Izincazelo ezibalulekile zokukusiza ukuthi uzulazule kwi-Medicare

-Delile

• I-Amyotrophic lateral sclerosis (ALS)
• Ukufakwa kwenhlekelele
• Izikhungo zeMedicare & Medicaid Services (CMS)
• Faka isicelo
• Coinsurance
• ICopay
• Ukuvaleka igebe
• Iyadonswa
• Imbobo yedonathi
• Imishini yezokwelapha ehlala njalo (i-DME)
• Isifo sokuqedwa kwezinso (ESRD)
• Usizo Olungeziwe
• Okuhlelekile
• Isikhathi sokubhaliswa okujwayelekile
• Izinhlelo ze-Health Maintenance Organisation (HMO)
• Inani lokulungiswa elihlobene nenyanga (IRMAA)
• Isikhathi sokuqala sokubhalisa
• Inhlawulo yokubhaliswa emuva kwesikhathi
• I-Medicaid
• I-Medicare Advantage (Ingxenye C)
• Inani eligunyazwe yi-Medicare
• Ingxenye yeMedicare A
• Ingxenye yeMedare B
• Ingxenye yeMedicare C
• Ingxenye yeMedare D
• Ama-akhawunti wokulondolozwa kwe-Medicare
• Izinhlelo zeMedigap
• Isikhathi sokubhalisa esivulekile
• Ukubhaliswa koqobo
• Imithi Yangempela
• Izindleko eziphuma ephaketheni
• Ubukhulu obuphuma ephaketheni
• Umhlinzeki obambe iqhaza
• Izinhlelo ze-Preferred Provider Organisation (PPO)
• I-Premium
• Umhlinzeki wokunakekelwa okuyisisekelo (PCP)
• Izinhlelo ze-Private Fee-For-Service (PFFS)
• Izinhlelo Ezikhethekile (SNP)
• Isikhathi sokubhalisa esikhethekile (SEP)
• Ukuphathwa Kwezokuphepha Komphakathi (SSA)
• Isikhathi sokulinda seminyaka emibili
• Amakhredithi omsebenzi

Ukuqonda imithetho nezindleko ze-Medicare kungakusiza ukuthi uhlelele izidingo zakho zokunakekelwa kwezempilo. Kepha ukuze uyiqonde ngokweqiniso iMedicare, okokuqala udinga ukujwayelana nemibandela ethile ebalulekile - {textend} kepha evame ukudida - {textend} imigomo.

Noma ngabe ubhekane nomshuwalense esikhathini esedlule, iMedicare inolimi lwayo futhi isebenzisa amagama akhethekile nemishwana esebenza kuphela ezinhlelweni zayo nasekuhlanganisweni kwayo. Ukwazi ukuthi la magama asho ukuthini nokuthi asebenza kanjani kwiMedicare kungakusiza ukuthi uhlele imininingwane, uzulazule inqubo, futhi wenze ukhetho olungcono kakhulu lwezempilo ongalwenza.

Nayi imigomo ejwayelekile ongayibona lapho uhlola izinketho zakho ze-Medicare:

I-Amyotrophic lateral sclerosis (ALS)

I-ALS yisimo esidala ukuwohloka kwemisipha futhi ekugcineni siholele ekufeni. Sibizwa nangokuthi isifo sikaLou Gehrig, esiqanjwe ngomdlali omkhulu we-baseball uLou Gehrig, owabulawa yi-ALS ngo-1941.

Uma une-ALS, ufanelekile ukuthola i-Medicare ngisho noma ungekho eminyakeni engama-65 ubudala. Futhi ufaneleke khona manjalo - {textend} ngaphandle kwesikhathi sokulinda seminyaka emibili esidingeka kakhulu ekufanelekeni kwe-Medicare lapho ungaphansi kweminyaka engama-65 ubudala futhi unokukhubazeka okungapheli.

Ukufakwa kwenhlekelele

Uqala ukuthola lokho okubizwa ngenhlekelele uma usufinyelele inani eliphakeme lokusebenzisa imali ephaketheni lemithi yakho kadokotela yonyaka.

