Yini i-Medicare? Konke Okudingayo Ukuze Ukwazi Mayelana Nezisekelo Zezokwelapha

-Delile

• Yini iMedicare?
• Ingxenye yeMedicare A
• Ingxenye yeMedare B
• Ingxenye yeMedicare C
• Ingxenye yeMedare D
• I-Medigap
• Yini i-Medicare embozayo?
• Ingxenye A Ukusabalala
• Ukuhlanganiswa kwengxenye B
• Ukuhlanganiswa kwengxenye C
• Ukufakwa kwengxenye D
• Ukusabalala kweMedigap
• Ukufaneleka kweMedicare
• Ukubhalisa ku-Medicare
• Ziyini izindleko?
• Izindleko zengxenye A
• Izindleko zengxenye B
• Izindleko zengxenye C
• Izindleko zengxenye D
• Izindleko zeMedigap
• Uyini umehluko phakathi kweMedicare neMedicaid?
• Ukuthatha

• I-Medicare inketho yomshuwalense wezempilo etholakala kubantu abaneminyaka engama-65 nangaphezulu kanye nalabo abanezimo ezithile zezempilo noma abakhubazekile.
• OkwangempelaI-Medicare (izingxenye A no-B) zimboza izidingo zakho eziningi zesibhedlela nezokwelapha.
• Ezinye izingxenye zeIMedicare (Ingxenye C, Ingxenye D, neMedigap) yizinhlelo zomshuwalense wangasese ezinikeza izinzuzo nezinsizakalo ezingeziwe.
• Izindleko ze-Medicare zanyanga zonke nonyaka zifaka ama-premium, ama-deductibles, ama-copayments, kanye ne-coinsurance.

I-Medicare iyinketho yomshuwalense wezempilo exhaswa nguhulumeni etholakala kubantu baseMelika abaneminyaka engama-65 nangaphezulu kanye nalabo abanezimo ezithile ezingapheli zezempilo nokukhubazeka. Kunezinketho eziningi ezahlukahlukene zokutholakala kwe-Medicare, ngakho-ke kubalulekile ukuqonda ukuthi yiluphi uhlobo lokumboza uhlelo ngalunye olungakunikeza lona.

Kulesi sihloko, sizohlola konke okufanele sazi mayelana nezisekelo ze-Medicare, kusukela ekusetshenzisweni, ezindlekweni, ekubhalisweni, nokuningi.

Yini iMedicare?

I-Medicare uhlelo oluxhaswe nguhulumeni olunikeza umshuwalense wezempilo kubantu baseMelika abaneminyaka engama-65 nangaphezulu. Abanye abantu abangaphansi kweminyaka yobudala engama-65 futhi abanezimo zezempilo ezingapheli noma ukukhubazeka nabo bangafanelekela ukutholakala kweMedare.

I-Medicare iqukethe "izingxenye" ​​eziningi ongazibhalisela izinhlobo ezahlukahlukene zokutholakala kokunakekelwa kwezempilo.

Ingxenye yeMedicare A

I-Medicare Part A, eyaziwa nangokuthi umshwalense wesibhedlela, ihlanganisa izinsizakalo ozitholayo lapho ungeniswe esibhedlela noma kwenye indawo yokunakekelwa kwezempilo yeziguli. Kukhona imali ekhishwayo yokuhlangabezana nezimali zokuqinisekisa. Kungase kudingeke nokuthi ukhokhe imali ekhokhelwa ukukhishwa kweNgxenye A, kuye ngezinga leholo lakho.

Ingxenye yeMedare B

I-Medicare Part B, eyaziwa nangokuthi umshuwalense wezokwelapha, ihlanganisa izinsizakalo zokuvikela, zokuxilonga nezokwelapha ezingaphandle ezihlobene nezimo zakho zezempilo. Kukhona imali ekhishwayo yonyaka kanye ne-premium yenyanga okumele uyikhokhe, kanye nezindleko ezithile zokuqinisekisa imali.

Ngokubambisana, izingxenye zeMedicare A no-B zaziwa ngokuthi “iMedicare yasekuqaleni.”

