Ngabe i-Medicare ihlanganisa izinsiza zezempilo zasekhaya?

-Delile

• Yini usizo lwezempilo lwasekhaya?
• Ngabe iMedicare ikufaka nini ukunakekelwa kwempilo ekhaya?
• Ziyini izindleko zabasizi bezempilo ekhaya?
• Yiziphi izinhlelo zeMedicare ezingaba ngcono kuwe uma wazi ukuthi udinga izinsizakalo zezempilo zasekhaya?
• Ingxenye A
• Ingxenye B
• Ingxenye C
• Izinhlelo zokwengeza zeMedicare noma iMedigap
• Okubalulekile

Izinsizakalo zezempilo zasekhaya zivumela umuntu ukuthi ahlale ekhaya lakhe ngenkathi ethola izindlela zokwelashwa ezidingekayo noma ukunakekelwa kwabahlengikazi abanamakhono. I-Medicare ihlanganisa ezinye zezinsizakalo zezempilo zasekhaya, kufaka phakathi ukwelashwa ngokomzimba nangokomsebenzi kanye nokunakekelwa kwabahlengikazi abanamakhono.

Kodwa-ke, i-Medicare ayihlanganisi zonke izinsizakalo zezempilo zasekhaya, ezinjengokunakekelwa ubusuku nemini, ukulethwa kokudla, noma ukunakekelwa kokugcina - eziningi zalezi zinsizakalo ziwela ngaphansi kwalowo osiza ezempilo ekhaya.

Qhubeka ufunde ukuze uthole mayelana nezinsizakalo ezihlanganisiwe ngaphansi kweMedicare, nokuthi abasizi bezempilo ekhaya bangawela noma bangaweli ngaphansi kwalesi sigaba.

Yini usizo lwezempilo lwasekhaya?

Abasizi bezempilo yasekhaya ngabasebenzi bezempilo abasiza abantu emakhaya abo lapho bekhubazekile, izifo ezingapheli, noma bedinga usizo olwengeziwe.

Abasizi bangasiza ngemisebenzi yokuphila kwansuku zonke, njengokugeza, ukugqoka, ukuya endlini yangasese, noma eminye imisebenzi yekhaya. Kulabo abadinga usizo ekhaya, abasizi bezempilo ekhaya bangabaluleka kakhulu.

Kodwa-ke, zihlukile kweminye imisebenzi yezempilo yasekhaya, engabandakanya abahlengikazi bezempilo basekhaya, abelaphi bomzimba, kanye nabelaphi basemsebenzini abanikeza ukunakekelwa kwezokwelapha nabanamakhono okudinga ukuqeqeshwa okukhethekile okubanzi nezitifiketi.

Ngokwe-Bureau of Labor Statistics yase-U.S., Izinga elijwayelekile lemfundo losizo lwezempilo yasekhaya yidiploma yesikole esiphakeme noma okulingana nayo.

Abanye abantu bangasebenzisa igama elithi "umsizi wezempilo yasekhaya" ukuchaza yonke imisebenzi enikeza ukunakekelwa ekhaya, kepha umsizi wezempilo wasekhaya ngokweqile uhlukile kunesi wezempilo wasekhaya noma umelaphi.

Lo mehluko ubalulekile uma kuziwa ekuqondeni ukuthi yini i-Medicare ezokwenzela futhi engeke ikuhlanganise uma kukhulunywa ngokunakekelwa kwasekhaya. I-Medicare ayikhokhi izinsizakalo eziningi ezingaphansi kwezinsizakalo zosizo lwezempilo. Lokhu kufaka phakathi:

• ukunakekelwa ubusuku nemini
• ukulethwa kokudla kwasekhaya noma usizo ngokudla
• izinsizakalo zokwakha ikhaya, njengokuwasha izingubo, ukuhlanza noma ukuthenga
• ukunakekelwa komuntu siqu, njengokusizwa ukugeza, ukugqoka noma ukusebenzisa indlu yangasese

Uma izinsizakalo zokunakekelwa komuntu ezivela kumsizi wezempilo yasekhaya kungukuphela kokunakekelwa okudingayo, iMedicare ayivamisile ukukubandakanya lokhu. Benza izinsizakalo zokunakekelwa kwezempilo ekhaya.

