Luyini Uhlelo Lwezidingo Ezikhethekile Ezifanelekayo Lwe-Medicare?

-Delile

• Luyini uhlelo lweMedicare Dual Eligible Special Needs Plan (D-SNP)?
• Ngubani ofaneleke kuma-SNPs we-Medicare Dual Eligible?
• Ukufanelekela iMedicare
• Ukufanelekela iMedicaid
• Ubhalisa kanjani ku-SNP Efanelekayo Yesibili?
• Yini ikhava ye-SNP Efanelekayo Yesibili?
• Yini ebiza i-SNP Eligible SNP?
• Izindleko ezijwayelekile zama-D-SNPs ngo-2020
• Ukuthatha

• Uhlelo lwe-Medicare Dual Eligible Special Needs Plan (D-SNP) uhlelo lweMedicare Advantage olwenzelwe ukuhlinzekela ngokukhethekile abantu ababhalise kuwo womabili amaMedicare (izingxenye A no-B) kanye neMedicaid.
• Lezi zinhlelo zisiza abantu abanezidingo eziphakeme kakhulu ukumboza izindleko ezingaphandle kwamaphakethe okungenzeka babhekane nazo ngaphansi kwezinhlelo zendabuko zeMedicare.

Uma uneminyaka engaphezu kwengama-65 noma unezimo ezithile zezempilo - futhi unezimali ezilinganiselwe zokukhokhela ukunakekelwa kwakho - ungawela eqenjini elikhethiwe elifanele izinhlelo zombili zomshuwalense wezempilo zomphakathi nezikahulumeni. Eqinisweni, abantu baseMelika abacishe babe yizigidi eziyi-12 banelungelo lokutholakala kokutholakala kweMedicare neMedicaid, ngokuya ngeminyaka yabo nezimo zezempilo. Uma ungomunye wabo, ungafaneleka ukuthola i-D-SNP.

Qhubeka ufunde ukuze ufunde ukuthi yini i-D-SNP nokuthi uyifanele yini.

Luyini uhlelo lweMedicare Dual Eligible Special Needs Plan (D-SNP)?

Uhlelo lwe-Medicare Special Needs Plan (SNP) luhlobo lwecebo le-Medicare Advantage (Ingxenye C) elihlinzeka ngohlobo lwe-Medicare enwetshiwe. Lezi zinhlelo ezizimele zisiza ukuxhumanisa ukunakekelwa nezinzuzo phakathi kweMedicare, okuwuhlelo lukahulumeni, neMedicaid, okuluhlelo lukahulumeni.

Ama-D-SNPs anzima kakhulu kuma-SNP ngokwezidingo zombili zokutholakala kanye nokufaneleka, kepha anikela ngezinzuzo eziphelele kakhulu kubantu abanesidingo esiphakeme kakhulu.

Ukuze ufanelekele i-D-SNP, kufanele ukhombise ukuthi ufanelekile. Kumele uqale ubhalise kuwo womabili ama-Medicare nohlelo lwe-Medicaid lombuso wakho, futhi kufanele ukwazi ukubhala lokho kufakwa.

Idalwe ngo-2003 yiCongress, ama-Medicare SNP ayatholakala kulabo asebenazo izingxenye zeMedicare A no-B. SNPs ziluhlobo lwecebo leMedicare Part C (Advantage) elilawulwa uhulumeni wesifundazwe futhi elinikezwa izinkampani zomshuwalense ezizimele. Bahlanganisa izinto eziningana zeMedicare: Ingxenye A yokutholiswa kokulaliswa esibhedlela, Ingxenye B yokuhlinzekwa kwezinsizakalo zezokwelapha ezingalaliswayo, kanye nokufakwa kweNgxenye D kwemithi kadokotela.

Akuzona zonke izifundazwe ezinikeza ama-Medicare SNPs. Kusukela ngo-2016, ama-38 athi kanye neWashington, D.C., nePuerto Rico banikela ngama-D-SNPs.

Ama-SNP ahlukaniswe ngezigaba ezintathu ngokuya ngohlobo lwabantu abalufanelekele.

• Izinhlelo Zezidingo Ezikhethekile Ezifanelekayo (D-SNPs). Lezi zinhlelo ezabantu abafanelekile ukuthola iMedicare kanye nohlelo lweMedicaid lombuso wabo.
• Izinhlelo Zezidingo Ezikhethekile Zesimo Esingapheli (C-SNPs). Lezi zinhlelo ze-Advantage zenzelwe abantu abanezimo zezempilo ezingapheli njengokuhluleka kwenhliziyo, umdlavuza, isifo sezinso sokugcina, ukuncika ezidakamizweni nophuzo oludakayo, i-HIV, nokuningi.
• Izinhlelo Zezidingo Ezikhethekile Zezikhungo (I-SNPs). Lezi zinhlelo ze-Advantage zenzelwe abantu abadinga ukuhlala esikhungweni noma esikhungweni sokunakekelwa kwesikhathi eside isikhathi esingaphezu kwezinsuku ezingama-90.