Ingxenye yeMedicare C

I-Medicare Part C, eyaziwa nangokuthi i-Medicare Advantage, iyindlela yomshuwalense yangasese ehlanganisa izinsizakalo zombili ze-Medicare Part A ne-Part B. Iningi lezinhlelo ze-Medicare Advantage libuye linikeze ukumbozwa okungeziwe ngemithi kadokotela, umbono, amazinyo, ukuzwa, nokuningi. Ungakhokha ama-premium akhokhelwa nyangazonke nama-copay ngalezi zinhlelo, yize ngayinye inezindleko ezihlukile.

Ingxenye yeMedare D

I-Medicare Part D, eyaziwa nangokuthi ukutholakala kwezidakamizwa kadokotela, ingangezwa kwi-Medicare yasekuqaleni futhi isize ukumboza ezinye zezindleko zakho zemithi kadokotela. Uzokhokha imali ehlukanisiwe edonswayo ne-premium yalolu hlelo.

I-Medigap

IMedigap, eyaziwa nangokuthi yi-Medicare supplemental insurance, nayo ingangezwa kwi-Medicare yasekuqaleni futhi isize ukumboza ezinye zezindleko zakho ze-Medicare ezingaphandle. Uzokhokha imali ehlukile oyisebenzisela lolu hlelo.

Yini i-Medicare embozayo?

Ukutholakala kwakho kwe-Medicare kuya ngokuthi yiziphi izingxenye ze-Medicare obhalise kuzo.

Ingxenye A Ukusabalala

I-Medicare Part A ihlanganisa izinsizakalo eziningi zezibhedlela, kufaka phakathi:

• ukunakekelwa esibhedlela
• ukunakekelwa kwe-inpatient rehab
• ukunakekelwa kwezifo zengqondo
• ukunakekelwa kwendawo yokunakekela abanamakhono okulinganiselwe
• ukunakekelwa kwempilo okulinganiselwe ekhaya
• ukunakekelwa kwe-hospice

I-Medicare Part A ayihlanganisi izinsizakalo zezibhedlela ezingaphandle, njengokuvakashelwa kwamakamelo okuphuthumayo okungabangeli ukuhlala kweziguli. Esikhundleni salokho, izinsizakalo zesibhedlela ezingalalisiwe zihlanganiswa ngaphansi kwe-Medicare Part B.

Ingxenye A ayihlanganisi izinto eziningi zasekamelweni lasesibhedlela, ukunakekelwa kwangasese nokugcinwa, noma ukunakekelwa kwesikhathi eside.

Ukuhlanganiswa kwengxenye B

I-Medicare Part B ihlanganisa izinsizakalo zokuvikela, zokuxilonga nezokwelapha ezidingekayo ngokwezempilo, kufaka phakathi:

• izinsizakalo zokuvimbela
• ezokuthutha eziphuthumayo ze-ambulensi
• izinsizakalo zokuxilonga, njengokuhlolwa kwegazi noma ama-X-ray
• imishanguzo kanye nemithi enikezwa uchwepheshe wezokunakekelwa kwempilo
• imishini yezokwelapha ehlala njalo
• izinsizakalo zocwaningo lomtholampilo
• izinsizakalo zezempilo yengqondo

IMedicare Part B ihlanganisa inqwaba yezinsizakalo zokuvimbela, kusuka ekuhlolweni kwezifo kuya ekuhlolweni kwezempilo yengqondo. Ihlanganisa nemithi yokugoma ethile, kufaka phakathi leyo yomkhuhlane, i-hepatitis B, ne-pneumonia.

Ingxenye B ayihlanganisi imishanguzo eningi kadokotela futhi inikela kuphela ngemithi elinganiselwe kakhulu.

