Yiziphi Izinhlelo Zama-Medicare Advantage Enikezwa yi-WellCare ngo-2021?

-Delile

• Izinketho zohlelo lwe-WellCare Medicare Advantage
• Izinhlelo ze-WellCare HMO
• Izinhlelo ze-WellCare PPO
• Izinhlelo Zezidingo Ezikhethekile ze-WellCare Medicare
• Izinhlelo ze-WellCare Private Fee-for-Service
• Yiziphi izifundazwe ezinikeza ngezinhlelo ze-WellCare Medicare Advantage?
• Zihlanganisani izinhlelo ze-WellCare Medicare Advantage?
• Zibiza malini izinhlelo ze-WellCare Medicare Advantage?
• Yini i-Medicare Advantage (Medicare Part C)?
• Ukuthatha

• I-WellCare inikeza izinhlelo ze-Medicare Advantage ezifundazweni ezingama-27.
• I-WellCare inikeza izinhlelo ze-PPO, HMO, kanye ne-PFFF Medicare Advantage.
• Izinhlelo ezithile ongazithola zizoya ngokuthi uhlala kuphi.
• I-WellCare itholwe yiCentene Corporation, esebenzela amalungu ayizigidi ezingama-23 kuzo zonke izifunda ezingama-50.

Izinhlelo ze-WellCare Health zingumhlinzeki womshuwalense waseTampa, eFlorida onikeza iMedicare Advantage (Ingxenye C) kanye neMedicare Part D (imishanguzo kadokotela) ehlelela abazuzi beMedicare ezifundazweni eziningi.

Lo mbhalo uzobheka izinhlobo ezahlukahlukene zohlelo lweMedicare Advantage ezinikezwa yiWellCare, futhi inikeze nezibonelo ezithile zezindleko ngaphansi kwezinhlelo ezahlukahlukene ze-WellCare ezweni lonke.

Izinketho zohlelo lwe-WellCare Medicare Advantage

Lokhu okulandelayo yizibonelo zezinhlobo zezinhlelo zeMedicare Advantage ezingatholakali endaweni yokumboza yomuntu. Amasu ngokuvamile aqondene kakhulu nesifunda, futhi iWellCare ingahle inganikeli ngazo zonke izinhlobo zamapulani endaweni ethile.

Izinhlelo ze-WellCare HMO

I-WellCare inikeza izinhlelo ze-Health Maintenance Organisation (HMO) njengengxenye yeminikelo yabo ye-Medicare Advantage. Imvamisa, uhlelo lwe-WellCare HMO luzobandakanya ukukhetha umhlinzeki wokunakekelwa okuyisisekelo (i-PCP) olawula ukunakekelwa komuntu. Lokhu kusho ukuthi i-PCP izodlulisela kochwepheshe bezokunakekelwa kwempilo abaku-network ye-WellCare.

Lapho umuntu eyilungu le-HMO, angakhokha izindleko eziphakeme noma ezigcwele uma ebona udokotela ongaphandle kwenethiwekhi.

Izinhlelo ze-WellCare PPO

I-WellCare inikeza izinhlelo ze-Preferred Provider Organisation (PPO) ezifundazweni ezibandakanya iFlorida, Georgia, New York neSouth Carolina. Lezi zinhlangano zinikela ngamanani ancishisiwe wokukhetha abahlinzeki abakwi-network, kepha umuntu usengathola ukubuyiselwa imali uma ebona abahlinzeki abangaphandle kwenethiwekhi.

Imvamisa, umuntu ngeke kudingeke athole ukuthunyelwa ukuze abone uchwepheshe. Kodwa-ke, kungahle kube nezimo lapho ukuthola ukuhanjiswa noma ukuthola ukugunyazwa kwangaphambili kwenqubo kungakhuthazwa, ikakhulukazi uma umhlinzeki engaphandle kwenethiwekhi.

Izinhlelo Zezidingo Ezikhethekile ze-WellCare Medicare

Izinhlelo Zezidingo Ezikhethekile (ama-SNP) yizinhlelo ze-Medicare Advantage ezibhekiswe kulabo abanesimo esithile sezempilo noma isidingo sezezimali.

Nazi izinhlobo ezahlukahlukene ze-SNPS ezitholakalela labo abahlangabezana nemibandela:

• Izinhlelo Zezidingo Ezikhethekile Zesimo Esingapheli (C-SNPs): kubantu abanezimo zempilo ezingalapheki
• Izinhlelo zezidingo ezikhethekile zezikhungo (I-SNPs): kubantu abahlala emakhaya asebekhulile noma ezindaweni zokunakekelwa zesikhathi eside
• Ama-SNP avumeleke kabili (D-SNPs): ezigulini ezikufanelekelayo ukutholakala kokubili kweMedicare neMedicaid

Lezi zinhlelo ngayinye inikela ngokulaliswa okuphelele esibhedlela, insizakalo yezokwelapha, nokutholakala kwemithi kadokotela kepha kwehlukaniswe ngokuya ngeziguli abazisebenzisayo.

Izinhlelo ze-WellCare Private Fee-for-Service

I-WellCare inikeza izinhlelo ze-Private Fee-for-Service (PFFS) ezindaweni ezikhethiwe zezwe. Lolu wuhlelo oluvame ukuhlinzeka ngezinga elibekiwe lokuthi yini ezokhokhela izibhedlela nodokotela ngezinsizakalo, nge-set copay, noma i-coinsurance, umninipholisi uzokhokha futhi.

Uhlelo lwe-PFFS lungaba nenethiwekhi yomhlinzeki noma umuntu angakwazi ukubona noma yimuphi umhlinzeki abamkhethayo. Umhlinzeki kumele amukele ukwabiwa okuvela kwi-Medicare noma amukele imigomo yohlelo lwe-PFFS lokuthi izokhokha ini.