Ngo-2020, ukumbozwa okuyinhlekelele kuqala ku- $ 6,350.Lapho usufinyelele le mali, uzokhokha kuphela ikopi elincane noma isiqiniseko semali unyaka wonke wenzuzo.

Izikhungo zeMedicare & Medicaid Services (CMS)

I-CMS yinhlangano ebumbene ebheka iMedicare neMedicaid, kanye nezikhungo ezenza isivumelwano nazo. Imithethonqubo eshicilelwe yi-CMS iqinisekisa ukuthi zonke izikhungo ezamukela iMedicare neMedicaid zokukhokha zihlangabezana namazinga athile.

Faka isicelo

Isimangalo isicelo sokukhokha esithunyelwe ohlelweni lomshuwalense njengeMedicare. Ngemuva kwalokho, iMedicare noma inkampani yomshuwalense ehlinzeka ngemboleko izocubungula isimangalo bese ikhokha umhlinzeki (uchwepheshe wezempilo noma indawo). I-Medicare noma inkampani yomshuwalense ingasenqaba isimangalo uma isevisi ingamboziwe noma izimo ezingadingeki zingafinyelelwanga.

Coinsurance

Izindleko zokubuyiselwa kwemali zensizakalo ziyipesenti yezindleko eziphelele obhekene nazo. I-Medicare Part B ine-coinsurance yama-20% wemali evunyelwe yi-Medicare yezinsizakalo eziningi ezihlanganisiwe. Lokhu kusho ukuthi i-Medicare izokhokha amaphesenti angama-80 wezindleko futhi uzokhokha amaphesenti angama-20 asele.

ICopay

I-copay, noma i-copayment, inani elibekiwe olikhokhela insizakalo ethile. Uhlelo lwakho luhlanganisa izindleko ezisele. Isibonelo, uhlelo lwakho lwe-Medicare Advantage lungahle lube ne-copay engu- $ 25 ekuvakasheni ngakunye kukadokotela.

Ukuvaleka igebe

Igebe lokumboza, elibizwa nangokuthi umgodi we-donut, libhekisela esikhathini lapho ungakhokhela khona ngaphezulu imishanguzo yakho kadokotela. Ngo-2020, uma wena nohlelo lwakho lwe-Medicare Part D senikhokhe inani eliphelele lamaRandi ayizigidi ezingama-4,020 ngemiyalelo yenu, nisesigodini sokutholakala ngokusemthethweni. Lesi sikhathi siphela uma usufinyelele ku- $ 6,350 edingekayo ukuthola ukumbozwa okuyinhlekelele.

Esikhathini esedlule, leli gebe lokumboza lishiye abazuzi beMedicare bekhokha ephaketheni ngayo yonke imishanguzo kadokotela. Kodwa izinguquko zakamuva emithethweni yomshuwalense yi-Affordable Care Act yenze leli gebe laba lula ukuphatha.

Kusukela ngoJanuwari 1, 2020, kunokuba ukhokhe amaphesenti ayi-100 ephaketheni, uzokhokha amaphesenti angama-25 ezindleko zemithi embozwe ejwayelekile neyamagama ngenkathi usegebe lokumboza.

Iyadonswa

Okudonswa imali inani odinga ukulikhokha ephaketheni ngenkonzo ngaphambi kokuthi uhlelo lwakho lwe-Medicare luzokhokha noma yiziphi izindleko. Ngo-2020, i-Medicare Part B idonswa ngu- $ 198.

Ngakho-ke, uzokhokha u- $ 198 wokuqala ephaketheni ngezinsizakalo zezempilo. Ngemuva kwalokho, uhlelo lwakho lwe-Medicare luzoqala ukukhokha.

Imbobo yedonathi

Umgodi wedonathi elinye igama elisetshenziselwa ukuchaza igebe lokumboza phakathi komkhawulo wokukhokha wengxenye D kanye nenkokhelo ephezulu yonyaka.

Imishini yezokwelapha ehlala njalo (i-DME)

I-DME ifaka izinto zokwelashwa ongazidinga ekhaya lakho ukuphatha isimo. I-DME ifaka izinto ezinjengamathangi e-oksijeni asekhaya nempahla noma izinsiza zokuhamba njengabahambahambayo. Uhlelo lwakho lwe-Medicare Part B luhlanganisa i-DME odokotela abagunyazwe yi-Medicare abakuyalile yona.

