Yini I-Medicare Eyimbozayo Uma Une-Dementia?

-Delile

• Ingabe i-Medicare ihlanganisa ukunakekelwa komqondo?
• Ingabe i-Medicare ikhava indawo noma ukunakekelwa kweziguli kokugula komqondo?
• Izibhedlela
• Izikhungo zabahlengikazi ezinamakhono (SNFs)
• Ingabe i-Medicare ihlanganisa ukunakekelwa kwasekhaya komqondo wokuwohloka komqondo?
• Ingabe i-Medicare ikhava ukuhlolwa kokuwohloka komqondo?
• Ngabe i-Medicare ihlanganisa i-hospice yabantu abane-dementia?
• Yiziphi izingxenye zeMedicare ezimboza ukunakekelwa komqondo?
• Ukutholakala kwemithi ngokwengxenye
• Ngubani ofanelekile ukuthola i-Medicare coverage ngokunakekelwa komqondo?
• Kuyini ukuwohloka komqondo?
• Okubalulekile

• I-Medicare ihlanganisa ezinye izindleko ezihambisana nokunakekelwa komqondo, kufaka phakathi ukuhlala kweziguli, ukunakekelwa kwempilo yasekhaya, kanye nokuhlolwa okudingekayo kokuxilongwa.
• Amanye amacebo we-Medicare, njengezinhlelo zezidingo ezikhethekile, enzelwe abantu abanezimo ezingapheli njengokuwohloka komqondo.
• I-Medicare ngokuvamile ayihlanganisi ukunakekelwa kwesikhathi eside, njengaleyo enikezwa ekhaya labahlengikazi noma endaweni yokuhlala esiziwayo.
• Kunezinsizakusebenza ezitholakalayo, ezinjengezinhlelo zeMedigap neMedicaid, ezingasiza ukumboza izinsizakalo zokunakekelwa komqondo ezingamboziwe yiMedicare.

I-Dementia yigama elisetshenziselwa ukubhekisa esimweni lapho ukucabanga, inkumbulo, kanye nokuthatha izinqumo sekuphazamisekile, kuphazamisa imisebenzi yansuku zonke. Isifo i-Alzheimer yindlela yokuwohloka komqondo. I-Medicare uhlelo lomshuwalense wezempilo oluhlanganisa ezinye izici zokunakekelwa komqondo.

Kulinganiselwa ukuthi abantu baseMelika banesifo i-Alzheimer noma olunye uhlobo lokuwohloka komqondo. Cishe amaphesenti angama-96 alaba bantu aneminyaka engama-65 nangaphezulu.

Qhubeka ufunde ukuze ufunde ukuthi yiziphi izingxenye zokunakekelwa komqondo okuhlinzekwa yi-Medicare nokuningi.

Ingabe i-Medicare ihlanganisa ukunakekelwa komqondo?

I-Medicare ihlanganisa ezinye, kodwa hhayi zonke, zezindleko ezihambisana nokunakekelwa komqondo. Lokhu kufaka:

• iziguli ezingalali zihlala ezikhungweni ezifana nezibhedlela nezindawo zabahlengikazi ezinamakhono
• ukunakekelwa kwempilo ekhaya
• ukunakekelwa kwe-hospice
• ukuhlolwa kwengqondo
• izivivinyo ezidingekayo zokuxilongwa komqondo
• imishanguzo kadokotela (Ingxenye D)

Abantu abaningi abanenkinga yokuwohloka komqondo bazodinga uhlobo oluthile lokunakekelwa kwesikhathi eside okubandakanya ukunakekelwa kwezingane. Ukunakekelwa kwezingane kubandakanya usizo ngemisebenzi yansuku zonke njengokudla, ukugqoka nokusebenzisa indlu yangasese.

I-Medicare ayihlanganisi ukunakekelwa kwesikhathi eside. Futhi ayihlanganisi ukunakekelwa kokugcinwa.

Kodwa-ke, kukhona ezinye izinsiza ezingakusiza ukukhokhela ukunakekelwa kwesikhathi eside nokugcinwa. Lokhu kufaka phakathi izinto ezifana neMedicaid, Izinhlelo Zokunakekelwa Kwabadala Konke (PACE), kanye nezinqubomgomo zomshuwalense wokunakekelwa kwesikhathi eside.

