Ngabe i-Medicare ihlanganisa izinsizakalo zeTelehealth?

-Delile

• Ukutholakala kwe-Medicare kanye ne-telehealth
• Ngabe i-Medicare Part B ihlanganisa ini?
• Yini embozwa yi-Medicare Part C?
• Isebenza kanjani?
• Izindleko
• Ubuchwepheshe
• Ngazi kanjani ukuthi ngiyakufanelekela ukumbozwa?
• Izikhungo ezivunyelwe
• Indawo
• Uhlelo lwezinsizakalo zokuphathwa kokunakekelwa okungapheli kwe-Medicare (CCM)
• Ukunweba ukufakwa kweMedicare kwe-telehealth
• I-ESRD
• Unhlangothi
• Izinhlangano ezinakekelayo (ACOs)
• Ukungena kwe-Virtual nokuvakashelwa kwe-E
• Izinzuzo ze-telehealth
• Ukuthatha

I-Medicare ihlanganisa izinsizakalo ezahlukahlukene zezokwelapha nezempilo, kufaka phakathi i-telehealth. I-Telehealth isebenzisa ubuchwepheshe bokuxhumana ngogesi ukuvumela ukuvakashelwa kwezempilo okude nokufunda. Qhubeka ufunde ukuze ufunde kabanzi nge-telehealth, yiziphi izingxenye ze-Medicare ezikumbozayo, nokuningi.

Ukutholakala kwe-Medicare kanye ne-telehealth

I-Medicare yakhiwa izingxenye eziningana lapho ngayinye inikela ngohlobo oluhlukile lokumbozwa. Izingxenye eziyinhloko zifaka:

• I-Medicare Part A (umshuwalense wesibhedlela)
• I-Medicare Part B (umshuwalense wezokwelapha)
• I-Medicare Part C (Izinhlelo zenzuzo)
• I-Medicare Part D (ukutholakala kwezidakamizwa kadokotela)

I-Telehealth imbozwe izingxenye ze-Medicare B kanye no-C. Sizokuhlehlisa lokhu ngezansi.

Ngabe i-Medicare Part B ihlanganisa ini?

I-Medicare Part B ihlanganisa ezinye izinsizakalo ze-telehealth. Ngokubambisana, i-Medicare Part A ne-Part B kwesinye isikhathi ibizwa ngokuthi yi-Medicare yasekuqaleni.

Ukuvakashelwa kwe-telehealth kuphathwa ngendlela efanayo nokuthi uye ekuvakasheni kweziguli ezingazelele. Izinhlobo zensizakalo yetelehealth ezihlanganiswayo zifaka:

• ukuvakashelwa emahhovisi
• ukubonisana
• ukwelashwa kwengqondo

Ezinye izibonelo zabasebenzi bezempilo abangakwazi ukuhlinzeka ngezinsizakalo ze-telehealth zifaka:

• odokotela
• abasizi bodokotela
• abahlengikazi
• izazi zokusebenza kwengqondo
• abahlengikazi abaqinisekisiwe
• izazi zokudla ezibhalisiwe
• ochwepheshe abanemvume yokudla
• osonhlalakahle basemitholampilo

Kwezinye izimo, ungathola izinsizakalo ze-telehealth ekhaya lakho. Kwabanye, uzodinga ukuya esikhungweni sokunakekelwa kwezempilo.

Yini embozwa yi-Medicare Part C?

I-Medicare Part C ibizwa nangokuthi yi-Medicare Advantage. Izinkampani zomshuwalense wangasese zidayisa amapulani engxenye C. Ingxenye C ifaka ukumbozwa okufanayo ne-Medicare yasekuqaleni kepha ingafaka nezinzuzo ezingeziwe.

Ngo-2020, kwenziwa izinguquko kwiNgxenye C engayivumela ukuthi inikeze izinzuzo eziningi ze-telehealth kune-Medicare yasekuqaleni. Lezi zinguquko zibandakanya ukufinyelela okwandisiwe kwezinzuzo ze-telehealth ezivela ekhaya esikhundleni sokudinga ukuvakashelwa esikhungweni sezempilo.

Izinzuzo ezingeziwe zingahluka ngokuya ngohlelo lwakho lwengxenye C. Hlola uhlelo lwakho oluthile ukuze ubone ukuthi hlobo luni lwezinzuzo ze-telehealth ezinikezwayo.

Ngezansi kunezibonelo ezithile zokuthi i-telehealth ingasetshenziswa nini:

• ukuqeqeshwa noma imfundo, njengezindlela zokufunda zokuqapha isifo sikashukela
• ukuhlela ukunakekelwa kwesimo esingelapheki sezokwelapha
• ukuthola ukubonisana nochwepheshe ongekho endaweni yangakini
• ukwelashwa kwengqondo
• ukuhlolwa, okufana nalokho kokudangala noma ukuphazamiseka kokusebenzisa utshwala
• ukuhlela ukunakekelwa kusengaphambili
• ukwelashwa okunomsoco
• ukuthola usizo lokuyeka ukubhema
• ukuthola ukuhlolwa kobungozi bezempilo

Isebenza kanjani?

