Yiluphi uhlelo oluhle kakhulu lwe-Medicare Advantage for You?

-Delile

• Izindlela zokukhetha uhlelo oluhle kakhulu lwezidingo zakho
• Izilinganiso zezinkanyezi zocwaningo ze-CMS
• Thola izinto eziza kuqala kuwe
• Nquma izidingo zakho zokunakekelwa kwezempilo ezikhethiwe
• Xoxani ngokuthi ungakwazi ukukhokha malini
• Buyekeza ukuthi yiziphi ezinye izinzuzo osuvele unazo
• Cabanga ukubhalisela iMedicare Part D kusenesikhathi
• Ukuthatha

Uma uthenga uhlelo lweMedicare Advantage kulo nyaka, ungahle uzibuze ukuthi yini uhlelo oluhle kakhulu kuwe. Lokhu kuzoya ngesimo sakho, izidingo zezokwelapha, ukuthi ungakhokhela malini, nezinye izinto.

Kunamathuluzi atholakalayo okusiza ukuthi uthole amapulani we-Medicare Advantage endaweni yangakini angahlangabezana nazo zonke izidingo zakho zokunakekelwa kwezempilo.

Lo mbhalo uzobheka ukuthi ungalunquma kanjani uhlelo oluhle kakhulu lwe-Medicare Advantage ngesimo sakho, kanye namathiphu wokuthi ungabhalisa kanjani kwi-Medicare.

Izindlela zokukhetha uhlelo oluhle kakhulu lwezidingo zakho

Ngalo lonke ushintsho olwenziwa ezinhlelweni zeMedicare emakethe, kungaba nzima ukunciphisa uhlelo oluhle kakhulu kuwe.Nazi izinto ezimbalwa okufanele uzibheke kuhlelo lwe-Medicare Advantage:

• izindleko ezihambelana nesabelomali sakho nezidingo zakho
• uhlu lwabahlinzeki be-in-network obandakanya noma yibaphi odokotela ongathanda ukubagcina
• ukumbozwa kwezinsizakalo nemithi owaziyo ukuthi uzodinga
• Isilinganiso senkanyezi ye-CMS

Qhubeka ufunde ukuze uthole ukuthi yini enye ongayicabanga lapho uthenga izinhlelo ze-Medicare Advantage endaweni yangakini.

Izilinganiso zezinkanyezi zocwaningo ze-CMS

Izikhungo ze-Medicare & Medicaid Services (CMS) zisebenzise uhlelo lwe-Five-Star Rating System ukukala ikhwalithi yezinsizakalo zezempilo nezidakamizwa ezinikezwa yi-Medicare Part C (Advantage) ne-Part D (imishanguzo kadokotela). Njalo ngonyaka, i-CMS ikhipha lezi zilinganiso zezinkanyezi nedatha eyengeziwe emphakathini.

Izinhlelo zeMedicare Advantage neNgxenye D zilinganiswa ngezinto ezahlukahlukene, kufaka phakathi:

• ukutholakala kokuhlolwa kwezempilo, ukuhlolwa, kanye nemithi yokugoma
• ukuphathwa kwezimo zezempilo ezingamahlalakhona
• isipiliyoni selungu ngohlelo lwezempilo
• ukuhlela ukusebenza nezikhalazo zamalungu
• ukutholakala kwamakhasimende kanye nesipiliyoni
• intengo yezidakamizwa, ukuphepha, nokunemba

Uhlelo ngalunye lwe-Medicare Part C no-D lunikezwa isilinganiso sinye nalezi zigaba, isilinganiso esisodwa senkanyezi eyodwa seNgxenye C no-D, nesilinganiso sohlelo jikelele.

Izilinganiso ze-CMS zingaba yindawo enhle ukuqala lapho uthenga ezitolo uhlelo oluhle kakhulu lwe-Medicare Advantage esifundazweni sakho. Cabanga ngokucwaninga lezi zinhlelo ngolwazi oluthe xaxa ukuthi yikuphi ukufakwa okufakiwe nokuthi kubiza malini.

Ukubona zonke izilinganiso zezinkanyezi ze-Medicare Part C no-D 2019, vakashela i-CMS.gov bese ulanda i-2019 Part C ne-D Medicare Star Ratings Data.

Thola izinto eziza kuqala kuwe

Zonke izinhlelo zeMedicare Advantage zimboza lokho okuvezwa yiMedicare yoqobo - lokhu kufaka ukumbozwa kwesibhedlela (Ingxenye A) nokutholakala kwezokwelapha (Ingxenye B).

Uma ukhetha uhlelo lwe-Medicare Advantage, okokuqala ufuna ukubheka ukuthi yiluphi uhlobo lokumboza oludingayo ngaphezu kokufakwa ngenhla.

