Medicare HMO ndi PPO Njira ndi Zosankha
Mapulani a Medicare Opindulitsa amaperekedwa ndi makampani a inshuwalansi yaumwini omwe amavomerezedwa ndi Medicare ndipo ali ndi mgwirizano wakupatsani madalitso a Medicare.
Kodi Pulogalamu ya Medicare Yopindulitsa Ndiyi?
Ngati mulowa nawo Pulogalamu ya Medicare Advantage, ndondomekoyi iyenera kupereka gawo lanu lonse (Inshuwalansi ya Chipatala) ndi Gawo B (Inshuwalansi ya zamankhwala), kuphatikizapo chithandizo chodzidzimutsa komanso mwamsanga.
Phindu lalikulu lokha losapangidwe ndi ndondomekozi ndi chipatala - izi zimapindula ndi Original Medicare ngakhale mutasankha ndondomeko ya Medicare Advantage Plan.
Mapulogalamu ambiri a Medicare Advantage amapereka chithandizo chowonjezera, monga masomphenya, kumva, mano, ndi machitidwe ambiri ndi mapulogalamu ena a thanzi ndi ukhondo. Ambiri opanga mapulani ndi Medicare mankhwala mankhwala Kuphunzira ( Medicare Part D ).
Mapulani ambiri a Medicare Advantage amapatsidwa ndondomeko yothandizira , kawirikawiri bungwe lokonza thanzi (HMO) kapena bungwe lothandizira (PPO). Mapulaniwa angafunike kuti musankhe dokotala wamkulu (PCP), kutumizirani kuchokera ku PCP kuti muwone katswiri, ndipo mugwiritse ntchito madokotala, zipatala, ndi zipatala zina ndi zina zomwe ziri mbali ya mndandanda wa pulaneti .
Makampani ena a inshuwalansi a zaumoyo amapereka mankhwala a Medicare Advantage omwe amadziwika kuti Dipatimenti yapayekha (Service Fee-for-Service (PFFS) yomwe ingakulole kuti muwone dokotala wina kapena kugwiritsa ntchito chipatala chilichonse chovomerezedwa ndi Medicare.
Komabe, mosiyana ndi oyamba a Medicare, mukhoza kukhala ndi mapepala kwa maulendo a udokotala ndipo si onse amene angakupatseni. Komabe, mu PFFS Mapulani, simusowa kusankha PCP ndipo simukusowa kutumiza kukawona katswiri.
Ndondomeko ya Medicare Yopindulitsa Ndiyi?
Mwezi uliwonse, Medicare amapereka ndondomeko yanu yopindulitsa ndalama zokwanira kuti mupereke chisamaliro chanu.
Ndondomeko yopindulitsa ndiye kuti ndiyenera kulipira dokotala, chipatala, ndi ena omwe akusamalira.
Ngakhale ndondomeko yanu yopindulitsa iyenera kutsatira malamulo a Medicare, ikhoza kukulipirani ndalama zowonjezera ndi zina zowonjezera , monga ndalama za dokotala, maulendo olimbitsa thupi (monga chikuku), ndi chaka chokha mankhwala ovomerezeka.
Inunso muli ndi udindo wa payroll yanu ya Medicare Part B pamwezi, yomwe imachotsedwa pa chitukuko chanu chachitetezo.
Mwachitsanzo: George C. amakhala ku Massachusetts ndipo ali ndi Medicare Advantage Plan kupyolera mu Fallon Community Health, imodzi mwa njira zabwino kwambiri zaumoyo m'dzikoli. Iye ali ndi dongosolo la HMO ndi kulandira mankhwala. Mphoto yake ya mwezi uliwonse imadula ndalama zokwana madola 208.40 (Medicare Part B premium ya $ 96.40 kuphatikizapo $ 112 zomwe zawonongedwa ndi kugwa). Kuwonjezera apo, ndalama zake zochokera kunja zimaphatikizapo ndalama zokwana madola 15 paulendo uliwonse wa PCP, $ 20 kwa katswiri aliyense wazomwe akuyendera, 10% zothandizira ndalama zogwiritsira ntchito zipangizo zamankhwala zotsalira, komanso ndalama zokwana madola 310 za mankhwala oyenera.
Kodi Ndingapeze Bwanji Pulogalamu Yabwino ya Medicare?
Kawirikawiri, mutha kukhala nawo Pulogalamu ya Medicare Advantage ngati muli ndi Medicare Part A ndi Part B ndipo mumakhala kumalo kumene kuli pulogalamu yabwino yomwe imalandira mamembala atsopano.
Zina zimangotenga zigawo zina m'dzikolo ndipo muyenera kukhala m'madera omwe amapanga dongosolo.