Ngubani ofaneleke kuma-SNPs we-Medicare Dual Eligible?

Ukuze ubhekelwe noma iyiphi i-SNPs, okokuqala kufanele ubhalise ezingxenyeni ze-Medicare A no-B (Medicare yasekuqaleni), ehlanganisa ukulaliswa esibhedlela nezinye izinsizakalo zezokwelapha.

Kunezinhlobonhlobo zama-D-SNP atholakalayo. Ezinye izinhlelo ze-Health Maintenance Organisations (HMO), kanti ezinye zingaba yizinhlelo ze-Preferred Provider Organisations (PPO). Izinhlelo ziyahluka ngokuya ngenkampani yomshuwalense oyikhethayo nendawo ohlala kuyo. Uhlelo ngalunye lungaba nezindleko ezihlukile.

Ungashayela i-800-MEDICARE ukuthola eminye imininingwane noma ukubuza imibuzo mayelana ne-D-SNPs nezinye izinzuzo zeMedicare.

Ukufanelekela iMedicare

Ufanelekile ukuthola i-Medicare lapho uneminyaka engama-65 noma ngaphezulu. Unezinyanga ezintathu ngaphambi nangemva kwenyanga lapho uhlanganisa khona iminyaka engama-65 ukubhalisela ukutholakala kokuqala kwe-Medicare.

Ufanele futhi ukuthola iMedicare, kungakhathalekile ukuthi uneminyaka emingaki, uma unesimo esifanelekile noma ukukhubazeka, okufana nesifo se-renal noma i-amyotrophic lateral sclerosis, noma ngabe ubusemshwalense wokukhubazeka kwezenhlalakahle izinyanga ezingama-24 noma ngaphezulu.

Uma ufanelekile, ungabhalisa ku-D-SNP ngesikhathi esifanele sokubhaliswa kwe-Medicare, inqobo nje uma kunikezwa ama-D-SNP endaweni yangakini.

• Ukubhaliswa kokuqala. Le nkathi iqala ezinyangeni ezintathu ngaphambi kosuku lwakho lokuzalwa lwama-65 futhi idlulela ezinyangeni ezintathu ngemuva kosuku lwakho lokuzalwa lwama-65.
• Ukubhaliswa kwe-Medicare Advantage. Lokhu kusuka ngoJanuwari 1 kuya kuMashi 31. Ngalesi sikhathi, ungabhalisa noma ushintshe uhlelo lwakho lweMedicare Advantage. Ungakwazi hhayi shintsha ukusuka ku-Medicare yasekuqaleni uye kuhlelo lwe-Advantage ngalesi sikhathi; ungakwenza lokhu ngesikhathi sokubhaliswa okuvulekile kuphela.
• Ukubhaliswa okujwayelekile kwe-Medicare. Lesi sikhathi sisukela ngoJanuwari 1 kuya kuMashi 31. Uma ungazange ubhalisele iMedicare yangempela ngesikhathi sokubhalisa kwakho kokuqala, ungabhalisa ngalesi sikhathi.
• Vula ukubhaliswa. Lokhu kusuka ngo-Okthoba 15 kuya kuDisemba 7. Noma ngubani okufanelekela iMedicare angabhalisa ngalesi sikhathi uma engakakwenzi lokho. Ungashintsha kwi-Medicare yasekuqaleni uye kuhlelo lwe-Advantage, futhi ungashintsha noma ushiye uhlelo lwakho lwamanje lwe-Advantage, Part D, noma iMedigap ngalesi sikhathi.
• Izinkathi zokubhalisa ezikhethekile. Lokhu kuyatholakala unyaka wonke futhi kusekelwe ekuguqulweni kwesimo sakho, njengokufaneleka okusha kwe-Medicare noma iMedicaid, ukuhambisa, ushintsho esimweni sakho sezokwelapha, noma ukumiswa kohlelo lwakho lwamanje.

Ukufanelekela iMedicaid

Ukufaneleka kweMedicaid kusekelwe ezintweni eziningana, kufaka phakathi imali oyitholayo, izimo zezempilo, nokuthi ngabe ufanelekile yini ukuthola iNgeniso Yezokuphepha Engeziwe. Ukuze uthole ukuthi ingabe unelungelo lokutholakala nge-Medicaid esifundeni sakho nokuthi uthole isiqinisekiso sokufaneleka kwakho, xhumana nehhovisi le-Medicaid lesifundazwe sakho.

Ubhalisa kanjani ku-SNP Efanelekayo Yesibili?