Ingabe i-Medicare ikhava indawo noma ukunakekelwa kweziguli kokugula komqondo?

I-Medicare Part A ihlanganisa ukuhlala kweziguli ezindaweni ezifana nezibhedlela nasezikhungweni zabahlengikazi ezinamakhono. Ake sibheke lokhu ngokuseduze.

Izibhedlela

I-Medicare Part A ihlanganisa ukulala esibhedlela. Lokhu kungafaka izikhungo ezifana nezibhedlela ezinakekela kakhulu, izibhedlela zokuhlumelelisa iziguli, nezibhedlela ezinakekela isikhathi eside. Ezinye zezinsizakalo ezihlanganisiwe yilezi:

• ikamelo eliyimfihlo
• ukudla
• ukunakekelwa okujwayelekile
• imithi eyingxenye yokwelashwa kwakho
• izinsizakalo ezengeziwe zesibhedlela noma izimpahla

Ngokuhlala esibhedlela okungalalisiwe, iMedicare Part A izokhokhela zonke izindleko ezinsukwini zokuqala ezingama-60. Izinsuku ezingama-61 kuya kwezingu-90, uzokhokha isiqinisekiso semali nsuku zonke esingu- $ 352. Ngemuva kwezinsuku ezingama-90 njengesiguli esingalaliswayo, uzoba nesibopho sazo zonke izindleko.

Uma uthola izinsizakalo zikadokotela esibhedlela, zizokhokhiswa yi-Medicare Part B.

Izikhungo zabahlengikazi ezinamakhono (SNFs)

I-Medicare Part A ibuye ihlanganise ukuhlala kweziguli kwi-SNF. Lezi yizikhungo ezinikeza ukunakekelwa kwezempilo okunekhono okunganikezwa kuphela ochwepheshe bezokunakekelwa kwezempilo njengodokotela, abahlengikazi ababhalisiwe, kanye nabelaphi bomzimba.

Uma udokotela wakho ethatha isinqumo sokuthi udinga ukunakekelwa kwamakhono nsuku zonke ngemuva kokulaliswa esibhedlela, bangancoma ukuhlala eSNF. Ukuhlala kwakho kungafaka izinto ezifana negumbi elizimele, ukudla, nemithi esetshenziswa esikhungweni.

Izinsuku zokuqala ezingama-20 ku-SNF, iMedicare Part A izokhokhela zonke izindleko. Ngemuva kwezinsuku ezingama-20, uzodinga ukukhokha isiqinisekiso semali nsuku zonke esingu- $ 176. Uma uke waba ku-SNF izinsuku ezingaphezu kwezingu-100, ukhokha zonke izindleko.

Ingabe i-Medicare ihlanganisa ukunakekelwa kwasekhaya komqondo wokuwohloka komqondo?

Ukunakekelwa kwempilo yasekhaya kulapho kuhlinzekwa ngezinsizakalo zezempilo ezinamakhono ekhaya. Ihlanganiswe ngazo zombili izingxenye zeMedicare A no-B. Lezi zinsizakalo zivame ukuhlanganiswa yi-ejensi yezempilo yasekhaya futhi zingafaka:

• ukunakekelwa kwamakhono okunakekelwa kwesikhashana
• ukunakekelwa ngezikhathi ezithile
• ukwelashwa ngokomzimba
• ukwelashwa emsebenzini
• ukwelashwa ngolimi lokukhuluma
• izinsizakalo zezenhlalakahle zezokwelapha

Ukuze ufanelekele ukunakekelwa kwezempilo ekhaya, okulandelayo kufanele kube yiqiniso:

• Kumele uhlukaniswe njengoboshwe ekhaya, okusho ukuthi unenkinga yokushiya ikhaya lakho ngaphandle kosizo lomunye umuntu noma insiza esiza njengesihlalo sabakhubazekile noma i-walker.
• Kufanele ukuthi uthola ukunakekelwa kwasekhaya ngaphansi kohlelo olubuyekezwa njalo futhi libuyekezwe ngudokotela wakho.
• Udokotela wakho kufanele aqinisekise ukuthi udinga ukunakekelwa okunekhono okunganikezwa ekhaya.

