Ngingakwazi Yini Ukushintsha Ukusuka Ensizakalweni Yezokwelapha ngibe iMedigap?

-Delile

• Uyini umehluko phakathi kwe-Medicare Advantage neMedigap
• Yini i-Medicare Advantage?
• Izinzuzo zohlelo lwe-Medicare Advantage
• Okubi kohlelo lweMedicare Advantage
• Yini iMedigap?
• Izinzuzo zohlelo lweMedigap
• Okubi kohlelo lweMedigap
• Ngingashintsha nini kusuka eMedicare Advantage ngiye eMedigap?
• Amathiphu wokukhetha uhlelo lwe-Medicare
• Ukuthatha

• IMedicare Advantage neMedigap zombili zithengiswa izinkampani zomshuwalense ezizimele.
• Banikeza izinzuzo ze-Medicare ngokungeziwe kulokho okushiwo yi-Medicare yangempela.
• Ungahle ungabhalisi kuzo zombili i-Medicare Advantage neMedigap, kepha ungashintsha phakathi kwalezi zinhlelo ngezikhathi ezithile zokubhalisa.

Uma njengamanje une-Medicare Advantage, ungashintshela ku-Medigap ngesikhathi esithile sokubhalisa windows. I-Medicare Advantage neMedigap yizibonelo zezinhlobo ezahlukene zomshuwalense ongaba nazo - hhayi nje ngasikhathi sinye.

Uma ufuna ukushintsha usuka kwi-Medicare Advantage uye eMedigap, nakhu okumele ukwazi ukuze kwenzeke.

Uyini umehluko phakathi kwe-Medicare Advantage neMedigap

IMedicare Advantage neMedigap yizinhlelo zombili zomshuwalense weMedicare ezinikezwa izinkampani zomshuwalense ezizimele; kodwa-ke, zinikeza izinhlobo ezahlukahlukene zokumbozwa.

I-Medicare Advantage (Ingxenye C) ingena esikhundleni sokutholakala kwe-Medicare yokuqala (izingxenye A no-B), kuyilapho iMedigap (iMedicare supplement) inikeza izinzuzo ezihlanganisa izindleko zokunakekelwa kwezempilo ngaphandle kwamaphepha ezinjenge-copays, i-coinsurance, ne-deductibles.

Ungabhaliswa kuphela kwi-Medicare Advantage noma iMedigap - hhayi womabili, ngakho-ke ukuqonda umehluko kulezi zinhlelo ezimbili zeMedicare kubaluleke kakhulu lapho uthengela ukutholakala kwakho kwe-Medicare.

Yini i-Medicare Advantage?

Eyaziwa nangokuthi i-Medicare Part C, amacebo we-Medicare Advantage ahlinzeka ngokuhlanganiswa okuhlanganisiwe esikhundleni se-Medicare-Medicare Part A yasekuqaleni (isibhedlela noma ukulala kokuhlala ngaphakathi), kanye ne-Medicare Part B (izinsizakalo zezokwelapha nokuhlinzekwa kokuhlinzekwa). Izinhlelo zeMedicare Advantage zingabandakanya ukumbozwa kwezidakamizwa zikaMedicare Part D kanye nokufakwa okwengeziwe kwezinto ezifana namazinyo, umbono, ukuzwa, nokuningi.

Abanye abantu bathola izinsizakalo zokuqoqa inkokhelo eyodwa yenyanga kulula ukuyiqonda futhi kaningi kubiza kakhulu, futhi abantu abaningi bajabulela izinsizakalo ezingeziwe ezinikezwa yizinhlelo ze-Medicare Advantage.

Ngokuya ngenkampani kanye nohlelo olukhethayo, izinhlelo eziningi zeMedicare Advantage zikhawulela abahlinzeki bezokunakekelwa kwempilo ongafinyelela kubo kuphela kulabo abaphakathi kwenethiwekhi yabo. I-Medicare Advantage ingaba yinkimbinkimbi kakhulu kune-Medicare yasekuqaleni uma umuntu onecebo le-Medicare Advantage edinga ukubona ochwepheshe bezokwelapha.

Izinzuzo zohlelo lwe-Medicare Advantage

• Ama-Medicare Advantage Plans angahle ahlanganise ezinye izinsiza ze-Medicare yendabuko ayenzi, njengokubona, izinhlelo zamazinyo, noma izinhlelo zokuphila kahle.
• Lezi zinhlelo zinganikela ngamaphakeji enzelwe abantu abanezimo ezithile zezokwelapha ezingamahlalakhona abadinga izinsizakalo ezithile.
• Lezi zinhlelo zibandakanya ukumbozwa kwezidakamizwa kadokotela.
• Izinhlelo zeMedicare Advantage zingabiza kancane uma umuntu edinga kuphela ukubona uhlu lwabahlinzeki bezokwelapha abagunyaziwe kuhlelo lweMedicare Advantage.