Isifo sokuqedwa kwezinso (ESRD)

I-ESRD yisigaba sokugcina sesifo sezinso, esibizwa nangokuthi isifo sezinso. Izinso zabantu abane-ESRD azisasebenzi. Badinga ukwelashwa nge-dialysis noma ukufakelwa izinso.

Uma une-ESRD, ungathola iMedicare ngaphandle kwesikhathi sokulinda seminyaka emibili, noma ngabe ungaphansi kweminyaka engama-65.

Usizo Olungeziwe

Usizo Olungeziwe uhlelo lweMedicare olusiza ababambiqhaza ukukhokhela izindleko zeMedicare Part D. Izinhlelo ezengeziwe zosizo zisekelwe emholweni wakho futhi zingakusiza nge-coinsurance noma ngezindleko ze-premium.

Okuhlelekile

I-formulary uhlu lwemithi ehlanganiswa nohlelo oluthile lweNgxenye D. Uma uthatha umuthi ongekho kwifomula yohlelo lwakho, kuzodingeka ukuthi ukhokhe ephaketheni noma ubuze udokotela wakho ukuthi anikeze umuthi ofanayo ohlelwa uhlelo lwakho.

Isikhathi sokubhaliswa okujwayelekile

Ungabhalisa kwi-Medicare yasekuqaleni (izingxenye A no-B) njalo ngonyaka phakathi kukaJanuwari 1 noMashi 31. Lokhu kwaziwa njengesikhathi sokubhaliswa okujwayelekile. Ukuze usebenzise leli windi, uzodinga ukufaneleka ku-Medicare kepha ungakatholi ukumbozwa.

Izinhlelo ze-Health Maintenance Organisation (HMO)

Izinhlelo zeMedicare Advantage (Ingxenye C) zingahlinzekwa ngezindlela ezimbalwa ezihlukile, kuya ngendawo okuyo. Ama-HMO awuhlobo lohlelo lwenzuzo oludumile. Nge-HMO, kudingeka ukuthi usebenzise inethiwekhi ebekiwe yabahlinzeki bezokunakekelwa kwezempilo kanye nezinsiza uma ufuna uhlelo lwakho lweMedicare ukumboza izindleko. Kungadingeka ukuthi ukhethe udokotela oyinhloko futhi udluliselwe kulowo dokotela uma ufuna ukubona ongoti.

Inani lokulungiswa elihlobene nenyanga (IRMAA)

Abazuzi beMedicare abenza imali engaphezu kwama- $ 87,000 bazokhokha ngaphezu kwe- $ 144.60 ejwayelekile B yiprimiyamu yanyanga zonke. Le-premium eyandisiwe ibizwa nge-IRMAA. Uma iholo lakho liphakeme, i-IRMAA yakho izoba ngaphezulu, kuze kufike ku- $ 491.60.

Isikhathi sokuqala sokubhalisa

Isikhathi sakho sokubhalisa sokuqala iwindi lezinyanga eziyi-7 eliqala ezinyangeni ezi-3 ngaphambi kwenyanga yosuku lwakho lokuzalwa lwama-65. Yilapho uqala ukubhalisela i-Medicare. Isikhathi sokubhalisa siphela ezinyangeni ezi-3 ngemuva kwenyanga yakho yokuzalwa.

Isibonelo, uma uhlanganisa iminyaka engama-65 ngo-Agasti 2020, isikhathi sakho sokubhalisa sokuqala sizoqala kusuka ngoMeyi 2020 kuye kuNovemba 2020.

Inhlawulo yokubhaliswa emuva kwesikhathi

Uma ungabhalisi kuNgxenye B lapho uqala ukuthola iMedicare, kungadingeka ukuthi ukhokhe inhlawulo yokubhaliswa sekwedlule isikhathi lapho ubhalisa.

Ngokuvamile, uzokhokha amanye amaphesenti ayi-10 unyaka ngamunye obungabhaliswanga. Inani lenhlawulo lengezwa enkokhelweni yakho yanyanga zonke ye-premium.

