Yini i-Medicare?

-Delile

• Isebenza kanjani iMedicare?
• Ziyini izingxenye zeMedicare?
• Ingxenye A (ukulaliswa esibhedlela)
• Ingxenye B (yezokwelapha)
• Ingxenye C (Medicare Advantage)
• Ingxenye D (imiyalelo)
• Isengezo seMedicare (iMedigap)
• Ungayithola kanjani iMedicare
• Amathiphu wokukhetha uhlelo lwe-Medicare
• Ukuthatha

• I-Medicare ngumshuwalense oxhaswa ngemali nguhulumeni wabantu abangama-65 noma ngaphezulu kanye nabantu abanezimo ezingapheli noma abakhubazekile.
• I-Medicare inikeza izinketho eziningi zomshuwalense ukusiza ukuhlangabezana nezidingo zakho.
• Ukwenza uhlu lwezimo onazo, imishanguzo oyithathayo, nodokotela obabonayo kungakusiza ukhethe izinhlelo zeMedicare.

Umshuwalense ungabiza, futhi ukuzama ukuthola zonke izinketho zokunakekelwa kwezempilo ongazithola kungakhathaza futhi kukukhungathekise.

Noma ngabe umusha ku-Medicare noma unentshisekelo yokuhlala unolwazi, nakhu okumele ukwazi mayelana nezisekelo zalolu hlelo lomshuwalense wezempilo.

Isebenza kanjani iMedicare?

I-Medicare wuhlelo lomshuwalense wezempilo oluxhaswe nguhulumeni olunikeza ukwelashwa kwabantu abangaphezu kweminyaka engama-65. Ungase ufaneleke ukuthola iMedicare uma:

• ngikhubazekile futhi bengithola izinzuzo zokukhubazeka kwezenhlalakahle iminyaka emibili
• ube nempesheni yokukhubazeka evela kwiBhodi Yesitimela Yomhlalaphansi
• unesifo sikaLou Gehrig (ALS)
• ukuhluleka kwezinso (isifo se-renal) bese uthola i-dialysis noma ukufakelwa kabusha kwezinso

Lo mshuwalense wezempilo ungasetshenziswa njengomshwalense oyinhloko noma njengokwengeza, ukumbozwa kokusekelayo. I-Medicare ingasetshenziselwa ukusiza ukukhokhela ukunakekelwa kwezokwelapha nokunakekelwa kwesikhathi eside, kepha kungenzeka kungazibandakanyi zonke izindleko zakho zezokwelapha.

Ixhaswa yizintela futhi, kwezinye izimo, amaprimiyamu akhishwa ekuhlolweni kwakho kwezokuphepha komphakathi noma okukhokhayo.

Ziyini izingxenye zeMedicare?

I-Medicare yakhelwe ukumboza izidingo zakho ezibalulekile zezokwelapha, njengokuhlala esibhedlela nokuvakasha kodokotela. Lolu hlelo lwakhiwe izingxenye ezine: Ingxenye A, Ingxenye B, Ingxenye C, neNgxenye D.

Ingxenye A neNxenye B kwesinye isikhathi ibizwa ngokuthi yi-Medicare yasekuqaleni. Lezi zingxenye ezimbili zihlinzeka ngemisebenzi eminingi ebalulekile.

Ingxenye A (ukulaliswa esibhedlela)

I-Medicare Part A ihlanganisa ukunakekelwa kwakho kwesibhedlela, kufaka phakathi izinsizakalo ezahlukahlukene ezihlobene nezibhedlela. Ukunakekelwa kwakho okuningi okuhlobene nokwelashwa kumbozwe yiNgxenye A uma kufanele uye esibhedlela njengesiguli esingalaliswayo. Ingxenye A ibuye inikeze ukunakekelwa kwe-hospice kulabo abagulela ukufa.

Kubantu abaningi abahola kancane, ngeke kube khona amaphrimiyamu. Abantu abanemiholo ephezulu kungadingeka bakhokhe imali encane nyangazonke ngalolu hlelo.

