Uyini Umehluko Phakathi Kwezinhlelo ze-Medicare Advantage PPO nezinhlelo ze-HMO?

-Delile

• Yini iMedicare Advantage PPO?
• Isebenza kanjani
• Okumbozayo
• Izindleko ezimaphakathi
• Ezinye izimali
• Iyini i-Medicare Advantage HMO?
• Isebenza kanjani
• Okumbozayo
• Izindleko ezimaphakathi
• Ezinye izimali
• Ishadi lokuqhathanisa le-PPO ne-HMO
• Unganquma kanjani ukuthi yikuphi okungcono kuwe
• Abahlinzeki
• Ukufunda
• Izindleko
• Ukutholakala
• Ukuthatha

I-Medicare Advantage (Ingxenye C) iyindlela ethandwayo ye-Medicare yabazuzi abafuna zonke izinketho zabo zokutholakala kwe-Medicare ngaphansi kohlelo olulodwa. Kunezinhlobo eziningi zamasu we-Medicare Advantage, kufaka phakathi Izinhlangano Zokulondolozwa Kwezempilo (HMOs) kanye Nezinhlangano Zabahlinzeki Abathandwayo (ama-PPO).

Zombili izinhlelo ze-HMO ne-PPO zithembele ekusebenziseni abahlinzeki be-in-network. Kodwa-ke, izinhlelo ze-PPO zinikela ngokuguquguquka ngokumboza abahlinzeki abangaphandle kwenethiwekhi ngezindleko eziphakeme. Kukhona futhi umehluko ongatholakala, ukutholakala, kanye nezindleko phakathi kwalezi zinhlobo ezimbili zamapulani.

Kulesi sihloko, sizohlola umehluko phakathi kwezinhlelo ze-Medicare Advantage PPO ne-HMO nokuthi singanquma kanjani ukuthi yiluphi uhlobo lwecebo olungalungela izidingo zakho.

Yini iMedicare Advantage PPO?

Izinhlelo zeMedicare Advantage PPO zinikela ngokuhlinzeka ngokuguquguquka kwabahlinzeki kulabo abakudingayo, yize kubiza kakhulu.

Isebenza kanjani

Izinhlelo ze-PPO zimboza bobabili abahlinzeki abakwi-network nabangaphandle kwenethiwekhi, odokotela nezibhedlela. Uzokhokha Ngaphansi ngezinsizakalo ezivela kubahlinzeki be-in-network kanye Okuningi ngezinsizakalo ezivela kubahlinzeki abangaphandle kwenethiwekhi. Ngaphansi kohlelo lwe-PPO, ukukhetha udokotela wokunakekelwa okuyisisekelo (i-PCP) akudingeki futhi futhi nokudluliselwa ekuvakasheleni ongoti akudingeki.

Okumbozayo

Izinhlelo ze-PPO ngokuvamile zihlanganisa zonke izinsizakalo ezihlelwa yizinhlelo ze-Medicare Advantage, kufaka phakathi:

• umshuwalense wesibhedlela
• umshuwalense wezokwelapha
• Ukusetshenziswa kwezidakamizwa kadokotela

Uma uthola izibhedlela noma izinsizakalo zezokwelapha ngaphansi kohlelo lwe-PPO, ukusebenzisa abahlinzeki abakwi-network kungakusiza ukuthi ugweme ukukhokha imali ephakeme. Njengoba uhlelo ngalunye lwe-Medicare Advantage PPO luhlukile, kuzodingeka ucwaninge ngezinhlelo ezithile ezinikezwa endaweni yakho ukuthola ukuthi yini enye ehlanganiswe kuhlelo ngalunye.

Izindleko ezimaphakathi

Izinhlelo zeMedicare Advantage PPO zinezindleko ezilandelayo:

• Uhlelo oluqondene ngqo nohlelo. Lawa ma-premium angaba kusuka ku- $ 0 kuye ku- $ 21 ngenyanga ngenyanga ka-2021.
• Ingxenye B ye-premium. Ngo-2021, i-premium B Part B yakho ingu- $ 148.50 ngenyanga noma ngaphezulu, kuya ngeholo lakho.
• In-network iyadonswa. Le mali imvamisa ingu- $ 0 kepha ingaba phezulu njengama- $ 500 noma ngaphezulu, kuya ngokuthi uhlela kuluphi uhlelo.
• Izidakamizwa ezidonswayo. Lokhu kudonswa kungaqala ku- $ 0 futhi kukhuphuke ngokuya ngohlelo lwakho lwe-PPO.
• Amakhophi. Lezi zimali zingahluka ngokuya ngokuthi ngabe ubona udokotela wokunakekelwa okuyisisekelo noma uchwepheshe nokuthi ngabe lezo zinsizakalo zikunethiwekhi noma zingaphandle kwenethiwekhi.
• Coinsurance. Le mali ngokuvamile ingamaphesenti angama-20 ezindleko zakho ezivunyelwe yi-Medicare ngemuva kokuthi kuhlangatshezwe ukudonswa kwemali yakho.