I-Medicare ihlanganisa zonke izinsizakalo zezempilo zasekhaya. Uma udinga imishini yezokwelapha efana nesihlalo esinamasondo noma umbhede wasesibhedlela, uzoba nesibopho samaphesenti angama-20 wezindleko.

Ingabe i-Medicare ikhava ukuhlolwa kokuwohloka komqondo?

I-Medicare Part B ihlanganisa izinhlobo ezimbili zokuvakashelwa kwempilo:

• Ukuvakashelwa kwe- "Welcome to Medicare", kuqediwe ezinyangeni zokuqala eziyi-12 ngemuva kokubhaliswa kwe-Medicare.
• Ukuvakashelwa Kwenhlalakahle Yonyaka kanye ezinyangeni eziyi-12 kuyo yonke iminyaka elandelayo.

Lokhu kuvakasha kufaka phakathi ukuhlolwa kokukhubazeka kwengqondo. Lokhu kusiza udokotela wakho ukuthi abheke izimpawu ezingaba khona zokuwohloka komqondo. Ukuze wenze lokhu, udokotela wakho angasebenzisa okukodwa noma inhlanganisela yalokhu okulandelayo:

• ukubukwa okuqondile kokubukeka kwakho, indlela oziphatha ngayo, nezimpendulo zakho
• ukukhathazeka noma imibiko evela kuwe noma amalungu omndeni
• ithuluzi lokuhlola lokuqonda eliqinisekisiwe

Ngokwengeziwe, iMedicare Part B ingabheka izivivinyo ezibhekwa njengezidingekayo ukusiza ukuxilonga ukuwohloka komqondo. Ezinye izibonelo zifaka izinto ezifana nokuhlolwa kwegazi nokucatshangelwa kobuchopho nge-CT scan noma nge-MRI scan.

Ngabe i-Medicare ihlanganisa i-hospice yabantu abane-dementia?

I-Hospice uhlobo lokunakekelwa olunikezwa abantu abagulela ukufa. Ukunakekelwa kwe-hospice kuphathwa yithimba labanakekela abagulayo futhi kungafaka izinsizakalo ezilandelayo:

• izinsizakalo zikadokotela nokunakekelwa kwabahlengikazi
• imithi yokusiza ukunciphisa izimpawu
• ukunakekelwa kweziguli zesikhashana esifushane ukusiza ukuphatha izimpawu
• imishini yezokwelapha enjengezihamba nezihlalo ezinamasondo
• izimpahla ezifana namabhandeshi noma amaketanga
• ukwelulekwa ngosizi wena noma umndeni wakho
• ukunakekelwa kwesikhashana esifushane, okuhlala isikhashana iziguli ukuvumela umnakekeli wakho oyinhloko ukuba aphumule

I-Medicare Part A izobhekelela ukunakekelwa kwe-hospice komuntu one-dementia uma konke okulandelayo kuyiqiniso:

• Udokotela wakho unqume ukuthi ulindelwe impilo yezinyanga eziyisithupha noma ngaphansi (yize bengakulungisa lokhu uma kunesidingo).
• Uyavuma ukwamukela ukunakekelwa okugxile ekududuzeni nasekusizeni izimpawu esikhundleni sokunakekelwa ukwelapha isimo sakho.
• Usayina isitatimende esikhombisa ukuthi ukhetha ukunakekelwa kwe-hospice ngokungafani nokunye ukungenelela okuhlanganiswe neMedare.

I-Medicare izokhokha zonke izindleko zokunakekelwa kwe-hospice, ngaphandle kwegumbi nebhodi. Ngezinye izikhathi ungahle ubhekane nokukhokhwa okuncane kwanoma imiphi imithi enikezwe ukusiza ukukhulula izimpawu.

Yiziphi izingxenye zeMedicare ezimboza ukunakekelwa komqondo?