Ukuhlanganiswa kwengxenye C

I-Medicare Part C ihlanganisa konke ngaphansi kohlelo lokuqala lwe-Medicare Part A ne-Part B. Izinhlelo eziningi ze-Medicare Part C nazo zihlanganisa:

• imishanguzo kadokotela
• izinsizakalo zamazinyo
• izinsizakalo zombono
• izinsizakalo zokuzwa
• izinhlelo zokuqina nobulungu bejimu
• izinzuzo zezempilo ezengeziwe

Akuzona zonke izinhlelo zeMedicare Advantage ezimboza izinsizakalo ezingenhla, ngakho-ke kubalulekile ukuqhathanisa izinketho zakho zokumboza lapho uthengela uhlelo oluhle kakhulu lweMedicare Advantage lwakho.

Ukufakwa kwengxenye D

I-Medicare Part D ihlanganisa imishanguzo kadokotela. Uhlelo ngalunye lwemithi kadokotela lwe-Medicare lunesisekelo, noma uhlu lwemithi evunyelwe ehlanganisiwe. I-formulary kufanele iqukathe okungenani imishanguzo emibili esigabeni ngasinye semithi ejwayelekile ebekiwe, kanye ne:

• izidakamizwa zomdlavuza
• ama-anticonvulsants
• imishanguzo
• ama-antipsychotic
• Izidakamizwa ze-HIV / AIDS
• izidakamizwa zokuzivikela

Kunemithi ethile kadokotela engamboziwe ngaphansi kweNgxenye D, njengaleyo esetshenziselwa ukwelapha ukungasebenzi kahle kwe-erectile noma izidakamizwa ezingekho emthethweni.

Uhlelo ngalunye lwemithi kadokotela lunemithetho yalo, ngakho-ke kubalulekile ukukucabangela lokhu lapho uqhathanisa amapulani.

Ukusabalala kweMedigap

Okwamanje kunezinhlelo eziyi-10 ezahlukahlukene zeMedigap ongazithenga ngezinkampani zomshuwalense wangasese. Izinhlelo zeMedigap zisiza ukumboza izindleko zokuphuma ephaketheni ezihambisana nezinsizakalo zakho zeMedicare, ezingafaka phakathi:

• Ingxenye A ebanjwayo
• Ingxenye A yokuqinisekisa imali kanye nezindleko zesibhedlela
• Ingxenye A yokubuyiselwa kwemali eshisiwe noma izindleko zokukhokha
• Ingxenye B idonselwa imali kanye nenyanga nenyanga
• Ingxenye B izindleko zokuqinisekisa noma izindleko zokukhokha
• Ingxenye B ishaja ngokweqile
• ukumpontshelwa igazi (amaphuzu amathathu okuqala)
• izindleko zokunakekelwa kwemali yokunakekelwa kwabahlengikazi abanamakhono
• izindleko zokwelashwa ngenkathi uhamba ngaphandle kwe-United States

Kubalulekile ukwazi ukuthi izinhlelo zeMedigap azinikezi ukumbozwa okwengeziwe kwe-Medicare. Esikhundleni salokho, zisiza kuphela ngezindleko ezihambisana nezinhlelo ze-Medicare obhalise kuzo.

Ukufaneleka kweMedicare

Iningi labantu lifanelekile ukuqala ukubhalisa kwi-Medicare yasekuqaleni izinyanga ezintathu ngaphambi kokuzalwa kwabo kwama-65. Kodwa-ke, kunezimo ezithile lapho ungafaneleka khona ukutholakala kwe-Medicare nganoma yisiphi isikhathi. Lokhu okuhlukile kufaka:

• Ukukhubazeka okuthile. Uma uthola izinzuzo zokukhubazeka zanyanga zonke ngeSocial Security Administration noma ngeRoad Retirement Board (RRB), uyakufanelekela ukuthola iMedicare ngemuva kwezinyanga ezingama-24.
• I-Amyotrophic lateral sclerosis (ALS). Uma une-ALS futhi uthola izinzuzo ze-Social Security noma ze-RRB, ufanelekile ukuthola iMedicare kusukela ngenyanga yokuqala.
• Isifo sokuqedwa kwezinso (ESRD). Uma une-ESRD, ufaneleke ngokuzenzakalela ukubhalisa ku-Medicare.

Lapho sebebhalise ezingxenyeni ze-Medicare A no-B, abaseMelika abafanelekile bangabhalisa ohlelweni lweMedicare Advantage.

