Ukuqonda izinhlelo zomshuwalense wezempilo

Izinkampani eziningi zomshuwalense zinikela ngezinhlobo ezahlukene zezinhlelo zezempilo. Futhi uma uqhathanisa amapulani, kwesinye isikhathi kungabonakala njengesobho lama-alfabhethi. Uyini umehluko phakathi kwe-HMO, i-PPO, i-POS, ne-EPO? Ingabe zinikeza ukumbozwa okufanayo?

Lo mhlahlandlela wezinhlelo zezempilo ungakusiza uqonde uhlobo ngalunye lwecebo. Ngemuva kwalokho ungakhetha kalula isu elifanele wena nomndeni wakho.

Ngokuya ngokuthi uwuthola kanjani umshuwalense wakho wezempilo, ungahle ube nokuzikhethela kwezinhlobo ezahlukene zamapulani.

Izinhlangano Zokulondolozwa Kwezempilo (HMOs). Lezi zinhlelo zinikela ngenethiwekhi yabahlinzeki bokunakekelwa kwezempilo kanye nama-premium akhokha nyangazonke. Abahlinzeki banenkontileka nohlelo lwezempilo. Lokhu kusho ukuthi babiza inani elibekiwe lezinsizakalo. Uzokhetha umhlinzeki wokunakekelwa oyinhloko. Lo muntu uzokuphatha ukunakekela kwakho futhi akudlulisele kochwepheshe. Uma usebenzisa abahlinzeki, izibhedlela, nabanye abahlinzeki abavela kunethiwekhi yohlelo, ukhokha kancane ephaketheni. Uma usebenzisa abahlinzeki ngaphandle kwenethiwekhi, kuzodingeka ukhokhe ngaphezulu.

Izinhlangano Zabahlinzeki Ababodwa (EPOs). Lezi yizinhlelo ezinikela ngamanethiwekhi abahlinzeki kanye nama-premium akhokhelwa ngenyanga. Kufanele usebenzise abahlinzeki nezibhedlela kusuka kuhlu lwenethiwekhi ukugcina izindleko zakho zokuphuma ephaketheni ziphansi. Uma ubona abahlinzeki ngaphandle kwenethiwekhi, izindleko zakho zizoba zinkulu kakhulu. Ngama-EPO, awudingi umhlinzeki wokunakekelwa okuyinhloko ukuphatha ukunakekelwa kwakho futhi akunikeze nokudluliselwa.

Izinhlangano Zabahlinzeki Abathandwayo (ama-PPO). Ama-PPO anikela ngenethiwekhi yabahlinzeki kanye nokuzikhethela kokubona abahlinzeki ngaphandle kwenethiwekhi ngemali ethe xaxa. Awudingi umhlinzeki wokunakekelwa oyinhloko ukuphatha ukunakekelwa kwakho. Uzokhokha ngaphezulu kuma-premium walolu hlelo uma kuqhathaniswa ne-HMO, kepha unenkululeko ethe xaxa yokubona abahlinzeki ngaphakathi nangaphandle kwenethiwekhi ngaphandle kwesidingo sokudluliselwa.

Izinhlelo zePoint-of-Service (POS). Izinhlelo ze-POS zifana ne-PPO. Banikela ngenzuzo engaphakathi kwenethiwekhi nangaphandle kwenethiwekhi. Ungabona noma yibaphi abahlinzeki abakwi-network ngaphandle kokudluliselwa. Kepha udinga ukuthunyelwa ukuze ubone abahlinzeki abangaphandle kwenethiwekhi. Ungonga imali ethile kuma-premium akhokhwa nyangazonke ngalolu hlobo lwecebo ngokuqhathaniswa ne-PPO.

