Ngabe i-Medicare Ikhava Ukwelashwa Kwezempilo Yengqondo?

-Delile

• I-Medicare Part A nokunakekelwa kwempilo yabagula ngaphakathi
• I-Medicare Part B nokunakekelwa kwempilo yezengqondo okungaphandle
• Izinsizakalo zezempilo yengqondo
• I-Medicare Part D kanye nokusetshenziswa kwezidakamizwa kadokotela
• Yini i-Medicare yasekuqaleni engayimbozi
• Ukudla okudlela endlini

I-Medicare isiza ukumboza ukunakekelwa kwempilo yabangalalayo nabangalaliswayo.

Kungasiza futhi ukumboza imishanguzo kadokotela engadingeka ekwelapheni impilo yezengqondo.

Qhubeka ufunde ukuze ufunde kabanzi mayelana nokuthi yiziphi izinsizakalo zokunakekelwa kwezempilo yengqondo ezihlanganiswa ngaphansi kweMedicare, nokuthi yini engekho.

I-Medicare Part A nokunakekelwa kwempilo yabagula ngaphakathi

I-Medicare Part A (umshuwalense wesibhedlela) isiza ukumboza izinsizakalo zempilo yezengqondo ezingalalisiwe esibhedlela sonke noma esibhedlela sabagula ngengqondo.

I-Medicare isebenzisa izikhathi zenzuzo ukukala ukusebenzisa kwakho izinsizakalo zesibhedlela. Isikhathi somhlomulo siqala usuku lokwamukelwa kweziguli futhi siphela ngemuva kwezinsuku ezingama-60 zilandelana zokunganakekelwa kwezibhedlela ezingalaliswayo.

Uma ungeniswa futhi esibhedlela ngemuva kwezinsuku ezingama-60 ungalaliswanga, isikhathi esisha sokuhlomula siqala.

Ezibhedlela ezijwayelekile, akunamkhawulo enanini lezikhathi zemihlomulo ongaba nazo ngokunakekelwa kwempilo yengqondo. Esibhedlela sabagula ngengqondo, unemikhawulo yokuphila izinsuku eziyi-190.

I-Medicare Part B nokunakekelwa kwempilo yezengqondo okungaphandle

I-Medicare Part B (umshuwalense wezokwelapha) ihlanganisa izinsizakalo eziningi ezihlinzekwa umnyango wezokwelapha esibhedlela kanye nezinsizakalo zeziguli ezihlinzekwa ngaphandle kwesibhedlela, njengokuvakashela:

• imitholampilo
• amahhovisi abelaphi
• amahhovisi odokotela
• izikhungo zezempilo yengqondo zomphakathi

Yize i-coinsurance nokudonswa kwemali kungasebenza, Ingxenye B nayo isiza ukukhokhela izinsizakalo ezinjenge:

• Ukuhlolwa kwengcindezi (i-1x ngonyaka)
• ukuhlolwa kwengqondo
• izivivinyo zokuxilonga
• i-psychotherapy yomuntu ngamunye neqembu
• Ukwelulekwa ngokomndeni (ngokusiza ekwelashweni kwakho)
• ukuhlola ukuthola ukufaneleka nemiphumela yezinsizakalo nokwelashwa
• ukwelashwa okwesikhashana (uhlelo oluhlelekile lwezinsizakalo zengqondo ezingalalisiwe)
• Ukubuyekezwa kwengozi yakho yokudangala (ngesikhathi wamukelekile ku-Medicare yokuvimbela ukuvakashelwa)
• ukuvakashelwa kahle kwezempilo minyaka yonke (okuyithuba elihle lokukhuluma nodokotela wakho ngempilo yakho yengqondo)

Izinsizakalo zezempilo yengqondo

I-Medicare Part B isiza ukumboza izinsizakalo zezempilo yengqondo nokuvakashelwa nabahlinzeki bokunakekelwa kwezempilo abemukela “isabelo”, noma inani eligunyaziwe. Igama elithi "ukwabiwa" lisho ukuthi umhlinzeki wezinsizakalo zezempilo yengqondo uyavuma ukukhokhisa inani lemali eligunyazwe yiMedicare ukuthola izinsizakalo. Kufanele ubuze umhlinzeki ukuthi bayayemukela yini “isabelo” ngaphambi kokuvuma izinsizakalo. Kungokuzuzisa kakhulu umhlinzeki wesevisi yezempilo yengqondo ukukwazisa uma bengakwamukeli ukwabiwa, kepha-ke, kufanele ukukuqinisekise lokhu ngaphambi kokusayina noma yiziphi izivumelwano nomhlinzeki.