Mapulani ena a Medicare Advantage amachititsa masemina a m'deralo kuti afotokoze zolinga zawo ndipo mukhoza kupeza ndi kukwaniritsa mapulogalamu pa nthawiyo. Mukhozanso kulembetsa mwa kuyitanitsa ndondomeko, kuyendera webusaiti ya pulaneti, kapena pa www.medicare.gov. Tsamba la Medicare likukuthandizani kufanizitsa mapulani m'deralo. Mutha kuitananso Medicare pa 800-633-4227.
Ngati mutembenukira ku dongosolo lina lopindulitsa, zonse muyenera kuchita ndikulowa nawo pulogalamu yatsopanoyo ndipo mutha kusokonezeka kuchoka ku dongosolo lanu lakale.
Simudzasowa chilichonse muzolemba zanu.
Medicare amalepheretsa pamene mungathe kujowina, kusinthana, kapena kusiya Chithandizo cha Medicare Advantage. Mukhoza kulumikiza ndondomeko pamene mukuyamba kulandira Medicare. Izi ndi nthawi iliyonse yoyambira miyezi itatu mwezi usanafike 65 ndipo umatha miyezi itatu pambuyo pa mwezi womwe unasintha 65.
Mwachitsanzo, ngati mutatsala zaka 65 pa April 28, nthawi yanu yoyenera ikuyamba pa January 1 ndipo imatha pa July 30th.
Ngati ndinu olumala ndipo muli ndi inshuwalansi ya Social Security Disability, mungagwirizane ndi ndondomeko yopindula miyezi itatu isanakwane miyezi itatu mutatha mwezi wanu wa 25 wodwala.
Mukhozanso kusinthanso kapena kuponya mwayi wanu pa nthawi yolembetsa pakati pa November 15 ndi December 31 chaka chilichonse.
Kuti mudziwe zambiri zokhudza inshuwalansi ya Medicare Advantage Plan, pitani ku webusaiti ya Medicare.
Kodi Ndiyenera Kudziwa Zotani Zokhudza Mapulogalamu Othandiza A Medicare?
Ndikofunika kuti mumvetse kusiyana pakati pa Original Medicare ndi Medicare Advantage Plans . Zinthu zina zomwe muyenera kukumbukira pazinthu zopindulitsa ndi izi:
- Muyenera kutsatira malamulo! Mwachitsanzo, ngati muli mu dongosolo labwino la HMO, muyenera kusankha PCP ndikugwiritsira ntchito makanema okha.
- Mungathe kujowina ndondomeko yopindula ngakhale mutakhala ndi chimodzi kapena zambiri zomwe zakhalapo kale . Palibe nthawi yolindira.
- Ngati ndondomeko yanu yopindula ikufuna kuti musayambe kutenga nawo mbali mu Medicare, mukhoza kulumikizana ndi njira ina kapena kubwerera ku Medicare Yoyamba.
- Ngati ndondomeko yanu yosaphatikizirapo sichiphatikizapo kulandira mankhwala osokoneza bongo, mukhoza kulumikiza dongosolo la Medicare Part D mdziko lanu. Komabe, malinga ndi Medicare: "Ngati muli m'dongosolo la Medicare Advantage Plan lomwe limaphatikizapo mankhwala osokoneza bongo ndipo mumagwiritsa ntchito Medicare Prescription Drug Plan, mudzasulidwa ku Medicare Advantage Plan ndikubwezeretsani ku Medicare Yopereka."
- Malingana ngati inu mwalembetsa mu Mapulani a Medicare, simukufunikira kugula mankhwala a Medicare Supplement (Medigap). Ndipotu, sikuletsedwa kuti wina akugulitseni ndondomeko ya Medigap ngati muli pulogalamu yabwino. Mapindu omwe amaperekedwa ndi ndondomeko ya Medigap akugwiritsidwa ntchito ndi ndondomeko yanu yopindulitsa ndipo ndalama zowonjezerapo sizilipira ndalama zomwe mumagwiritsira ntchito, zomwe mumapereka, kapena ndalama zanu.
Njira za Medicare Zopindulitsa ndi Kusintha kwa Zaumoyo
Medicare Zopindulitsa ndondomeko zimagula federal boma kuposa chikhalidwe cha Medicare. Kuchokera mu 2012, Medicare idzayamba kuchepetsa ndalama zothandizira izi.
Ngati mwalembetsa mu dongosolo la Medicare Advantage, mungafunikire kulipira mtengo wapamwamba kapena kuthandizira phindu lochepa. Komabe, mapulaniwa sangathe kuchepetsa ubwino uliwonse umene mungalandire kuchokera ku Medicare wamba.