Ngakho-ke i-telehealth isebenza kanjani kahle neMedicare? Ake sihlole lokhu ngemininingwane ethe xaxa.

Izindleko

Uma uneNgxenye B, uzoba nesibopho sokukhokhwa kwemali engamaphesenti angama-20 yezindleko zezinsizakalo ze-telehealth ozitholayo. Khumbula ukuthi kufanele uqale uhlangabezane ne-Part B yakho ekhishwayo, eyi- $ 198 ka-2020.

Izinhlelo ze-Part C ziyadingeka ukuhlinzeka ukumbozwa okuyisisekelo okufanayo ne-Medicare yasekuqaleni. Kodwa-ke, uzofuna ukuxhumana nomhlinzeki wohlelo lwakho ngaphambi kokusebenzisa amasevisi we-telehealth ukuze uqiniseke ukuthi insizakalo ethile iyahlanganiswa.

Ubuchwepheshe

Kaningi ungathola izinsizakalo ze-telehealth esikhungweni sokunakekelwa kwezempilo. Noma kunjalo, kwesinye isikhathi zingasetshenziswa zisuka ekhaya.

Ukuze usebenzise izinsizakalo ze-telehealth ekhaya, kuzodingeka uqiniseke ukuthi unobuchwepheshe obudingekayo, kufaka phakathi:

• ukufinyelela kwe-inthanethi noma idatha yeselula
• ikhompyutha, i-laptop, i-smartphone, noma ithebhulethi
• ikheli lakho le-imeyili ukuze umhlinzeki wakho wezokunakekelwa kwempilo akwazi ukuxhumana nawe futhi athumele isixhumanisi kuwebhusayithi yenkomfa yevidiyo noma kwisoftware edingekayo

Lawa mathuluzi azovumela ukuxhumana kwesikhathi sangempela, izindlela ezimbili, umsindo / ividiyo nomhlinzeki wakho wezokunakekelwa kwempilo.

Hlola ubuchwepheshe bakho be-teleconferencing nomngani noma ilungu lomndeni ngaphambi kokuqokwa kwakho kokuqala kwe-telehealth. Lokhu kuzokusiza ukuxazulula noma yiziphi izinkinga ezingaba khona ngaphambi kokuzama ukusebenzisa lezi zinsizakalo ngochwepheshe bezokunakekelwa kwempilo.

Ngazi kanjani ukuthi ngiyakufanelekela ukumbozwa?

Uma usubhalise kwi-Medicare yoqobo, uzokwazi ukuthola izinsizakalo ze-telehealth.

Ungahle ufaneleke ukuthola i-Medicare uma uneminyaka engama-65 nangaphezulu, unesifo se-renal end (ESRD) noma i-ALS, noma uma ungakwazi ukusebenza ngenxa yokukhubazeka okutholakele.

Izikhungo ezivunyelwe

Abantu abanengxenye ye-Part B bavame ukuya esikhungweni sokunakekelwa kwezempilo ukuthola izinsizakalo ze-telehealth. Buza ngohlelo lwakho ukuthola ukuthi kufanele uye yini endaweni evunyelwe ukuvakasha kwakho. Lezi zinhlobo zezikhungo zifaka:

• amahhovisi odokotela
• izibhedlela
• izindawo zabahlengikazi abanamakhono
• izikhungo zezempilo yengqondo zomphakathi
• imitholampilo yasemakhaya
• izibhedlela zokufinyelela ezibucayi
• izindawo zokudayela ezidayiswa esibhedlela
• izikhungo zezempilo ezifanelekayo, okuyizinhlangano ezingenzi nzuzo ezikhokhelwa nguhulumeni ezinikeza izinsizakalo zezokwelapha kulabo abangakwazi ukuzikhokhela

Indawo

Uhlobo lwezinsizakalo ze-telehealth ongazithola nge-Medicare yoqobo lungancika endaweni yakho. Lokhu kusho ukuthi kufanele utholakale esifundeni esingaphandle kweMetropolitan Statistical Area noma indawo yasemaphandleni yezempilo.

Lezi zindawo zinqunywa yizikhungo zikahulumeni. Ungahlola ukufaneleka kwendawo yakho kuwebhusayithi Yezinsizakusebenza Zezempilo Nezokuphathwa Kwezinsizakalo.

Khumbula ukuthi izinhlobo ezithile kuphela zabahlinzeki bokunakekelwa kwezempilo nokuqokwa ezihlanganiswayo. Uma ungenaso isiqiniseko sokuthi kukhona okuthile okuhlanganisiwe, buza umhlinzeki wakho womshuwalense ngaphambi kokuqala izinsizakalo ze-telehealth.