Ngeke ukhokhe isijeziso sokubhaliswa sekwedlule isikhathi uma ufanelekela isikhathi esikhethekile sokubhalisa.

I-Medicaid

IMedicaid wuhlelo lomshuwalense wezempilo olwenzelwe abantu abanemali engenayo elinganiselwe. Izinhlelo zeMedicaid zilawulwa umbuso ngamunye, ngakho-ke imithetho nemininingwane yohlelo ngqo ingahluka.

Uma ufanelekela iMedicaid, ungayisebenzisa eceleni kweMedicare futhi unciphise noma uqede izindleko zakho ezingaphandle kwephaketheni.

I-Medicare Advantage (Ingxenye C)

Izinhlelo zeMedicare Advantage zibizwa nangokuthi izinhlelo zeMedicare Part C. Banikezwa yizinkampani ezizimele ezenza isivumelwano neMedicare.

Izinhlelo zenzuzo zithatha indawo yeMedicare yangempela (Ingxenye A noNgxenye B). Zonke izinhlelo ze-Medicare Advantage kumele zihlanganise konke okuhlanganiswa izingxenye ze-A no-B. Futhi, izinhlelo eziningi zengeza ukumbozwa okungeziwe kwezinto ezifana nokunakekelwa kwamazinyo, izinsizakalo zombono, noma imithi.

Izinhlelo zeMedicare Advantage zinamaprimiyamu abo, imali ebanjwayo, nezinye izindleko ezingaphandle kwephaketheni.

Inani eligunyazwe yi-Medicare

IMedare ibeke amanani ezowakhokhela izinsizakalo zezempilo. Le ntengo ebekiwe ibizwa ngemali evunyelwe yi-Medicare. Zonke izikhungo zokunakekelwa kwezempilo ezamukela iMedicare zivumile ukukhokhisa lezi zimali ezivunyelwe ngezinsizakalo.

Ingxenye yeMedicare A

I-Medicare Part A ngumshwalense wesibhedlela. Ihlanganisa ukuhlala kwakho esibhedlela, kanye nokuhlala ezindaweni zokunakekelwa zesikhathi eside. Ungathola futhi ukumbozwa kwezempilo yasekhaya noma ukunakekelwa kwe-hospice.

Ingxenye yeMedare B

I-Medicare Part B umshuwalense wezokwelapha. Ifaka izinto ezinjengokuvakasha kukadokotela, ukuvakashelwa ngongoti, impilo yengqondo, nemishini yezokwelapha eqinile. Ingxenye B ibuye inakekele ukunakekelwa okuphuthumayo nokuhambela igumbi labezimo eziphuthumayo.

Ingxenye yeMedicare C

I-Medicare Advantage kwesinye isikhathi ibizwa ngokuthi yi-Medicare Part C. Amagama womabili abhekise kuhlelo olufanayo. Ngakho-ke, uhlelo lwengxenye C luhlelo lwenzuzo.

Ingxenye yeMedare D

I-Medicare Part D ihlanganisa okwehlukile kwemithi kadokotela. Izingxenye ze-Medicare A no-B zinikela kuphela ngemithi yokuhlinzekwa ngemithi kadokotela engaphandle, ngakho-ke abanye abahlomuli bakhetha ukuthenga ukumbozwa okwengeziwe ngecebo lengxenye D. Uhlelo lwakho lweNgxenye D luzoba ne-premium ehlukile.

Ama-akhawunti wokulondolozwa kwe-Medicare

I-akhawunti yokonga i-Medicare (MSA) iwuhlobo lwecebo leMedicare Advantage eline-akhawunti ephezulu yokonga edonswayo. I-MSA ihlela ukufaka imali kwi-akhawunti yokonga, engasetshenziselwa ukukhokhela izindleko zakho zokwelashwa ngaphambi kokuhlangabezana nemali oyibanjelwe.

Izinhlelo zeMedigap

Izinhlelo zeMedigap yizinhlelo zokwengeza ezikusiza ukuthi ukhokhele izindleko ezingaphandle kwezikhwama zeMedicare yangempela. Kunezinhlelo eziyi-10 ezahlukahlukene zeMedigap.

