Ukuqonda iMedicare

I-Medicare ngumshwalense wezempilo ophethwe nguhulumeni kubantu abaneminyaka engama-65 noma ngaphezulu. Abanye abantu futhi bangathola iMedicare:

• Abantu abasha abanokukhubazeka okuthile
• Abantu abanokulimala kwezinso okungapheli (isifo sezinso zokugcina) futhi badinga i-dialysis noma ukufakelwa izinso

Ukuze uthole i-Medicare, kufanele ube yisakhamuzi sase-United States noma ube yisakhamuzi esisemthethweni esihlale ezweni okungenani iminyaka emihlanu.

I-Medicare inezingxenye ezine. Izingxenye A no-B nazo zibizwa nge- "Original Medicare."

• Ingxenye A - Ukunakekelwa kwesibhedlela
• Ingxenye B - Ukunakekelwa kweziguli
• Ingxenye C - Medicare Advantage
• Ingxenye D - Uhlelo Lokulungiswa Kwezidakamizwa Lwe-Medicare

Iningi labantu likhetha i-Original Medicare (izingxenye A no-B) noma i-Medicare Advantage. Nge-Original Medicare, unenketho yokukhetha futhi uHlelo D lwemithi yakho kadokotela.

Incenye yeMedicare A ihlanganisa tinsita netintfo letidzingekako kwelapha sifo noma timo tetekwelashwa letenteka ngalesikhatsi

• Ukunakekelwa esibhedlela.
• Ukunakekelwa kwendawo yabahlengikazi abanamakhono, lapho uthunyelwa ukuyolulama ekuguleni noma enkambisweni. (Ukuthuthela emakhaya asebekhulile lapho ungasakwazi ukuhlala ekhaya akuhlanganiswa neMedicare.)
• Ukunakekelwa kwabahlengikazi.
• Ukuvakashelwa kwezempilo emakhaya.

Izinsizakalo nezinto ezihlinzekwa ngenkathi usesibhedlela noma esikhungweni esingafakwa yilezi:

• Ukunakekelwa okunikezwa odokotela, abahlengikazi, nabanye abahlinzeki bezempilo
• Izidakamizwa
• Ukunakekelwa kwabahlengikazi
• Ukwelashwa ukusiza ngenkulumo, ukugwinya, ukunyakaza, ukugeza, ukugqoka nokunye
• Ukuhlolwa kweLab nezithombe
• Ukuhlinzwa nezinqubo
• Izihlalo ezinamasondo, izihambahamba neminye imishini

Iningi labantu alikhokhi imali ekhokhwa ngenyanga ngeNgxenye A.

Ukunakekelwa kweziguli ezingalaliswayo. I-Medicare Part B isiza ukukhokhela ukwelashwa nezinsizakalo ezinikezwa njengesiguli esingalaliswayo. Ukunakekelwa kweziguli ezingalapheka kungenzeka ku:

• Igumbi lezimo eziphuthumayo noma enye indawo yesibhedlela, kepha lapho ungamukelwa
• Amahhovisi abahlinzeki bezempilo (kufaka phakathi udokotela ongumhlengikazi, owelapha, nabanye)
• Isikhungo sokuhlinzwa
• Indawo yokusebenzela noma yezithombe
• Ikhaya lakho

Izinsizakalo nabanye abahlinzeki bezempilo. Iphinde ikhokhele izinsizakalo zokuvikela ezempilo, njenge:

• Ukuvakashelwa kwe-Wellness nezinye izinsizakalo zokuvimbela, ezinjengomkhuhlane kanye ne-pneumonia shots kanye nama-mammograms
• Izinqubo zokuhlinza
• Ukuhlolwa kweLab nama-x-ray
• Izidakamizwa nemithi ongakwazi ukuzinika yona, njengemithi oyinikezwa ngemithambo yakho
• Ukondla amashubhu
• Ukuvakasha nomhlinzeki
• Izihlalo ezinamasondo, abahamba ngezinyawo nezinye izinto
• Futhi okuningi