Okubi kohlelo lweMedicare Advantage

• Ezinye izinhlelo zinganciphisa odokotela ongababona, okungaholela ezindlekweni eziphuma ephaketheni uma ubona udokotela ongekho kwinethiwekhi.
• Abanye abantu abagula kakhulu bangathola ukuthi i-Medicare Advantage ibiza kakhulu ngenxa yezindleko eziphuma ephaketheni futhi badinga ukubona abahlinzeki abangafanelekile ngaphansi kohlelo oluthile.
• Amanye amacebo kungenzeka angatholakali ngokuya ngendawo yomuntu.

Ungajoyina i-Medicare Advantage ngemuva kweminyaka yobudala engama-65 nangemva kokubhalisela i-Medicare Part A no-B. Uma unesifo se-renal end (ESRD), ungajoyina uhlelo olukhethekile lwe-Medicare Advantage olubizwa nge-Special Needs Plan (SNP) ).

Yini iMedigap?

Izinhlelo zokwengeza zeMedicare, ezibizwa nangokuthi iMedigap, ziyindlela yomshuwalense esiza ukumboza izindleko zokunakekelwa kwezempilo ezingaphandle kwesikhwama ezinjenge-coinsurance, ama-copay, kanye, nama-deductibles.

Izinhlelo zeMedigap zithengiswa izinkampani zomshuwalense ezizimele, futhi ngaphandle kokuthi uthenge uhlelo lwakho lweMedigap ngaphambi kukaJanuwari 1, 2006, azibandakanyi imishanguzo kadokotela. Uma ukhetha iMedigap, udinga ukubhalisa ohlelweni lweMedicare Part D ukuze ube nokutholakala kwemithi kadokotela.

Inqubomgomo yeMedigap iyisengezo ezinzuzweni zakho zeMedicare Part A no Part B. Usazokhokha i-premium yakho ye-Medicare Part B ngaphezu kwe-premium yakho yeMedigap.

Izinzuzo zohlelo lweMedigap

• Izinhlelo zeMedigap zihleliwe, okusho ukuthi uma unyakaza, usengakwazi ukugcina ukumbozwa kwakho. Awudingi ukuthola uhlelo olusha njengoba uvame ukwenza ngeMedicare Advantage.
• Lezi zinhlelo zingasiza ukwelekelela izindleko zokunakekelwa kwezempilo ezingakhokhwa yiMedicare, okunciphisa umthwalo wezezimali womuntu.
• Ngenkathi izinhlelo zeMedigap zivame ukubiza kakhulu ekugcineni ngaphambi kwezinhlelo zeMedicare Advantage, uma umuntu egula kakhulu, ngokuvamile anganciphisa izindleko.
• Izinhlelo zeMedigap zivame ukwamukelwa kuzo zonke izikhungo ezithatha iMedicare, zibenze babe nemikhawulo engaphansi kunezinhlelo zeMedicare Advantage.

Okubi kohlelo lweMedigap

• Izinhlelo zeMedigap zidinga ukukhokha imali eyengeziwe yomshwalense, engahle idide abanye abantu.
• I-premium yanyangazonke ivame ukuba ngaphezulu kune-Medicare Advantage.
• I-Plan F, enye yezinhlelo ezaziwa kakhulu zeMedigap, ifaka izindleko eziningi ezingaphandle kwephaketheni. Kuyahamba ngo-2020 kwabemukeli abasha be-Medicare. Lokhu kungathinta ukuthandwa kwezinhlelo zeMedigap.

Izinqubomgomo zeMedigap zenziwa zifane neMedicare. Lokhu kusho ukuthi ungakhetha kusuka kuzinqubomgomo eziningana ezifanayo ezweni lonke. Kodwa-ke, izinkampani zomshuwalense zingakhokhisa amanani ahlukile ngezinqubomgomo zeMedigap. Kungakho kukhokhela ukuqhathanisa izinketho lapho uthenga iMedigap. Izinhlelo zokwengeza zeMedicare zisebenzisa amagama njengamagama. Izinhlelo eziyi-10 ezikhona njengamanje zifaka phakathi: A, B, C, D, F, G, K, L, M, noN.

Ngaphandle kokuthi uthenge uhlelo lwakho lweMedigap ngaphambi kuka-2020, uzodinga ne-Medicare Part D futhi uma ufuna ukumbozwa ngemithi kadokotela.

Ngingashintsha nini kusuka eMedicare Advantage ngiye eMedigap?