Lezi zinhlelo zinikezwa yizinkampani ezenza isivumelwano noMedare. Izindleko zakho zeMedigap zingahluka ngokuya ngesimo sakho.

Isikhathi sokubhalisa esivulekile

Izikhathi zokubhalisa ezivulekile zenzeka ngesikhathi esinqunyiwe njalo ngonyaka, kusuka ngo-Okthoba 15 kuya kuDisemba 7. Ngesikhathi sefasitela lokubhalisa elivuliwe, ungabhalisela uhlelo lwe-Advantage, uthenge iMedigap, nokuningi.

Ukubhaliswa koqobo

Isikhathi sakho sokuqala sokubhalisa yilapho uqala ukubhalisa kwi-Medicare. Lokhu kuvame ukuba ngesikhathi sokubhaliswa kokuqala, ewindini lezinyanga eziyi-7 ezungeze usuku lwakho lokuzalwa lwama-65. Uma ungaphansi kweminyaka engama-65, futhi kungaba yiminyaka engu-2 ngemuva kokuqala ukuthola izinzuzo zokukhubazeka kwezenhlalakahle.

Imithi Yangempela

Izingxenye ze-Medicare A no-B ndawonye zivame ukubizwa ngokuthi yi-Medicare yasekuqaleni, noma i-Medicare yendabuko. I-Original Medicare ayifaki Ingxenye C (izinhlelo ze-Advantage), Ingxenye D, noma izinhlelo zeMedigap.

Izindleko eziphuma ephaketheni

Izindleko zakho eziphuma ephaketheni yizamba ozikhokhela ukunakekelwa kwakho kwezempilo. Kungafaka phakathi imali yakho ekhishwayo, i-coinsurance, namanani we-copayment.

Ubukhulu obuphuma ephaketheni

Isamba esivela ephaketheni yisamba semali ozoyikhokhela izinsizakalo zokunakekelwa kwezempilo okugunyaziwe kunoma yimuphi unyaka othize. Uma usufinyelele leli nani, i-Medicare izolanda zonke izindleko zalezi zinsizakalo ezivunyelwe.

Ama-maximum aphuma ephaketheni afaka amanani we-copayment kanye ne-coinsurance. Izinhlelo zeMedicare Advantage kuphela (Ingxenye C) ezinazo. Uhlelo ngalunye lweMedicare Advantage lungasetha leli nani, ngakho-ke lingahluka. Ngo-2020, umkhawulo ophuma ephaketheni awukwazi ukweqa u- $ 6,700 ngonyaka.

Umhlinzeki obambe iqhaza

Umhlinzeki obambe iqhaza ungumhlinzeki wezokunakekelwa kwezempilo osebenza noMedicare ukuhlinzeka insizakalo noma oyingxenye yenethiwekhi yohlelo lwe-HMO noma lwe-PPO. Abahlinzeki ababambe iqhaza bavumile ukwamukela inani eligunyaziwe le-Medicare lezinsizakalo kanye nokwelapha abahlomuli be-Medicare.

Izinhlelo ze-Preferred Provider Organisation (PPO)

Ama-PPO ngolunye uhlobo oludumile lwecebo leMedicare Advantage. Njenge-HMO, ama-PPO asebenza ngenethiwekhi yesethi yabahlinzeki. Nge-PPO, noma kunjalo, ungaya ngaphandle kwenethiwekhi yakho uma uzimisele ukukhokha inani eliphakeme lokukhokha noma lokuqinisekisa imali.

I-Premium

I-premium inani elikhokhwa njalo ngenyanga lokutholakala komshuwalense. Njengoba abantu abaningi bengakhokhi imali ye-Medicare Part A, imvamisa uzokhokha imali ekhokhelwa Ingxenye B kuphela uma une-Medicare yoqobo. Iphrimiyamu yengxenye B ngo-2020 ingu- $ 144.60.

Izinhlelo zeMedicare Advantage, izinhlelo zeNgxenye D, nezinhlelo zeMedigap zithengiswa izinkampani zomshuwalense ezizimele. Lokhu kungakhokhisa i-premium ehlukile ngokuya ngenkampani noma ngohlelo olikhethayo.