Ingxenye B (yezokwelapha)

I-Medicare Part B ihlanganisa ukunakekelwa kwakho jikelele kwezokwelapha nokunakekelwa kweziguli ongakudinga ukuze uhlale uphilile, kufaka phakathi:

• ingxenye enkulu yezinsizakalo zokuvimbela
• izinto zokwelashwa (ezaziwa njengemishini yezokwelapha eqinile, noma i-DME)
• izinhlobo eziningi ezahlukahlukene zokuhlolwa nokuhlolwa
• izinsizakalo zezempilo yengqondo

Ngokuvamile kune-premium yalolu hlobo lokutholakala kwe-Medicare, ngokuya ngeholo lakho.

Ingxenye C (Medicare Advantage)

I-Medicare Part C eyaziwa nangokuthi i-Medicare Advantage, akuyona inzuzo yezokwelapha ehlukile. Kungumbandela ovumela izinkampani zemishwalense ezimele ezivunyiwe ukuthi zinikeze izinhlelo zomshuwalense kubantu ababhalise kuzingxenye A no-B.

Lezi zinhlelo zihlanganisa zonke izinzuzo kanye nezinsizakalo ezithathwa izingxenye A no-B. Bangase banikele nangezinzuzo ezengeziwe, njengokufakwa kwezidakamizwa kadokotela, amazinyo, umbono, ukuzwa, nezinye izinsizakalo. Izinhlelo zeMedicare Advantage zivame ukuba nezimali ezingeziwe ezinjengama-copay nama-deductibles. Ezinye izinhlelo azinawo amaprimiyamu, kepha uma uhlelo olukhethayo lune-premium, lungadonswa kusheke lakho lokuphepha komphakathi.

Ingxenye D (imiyalelo)

I-Medicare Part D ihlanganisa imishanguzo kadokotela. Izindleko noma i-premium yalolu hlelo incike kumholo wakho, futhi ama-copayments akho kanye nokwehliswayo kuncike ohlotsheni lwemithi oyidingayo.

I-Medicare inikeza uhlu, olubizwa ngokuthi i-formulary, yezidakamizwa uhlelo ngalunye lweNgxenye D luhlanganisa ukuze wazi ukuthi imithi oyidingayo ihlanganiswe yini nohlelo olucabangayo.

Isengezo seMedicare (iMedigap)

Noma isengezo seMedicare singabizwa ngokuthi "ingxenye," singenye yezinhlobo ezinhlanu ezinkulu zomshuwalense weMedicare okufanele uzicabangele. IMedigap isebenza ngeMedicare yasekuqaleni futhi isiza ukumboza izindleko ezingaphandle kwephakethe uMedare wokuqala ongazenzi.

IMedigap ithengiswa izinkampani ezizimele, kepha iMedicare idinga ukuthi izifundazwe eziningi zinikeze ukumbozwa okufanayo. Kunezinhlelo eziyi-10 zeMedigap ezitholakalayo: A, B, C, D, F, G, K, L, M, noN. Uhlelo ngalunye luhluke kancane kokucacisiwe kwalokhu elikumbozayo.

Uma ngabe ubulungele ukuthola iMedicare ngemuva kukaJanuwari 1, 2020, awufanelekile ukuthenga amapulani C noma F; kepha, uma ubufanelekile ngaphambi kwalolo suku, ungabathenga. Uhlelo lweMedigap D noHlelo G njengamanje luhlinzeka ngokumbozwa okufanayo njengoba izinhlelo C no-F.

Ungayithola kanjani iMedicare

Uzobhaliswa ngokuzenzakalela kuhlelo uma usuvele uthola izinzuzo zokuphepha komphakathi. Uma ungatholi izinzuzo, ungaxhumana nehhovisi lezokuphepha komphakathi kuze kufike ezinyangeni ezintathu ngaphambi kosuku lwakho lokuzalwa lwama-65th ukubhalisa.