Ngaphansi kwezimo ezithile, ungabhaliswa ngokuzenzakalela izingxenye zeMedicare A no-B lapho usuba neminyaka engama-65. Kodwa ngeke ubhalise ngokuzenzakalela ku-D-SNP ngoba wuhlobo lwecebo leMedicare Advantage (Ingxenye C).

Ungathenga amapulani we-Medicare Advantage, kufaka phakathi ama-D-SNP, ngesikhathi sokubhaliswa esivunyelwe yi-Medicare: Isikhathi sokubhaliswa kwe-Medicare Advantage kusuka ngoJanuwari 1 kuya ku-Mashi 31, ukubhaliswa okuvulekile kusuka ngo-Okthoba 15 kuya kuDisemba 7, noma ngesikhathi sokubhaliswa okukhethekile uma une shintsha esimweni sakho.

Ukubhalisa kunoma yiluphi uhlelo lwe-Medicare Advantage, kufaka phakathi ama-D-SNPs, landela lezi zinyathelo:

• Khetha uhlelo endaweni yangakini (bona ithuluzi lokuthola uhlelo lweMedicare lwezinhlelo eziku-ZIP code yakho).
• Ukubhalisa ku-inthanethi noma ukucela ifomu lephepha ukuze ubhalise ngeposi, vakashela iwebhusayithi yenkampani yomshuwalense ngohlelo olukhethile.
• Shayela ku-800-MEDICARE (800-633-4227) uma udinga usizo.

• ikhadi lakho le-Medicare
• usuku oluthile oqale ngalo ukumbozwa kwezingxenye ze-Medicare A kanye / noma B
• ubufakazi bokusetshenziswa kweMedicaid (ikhadi lakho leMedicaid noma incwadi esemthethweni)

Yini ikhava ye-SNP Efanelekayo Yesibili?

Ama-D-SNPs yizinhlelo ze-Medicare Advantage, ngakho-ke ahlanganisa zonke izinsizakalo ezifanayo nezinye izinhlelo zeMedicare Advantage. Lokhu kufaka phakathi:

• Ama- $ 0 amaprimiyamu anyanga zonke
• izinsizakalo zokuxhumanisa ukunakekelwa
• Ingxenye yeMedare D
• ezinye izinto ezithengiswa ekhawunteni nemithi
• ukuthuthwa kwezinsizakalo zezokwelapha
• telehealth
• izinzuzo zokubona nezokuzwa
• ukufaneleka nobulungu bejimu

Ngezinhlelo eziningi zeMedicare Advantage, ukhokha ingxenye yohlelo lwakho ngaphandle kwezikhwama. Nge-D-SNP, i-Medicare neMedicaid zikhokha kakhulu noma zonke izindleko.

I-Medicare ikhokha isabelo sezindleko zakho zezokwelapha kuqala, bese iMedicaid ikhokha noma yiziphi izindleko ezingasala. IMedicaid yaziwa njengomkhokhi "wokugcina" wezindleko ezingamboziwe noma ezihlanganiswe kuphela yiMedicare.

Ngenkathi umthetho wesifundazwe ubeka izindinganiso zokuthola imali zeMedicaid, izwe ngalinye linemikhawulo yalo yokufaneleka neMedicaid nemingcele yokubika. Ukuhlelwa kokuhlelwa kuyahlukahluka ngombuso, kepha kunezinhlelo ezithile ezibandakanya zonke izinzuzo ze-Medicare neMedicaid.

Yini ebiza i-SNP Eligible SNP?

Imvamisa, nge-Special Needs Plan (SNP), uzokhokha isabelo esifana nalokho ozokhokha ngaphansi kwanoma yiluphi uhlelo lwe-Medicare Advantage. Amaphrimiyamu, ama-copayments, ama-coinurances, kanye nemali ebanjwayo ingahluka ngokuya ngohlelo olukhethayo. Nge-D-SNP, izindleko zakho ziphansi ngoba impilo yakho, ukukhubazeka, noma isimo sezezimali sikufanelekele ukuthola ukwesekwa okwengeziwe okuvela kohulumeni bakahulumeni nabezwe.

Izindleko ezijwayelekile zama-D-SNPs ngo-2020

Ukuthatha

• Uma unezidingo eziningi zezempilo noma ukukhubazeka futhi iholo lakho lilinganiselwe, ungahle ufanelekele ukuxhaswa zombuso kanye nezwe.
• Izinhlelo zeDual Eligible Special Needs Plans (D-SNPs) ziwuhlobo lwecebo leMedicare Advantage elihlanganisa ukwelashwa kwakho esibhedlela, ukunakekelwa kwabangalalayo, kanye nemiyalo; izindleko zohlelo zimbozwa ngezimali zikahulumeni nezikahulumeni.
• Uma ufanelekela kokubili i-Medicare kanye nohlelo lwe-Medicaid lombuso wakho, ungaba nelungelo lokunakekelwa kwezempilo okuphansi noma okungabizi ngaphansi kwe-D-SNP.