Izinhlelo zeCalifornia Medicare ngo-2021

-Delile

• Yini iMedicare?
• Ingxenye A (ukumbozwa kweziguli nezibhedlela)
• Ingxenye B (ukumbozwa kweziguli ezingaphandle kanye nokwelashwa)
• Ingxenye D (Ukusetshenziswa kwezidakamizwa kadokotela)
• Inzuzo yeMedicare
• Yiziphi izinhlelo ze-Medicare Advantage ezitholakala eCalifornia?
• I-HMO
• I-PPO
• SNP
• Abahlinzeki eCalifornia
• Ngubani ofanelekela i-Medicare eCalifornia?
• Ngingabhalisa nini eMedicare eCalifornia?
• Isikhathi sokubhalisa sokuqala
• Isikhathi sokhetho saminyaka yonke
• Ukubhaliswa okuvulekile kweMedicare Advantage
• Isikhathi sokubhaliswa okujwayelekile
• Izinkathi zokubhalisa ezikhethekile
• Amathiphu wokubhalisa kwi-Medicare eCalifornia
• Izinsiza zaseCalifornia Medicare
• Uhlelo Lokululekwa Ngomshuwalense Wezempilo Nokukhuthaza (HICAP)
• Imithi
• Ukusabalala okuxhasiwe ngumqashi
• Yini okufanele ngiyenze ngokulandelayo?

Yini iMedicare?

I-Medicare ukuvikela umshuwalense wezempilo kubantu abaneminyaka engama-65 nangaphezulu. Ungase futhi ufaneleke ukuthola i-Medicare uma ungaphansi kweminyaka engama-65 ubudala futhi uhlala nokukhubazeka okuthile noma izimo zezempilo.

Izinhlelo zeMedicare eCalifornia zifaka:

• Imithi yokuqala: uhlelo lomshuwalense wezempilo olulawulwa yiCenters for Medicare & Medicaid Services (CMS)
• Inzuzo yeMedicare: izinhlelo ezinikezwa ngezinkampani zomshuwalense ezizimele ezenza isivumelwano ne-CMS
• Izinhlelo zemithi kadokotela: izinhlelo zomshuwalense ezibandakanya izindleko zemithi kadokotela

Ingxenye A (ukumbozwa kweziguli nezibhedlela)

Ingxenye A ihlanganisa ukunakekelwa okutholayo ngenkathi uhlala ezibhedlela, ezibhedlela ezibucayi zokufinyelela, nesikhathi esilinganiselwe ezikhungweni zabahlengikazi abanamakhono. Iningi labantu alikhokhi imali ekhokhwa njalo ngenyanga yezinhlelo zePart A, kepha kukhona okudonswayo uma ungeniswa esibhedlela.

Ingxenye B (ukumbozwa kweziguli ezingaphandle kanye nokwelashwa)

Ingxenye B ihlanganisa ukunakekelwa ngaphandle kwesibhedlela ngezinto ezifana:

• ukuvakashelwa odokotela
• ukuhlolwa kokuxilongwa
• ukuhlolwa kwelebhu
• imishini yezokwelapha ehlala njalo

Uzokhokha imali eyengeziwe yezinhlelo zeNgxenye B. Amaphrimiyamu asethwe yi-CMS futhi ayashintsha unyaka ngamunye ngokuya ngezindleko zokunakekelwa kwezempilo zizonke.

Ingxenye D (Ukusetshenziswa kwezidakamizwa kadokotela)

Wonke umuntu oku-Medicare ufanelekile (Ingxenye D), kepha kufanele uyithole ngomshuwalense wangasese. Kubalulekile ukuqhathanisa lezi zinhlelo ngoba izindleko nokufakwa kwemali kuyehluka.

Inzuzo yeMedicare

Izinhlelo zeMedicare Advantage (Ingxenye C) zinikezwa ngabanikezeli bomshuwalense abazimele abahlanganisa konke ukumbozwa kwakho kwezingxenye A no-B, futhi kwesinye isikhathi ukutholakala kwezidakamizwa kadokotela, kuhlelo olulodwa. Ngezinhlelo ze-Medicare Advantage, usakhokha i-Medicare Part B premium.

Izinhlelo zeMedicare Advantage kumele zihlanganise izinto ezifanayo nezingxenye zeMedicare A no-B, kepha ezinye zinokufakwa okwengeziwe (kanye ne-premium eyengeziwe) yezinto ezifana:

• izinsizakalo zamazinyo noma umbono
• Izindunduma zesihlalo sabakhubazekile ekhaya
• ukulethwa kokudla
• ukuthuthwa kuya nokubuya kuma-aphoyintimenti ezokwelapha

Yiziphi izinhlelo ze-Medicare Advantage ezitholakala eCalifornia?