Uhlelo lwezinsizakalo zokuphathwa kokunakekelwa okungapheli kwe-Medicare (CCM)

Uhlelo lwezinsizakalo ze-CCM luyatholakala kubantu abane-Medicare yasekuqaleni abanezimo zezempilo ezingamahlalakhona ezimbili noma ngaphezulu okulindeleke ukuthi zihlale izinyanga eziyi-12 noma ngaphezulu.

Izinsizakalo ze-CCM zikuvumela ukuthi wakhe uhlelo lokunakekela olwenziwe ngezifiso. Lolu hlelo lubheka:

• izimo zakho zempilo
• uhlobo lokunakekelwa oludingayo
• abahlinzeki bakho bezempilo abahlukahlukene
• imithi oyiphuzayo
• imisebenzi yomphakathi oyidingayo
• imigomo yakho yezempilo
• uhlelo lokuxhumanisa ukunakekelwa kwakho

Izinsizakalo ze-CCM zifaka nosizo ekuphathweni kwemithi kanye nokufinyelela ku-24/7 kochwepheshe bezokunakekelwa kwempilo. Lokhu kungabandakanya izinsizakalo ze-telehealth. Ukuxhumana ngocingo, i-imeyili, noma izingosi zeziguli nakho kuyingxenye yalolu hlelo.

Uma unentshisekelo yokusebenzisa izinsizakalo ze-CCM, buza abahlinzeki bakho bezokunakekelwa kwezempilo ukuthi bayakunikeza yini.

Kungabuye kube nemali ekhokhwa nyangazonke yalezi zinsizakalo ngaphezu kwe-Part B yakho ekhishwayo kanye ne-coinsurance, ngakho-ke hlola ngohlelo lwakho oluthile. Uma unomshuwalense wokungezelela, kungasiza ukumboza imali yenyanga.

Ukunweba ukufakwa kweMedicare kwe-telehealth

Umthetho Wezezimali we-Bipartisan ka-2018 wandise ukumbozwa kwe-telehealth kulabo abane-Medicare. Manje kunezimo ezithile lapho ungahle ukhululwe emithethweni ejwayelekile yeMedicare ehlobene ne-telehealth. Ake sihlolisise:

I-ESRD

Uma une-ESRD futhi uthola i-dialysis esekhaya, ungathola izinsizakalo ze-telehealth ekhaya noma esikhungweni sakho se-dialysis. Imikhawulo yendawo ehlobene ne-telehealth nayo iyasuswa.

Kodwa-ke, kufanele ube nokuvakasha komuntu ngezikhathi ezithile nomhlinzeki wakho wezokunakekelwa kwempilo ngemuva kokuqala i-dialysis yasekhaya. Lokhu kuvakasha kufanele kwenzeke kanye ngenyanga ezinyangeni ezi-3 zokuqala bese kuthi njalo ezinyangeni ezintathu kuye phambili.

Unhlangothi

Izinsizakalo zeTelehealth zingakusiza ukuthi uthole ukuhlolwa okusheshayo, ukuxilongwa, kanye nokwelashwa kwesifo sohlangothi. Ngakho-ke, izinsizakalo ze-telehealth zingasetshenziselwa isifo sohlangothi noma ngabe ukuphi.

Izinhlangano ezinakekelayo (ACOs)

Ama-ACO ngamaqembu abahlinzeki bezokunakekelwa kwezempilo abasebenza ndawonye ukuhlanganisa ukunakekelwa kwabantu abane-Medicare. Lolu hlobo lokunakekelwa okuhlelekile luzoqinisekisa ukuthi uma ugula noma unezimo zempilo ezingamahlalakhona, uzothola ukunakekelwa okudingayo.

Uma une-Medicare futhi usebenzisa i-ACO, manje usuyakufanelekela ukuthola izinsizakalo zethelevishini ekhaya. Imikhawulo yendawo ayisebenzi.

Ukungena kwe-Virtual nokuvakashelwa kwe-E

I-Medicare ibuye ihlanganise ezinye izinsizakalo ezifanayo kakhulu nokuvakashelwa kwe-telehealth. Lezi zinsizakalo zitholakala kubo bonke abahlomuli be-Medicare ezweni lonke, kungakhathalekile ukuthi bakuphi.

• Ukungena kwangempela. Lokhu ukuxhumana okufishane komsindo noma kwevidiyo okucelile kumhlinzeki wakho wezokunakekelwa kwezempilo ukuze ugweme ukuvakashelwa ngokungadingekile kwamahhovisi.
• Ukuvakashelwa nge-E. Lokhu kukunikeza enye indlela yokuxhumana nomhlinzeki wakho wezokunakekelwa kwempilo ngengosi yesiguli.