Ukuphathwa Kwezokuphepha Komphakathi kuphatha ukubhaliswa kweMedicare. Kunezindlela ezintathu ezilula zokufaka isicelo:

• usebenzisa uhlelo lokusebenza lwe-Medicare online kuwebhusayithi ye-Social Security Administration
• ngishayela iSocial Security Administration ngo-1-800-772-1213 (TTY: 1-800-325-0778)
• uvakashele ihhovisi langakini le-Social Security Administration

Uma ungumsebenzi wesitimela osuthathe umhlalaphansi, xhumana neBhodi Yesitimela Yokuthatha Umhlalaphansi ku-1-877-772-5772 (TTY: 1-312-751-4701) ukuze ubhalise.

Amathiphu wokukhetha uhlelo lwe-Medicare

Lapho ukhetha izinketho ze-Medicare ukuhlangabezana nezidingo zakho zokunakekelwa kwezempilo, kubalulekile ukuthi ubheke izidingo zakho zokunakekelwa kwezempilo. Nawa amathiphu ambalwa wokukhetha uhlelo noma inhlanganisela yamasu wokusebenzela wena:

• Zama ukulinganisa ukuthi usebenzise malini ekunakekelweni kwezempilo ngonyaka odlule ngaleyo ndlela ungalinganisa kangcono ukuthi yimaphi amapulani azokulondolozela imali.
• Bhala uhlu lwezimo zakho zezokwelapha ukuze uqiniseke ukuthi zimbozwe yizinhlelo ozicabangayo.
• Bhala phansi odokotela obabonayo njengamanje bese ubuza ukuthi bayayemukela yini i-Medicare noma ukuthi yimaphi amanethiwekhi we-Health Maintenance Organisation (HMO) noma ama-Preferred Provider Organisation (PPO).
• Bhala uhlu lwezokwelapha noma izibhedlela ongazidinga ngonyaka ozayo.
• Qaphela noma yimuphi omunye umshuwalense onawo, uma ungawusebenzisa neMedicare, nokuthi ungawuqeda kanjani lo msebenzi uma kunesidingo.
• Ngabe udinga umsebenzi wamazinyo, ufake izibuko noma izinsiza-kuzwa, noma ungathanda okunye ukumbozwa okwengeziwe?
• Ngabe wena noma uhlela ukuhamba ngaphandle kwendawo yakho noma ngaphandle kwezwe?

Zonke lezi zinto zingakusiza unqume ukuthi iziphi izingxenye zeMedicare ezingakwazi ukuhlangabezana nezidingo zakho nokuthi yiziphi izinhlelo ozozicabangela.

Ngenkathi iMedicare yasekuqaleni yeMedare ihlinzeka ngezinsizakalo eziningi, akuzona zonke izimo zezokwelapha ezihlanganiswayo. Isibonelo, ukunakekelwa kwesikhathi eside akubhekwa njengengxenye ye-Medicare. Uma udinga ukunakekelwa kwesikhathi eside, cabanga ngohlelo lweMedicare Advantage noma iMedigap olunganikeza izinzuzo ezinomkhawulo zokunakekelwa kwesikhathi eside.

Njengoba imishanguzo kadokotela ingamboziwe yi-Medicare yasekuqaleni, uma udinga ukumbozwa ngemithi kadokotela, uzodinga ukubhalisa kwi-Medicare Part D noma kwi-Medicare Advantage, enikeza ngezinhlelo ezihlanganisa eminye imishanguzo kadokotela.

Ukuthatha

• Ukwazi ukuthi yiziphi izinhlelo ezikulungele kuncike kumholo wakho, impilo yonke, iminyaka, nokuthi uzodinga luphi uhlobo lokunakekelwa. Kungcono ufunde izinsizakalo nezinhlelo ngokucophelela bese ukhetha izinhlelo ezisebenza kangcono kuwe.
• Izikhathi zokubhalisa zikhawulelwe kwezinye izinhlelo, ngakho-ke qiniseka ukuthi ubhalisa ukuze ungabi negebe ekuhlanganisweni.
• Uma ukhathazekile ngokuthi insizakalo oyifisayo ihlanganiswa yini yiMedicare, ungakhuluma nodokotela wakho, cinga kwi-Medicare Coverage Database online ku-www.cms.gov/medicare-coverage-database/, noma uthinte i-Medicare ngo-1-800- IMITHI (1-800-633-4227).