Ixhaswa Kanjani Imithi: Ngubani Okhokhela iMedicare?

-Delile

• Ixhaswa kanjani iMedicare?
• Kubiza malini ngo-2020?
• Izindleko zeMedicare Part A
• Izindleko zeMedicare Part B
• Izindleko zeMedicare Part C (Advantage)
• Izindleko zeMedicare Part D
• Izindleko zeMedicare Supplement (Medigap)
• Ukuthatha

• I-Medicare ixhaswe ngokuyinhloko nge-Federal Insurance Contributions Act (FICA).
• Izintela ezivela ku-FICA zifaka isandla kwizimali ezimbili zokuthembela ezihlanganisa izindleko ze-Medicare.
• Isikhwama sokuthembela se-Medicare Hospital (HI) sihlanganisa izindleko ze-Medicare Part A.
• Isikhwama sokuthembela se-Supplementary Medical Insurance (SMI) sihlanganisa izindleko ze-Medicare Part B ne-Part D.
• Ezinye izindleko ze-Medicare zixhaswa ngamaphrimiyamu ecebo, inzalo yesikhwama sezikhwama, nezinye izimali ezivunyelwe uhulumeni.

I-Medicare inketho yomshuwalense wezempilo oxhaswe nguhulumeni onikeza ukumbozwa kwezigidi zabantu baseMelika abaneminyaka engama-65 nangaphezulu, kanye nabantu abanezimo ezithile. Noma ezinye izinhlelo zeMedicare zikhangiswa njenge- “mahhala,” izindleko zeMedicare zingamakhulu ezigidigidi zamaRandi unyaka nonyaka.

Ngakho-ke, ngubani okhokhela iMedare? I-Medicare ixhaswa ngemali yezimali ethembekile ekhokhelwa intela, inzalo yesikhwama semali ethembekile, amaphrimiyamu abazuzi, nemali eyengeziwe evunyelwe yiCongress.

Lo mbhalo uzobheka izindlela ezahlukahlukene ezixhaswa ngayo ingxenye ngayinye yeMedicare nezindleko ezihambisana nokubhaliswa kuhlelo lweMedicare.

Ixhaswa kanjani iMedicare?

Ngo-2017, iMedicare yamboza abahlomuli abangaphezu kwezigidi ezingama-58, futhi izindleko eziphelele zokutholakala zingaphezulu kwama- $ 705 billion.

Izindleko ze-Medicare zikhokhelwa ikakhulukazi izimali ezimbili zokwethemba:

• Isikhwama sokuthembela se-Medicare Hospital Insurance (HI)
• Isikhwama sokuthembela se-Supplementary Medical Insurance (SMI)

Ngaphambi kokuthi singene ekuboneni ukuthi ngayinye yalezi zimali ezethembayo ikhokha kanjani i-Medicare, kufanele siqale siqonde ukuthi zixhaswa kanjani.

Ngo-1935, umthetho we-Federal Insurance Contributions Act (FICA) wamiswa. Lokhu kuhlinzekelwa kwentela kuqinisekisa ukuxhaswa ngezinhlelo zombili zeMedicare nezeNhlalakahle ngokukhokha kanye nentela yemali engenayo. Nakhu ukuthi kusebenza kanjani:

• Emholweni wakho ophelele, amaphesenti angu-6.2 abanjelwe i-Social Security.
• Ngaphezu kwalokho, amaphesenti angu-1.45 omholo wakho ophelele abanjelwe iMedicare.
• Uma uqashwe yinkampani, umqashi wakho ufana namaphesenti angu-6.2 we-Social Security kanye no-1.45% we-Medicare, ngenani eliphelele lama-7.65%.
• Uma uzisebenza, uzokhokha amaphesenti angama-7.65 entela.

Ukuhlinzekwa kwentela okungamaphesenti angu-2.9 kweMedicare kuya ngqo ezikhwameni ezimbili zokuthembela ezinikeza ukumbozwa kwezindleko zeMedicare. Bonke abantu abasebenza e-United States njengamanje banikela ngentela ye-FICA ukukhokhela uhlelo lwamanje lwe-Medicare.