Iningi labantu likhokha imali ekhokhwa nyangazonke engxenyeni B. Uphinde ukhokhe imali encane ekhishwa minyaka yonke. Uma leyo mali seyihlangatsheziwe, ukhokha u-20% wezindleko zezinsizakalo eziningi. Lokhu kubizwa nge-coinsurance. Uphinde ukhokhe imali ekhokhelwa ukuvakashelwa odokotela. Le yimali encane, imvamisa engaba ngama- $ 25 noma ngaphezulu, ngokuvakashelwa udokotela ngamunye noma uchwepheshe ngamunye.

Empeleni okuhlanganiswa endaweni yakho kuncike kulokhu:

• Imithetho ye-Federal kanye neyezwe
• Okunqunywa yiMedicare kuyambozwa
• Yini izinkampani zendawo ezithatha ukumboza

Kubalulekile ukuthi uhlale uhlola ukumbozwa kwakho ngaphambi kokusebenzisa insizakalo ukuthola ukuthi yini iMedicare ezokukhokhela nokuthi yini ongayidinga ukuyikhokhela.

Izinhlelo zeMedicare advantage (MA) zinikela ngezinzuzo ezifanayo neNgxenye A, Ingxenye B, nengxenye D. Lokhu kusho ukuthi umbozwe ukunakekelwa kwezokwelapha kanye nezibhedlela kanye nemithi kadokotela. Izinhlelo ze-MA zihlinzekwa yizinkampani zomshuwalense ezizimele ezinikezwe abasebenza noMedicare.

• Ukhokha imali ekhokhwa nyangazonke yalolu hlobo lohlelo.
• Imvamisa kufanele usebenzise odokotela, izibhedlela, nabanye abahlinzeki abasebenza ngohlelo lwakho noma uzokhokha imali ethe xaxa.
• Izinhlelo ze-MA zihlanganisa zonke izinsizakalo ezihlinzekwa yi-Original Medicare (ingxenye A nengxenye B).
• Banikela ngokumbozwa okwengeziwe okufana nokubona, ukuzwa, amazinyo, kanye nokusetshenziswa kwezidakamizwa kadokotela. Kwezinye izimo, kungadingeka ukuthi ukhokhe imali eyengeziwe ngezinzuzo ezithile ezingeziwe ezinjengokunakekelwa kwamazinyo.

Uma une-Original Medicare (izingxenye A no-B) futhi ufuna ukumbozwa ngemithi kadokotela, kufanele ukhethe uHlelo Lwezidakamizwa Lwe-Medicare (Plan D). Lokhu kufakwa kunikezwa izinkampani zomshuwalense ezizimele ezivunyelwe yiMedicare.

Awukwazi ukukhetha uHlelo D uma unohlelo lweMedicare Advantage ngoba ukumbozwa kwezidakamizwa kunikezwa yilezo zinhlelo.

IMedigap iyinqubomgomo yomshuwalense yokwengeza ye-Medicare edayiswa izinkampani ezizimele. Kuyasiza ukukhokha izindleko ezinjengama-copayments, i-coinsurance, nama-deductibles. Ukuthola inqubomgomo yeMedigap kufanele ube ne-Original Medicare (ingxenye A nengxenye B). Ukhokhela inkampani yomshuwalense yangasese imali ekhokhwa nyangazonke yenqubomgomo yakho yeMedigap ngaphezu kweprimiyamu yanyanga zonke engxenye B oyikhokhela iMedicare.

Kufanele ujoyine i-Medicare Part A phakathi kwezinyanga ezintathu ngaphambi kwenyanga yakho yokuzalwa (uhlanganisa iminyaka engama-65) nezinyanga ezintathu ngemuva kwenyanga yakho yokuzalwa. Unikezwa iwindi lezinyanga eziyi-7 ukuze ujoyine.