Ngabe iMedicare ikufaka nini ukunakekelwa kwempilo ekhaya?

I-Medicare Part A (izinsizakalo zesibhedlela) ne-Medicare Part B (izinsizakalo zezokwelapha) zihlanganisa ezinye izici zempilo yasekhaya.

Ngokufanelekile, impilo yasekhaya ingakhulisa ukunakekelwa kwakho futhi ivimbele ukuphinda ungeniswe esibhedlela. Kunezinyathelo nezimo eziningana zokufanelekela ukunakekelwa kwezempilo ekhaya:

• Kufanele ube ngaphansi kokunakekelwa ngudokotela okwenzele uhlelo olubandakanya ukunakekelwa kwezempilo ekhaya. Udokotela wakho kufanele abuyekeze uhlelo ngezikhathi ezithile ukuze aqiniseke ukuthi lusakusiza.
• Udokotela wakho kufanele aqinisekise ukuthi udinga izinsizakalo zokunakekelwa kwabahlengikazi abanamakhono nezinsizakalo zokwelapha. Ukuze udinge lokhu kunakekelwa, udokotela wakho kufanele anqume ukuthi isimo sakho sizothuthuka noma silondoloze ngezinsizakalo zezempilo zasekhaya.
• Udokotela wakho kufanele aqinisekise ukuthi uya ekhaya. Lokhu kusho ukuthi kunzima kakhulu noma kuyinselele yezokwelapha kuwe ukuthi ushiye ikhaya lakho.

Uma uhlangabezana nalezi zidingo, izingxenye ze-Medicare A no-B zingakhokhela izinsizakalo zezempilo zasekhaya, kufaka phakathi:

• ukunakekelwa kwabahlengikazi abanesikhathi esithile, okungabandakanya ukunakekelwa kwesilonda, ukunakekelwa kwe-catheter, ukuqapha izimpawu ezibalulekile, noma ukwelashwa ngemithambo (njengama-antibiotic)
• ukwelashwa emsebenzini
• ukwelashwa ngokomzimba
• izinsizakalo zezenhlalakahle zezokwelapha
• izifo zolimi lokukhuluma

Ngokusho kwe-Medicare.gov, iMedicare iyayikhokhela "imisebenzi yosizo lwezempilo yasekhaya yesikhashana noma ngezikhathi ezithile." Kuyaqondakala lokhu kudideka.

Kusho ukuthi umsebenzi wezempilo wasekhaya angahlinzeka ngezinsizakalo zokunakekelwa komuntu ezinikezwa ngumsizi wezempilo wasekhaya. Umehluko ukuthi, ekubuyiselweni kwemali, kufanele futhi uthole izinsizakalo zabahlengikazi abanamakhono futhi.

Ziyini izindleko zabasizi bezempilo ekhaya?

Uma udokotela wakho ethathe izinyathelo zokukusiza ufanelekele izinsizakalo zezempilo zasekhaya, cishe bazokusiza ukuthi uxhumane ne-ejensi yezempilo yasekhaya.

Lezi zinhlangano kufanele zikunikeze incazelo yalokho okwenziwa yiMedicare futhi engafaki ngeSaziso Sokuhlomula Kwangaphambili. Ngokufanelekile, lokhu kusiza ukunciphisa izindleko zokumangala kuwe.

Lapho i-Medicare ivuma izinsizakalo zakho zezempilo zasekhaya, awunakukhokha lutho ngezinsizakalo zokunakekelwa kwempilo yasekhaya, noma ngabe ungaba nesibopho samaphesenti angama-20 emali evunyelwe yi-Medicare yemishini yezokwelapha eqinile (i-DME), engafaka izimpahla zokwelapha ngokomzimba, izimpahla zokunakekelwa kwamanxeba , namadivayisi okusiza.

Imvamisa kunomkhawulo wesikhathi sezinsuku ezingama-21 wokuthi ungathola izinsizakalo ezingabizi isikhathi esingakanani. Kodwa-ke, udokotela wakho anganweba lo mkhawulo uma engalinganisela ukuthi isidingo sakho sezinsizakalo zezempilo zasekhaya singaphela nini.