Yiziphi izifundazwe ezinikeza ngezinhlelo ze-WellCare Medicare Advantage?

I-WellCare inikeza izinhlelo ze-Medicare Advantage ezifundazweni eziningana. Lokhu kufaka phakathi:

• I-Alabama
• E-Arizona
• I-Arkansas
• California
• I-Connecticut
• EFlorida
• IGeorgia
• IHawaii
• I-Illinois
• I-Indiana
• EKentucky
• ELouisiana
• Maine
• EMichigan
• UMississippi
• EMissouri
• ENew Hampshire
• Ijezi elisha
• I-New York
• ENyakatho Carolina
• I-Ohio
• Rhode Island
• ENingizimu Carolina
• ETennessee
• ITexas
• I-Vermont
• Washington

Inombolo nohlobo lwezinhlelo ezinikezwa yi-WellCare kulezi zifundazwe zingahluka.

Zihlanganisani izinhlelo ze-WellCare Medicare Advantage?

Izinhlelo ze-WellCare Medicare Advantage zingahluka ngesifundazwe nesifunda. Kodwa-ke, izinhlelo eziningi zinikeza izinzuzo ezilandelayo ngaphezu kwezingxenye ze-Medicare A no-B. Lokhu kufaka phakathi:

• ubulungu bokuqina bonyaka
• izinsizakalo zamazinyo, kufaka phakathi ukuvikelwa nokwelashwa
• Ukusetshenziswa kwezidakamizwa kadokotela
• ukuhanjiswa ekuvakasheni kodokotela nasemakhemisi
• izinsizakalo zokubona nokusiza ukukhokhela izingilazi namalensi oxhumana nawo

Lapho uhlola uhlelo oluthile, funda ngokucophelela incazelo yohlelo yezinzuzo ukuze ubone izinhlobo zezinsizakalo ezengeziwe ezinikezwa yi-WellCare.

Zibiza malini izinhlelo ze-WellCare Medicare Advantage?

I-WellCare inikeza ezinye izinhlelo ze-Medicare Advantage nge-premium engu- $ 0. Kusamele ukhokhele i-Medicare Part B premium yakho inyanga nenyanga ku-Medicare kodwa ungathola izinsizakalo ezingeziwe ngaphandle kwe-premium yenyanga evela kwa-WellCare. Akunandaba ukuthi ukhokha malini, uzoba nemali ebanjwayo, ama-copayments, noma i-coinsurance yezinsizakalo, njengoba kusethwe uhlelo lwakho kanye neMedicare.

Okulandelayo ezinye zezibonelo zezinhlelo ze-WellCare Medicare Advantage ezitholakala ezweni lonke nokuthi yini ongayikhokha ngo-2021.

Izinhlelo ezitholakalayo nezindleko zingahluka unyaka nonyaka. Uma unecebo elithile le-WellCare Medicare Advantage, uhlelo luzokwazisa ekwindla nganoma yiluphi ushintsho kuzindleko.

Yini i-Medicare Advantage (Medicare Part C)?

I-Medicare Advantage (Ingxenye C) uhlelo lwezempilo "oluhlanganisiwe" lapho inkampani yomshwalense yangasese inesibopho sokuhlinzeka ngembozo yomuntu ye-Medicare. I-Medicare Part C ivame ukufaka i-Part A (ukumbozwa kwesibhedlela), Ingxenye B (ukumbozwa kwezokwelapha), kanye ne-Part D (ukumbozwa kwezidakamizwa kadokotela). Kodwa-ke, ezinye izinhlelo ze-WellCare azihlanganisi Ingxenye D.

Uma uthenga uhlelo lwe-Medicare Advantage, i-Medicare ikhokha inkampani yakho yomshuwalense oyikhethayo ukukunikeza izinzuzo zezempilo. Ukuze uhlale uncintisana, uhlelo lwakho lomshuwalense lungakunikeza izinzuzo ezingeziwe ezingatholakali kwi-Medicare yasekuqaleni. Lokhu kufaka phakathi izinsizakalo ezinjengamazinyo, umbono, noma ukumbozwa kokuzwa.

Izinkampani ezinikeza iMedicare Advantage zivame ukwenza isivumelwano nodokotela nezibhedlela ukuxoxisana ngezindleko zezinsizakalo zezokwelapha. Uma udokotela noma isibhedlela evuma ukuhlinzeka ngezinsizakalo ngezinga elithile nenkampani yomshuwalense, inkampani ngokuvamile izobakhetha njengabahlinzeki be "in-network".

Izinhlelo zeMedicare Advantage zibhekiswe kakhulu esifundeni nasesifundeni ngenxa yendlela uhlelo oluxoxisana ngayo nezibhedlela nodokotela endaweni ngayinye. Ngenxa yalokhu, akuzona zonke izinhlobo zezinhlelo ze-WellCare ezitholakalayo kuzo zonke izifundazwe.

Ukuthatha

I-WellCare inikeza izinhlelo ze-Medicare Advantage ne-Medicare Part D ezifundazweni ezingama-27, ngezinhlelo ezahlukahluka ngesifunda. Lezi zinhlelo zingafaka ama-PPOs, ama-HMO, nama-PFFF, futhi zingakusiza ukuphatha izindleko zezempilo kanye nemithi kadokotela engafakwanga ngaphansi kwezinhlelo ezijwayelekile zeMedicare.

Ungathola ukuthi ngabe i-WellCare inikeza uhlelo endaweni yakho ngokusesha i-Medicare's ithole ithuluzi lokuhlela.

Lo mbhalo uvuselelwe ngoNovemba 20, 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.