Ungahle ufune ukuvakashela iZikhungo zeMedicare neMedicaid Services ’Physician Compare, ukuthola udokotela owemukela izinsizakalo zeMedicare. Uhlu lochwepheshe noma imikhuba yeqembu ezindaweni ezikhethekile nezindawo ozibalulayo, kanye namaphrofayli anemininingwane, amamephu nezikhombisi-ndlela zokushayela ziyatholakala.

Izinhlobo zezobuchwepheshe zezempilo ezihlanganisiwe zifaka:

• odokotela bezokwelapha
• odokotela bengqondo
• izazi zokusebenza kwengqondo
• osonhlalakahle basemitholampilo
• ochwepheshe bezokwelapha
• abasizi bodokotela
• abahlengikazi

I-Medicare Part D kanye nokusetshenziswa kwezidakamizwa kadokotela

I-Medicare Part D (ukumbozwa ngemithi kadokotela) yizinhlelo eziqhutshwa yizinkampani ezizimele ezivunyelwe yiMedicare. Njengoba uhlelo ngalunye lungahluka ngokumbozwa nangezindleko, kubalulekile ukwazi imininingwane yohlelo lwakho nokuthi lusebenza kanjani emithini yokwelashwa kwezempilo yengqondo.

Izinhlelo eziningi zinohlu lwezidakamizwa uhlelo oluhlanganayo. Yize lezi zinhlelo zingadingeki ukumboza yonke imithi, iningi liyadingeka ukumboza imishanguzo engasetshenziselwa ukunakekelwa kwezempilo yengqondo, njenge:

• imishanguzo
• ama-anticonvulsants
• ama-antipsychotic

Uma udokotela wakho ekuchazela ngomuthi ongawuhlanganisi uhlelo lwakho, wena (noma omele wena, ofana nommiseli) ungacela ukuzimisela kokumbozwa kanye / noma okuhlukile.

Yini i-Medicare yasekuqaleni engayimbozi

Izinsizakalo zokunakekelwa kwezempilo yengqondo ngokuvamile ezingafakwanga ngaphansi kwezingxenye ze-Medicare A no-B yilezi:

• igumbi langasese
• ubuhlengikazi bomsebenzi wangasese
• ithelevishini egumbini noma ifoni
• ukudla
• izinto zomuntu siqu (umuthi wokuxubha, izinsingo, amasokisi)
• ukuthuthwa kuya noma kusuka ezinsizakalweni zokunakekelwa kwezempilo yengqondo
• ukuhlolwa kwekhono lomsebenzi noma ukuqeqeshwa okungeyona ingxenye yokwelashwa kwezempilo yengqondo
• amaqembu okusekela (njengoba ehlukaniswe nokwelashwa kwengqondo kweqembu, okumboziwe)

Ukudla okudlela endlini

I-Medicare isiza ukumboza ukunakekelwa kwempilo yabangalali nabangalaliswayo ngezindlela ezilandelayo:

• Ingxenye A isiza ukumboza izinsizakalo zempilo yezengqondo ezingalalisiwe.
• Ingxenye B isiza ukumboza izinsizakalo zezempilo yengqondo nokuvakashelwa nabahlinzeki bokunakekelwa kwempilo.
• Ingxenye D isiza ukumboza imithi yokwelashwa.

Qiniseka ukuthi ubuyekeza imininingwane ngohlobo nobungako bokusabalala nomhlinzeki wakho ukuze unqume ukuthi iziphi izinsizakalo ezithile ezihlanganiswayo nokuthi kungakanani.

Isibonelo, ukuze i-Medicare ikhokhele izindleko, bonke abahlinzeki bokunakekelwa kwezempilo yengqondo kumele bamukele inani eligunyaziwe lezinsizakalo zokunakekelwa kwezempilo njengenkokhelo ephelele.

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.