ECalifornia, izinhlelo zeMedicare Advantage ziwela ezigabeni ezintathu: Izinhlangano Zokulondolozwa Kwezempilo (HMOs), Izinhlangano Zabahlinzeki Abathandwayo (ama-PPOs), kanye Nezinhlelo Zezidingo Ezikhethekile (SNPs).

I-HMO

Nge-HMO, ukhetha udokotela oyinhloko oqondisa ukunakekelwa kwakho futhi akuthumele kochwepheshe njengoba kudingeka. Izinhlelo eziningi zidinga ukuthi uthole ukunakekelwa kubahlinzeki kunethiwekhi ye-HMO.

Ukunakekelwa ngaphandle kwenethiwekhi ye-HMO ngokuvamile akuhlanganiswa ngaphandle kokuthi ukunakekelwa okuphuthumayo, ukunakekelwa okuphuthumayo okungaphandle kwendawo, noma i-dialysis engaphandle kwendawo.

Ezinye izinhlelo ze-HMO zidinga ukuthi uthenge ukumbozwa kwezidakamizwa okuhlukile (Ingxenye D).

Ukutholakala kwezinhlelo ze-HMO eCalifornia kuyahlukahluka esifundeni, futhi azitholakali yonke indawo.

I-PPO

Nge-PPO, ungathola ukunakekelwa kusuka kumanethiwekhi odokotela nezinsiza ezihlinzeka ngezinsizakalo ezimbozwe ngaphansi kohlelo lwakho.

Ungathola futhi ukunakekelwa kumhlinzeki wezokwelapha ngaphandle kwenethiwekhi yakho, kepha izindleko zakho ezingaphandle kwephaketheni ngokuvamile ziba ngaphezulu.

Ama-PPO amaningi awadingi ukuthunyelwa ukuze abone onguchwepheshe.

ICalifornia ayinazo izinhlelo ze-Medicare Advantage PPO ezisemaphandleni, kepha izifunda ezingama-21 zinezinhlelo ze-PPO zasendaweni ezitholakalayo.

SNP

Ama-SNP ayatholakala kubantu abadinga izinga eliphakeme lokuphathwa nokunakekelwa okuhlelekile. Ungahle ukwazi ukuthola iSNP uma:

• unesimo sempilo esingapheli noma esikhubazayo, njengesifo sikashukela noma ukwehluleka kwenhliziyo okungamahlalakhona
• "bafanelekile kabili" kuzo zombili i-Medicare neMedicaid
• ngihlala ekhaya lasebekhulile noma esikhungweni esifanayo noma ngihlala ekhaya kodwa ngithole ukunakekelwa kwezinga elifanayo nelomuntu ohlala ekhaya lasebekhulile

Abahlinzeki eCalifornia

Lezi zinkampani zinikela ngezinhlelo zeMedicare Advantage eCalifornia:

• I-Aetna Medicare
• Uhlelo Lokuqondanisa Impilo
• I-Anthem Blue Cross
• IBlue Cross yaseCalifornia
• Usuku olusha ceke
• Uhlelo lwe-Central Health Medicare
• Uhlelo lwezempilo lweClever Care
• IGolden State
• I-Health Net Community Solutions, Inc.
• Impilo Net yaseCalifornia
• Humana
• Uhlelo lwe-Imperial Health of California, Inc.
• UKaiser Permanente
• Skena Uhlelo Lwezempilo
• UnitedHealthcare
• I-WellCare

Akuzona zonke izinkampani zenethiwekhi ezinikeza ngezinhlelo kulo lonke izwe, ngakho-ke izinketho onazo zizohluka ngokuya ngendawo ohlala kuyo.

Ngubani ofanelekela i-Medicare eCalifornia?

Izakhamizi zaseCalifornia zifanelekile ezinhlelweni zeMedicare neMedicare Advantage uma:

• uyisakhamuzi sase-United States noma ohlala ngokomthetho kule minyaka emihlanu noma ngaphezulu edlule
• uneminyaka engama-65 noma ngaphezulu, futhi wena noma oshade naye nihlangabezana nezimfuneko zomsebenzi oxhaswe yi-Medicare

Abantu abangaphansi kweminyaka engama-65 bangafaneleka uma:

• unokukhubazeka futhi uthola i-Social Security Disability Insurance (SSDI) noma i-Railroad Retirement Board
• une-amyotrophic lateral sclerosis (ALS) noma isifo sezinso sesigaba sokugcina (ESRD)

Uma usenemibuzo mayelana nokuthi uyafaneleka yini, ungasebenzisa ithuluzi lokufaneleka eliku-inthanethi le-Medicare.

Ngingabhalisa nini eMedicare eCalifornia?

Isikhathi sokubhalisa sokuqala

Isikhathi sokuqala sokubhalisa (i-EIP) isikhathi esiyizinyanga eziyi-7 esiqala izinyanga ezintathu ngaphambi kosuku lwakho lokuzalwa lwama-65 futhi luphele ezinyangeni ezintathu ngemuva kokuhlanganisa iminyaka engama-65. Uma ubhalisa, ukumbozwa kwakho kuzoqala okokuqala enyangeni ozoba neminyaka engama-65 ubudala.