Imithombo eyengeziwe yemali yezimali i-Medicare ifaka:

• izintela ezikhokhwa kumholo we-Social Security
• inzalo evela ezikhwameni ezimbili zetrasti
• izimali ezivunyelwe yiCongress
• amaphrimiyamu avela ezingxenyeni zeMedicare A, B, noD

I- Isikhwama sokuthembela se-Medicare HI ihlinzeka ngokuyinhloko ngezimali zeMedicare Part A. Ngaphansi kweNgxenye A, abahlomuli bahlanganiswa ngezinsizakalo zesibhedlela, kufaka phakathi:

• ukunakekelwa esibhedlela
• ukunakekelwa kokuvuselelwa kweziguli
• ukunakekelwa kwendawo yokuhlengikaza
• ukunakekelwa kwempilo ekhaya
• ukunakekelwa kwe-hospice

I- Isikhwama sokuthembela se-SMI ihlinzeka ngokuyinhloko ngemali ye-Medicare Part B ne-Medicare Part D. Ngaphansi kweNgxenye B, abahlomuli bathola ukufakwa kwezinsizakalo zezokwelapha, kufaka phakathi:

• izinsizakalo zokuvimbela
• izinsizakalo zokuxilonga
• izinsizakalo zokwelashwa
• izinsizakalo zezempilo yengqondo
• imithi ethile kadokotela kanye nemithi yokugoma
• imishini yezokwelapha ehlala njalo
• izivivinyo zokwelashwa

Zombili izimali zokwethenjwa zisiza ukumboza izindleko zokuphatha ze-Medicare, njengokuqoqa izintela ze-Medicare, ukukhokhela izinzuzo, nokubhekana namacala okukhwabanisa nokuhlukumeza kwe-Medicare.

Yize iMedicare Part D ithola olunye uxhaso esikhwameni sokuthembela se-SMI, ingxenye yoxhaso lwawo womabili ama-Medicare Part D ne-Medicare Advantage (Ingxenye C) ivela kumaphrimiyamu abahlomuli. Ngokuqondene nezinhlelo ze-Medicare Advantage ikakhulukazi, noma yiziphi izindleko ezingakhokhelwa yimali ye-Medicare kumele zikhokhelwe ngezinye izimali.

Kubiza malini ngo-2020?

Kunezindleko ezahlukahlukene ezihambisana nokubhaliswa kwi-Medicare. Nazi ezinye ozozibona ohlelweni lwakho lwe-Medicare:

• Amaphrimiyamu. I-premium inani olikhokhayo ukuze uhlale ubhalisile kwi-Medicare. Izingxenye A no-B, ezakha i-Medicare yangempela, zombili zinezinkokhelo zanyanga zonke. Ezinye izinhlelo zeMedicare Part C (Advantage) zine-premium ehlukile, ngaphezu kwezindleko zokuqala zeMedicare. Izinhlelo ze-Part D nezinhlelo zeMedigap nazo zikhokhisa imali ekhokhwa njalo ngenyanga.
• Okudonswayo. Okudonswayo inani lemali olikhokhayo ngaphambi kokuthi i-Medicare izokhokhela izinsizakalo zakho. Ingxenye A inokudonselwa isikhathi sesibonelelo ngasinye, kanti Ingxenye B idonswa ngonyaka. Ezinye izinhlelo ze-Part D kanye nezinhlelo ze-Medicare Advantage zokutholakala kwezidakamizwa nazo zinokudonswa kwezidakamizwa.
• Amakhophi. Ama-copayment yizimali ezikhokhwa ngaphambili ozikhokhela njalo lapho uvakashela udokotela noma uchwepheshe. Izinhlelo ze-Medicare Advantage, ikakhulukazi izinhlelo ze-Health Maintenance Organisation (HMO) kanye ne-Preferred Provider Organisation (PPO), zikhokhisa amanani ahlukile ngalokhu kuvakashelwa. I-Medicare Part D ihlela ukukhokhisa ama-copayment ahlukahlukene ngokuya ngemithi oyiphuzayo.
• Coinsurance. I-Coinsurance iphesenti lezindleko zezinsizakalo okufanele uzikhokhe ephaketheni. Kwi-Medicare Part A, i-coinsurance inyusa isikhathi eside usebenzisa izinsizakalo zesibhedlela. Ku-Medicare Part B, i-coinsurance iyinani lephesenti elibekiwe. I-Medicare Part D ikhokhisa i-coinsurance noma i-copayment yemithi yakho.
• Ama-maximum aphuma ephaketheni. Zonke izinhlelo zeMedicare Advantage zibeka isamba sokuthi uzosebenzisa malini ephaketheni; lokhu kubizwa ngokuthi yi-out-of-pocket maximum. Leli nani liyahluka ngokuya ngohlelo lwakho lwe-Advantage.
• Izindleko zezinsizakalo ezingamboziwe ngohlelo lwakho. Uma ubhalise ohlelweni lwe-Medicare olungazibandakanyi izinsizakalo ozidingayo, uzoba nesibopho sokukhokha lezi zindleko uphuma nazo ephaketheni.

Ingxenye ngayinye ye-Medicare inezindleko ezahlukahlukene, njengoba kubhalwe ngenhla. Kanye nezikhwama ezimbili zokwethemba ezisethelwe ingxenye ngayinye ye-Medicare, ezinye zalezi zindleko zenyanga nazo zisiza ukukhokhela izinsizakalo ze-Medicare.