Ukubhalisa ku-Medicare

Iningi labantu abafanele ukutholakala kwe-Medicare kumele babhalise ngezikhathi zokubhalisa. Izikhathi nezikhathi zokugcina zokubhaliswa kwe-Medicare zifaka:

• Ukubhaliswa kokuqala. Lokhu kufaka izinyanga ezintathu ngaphambi, inyanga ka, nezinyanga ezi-3 ngemuva kokuthi ube neminyaka engama-65.
• Ukubhaliswa okujwayelekile. Lokhu kusuka ngoJanuwari 1 kuya kuMashi 31 uma uphuthelwe isikhathi sakho sokuqala sokubhalisa. Kodwa-ke, izimali zokubhaliswa sekwedlule isikhathi zingasebenza.
• Ukubhaliswa okukhethekile. Lokhu kuyinketho yenombolo ethile yezinyanga ngokuya ngesizathu sakho sokufaneleka.
• Ukubhaliswa kweMedigap. Lokhu kufaka izinyanga eziyisithupha ngemuva kokuhlanganisa iminyaka engama-65.
• Ukubhaliswa kwe-Medicare Part D. Lokhu kusuka ngo-Ephreli 1 kuya kuJuni 30 uma uphuthelwe yisikhathi sakho sokuqala sokubhalisa.
• Vula ukubhaliswa. Ungashintsha ukumbozwa kwakho kusuka ngo-Okthoba 15 kuya kuDisemba 7 unyaka ngamunye uma ufuna ukubhalisa, ukulahla, noma ukushintsha uhlelo lweMedicare.

Uzobhaliswa ngokuzenzekelayo ezingxenyeni ze-Medicare A no-B uma:

• uneminyaka engama-65 yobudala ezinyangeni ezine futhi ubulokhu uthola izinzuzo zokukhubazeka
• awukabi neminyaka yobudala engama-65 kodwa ubulokhu uthola izinzuzo zokukhubazeka izinyanga ezingama-24
• awukabi neminyaka yobudala engama-65 kodwa utholwe une-ALS noma i-ESRD

Kubantu abangabhalisile ngokuzenzakalela ku-Medicare, kuzodingeka ubhalise kuwebhusayithi Yezokuphepha Komphakathi. Uma ungabhalisi ngesikhathi sokubhalisa, kunezinhlawulo zokubhaliswa sekwedlule isikhathi.

Ziyini izindleko?

Izindleko zakho ze-Medicare zizoya ngohlobo lwecebo onalo.

Izindleko zengxenye A

Izindleko zeMedicare Part A zifaka:

• Ingxenye A premium: iphansi njengo- $ 0 (Ingxenye A engenayo i-premium) noma ifike ku- $ 471 ngenyanga, kuya ngokuthi wena noma oshade naye nisebenze isikhathi esingakanani esikhathini sakho sokuphila
• Ingxenye A ebanjwayo: $ 1,484 ngesikhathi senzuzo ngayinye
• Ingxenye A coinsurance: kusuka ku- $ 0 kuya ezindlekweni ezigcwele zezinsizakalo ngokuya ngobude bokuhlala kwakho

Izindleko zengxenye B

Izindleko zeMedicare Part B zifaka:

• Ingxenye B premium: ukuqala ku- $ 148.50 ngenyanga noma ngaphezulu, ngokuya ngeholo lakho
• Ingxenye B iyadonswa: $ 203 ngonyaka
• Ingxenye B yesibambiso: Amaphesenti angama-20 emali evunyelwe yi-Medicare yezinsizakalo ezihlanganisiwe zeNgxenye B

Izindleko zengxenye C

Usazokhokha izindleko zokuqala zeMedicare lapho ubhalisa kwiMedicare Part C. Izinhlelo zeMedicare Advantage nazo zingakhokhisa izindleko zohlelo, ezingafaka phakathi:

• imali ekhokhwa njalo ngenyanga
• ngonyaka odonswayo
• umuthi odonswayo ungadonswa
• ama-copayments kanye ne-coinsurance

Lezi zindleko zohlelo lwe-Medicare Advantage zingahluka ngokuya ngokuthi uhlala kuphi nomhlinzeki womshuwalense owukhethayo.