Njengokuvakasha kwe-telehealth, uzoba nesibopho samaphesenti angama-20 kuphela wezindleko zokungena noma ukuvakasha nge-E. Ukusetha ukungena kwangempela noma ukuvakashelwa nge-E, kufanele uqale ukhulume nomhlinzeki wakho wezokunakekelwa kwempilo.

NgoMashi 2020, iWorld Health Organisation futhi yamemezela ubhadane lwe-COVID-19, isifo esibangelwe i-coronavirus yenoveli ka-2019.

Ngenxa yalokhu, ezinye izinguquko zenziwe emisebenzini ye-telehealth ehlanganiswe yi-Medicare. Lezi zinguquko zenziwa ukusiza ukuvimbela ukusabalala kwegciwane, ikakhulukazi kulabo abasengozini yokugula okungathi sína.

Ukuqala ngoMashi 6, 2020, lezi zinguquko ezilandelayo zisebenza okwesikhashana:

• Abazuzi beMedicare bangathola izinsizakalo ze-telehealth kusuka kunoma yiluphi uhlobo lwesikhungo esivela, kubandakanya nasekhaya labo.
• Imikhawulo yendawo isusiwe, ngakho-ke abahlomuli beMedicare noma kuphi ezweni lonke bangasebenzisa izinsizakalo ze-telehealth.
• Abahlinzeki bezokunakekelwa kwempilo manje sebenganciphisa noma banciphise ukwabelana ngezindleko ngezinsizakalo ze-telehealth ezikhokhelwa yizinhlelo zezempilo ezifana ne-Medicare.
• Awusadingeki ukuba nobudlelwano obusunguliwe nomhlinzeki othile wezokunakekelwa kwempilo ukuze usebenzise izinsizakalo zethelevishini.

Izinzuzo ze-telehealth

I-Telehealth inezinzuzo eziningana ezingaba khona. Okokuqala, kungasiza ukuvikela abahlomuli be-Medicare phakathi nezimo ezinobungozi obukhulu. Lokhu kube yiqiniso ikakhulukazi ngesikhathi sobhadane lwe-COVID-19 kepha futhi kungaba umkhuba omuhle ngenkathi yesikhuhlane.

ITelehealth nayo isiza ukwenza lula izinsizakalo zezempilo. Isibonelo, izinto ezinjengokulandela okujwayelekile nokuqapha izimo ezingalapheki kaningi kungenziwa kusetshenziswa i-telehealth. Lokhu kungahle kunciphise ivolumu yokuvakashelwa ngabantu ngaphakathi kohlelo lokunakekelwa kwezempilo oselucindezelwe kakhulu.

I-Telehealth ingaba wusizo futhi uma usezindaweni zasemakhaya, okunzima ukufinyelela kuzo, noma ezindaweni ezinezinsiza eziphansi. Inikeza ukufinyelela okulungele kochwepheshe bezempilo abahlukahlukene noma ochwepheshe okungenzeka ukuthi abekho endaweni yangakini.

Noma i-telehealth inikela ngezinzuzo ezimbalwa, akuwona wonke umuntu owaziyo ukuthi kuyindlela. Isifundo esisodwa esincane sango-2020 esikhungweni se-dialysis sathola ukuthi bangamaphesenti angama-37 kuphela ababambiqhaza ababezwile nge-telehealth. Lokhu kukhombisa ukuthi kudingeka imizamo yokwandisa ulwazi.

Ukuthatha

I-Telehealth ilapho izinsizakalo zezokwelapha zebanga elide zihlinzekwa ngokusebenzisa ubuchwepheshe, njenge-videoconferencing. I-Medicare ihlanganisa ezinye izinhlobo ze-telehealth, futhi kubukeka sengathi lokhu kufakwa kuzokwanda kuya phambili.

I-Medicare Part B ifaka i-telehealth uma isetshenziselwa ukuvakashela ihhovisi, i-psychotherapy, noma ukubonisana. Kuphela kuphela ochwepheshe bezempilo nezindawo ezihlanganisiwe. I-Medicare Part C inganikela ngokumbozwa okwengeziwe, kepha lokhu kungahluka ngohlelo lwakho oluthile.

Imvamisa, kunemikhawulo yendawo yezinsizakalo ze-Medicare ezihlanganiswe nge-telehealth. Kodwa-ke, lokhu kunwetshwe yi-2018 Bipartisan Budget Act kanye nomqedazwe we-COVID-19.

Uma unentshisekelo yokuthola izinsizakalo ze-telehealth, khuluma nomhlinzeki wakho wezokunakekelwa kwempilo. Bazokwazisa ukuthi ingabe bayabanikeza nokuthi ungahlela kanjani i-aphoyintimenti.

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.