Uma ungabhaliseli Ingxenye A ngaphakathi kwalelo windi, uzokhokha imali yenhlawulo ukujoyina uhlelo, futhi ungakhokha amaprimiyamu aphezulu enyanga. Noma ngabe usasebenza futhi uzokhokhiswa umshwalense wakho womsebenzi, udinga ukubhalisela iMedicare Part A. Ngakho-ke ungalindi ukujoyina iMedicare.

Ungabhalisela iMedicare Part B lapho uqala ukubhalisela ingxenye A, noma ungalinda uze udinge lolo hlobo lokumbozwa.

Ungakhetha phakathi kwe-Medicare yasekuqaleni (Ingxenye A noNgxenye B) noma uhlelo lweMedicare Advantage (Ingxenye C). Isikhathi esiningi, ungashintsha uye emuva naphakathi kwalezi zinhlobo zokumbozwa okungenani kanye ngonyaka.

Nquma ukuthi ngabe ufuna ukumbozwa ngemithi kadokotela noma Ingxenye D. Uma ufuna ukumbozwa ngemithi kadokotela udinga ukuqhathanisa amapulani aqhutshwa izinkampani zomshuwalense. Ungaqhathanisi nje amaphrimiyamu ngenkathi uqhathanisa amapulani. Qiniseka ukuthi imishanguzo yakho imboziwe ngohlelo obukelile.

Cabanga ngezinto ezingezansi lapho ukhetha uhlelo lwakho:

• Ukufunda - Uhlelo lwakho kufanele luhlanganise izinsizakalo nemithi oyidingayo.
• Izindleko - Qhathanisa izindleko odinga ukuzikhokha ezinhlelweni ezahlukahlukene. Qhathanisa izindleko zamaphrimiyamu akho, imali ekhishiwe, nezinye izindleko phakathi kwezinketho zakho.
• Imithi kadokotela - Hlola ukuqinisekisa ukuthi yonke imithi yakho imboziwe ngaphansi kwe-formulary yohlelo.
• Ukukhetha udokotela nesibhedlela - Hlola ukubona ukuthi ungamsebenzisa yini udokotela nesibhedlela osithandayo.
• Ukunakekelwa kwekhwalithi - Hlola izibuyekezo nezilinganiso zamapulani nezinsizakalo ezinikezwa amapulani asendaweni yangakini.
• Ukuvakasha - Thola ukuthi ngabe lolu hlelo luyakusibekela yini uma uya kwelinye izwe noma ngaphandle kwase-United States.

Ukuze ufunde kabanzi nge-Medicare, funda ngezinhlelo ze-Medicare Advantage ezitholakala endaweni yakho, bese uqhathanisa odokotela, izibhedlela, nabanye abahlinzeki endaweni yakho, iya ku-Medicare.gov - www.medicare.gov.

Izikhungo zewebhusayithi yeMedicare neMedicaid Services. Yini iMedicare? www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare. Kufinyelelwe ngoFebhuwari 2, 2021.

Izikhungo zewebhusayithi yeMedicare neMedicaid Services. Yini i-Medicare yezempilo ehlanganisa. www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover. Kufinyelelwe ngoFebhuwari 2, 2021.

Izikhungo zewebhusayithi yeMedicare neMedicaid Services. Izithasiselo neminye imishwalense. www.medicare.gov/supplements-other-insurance. Kufinyelelwe ngoFebhuwari 2, 2021.

UStefanacci RG, uCantelmo JL. Ukunakekelwa okuphethwe ngabantu abadala baseMelika. Ku: Gcwalisa i-HM, i-Rockwood K, i-Young J, ama-eds. Incwadi kaBrocklehurst ye-Geriatric Medicine ne-Gerontology. Umhlaka 8. IPhiladelphia, PA: Elsevier; I-2017: isahluko 129.

• Imithi
• I-Medicare Prescription Drug Coverage