipiro a 2018; Kusintha kwa Nthawi Zowonjezereka Zapadera ndi Ogulitsa Opangira ndi Okhazikitsa Mapulani Pulogalamu >. December 22, 2016.
United States Dipatimenti Yochita Ntchito. FAQs za Zodalirika Care Act Makhalidwe a Part XII. February 20, 2013.
United States Dipatimenti Yochita Ntchito. Ma FAQs on Affordable Care Act Makhalidwe (Gawo XVIII) ndi Mental Health Parity Ntchito, January 9, 2014.