Izinhlelo Zempilo Ezinciphisiwe Eziphezulu (HDHPs). Lolu hlobo lwepulani lunikela ngamaphrimiyamu aphansi nyangazonke kanye nemali edonswayo ephezulu minyaka yonke. I-HDHP ingaba enye yezinhlobo zepulani ngenhla ngokudonswa okuphezulu. Okudonswayo inani lemali okufanele ulikhokhe ngaphambi kokuba umshuwalense wakho uqale ukukhokha. Ngo-2020, ama-HDHP anokudonswa okungama- $ 1,400 umuntu ngamunye kanye no- $ 2,800 ngomndeni ngamunye ngonyaka noma ngaphezulu. Abantu abanalezi zinhlelo bavame ukuthola i-akhawunti yokonga yezokwelapha noma yokubuyisela imali. Lokhu kukusiza ukuthi wonge imali yezindleko ezikhishwayo nezinye ezikhishwa ephaketheni. Kungakusiza futhi ukuthi wonge imali kuzintela.

Imali yesevisi (FFS) izinhlelo azivamile namuhla. Lezi zinhlelo zinikeza inkululeko yokubona noma yimuphi umhlinzeki noma isibhedlela ozikhethele sona. Uhlelo lukhokha inani elibekiwe ngenkonzo ngayinye, bese ukhokha okusele. Awudingi ukudluliselwa. Kwesinye isikhathi, ukhokhela insizakalo ngaphambili, ufake isimangalo, bese uhlelo lukubuyisela. Lolu uhlelo lomshuwalense wezempilo olubizayo lapho lungafaki inethiwekhi noma inketho ye-PPO.

Izinhlelo zenhlekelele unikeze izinzuzo zezinsizakalo eziyisisekelo nokugula okukhulu noma ukulimala. Ziyakuvikela ezindlekweni zengozi enkulu noma ukugula. Lezi zinhlelo azinakho ukumbozwa okuhle kwabantu abanezinkinga zempilo abadinga ukunakekelwa okuvamile noma ukuhlolwa. Ungathenga kuphela uhlelo oluyinhlekelele uma ungaphansi kweminyaka engama-30 noma ungafakazela ukuthi awukwazi ukukhokhela ukumbozwa kwezempilo. Amaphrimiyamu anyanga zonke aphansi, kepha okubanjelwe lezi zinhlelo kuphezulu impela. Njengomuntu ngamunye, ukudonswa kwakho kungaba cishe ngama- $ 6,000. Uzodinga ukukhokha imali ebanjwayo ephezulu ngaphambi kokuthi umshuwalense uqale ukukhokha.

Lapho ukhetha uhlelo, cabanga ngezidingo zakho zokwelashwa nezinto ozithandayo. Ngaphezu kohlobo lohlelo, qiniseka ukuthi uqhathanisa izinzuzo, izindleko eziphuma ephaketheni, nenethiwekhi yomhlinzeki ngokulingana okuhle.

Isisekelo se-AHIP. Umhlahlandlela wabathengi wokuqonda amanethiwekhi wohlelo lwezempilo. www.ahip.org/wp-content/uploads/2018/08/ConsumerGuide_PRINT.20.pdf. Kufinyelelwe ngoDisemba 18, 2020.

Healthcare.gov iwebhusayithi. Ungalukhetha kanjani uhlelo lomshuwalense wezempilo. Uhlelo lomshuwalense wezempilo nezinhlobo zenethiwekhi: ama-HMO, ama-PPO, nokuningi. www.healthcare.gov/choose-a-plan/plan-types. Kufinyelelwe ngoDisemba 18, 2020.

Ezempilo.gov.website. Uhlelo lwezempilo oludonswayo oluphezulu (HDHP). www.healthcare.gov/glossary/high-deductible-health-plan/. Kufinyelelwe ngoFebhuwari 22, 2021.

Healthcare.gov iwebhusayithi. Ungalukhetha kanjani uhlelo lomshuwalense wezempilo: izinto ezi-3 okufanele wazi ngaphambi kokukhetha uhlelo lomshuwalense wezempilo. www.healthcare.gov/choose-a-plan. Kufinyelelwe ngoDisemba 18, 2020.

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