Izindleko zeMedicare Part A

I-Part A premium ingu- $ 0 kwabanye abantu, kepha ingaba phezulu ku- $ 458 kwabanye, kuya ngokuthi usebenze isikhathi esingakanani.

Ingxenye A edonswayo ingama- $ 1,408 ngasikhathi sosizo, esiqala lapho ungeniswa esibhedlela futhi siphela lapho usudedelwe izinsuku ezingama-60.

I-Part A coinsurance yi $ 0 ezinsukwini zokuqala ezingama-60 zokuhlala kwakho esibhedlela. Ngemuva kosuku lwama-60, i-coinsurance yakho ingahle isuke ku- $ 352 ngosuku ngezinsuku 61 kuya ku-90 kuya ku- $ 704 yezinsuku “zokulondolozwa kwempilo yonke” izinsuku ngemuva kosuku lwama-90. Ingahamba ize ifike emaphesentini ayi-100 wezindleko, kuya ngobude hlala.

Izindleko zeMedicare Part B

Iphrimiyamu yengxenye B iqala ku- $ 144.60 futhi inyuke ngokuya ngeholo lakho lonyaka lemali engenayo.

Ingxenye B edonswayo ingu- $ 198 wango-2020. Ngokungafani neNgxenye A ebanjwayo, leli nani lonyaka ngonyaka hhayi isikhathi ngasinye sezinzuzo.

Ingxenye B yesibambiso semali engamaphesenti angama-20 wezindleko zemali yakho evunyelwe yi-Medicare. Leli inani iMedare evumile ukukhokha umhlinzeki wakho ngezinsizakalo zakho zezokwelapha. Kwezinye izimo, futhi ungakhokha imali eyeqile kwengxenye B.

Izindleko zeMedicare Part C (Advantage)

Ngaphezu kwezindleko ze-Medicare yasekuqaleni (izingxenye A no-B), ezinye izinhlelo ze-Medicare Advantage nazo zibiza imali ekhokhwa njalo ngenyanga ukuze uhlale ubhalisile. Uma ubhalise ohlelweni lwengxenye C oluhlanganisa imishanguzo kadokotela, kungadingeka ukuthi ukhokhe imali ekhishwayo, ama-copayments, kanye ne-coinsurance. Futhi, uzoba nesibopho samanani ekhokha lapho uvakashela udokotela wakho noma uchwepheshe.

Izindleko zeMedicare Part D

Iphrimiyamu yengxenye D iyahluka ngokuya ngohlelo olukhethayo, olungathintwa indawo okuyo nenkampani ethengisa uhlelo. Uma wephuze ukubhalisa kuhlelo lwakho lwe-Part D, le premium ingaphakama.

Ingxenye D edonswayo nayo iyahluka ngokuya ngokuthi yiliphi uhlelo obhalisela kulo. Inani eliphakeme kakhulu elingadonselwa noma yiliphi uhlelo lweNgxenye D elingakukhokhisa ngalo ngu- $ 435 ngo-2020.

Inani le-Part D lokukhokha kanye ne-coinsurance lithembele ngokuphelele kuzidakamizwa ozithathayo ngaphakathi kwefomula yohlelo lwakho lwezidakamizwa. Zonke izinhlelo zine-formulary, okuyiqoqo lemithi yonke ehlanganiswa nohlelo.

Izindleko zeMedicare Supplement (Medigap)

I-premium ye-Medigap iyahluka ngokuya ngohlobo lwemali obhalisela kuyo. Isibonelo, izinhlelo ze-Medigap ezinababhalisile abambalwa nokufakwa okuningi kungabiza ngaphezu kwezinhlelo ze-Medigap ezihlanganisa okuncane.

Khumbula nje ukuthi uma usubhalisile kuhlelo lweMedigap, ezinye izindleko zoqobo zeMedicare manje sezizokhokhiswa ngohlelo lwakho.

Ukuthatha

I-Medicare ixhaswe ngokuyinhloko ngezimali zokwethenjwa, ama-premium akhokhwa ngenyanga, izimali ezivunyelwe yiCongress, kanye nenzalo yesikhwama se-trust. Izingxenye ze-Medicare A, B, no-D zonke zisebenzisa imali yesikhwama sokwethemba ukusiza ukukhokhela izinsizakalo. Ukufakwa okungeziwe kwe-Medicare Advantage kuxhaswa ngosizo lwamaphrimiyamu nyangazonke.

Izindleko ezihambisana neMedicare zingangezelela, ngakho-ke kubalulekile ukwazi ukuthi uzobe ukhokha ini ephaketheni uma usubhalisele uhlelo lweMedicare.

Ukuthenga ezitolo ze-Medicare endaweni yangakini, vakashela i-Medicare.gov ukuqhathanisa izinketho eziseduze nawe.