Ngokungafani neMedicare yasekuqaleni, izinhlelo zeMedicare Advantage PPO nazo zinezinga eliphakeme kakhulu lokuphuma ephaketheni. Leli nani liyahlukahluka kepha ngokuvamile liphakathi nezinkulungwane.

Ezinye izimali

Ngecebo le-PPO, uzokweleta imali eyengeziwe yokubona abahlinzeki abangaphandle kwenethiwekhi. Lokhu kusho ukuthi uma ukhetha i-PCP, vakashela isibhedlela, noma ufune izinsizakalo kumhlinzeki ongekho kwinethiwekhi yakho ye-PPO, ungakhokha ngaphezu kwezindleko ezijwayelekile ezibalwe ngenhla.

Iyini i-Medicare Advantage HMO?

Izinhlelo zeMedicare Advantage HMO azihlinzeki ngokuhlinzeka ngokuguquguquka, ngaphandle kwezimo zezokwelapha eziphuthumayo.

Isebenza kanjani

Izinhlelo ze-HMO zimboza abahlinzeki be-in-network, odokotela nezibhedlela kuphela, ngaphandle kwezimo zokunakekelwa kwezimo eziphuthumayo noma ukunakekelwa okuphuthumayo okungaphandle kwendawo kanye ne-dialysis. Kwezinye izimo, ungakwazi futhi ukusebenzisa abahlinzeki bangaphandle kwenethiwekhi, kepha uzokhokha amaphesenti ayi-100 wezinsizakalo ngokwakho.

Ngaphansi kohlelo lwe-HMO, kuyadingeka ukuthi ukhethe i-PCP engaphakathi kwenethiwekhi futhi kuzodingeka futhi ukuthi udlulisele ukuvakashelwa kochwepheshe be-in-network.

Okumbozayo

Njengezinhlelo ze-PPO, izinhlelo ze-HMO zimboza zonke izinsizakalo ezivame ukumbozwa yizinhlelo ze-Medicare Advantage, kufaka phakathi:

• umshuwalense wesibhedlela
• umshuwalense wezokwelapha
• Ukusetshenziswa kwezidakamizwa kadokotela

Uma ufuna izibhedlela noma izinsizakalo zezokwelapha, kuzodingeka ukhethe ohlwini lwabahlinzeki be-in-network abahlelwa yi-HMO yakho. Uma ufuna izinsizakalo ezingaphandle kohlu lwabahlinzeki bakho be-in-network, ungahle ukhokhe inani eligcwele lalawo masevisi.

Kodwa-ke, ezimweni eziphuthumayo, njengalapho usohambweni, ungambozwa ngokuya ngemigomo ethile yohlelo lwakho.

Izindleko ezimaphakathi

Izinhlelo ze-Medicare Advantage HMO zinezindleko eziyisisekelo ezifanayo nezinhlelo ze-PPO, kufaka phakathi uhlelo lwanyanga zonke kanye nama-premium we-Part B, ama-deductibles, kanye nama-copayments kanye ne-coinsurance. Njengoba kudingwa umthetho, uhlelo lwakho lwe-HMO luzoba nesilinganiso seminyaka yonke esikhwameni sezindleko ozikweletayo.

Ezinye izimali

Njengoba izinhlelo ze-HMO zidinga ukuthi ufune izinsizakalo kunethiwekhi, ngokuvamile ngeke ubhekane nezimali ezengeziwe ngaphandle kokuthi unqume ukusebenzisa abahlinzeki abangaphandle kwenethiwekhi. Ezimweni eziphuthumayo, ungakweleta ezinye izindleko, kepha kuzodingeka uhlole ngohlelo lwakho ukubona ukuthi yiziphi lezi zimali.

Ishadi lokuqhathanisa le-PPO ne-HMO

Kunokufana okuningi phakathi kwezinhlelo ze-Medicare Advantage PPO ne-HMO, njengezindleko zamaphrimiyamu, ama-deductibles, nezinye izimali zohlelo. Umehluko omkhulu phakathi kwalezi zinhlobo ezimbili zamapulani ngokuyinhloko ususelwa ekuhlanganisweni nasezindlekweni zamasevisi akwi-network nangaphandle kwenethiwekhi.

Ngezansi kukhona ishadi lokuqhathanisa lokho uhlelo ngalunye olunikezayo ngokuya ngezindleko nezindleko.

Akunandaba ukuthi ukhetha uhlobo luni lohlelo lweMedicare Advantage, hlala ubheke kakhulu izinketho ezithile zokuhlanganisa kanye nezindleko ezihambisana nohlelo olukhethayo. Ngoba izinhlelo ze-Advantage zinikezwa izinkampani zomshuwalense ezizimele, zingahluka kulokho ezingakunikeza nakwalokho abanquma ukukukhokhisa.