Yiziphi izinhlelo zeMedicare ezingaba ngcono kuwe uma wazi ukuthi udinga izinsizakalo zezempilo zasekhaya?

I-Medicare ihlukanisa izinsizakalo zayo ngamaqoqo ezinhlamvu ahlukene, kufaka phakathi izingxenye ze-Medicare A, B, C (Medicare Advantage), kanye no-D (ukutholakala kwezidakamizwa kadokotela).

Ingxenye A

I-Medicare Part A yingxenye enikezela ngesibhedlela. I-Medicare Part A ikhululekile kubantu abaningi lapho bona noma abalingani babo besebenza okungenani amakota angama-40 akhokha intela yeMedare.

Yize Ingxenye A “iwukuhlinzekwa esibhedlela,” isabandakanya izinsizakalo zezempilo zasekhaya ezinamakhono ngoba zingaba ukuqhubeka kokunakekelwa obukuthola esibhedlela futhi kubalulekile ekululameni kwakho konke.

Ingxenye B

I-Medicare Part B yingxenye ehlanganisa izinsizakalo zezokwelapha. Wonke umuntu okuNgxenye B ukhokha imali yomshwalense, kanti abanye abantu bangakhokha kakhulu ngokuya ngeholo labo. Ingxenye B ikhokhela ezinye zezinsizakalo zezempilo ekhaya, kufaka phakathi imishini yezokwelapha.

Ingxenye C

I-Medicare Part C yaziwa nangokuthi yi-Medicare Advantage. Ihlukile kwi-Medicare yendabuko ngoba ihlanganisa izingxenye ze-A, B, kwesinye isikhathi i-D (ukumbozwa ngemithi kadokotela), futhi kwesinye isikhathi nezinsizakalo ezengeziwe, kuya ngohlelo lwakho.

Izibonelo zezinhlelo ze-Medicare Advantage Plans zifaka inhlangano yokulondolozwa kwezempilo (i-HMO) noma inhlangano ehlinzekwayo yokuhlinzeka (i-PPO). Uma unalezi zinhlobo zohlelo, kuzodingeka ukuthi uthole izinsizakalo zakho zezempilo zasekhaya kusuka kwi-ejensi uhlelo lwakho olwenza isivumelwano nalo ngqo.

Ezinye izinhlelo ze-Medicare Advantage zinikela ngokuqhubeka kokuhlinzekwa kwezinsizakalo zezempilo zasekhaya, futhi lolu lwazi kufanele lufakwe encazelweni yakho yezinzuzo.

Izinhlelo zokwengeza zeMedicare noma iMedigap

Uma une-Medicare yangempela (izingxenye A no-B, hhayi i-Medicare Advantage), ungakwazi ukuthenga uhlelo lwe-Medicare supplement, olubizwa nangokuthi iMedigap.

Ezinye izinhlelo zeMedigap zikhokhela izindleko ze-coinsurance zeNgxenye B, ezingakusiza ukukhokhela izinsizakalo zezempilo zasekhaya. Kodwa-ke, lezi zinhlelo azinikezi ukunwetshwa kwenkonzo yezempilo yasekhaya enwetshiwe.

Abanye abantu bakhetha ukuthenga umshuwalense ohlukile wokunakekelwa kwesikhathi eside, ongeyona ingxenye yeMedicare. Lezi zinqubomgomo zingasiza ukumboza izinsizakalo eziningi zokunakekelwa kwempilo yasekhaya nezikhathi ezinde kuneMedicare. Kodwa-ke, izinqubomgomo ziyahlukahluka futhi zimelela izindleko ezengeziwe kwabadala.

Okubalulekile

I-Medicare ayikhokhi izinsizakalo zosizo lwezempilo ekhaya uma kungekho igama lokunakekelwa elinamakhono. Uma udokotela wakho ethi udinga ukunakekelwa okunekhono, ungakwazi ukuthola izinsizakalo zokunakekelwa komuntu ngenkathi uthola ukunakekelwa okunekhono.

Indlela engcono kakhulu ukuxhumana nodokotela wakho kanye ne-ejensi yezempilo yasekhaya elindelekile ukuze uqonde ukuthi yiziphi izindleko futhi azimbozwa nokuthi isikhathi esingakanani.

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.