Umhlinzeki wokunakekelwa okuyisisekelo (PCP)

I-PCP yakho ngudokotela okubonela ukunakekelwa okuvamile nokuvimbela, njengama-physicals wonyaka. Ngaphansi kwezinhlelo ezithile ze-Medicare Advantage HMO, kuzodingeka usebenze ne-PCP eku-network. Futhi uma udinga ukunakekelwa okukhethekile, i-PCP yakho kuzodingeka idlulisele uhlelo lwakho ukumboza lokhu kunakekelwa.

Izinhlelo ze-Private Fee-For-Service (PFFS)

Uhlelo lwe-PFFS luhlobo olungajwayelekile kakhulu lwecebo leMedicare Advantage elingenayo inethiwekhi noma elidinga ukuthi ube nodokotela oyinhloko. Esikhundleni salokho, uzokhokha inani elibekiwe lenkonzo ngayinye oyithola kunoma iyiphi indawo evunyelwe yi-Medicare.

Izinhlelo Ezikhethekile (SNP)

Ezinye izinkampani zinikela ngezinhlelo zeMedicare Advantage ezaziwa njengeSNPs. I-SNP yenzelwe abazuzi abanezidingo ezikhethekile zezezimali noma zokunakekelwa kwezempilo.

Isibonelo, ungahle ubone ama-SNP ngokukhethekile:

• abantu abahlala ezikhungweni zabahlengikazi
• abantu abanemiholo elinganiselwe
• abantu abalawula isimo esingelapheki njengesifo sikashukela

Isikhathi sokubhalisa esikhethekile (SEP)

I-SEP iwindi elikuvumela ukuthi ubhalise ku-Medicare ngaphandle kwezikhathi zokubhalisa zokuqala noma ezijwayelekile. Ama-SEP ayenzeka uma unoshintsho olukhulu empilweni, njengokuthuthela endaweni entsha noma uthathe umhlalaphansi emsebenzini obekunikeza umshuwalense wakho wezempilo.

Ngemuva komcimbi wakho wokushintsha noma wempilo, uzoba newindi lezinyanga eziyi-8 ukuze ubhalisele iMedicare.Uma ubhalisa ngalesi sikhathi, ngeke ukhokhe isijeziso sokubhaliswa sekwedlule isikhathi.

Ukuphathwa Kwezokuphepha Komphakathi (SSA)

ISocial Security Administration (SSA) iyinhlangano yenhlangano eyengamele izinzuzo zomhlalaphansi nezokukhubazeka. Uma uthola izinzuzo ze-SSA, ungathola i-Medicare Part A mahhala. Uma ubulokhu uthola izinzuzo zokukhubazeka Kwezenhlalakahle iminyaka emibili, uzobhaliswa ngokuzenzekelayo ku-Medicare, noma ngabe ungaphansi kweminyaka engama-65.

Isikhathi sokulinda seminyaka emibili

Ungathola i-Medicare uma ungaphansi kweminyaka engama-65 futhi unokukhubazeka okungapheli. Kuzodingeka ufanelekele imali engenayo yokukhubazeka kwezenhlalakahle bese uyithola iminyaka emibili ngaphambi kokuthi kuqale ukubhekwa kweMedare. Lokhu kwaziwa njengesikhathi sokulinda seminyaka emi-2.

Kubalulekile ukuqaphela ukuthi lesi sikhathi sokulinda seminyaka emibili asisebenzi kubantu abane-ESRD noma i-ALS.

Amakhredithi omsebenzi

Amakhredithi omsebenzi anquma ukufaneleka kwakho kwezinzuzo Zokuphepha Komphakathi kanye nengxenye engakhokhelwa ye-premium A. Uhola amakhredithi omsebenzi ngesilinganiso esingu-4 ngonyaka - {textend} futhi ngokuvamile uzodinga amakhredithi angama-40 ukuthola izinzuzo ezingakhokhelwa ze-Part A noma ze-SSA . Abasebenzi abasebancane abakhubazekile bangafanelekela ukuthola izikweletu ezimbalwa.

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.