Unganquma kanjani ukuthi yikuphi okungcono kuwe

Ukukhetha uhlelo oluhle kakhulu lweMedicare Advantage kuncike ngokuphelele esimweni sakho sezokwelapha nesezimali. Okusebenzela omunye umuntu kungenzeka kungakusebenzeli, ngakho-ke kubalulekile ukwenza ucwaningo lwakho ngezinhlelo ezisendaweni yangakini.

Nazi izinto ezimbalwa okufanele uzicabangele lapho ukhetha ukuthi ubhalise yini kuhlelo lwe-PPO noma lwe-HMO Advantage.

Abahlinzeki

Uma ukwazisa ukuguquguquka kwabahlinzeki, uhlelo lwe-PPO lungaba nentshisekelo yakho, njengoba lunikeza ukumbozwa kwazo zombili izinsizakalo zenethiwekhi nezangaphandle. Kodwa-ke, lokhu kungaba yindlela ongayikhetha kuphela uma unamandla wezezimali wokuvakashela abahlinzeki abangaphandle kwenethiwekhi, njengoba lezi zikhokhelo zezokwelapha zingangeza ngokushesha.

Uma ulungile ngokusebenzisa abahlinzeki be-in-network kuphela, uhlelo lwe-HMO luzokuvumela ukuthi uhlale ngaphakathi kwenethiwekhi ngaphandle komthwalo owengeziwe wezezimali.

Ukufunda

Ngokomthetho, zonke izinhlelo zeMedicare Advantage kufanele zihlanganise okungenani iMedicare Part A kanye nengxenye B. Ngaphezu kwalokho, cishe zonke izinhlelo ze-Advantage ziphinde zihlanganise imishanguzo kadokotela, umbono kanye nezinsizakalo zamazinyo. Lezi zinketho zokumboza zicacisiwe kuhlelo ngalunye, kepha imvamisa akukho mehluko omkhulu phakathi kwezinketho zokutholakala kwezinhlelo eziningi ze-PPO ne-HMO Advantage.

Enye into okufanele uyicabangele ukuthi ngabe ukumbozwa okunikezwa yizinhlelo ze-PPO ne-HMO kuzothinteka yini esimweni sakho sezokwelapha. Isibonelo, kusikisela ukuthi abantu abanezimo zezempilo ezingamahlalakhona kungenzeka ukuthi bangazibhalisi ezinhlelweni ze-HMO futhi babhalise kwezinye izinhlobo zezinhlelo zezempilo, njenge.

Izindleko

Izinhlelo ze-Medicare Advantage PPO ne-HMO zingahluka ezindlekweni zazo kuya ngesimo ohlala kuso nokuthi uluhlobo luni lokusibekela olifunayo. Akunandaba ukuthi ukhetha luphi uhlaka, yonke iminikelo yohlelo ingakhokhisa ama-premium, ama-deductibles, ama-copayments, kanye ne-coinsurance. Inani lale mali ekhokhwayo lincike ohlelweni olukhethile.

Futhi, cabanga ukuthi kungahle kube nezindleko ezingeziwe ezihlotshaniswa nohlelo lwakho kuya ngabanikezeli obabonayo. Isibonelo, uma uvakashela umhlinzeki ongaphandle kwenethiwekhi kuhlelo lwe-PPO, uzokhokha okuningi ephaketheni ngalezo zinsizakalo.

Ukutholakala

Izinhlelo zeMedicare Advantage zisuselwa endaweni, okusho ukuthi kumele ubhalise esifundeni ohlala kuso njengamanje futhi uthole izinsizakalo zezokwelapha. Lokhu kusho ukuthi izinhlelo ze-PPO ne-HMO zingahluka ngokuya ngokuthi uhlala kuphi.

Ezinye izinkampani ezizimele zizonikela ngohlobo olulodwa lwecebo, kanti ezinye zizoba nezakhiwo eziningi ongakhetha kuzo. Lapho uhlala khona kuzonquma ukutholakala kohlelo, ukumbozwa, kanye nezindleko zanoma yiluphi uhlobo lwecebo leMedicare Advantage olikhethayo.

Ukuthatha

Izinhlelo zeMedicare Advantage PPO ne-HMO ziyindlela enhle yomshuwalense kubantu abafuna ukuthola ukumbozwa kweMedicare ngaphansi kohlelo olulodwa lwesambulela.

Ngenkathi kunokufana phakathi kwalezi zinhlobo ezimbili zamapulani, kukhona nokwehluka kokutholakala, ukumbozwa, nezindleko. Lapho ukhetha uhlelo oluhle kakhulu lwe-Medicare Advantage ngawe, qiniseka ukuthi ubheka okuthandwa ngumhlinzeki wakho, isimo sezezimali, kanye nezidingo zezokwelapha.

Noma kunini lapho usukulungele ukukhetha uhlelo lwe-Medicare Advantage, vakashela ithuluzi lokuthola uhlelo lwe-Medicare ukuthola ulwazi mayelana nezinhlelo ezisendaweni yakho.

Lo mbhalo uvuselelwe ngoNovemba 17, 2020, ukukhombisa imininingwane ye-2021 Medicare.

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