Ezinye izifundazwe zidinga izinkampani zomshuwalense ukuthi zithengise okungenani uhlobo olulodwa lwenqubomgomo yeMedigap kulabo abangaphansi kweminyaka engama-65 abafanelekela ukuthola iMedicare. Ezinye izifundazwe kungenzeka zingabi nezinhlelo zeMedigap ezitholakala kulabo abangaphansi kweminyaka engama-65 abane-Medicare.

Ungathenga inqubomgomo yeMedigap ngesikhathi sokubhalisa esivulekile sezinyanga eziyi-6 esenzeka ngemuva kokuthi usuqede iminyaka engama-65 futhi ubhalise kwi-Medicare Part B. Uma ungabhalisi ngalesi sikhathi, izinkampani zomshuwalense zingakhuphula amaphrimiyamu anyanga zonke.

Ungashintsha kuphela kusuka ku-Medicare Advantage uye eMedigap ngezikhathi ezibalulekile zonyaka. Futhi, ukuze ubhalise eMedigap, kufanele uphinde ubhalise kwiMedicare yangempela.

Izikhathi lapho ungashintsha khona kusuka ku-Medicare Advantage uye eMedigap zifaka:

• Isikhathi sokubhalisa esivulekile seMedicare Advantage (Januwari 1 – Mashi 31). Lona umcimbi waminyaka yonke lapho, uma ubhalisile kwi-Medicare Advantage, ungashintsha izinhlelo ze-Medicare Advantage noma ushiye uhlelo lwe-Medicare Advantage, ubuyele ku-Medicare yasekuqaleni, bese ufaka isicelo sohlelo lwe-Medigap.
• Isikhathi sokubhalisa esivulekile (ngo-Okthoba 15 – Disemba 7). Kwesinye isikhathi okubizwa ngokuthi yisikhathi sokubhaliswa konyaka (i-AEP), ungabhalisa kunoma yiluphi uhlelo lweMedicare, futhi ungashintsha kuMedicare Advantage ubuyele eMedare yasekuqaleni bese ufaka isicelo sohlelo lweMedigap ngalesi sikhathi.
• Isikhathi sokubhalisa esikhethekile. Ungakwazi ukushiya uhlelo lwakho lwe-Advantage uma uhamba futhi uhlelo lwakho lwe-Medicare Advantage alunikezwa kukhodi yakho entsha ye-zip.
• Isikhathi sokuhlolwa seMedicare Advantage. Izinyanga eziyi-12 zokuqala ngemuva kokubhalisa kwi-Medicare Advantage yaziwa ngokuthi yisikhathi sokulinga se-Medicare Advantage, uma lesi yisikhathi sakho sokuqala ukuba nohlelo lwe-Advantage, ungabuyela ku-Medicare yasekuqaleni bese ufaka isicelo seMedigap.

Amathiphu wokukhetha uhlelo lwe-Medicare

• Sebenzisa amasayithi afana ne-Medicare.gov ukuqhathanisa intengo yamapulani.
• Shayela umnyango womshuwalense wombuso wakho ukuthola ukuthi ngabe uhlelo olucabangayo lube nezikhalazo ngalo.
• Khuluma nabangane bakho abane-Medicare Advantage noma i-Medigap bese uthola ukuthi yini abayithandayo nabangayithandi.
• Thinta abahlinzeki bakho bezokwelapha obathandayo ukuthola ukuthi bayaluthatha yini uhlelo lweMedicare Advantage olucubungulayo.
• Linganisa isabelomali sakho ukuthola ukuthi ungalindela kangakanani ukukhokha njalo ngenyanga.

Ukuthatha

• Izinhlelo zeMedicare Advantage neMedigap ziyingxenye ye-Medicare engenza ukuthi ukufakwa kwezempilo kungabizi kakhulu.
• Ngenkathi ukukhetha okukodwa noma okunye kudinga ucwaningo nesikhathi, ngakunye kunamandla okukugcinela imali ezindlekweni zokunakekelwa kwezempilo uma kunesidingo.
• Uma ungenaso isiqiniseko sokuthi ungaqala kuphi, shayela u-1-800-MEDICARE futhi abamele iMedicare bangakusiza uthole izinsiza ozidingayo.

Imininingwane ekule webhusayithi ingakusiza ekwenzeni izinqumo eziphathelene nomshuwalense, kepha ayihloselwe ukunikeza iseluleko maqondana nokuthengwa noma ukusetshenziswa kwanoma imuphi umshwalense noma imikhiqizo yomshuwalense. I-Healthline Media ayisebenzisi ibhizinisi lomshwalense nganoma iyiphi indlela futhi ayinamalayisensi njengenkampani yomshuwalense noma umkhiqizi kunoma iyiphi indawo yase-U.S. I-Healthline Media ayincomi noma ivumele noma yiziphi izinkampani zangaphandle ezingase zenze ibhizinisi lomshwalense.