Uma ubambezela ukubhaliswa kuze kube yinyanga noma ngemuva kosuku lwakho lokuzalwa, ungaba negebe kumshwalense wakho wezempilo.

Isikhathi sokhetho saminyaka yonke

Ungabhalisa ezinhlelweni ze-Medicare Advantage phakathi Okthoba 15 noDisemba 7 unyaka ngamunye. Ukufunda kuqala ngoJanuwari 1.

Ukubhaliswa okuvulekile kweMedicare Advantage

Uma usuvele usohlelweni lwe-Medicare Advantage futhi ufuna ukushintshela kolunye uhlelo lwe-Medicare Advantage noma uye ku-Medicare yasekuqaleni, ungakwenza lokho phakathi Januwari 1 noMashi 31 unyaka ngamunye.

Isikhathi sokubhaliswa okujwayelekile

Ukubhaliswa okujwayelekile kuphakathi Januwari 1 noMashi 31 unyaka ngamunye.Uma une-Medicare Part A futhi ufuna ukubhalisa ku-Part B, uhlelo lwe-Medicare Advantage, noma ukumbozwa kwe-Part D ungakwenza ngalesi sikhathi. Ukufunda kuyasebenza Julayi 1.

Izinkathi zokubhalisa ezikhethekile

Izikhathi zokubhalisa ezikhethekile zikuvumela ukuthi ubhalise ngaphandle kwezikhathi ezijwayelekile zokubhalisa ngaphansi kwezimo ezikhethekile. Isibonelo, isikhathi sokubhalisa esikhethekile sikuvumela ukuthi ubhalise kuhlelo olusha ngaphandle kwenhlawulo uma ulahlekelwa uhlelo lomshuwalense oluxhaswe ngumqashi futhi udinga ukubhalisa engxenyeni B, noma uphume endaweni yesevisi yakho yohlelo lwakho lwamanje.

Amathiphu wokubhalisa kwi-Medicare eCalifornia

Izinhlelo zeMedicare neMedicare Advantage eCalifornia zingadida, ngakho-ke ngaphambi kokuba ubhalise kubalulekile ukuhlola izinqumo zakho bese uqhathanisa izinto ezifana nokuthi:

• izindleko
• ukumbozwa
• abahlinzeki nezinsiza kunethiwekhi yohlelo
• Izilinganiso zezinkanyezi ze-CMS zezinhlelo zeNgxenye C no-Part D

Uma udinga usizo lokunquma ukuthi yiziphi izinhlelo ezifanele izidingo zakho noma unemibuzo mayelana nezinketho ezitholakalayo, kunezinsiza eziningi zokukusiza.

Izinsiza zaseCalifornia Medicare

Uhlelo Lokululekwa Ngomshuwalense Wezempilo Nokukhuthaza (HICAP)

UMnyango Wokuguga waseCalifornia unikeza ukwelulekwa nge-Medicare nge-HICAP. Banikeza:

• imininingwane ngokubhaliswa kweMedicare
• izincazelo zezingxenye A, B, no-C, nokuthi unganquma kanjani ukuthi yikuphi ukumboza okudingayo
• izimpendulo zemibuzo emayelana nokusetshenziswa kwezidakamizwa kadokotela engxenyeni D, izindleko, nokufaneleka

I-HICAP iyimfihlo futhi imahhala kunoma ngubani ofanelekela i-Medicare noma mayelana nokufanelekela. Ungasesha izinsizakalo ze-HICAP zendawo nge-county noma ushayele ku-800-434-0222.

Imithi

Thintana noMedicare ngqo ukuze uthole usizo ngokubhalisa noma ukuhlela imibuzo ngokushayela u-800-MEDICARE (800-633-4227) noma uvakashele i-medicare.gov. Ungashayela nehhovisi le-CMS lesifunda eSan Francisco ku-415-744-3501.

Ukusabalala okuxhasiwe ngumqashi

Uma unokukhathazeka noma udinga usizo ngokutholakala kwe-Medicare California okuthengwe ngumqashi, thintana noMnyango Wezempilo waseCalifornia ophethwe yi-888-466-2219 noma uthumele i-imeyili [email protected]

Yini okufanele ngiyenze ngokulandelayo?

Lapho usukulungele ukubhalisela i-Medicare eCalifornia:

• nquma ukuthi yikuphi ukumbozwa okudingayo bese ucwaninga ngezinhlelo ezitholakalayo, izinketho zokuhlanganisa, nezindleko
• thinta i-HICAP noma i-Medicare uma unemibuzo mayelana nokufaneleka noma ukumbozwa
• thola ukuthi isikhathi esilandelayo sokubhalisa siqala nini

Lo mbhalo uvuselelwe ngo-Okthoba 5, 2020 ukukhombisa imininingwane ye-2021 Medicare.

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.