Masenze ukubuyekeza okusheshayo kwezingxenye zeMedicare ezihlanganisa ukunakekelwa komqondo:

Ukutholakala kwemithi ngokwengxenye

Ngubani ofanelekile ukuthola i-Medicare coverage ngokunakekelwa komqondo?

Ukuze ufanelekele ukumbozwa komqondo yi-Medicare yokuwohloka komqondo, kufanele uhlangabezane nenqubo ejwayelekile yokufaneleka kweMedicare. Lokhu ngukuthi:

• uneminyaka engama-65 noma ngaphezulu
• noma yibuphi ubudala futhi unokukhubazeka
• noma yibuphi ubudala futhi unesifo sesifo sokuphela kwesigaba (ESRD)

Kodwa-ke, kukhona nezinhlelo ezithile zeMedicare abantu abanenkinga yokuwohloka komqondo abangafanelekela ukuzithola. Kulezi zimo, ukuxilongwa kokuwohloka komqondo kungadingeka:

• Izinhlelo zezidingo ezikhethekile (SNPs): Ama-SNP ayiqembu elikhethekile lezinhlelo ze-Advantage ezibhekana ngqo nezidingo zabantu abanezimo ezithile zezempilo, kufaka phakathi ukuwohloka komqondo. Ukuhlanganiswa kokunakekelwa nakho kuvame ukufakwa.
• Izinsizakalo zokuphathwa kokunakekelwa okungapheli (CCMR): Uma unesifo sokuwohloka komqondo futhi okungenani unesimo esisodwa esingelapheki, ungahle ufaneleke ukuthola i-CCMR. I-CCMR ifaka phakathi ukwakhiwa kohlelo lokunakekelwa, ukuxhumanisa ukunakekelwa nemithi, kanye nokufinyelela ku-24/7 kochwepheshe bezempilo abaqeqeshiwe ngezidingo zezempilo.

Kuyini ukuwohloka komqondo?

Ukuwohloka komqondo kwenzeka lapho ulahlekelwa ngamakhono okuqonda njengokukhumbula, ukucabanga nokwenza izinqumo. Lokhu kungathinta kakhulu ukusebenza komphakathi kanye nemisebenzi yokuphila kwansuku zonke. Isibonelo, umuntu onesifo sokuwohloka komqondo angaba nobunzima:

• ukukhumbula abantu, izinkumbulo ezindala, noma izinkomba
• ukwenza imisebenzi yansuku zonke ngokuzimela
• ukuxhumana noma ukuthola amagama afanele
• ukuxazulula izinkinga
• ukuhlala uhlelekile
• anake
• ukulawula imizwa yabo

Alukho nje uhlobo olulodwa lokuwohloka komqondo. Kunezinhlobo eziningi empeleni, ngayinye inezici ezahlukahlukene. Kubandakanya:

• Isifo i-Alzheimer's
• Ukuwohloka komqondo komzimba kaLewy
• Ukuwohloka komqondo kwangaphambili
• Ukuwohloka komqondo ngemithambo yegazi
• Ukuwohloka komqondo okuxubekile, okuyinhlanganisela yezinhlobo ezimbili noma ngaphezulu zomqondo wokuwohloka komqondo

Okubalulekile

I-Medicare ihlanganisa ezinye izingxenye zokunakekelwa komqondo. Ezinye izibonelo zifaka phakathi ukulala ngaphakathi esibhedlela esikhungweni sabahlengikazi abanamakhono, ukunakekelwa kwempilo yasekhaya, kanye nokuhlolwa okudingekayo kwezokwelapha.

Ngokwengeziwe, abantu abanenkinga yokuwohloka komqondo bangafanelekela izinhlelo ezithile zeMedicare ezilungiselelwe izidingo zabo ezithile. Lokhu kufaka izinto ezinjengezinhlelo zezidingo ezikhethekile nezinsizakalo zokuphathwa kokunakekelwa okungamahlalakhona.

Ngenkathi abantu abaningi abane-dementia bedinga uhlobo oluthile lokunakekelwa kwesikhathi eside, iMedicare uqobo ayikumbozi lokhu. Ezinye izinhlelo, njengeMedicaid, zingasiza ukumboza izindleko zokunakekelwa kwesikhathi eside.