Izindleko zengxenye D

Uzokhokha i-premium ehlukile yohlelo lwe-Medicare Part D, kanye nama-copayments emithi yakho kadokotela. La manani we-copayment ayahluka ngokuya ngemithi yakho kadokotela ewela kuyo. Uhlelo ngalunye lunezindleko ezahlukahlukene nezidakamizwa ezifakwe emabangeni abo.

Izindleko zeMedigap

Uzokhokha i-premium ehlukile ngenqubomgomo yeMedigap. Kodwa-ke, khumbula ukuthi izinhlelo zeMedigap zihloselwe ukusiza ukukhokha ezinye zezindleko zasekuqaleni zeMedicare.

Ezinye zezindlela zokukhokha imali yakho ye-Medicare inyanga ngayinye zifaka:

• Iwebhusayithi yakwaMedicare, enesikweletu noma ikhadi lesikweletu
• ngeposi, kusetshenziswa isheke, imali, noma ifomu lokukhokha

Enye indlela yokukhokha isikweletu sakho seMedicare ibizwa ngeMedicare Easy Pay. I-Medicare Easy Pay iyinsizakalo yamahhala ekuvumela ukuthi ukhokhele amaphrimiyamu akho akhishwa nyangazonke e-Medicare Part A no-Part B ngokuhoxa okuzenzekelayo kwebhange.

Uma ubhalise ezingxenyeni ze-Medicare A no-B, ungathola kabanzi mayelana nokuthi ungabhalisa kanjani kwi-Medicare Easy Pay ngokuchofoza lapha.

Uyini umehluko phakathi kweMedicare neMedicaid?

Imithi wuhlelo lomshuwalense wezempilo oluxhaswe nguhulumeni olutholakala kubantu baseMelika abaneminyaka engama-65 nangaphezulu kanye nalabo abanezimo ezithile noma abakhubazekile.

I-Medicaid wuhlelo lomshuwalense wezempilo oluxhaswe nguhulumeni olutholakalela abaseMelika abafanelekayo abanemali engenayo ephansi.

Ungahle ufanelekele ukufakwa kokubili kwe-Medicare neMedicaid. Uma lokhu kwenzeka, i-Medicare izoba umshuwalense wakho oyinhloko futhi i-Medicaid izoba yimshwalense wakho wesibili wokusiza ngezindleko nezinye izinsizakalo ezingakhokhelwa yi-Medicare.

Ukufaneleka kweMedicaid kunqunywa umbuso ngamunye futhi kusekelwe kulezi zindlela ezilandelayo:

• umholo ophelele waminyaka yonke
• usayizi wendlu
• isimo somndeni
• isimo sokukhubazeka
• isimo sokuba yisakhamuzi

Ungabona ukuthi uyakufanelekela yini ukutholakala nge-Medicaid ngokuxhumana noma ngokuvakashela ihhovisi lezenhlalakahle yangakini ukuthola eminye imininingwane.

Ukuthatha

I-Medicare iyindlela ethandwayo yomshuwalense wezempilo kubantu baseMelika abaneminyaka engama-65 nangaphezulu noma abanokukhubazeka okuthile. I-Medicare Part A ihlanganisa izinsizakalo zesibhedlela, kanti i-Medicare Part B ihlanganisa izinsizakalo zezokwelapha.

I-Medicare Part D isiza ukumboza izindleko zemithi kadokotela, futhi uhlelo lweMedigap lusiza ukumboza izindleko ze-Medicare premium nezindleko zemali. Izinhlelo zeMedicare Advantage zinikela ngokulula kwazo zonke izinketho zokuhlanganisa endaweni eyodwa.

Ukuze uthole futhi ubhalise ohlelweni lwe-Medicare endaweni yakho, vakashela i-Medicare.gov bese usebenzisa ithuluzi lokuthola uhlelo online.

Lo mbhalo uvuselelwe ngoNovemba 18, 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.