Izinhlelo eziningi ze-Medicare Advantage zinikeza eyodwa, uma kungeyona yonke, yalezi zinhlobo ezingeziwe zokumbozwa:

• Ukusetshenziswa kwezidakamizwa kadokotela
• ukumbozwa kwamazinyo, kufaka phakathi izivivinyo nezinqubo zonyaka
• ukumbozwa kombono, kufaka phakathi izivivinyo zaminyaka yonke namadivayisi wokubuka
• ukumbozwa kokuzwa, kufaka phakathi izivivinyo namadivayisi okuzwa
• ubulungu bokuqina
• ezokuthutha kwezokwelapha
• izinzuzo ezengeziwe zokunakekelwa kwezempilo

Ukuthola uhlelo oluhle kakhulu lweMedicare Advantage kusho ukwenza uhlu lokuhlola lwezinsizakalo ofuna ukuzitholela zona. Ngemuva kwalokho ungathatha uhlu lwakho lokuhlola ukufakwa kuThuluzi Lokuthola i-Medicare 2020 Plan bese uqhathanisa amapulani amboza okudingayo.

Uma uthola uhlelo olubukeka lukuhle, ungesabi ukufonela inkampani ukubuza ukuthi ngabe ikunikeza noma ikuphi ukumbozwa okungeziwe noma izinzuzo.

Nquma izidingo zakho zokunakekelwa kwezempilo ezikhethiwe

Ngaphezu kokukhomba okufunayo ohlelweni lokunakekelwa kwezempilo, kubalulekile futhi ukunquma ukuthi yini oyidingayo ngezidingo zakho zesikhathi eside zokunakekelwa kwezempilo.

Uma unesimo esingelapheki noma uhamba kaningi, lezi zinto zingadlala indima kuhlobo lwecebo oludingayo. Izinhlelo ezahlukahlukene zinikela ngezinzuzo ezahlukahlukene ngokuya ngesimo sakho uqobo.

Ngaphakathi kohlelo lokulinganiswa kwe-CMS, ungathola ukuthi yimaphi amapulani alinganiselwa kakhulu ezimeni ezahlukahlukene zezempilo ezingamahlalakhona. Izinhlelo zilinganiswa ngekhwalithi yazo yokunakekelwa kwe-osteoporosis, isifo sikashukela, ushukela ophakeme wegazi, umfutho wegazi ophakeme, isifo sezinso, isifo samathambo, izimo zesinye, nokunakekelwa kwabantu abadala (ukuwa, imithi, ubuhlungu obungapheli).

Uhlobo lwecebo le-Medicare Advantage onalo nalo lubalulekile. Kunezinhlobo ezinhlanu zezinhlaka zohlelo ofuna ukuzibheka lapho ufuna uhlelo:

• Izinhlelo ze-Health Maintenance Organisation (HMO). Lezi zinhlelo zigxile kakhulu kuzinsizakalo zokunakekelwa kwezempilo eziku-network.
• Izinhlelo ze-Preferred Provider Organisation (PPO). Lezi zinhlelo zikhokhisa amanani ahlukile ngokuya ngokuthi ngabe izinsizakalo zikunethiwekhi noma azikho kwinethiwekhi. (“Inethiwekhi” yiqembu labahlinzeki abenza izinkontileka zokuhlinzeka ngezinsizakalo zenkampani ethile yomshuwalense kanye nohlelo.) Lokhu kunganikeza izinketho eziningi zokuthola ukunakekelwa okungaphandle kwenethiwekhi.
• Imali Yezinkonzo Ezizimele (PFFS)amacebo. Lezi zinhlelo zikuvumela ukuthi uthole ukunakekelwa kunoma yimuphi umhlinzeki ovunyelwe yi-Medicare ozokwamukela imali evunyelwe kusuka kuhlelo lwakho.
• Izinhlelo Ezikhethekile Zezidingo (SNP). Lezi zinhlelo zinikeza usizo olwengeziwe ezindlekweni zezokwelapha ezihambisana nezimo ezithile zezempilo ezingamahlalakhona.
• I-akhawunti ye-Medicare Medical Savings (MSA)amacebo. Lezi zinhlelo zihlanganisa uhlelo lwezempilo olunokudonswa okuphezulu ne-akhawunti yokonga yezokwelapha.

Uhlelo ngalunye lunikeza izinketho zokubhekela izidingo zakho zokunakekelwa kwezempilo. Uma unezimo zempilo ezingalapheki, ama-SNP enzelwe ukusiza ukunciphisa izindleko zesikhathi eside. Ngakolunye uhlangothi, uhlelo lwe-PFFS noma lwe-MSA lungasiza uma uhamba futhi udinga ukubona abahlinzeki abangaphandle kwenethiwekhi.

Xoxani ngokuthi ungakwazi ukukhokha malini

Enye yezinto ezibaluleke kakhulu okufanele uzicabangele lapho ukhetha uhlelo oluhle kakhulu lwe-Medicare Advantage ukuthi luzokubiza malini. Ithuluzi le-Find a Medicare Plan libala imininingwane elandelayo yezindleko nezinhlelo:

• imali ekhokhwa njalo ngenyanga
• Ingxenye B ye-premium
• ku-network kudonswa minyaka yonke
• izidakamizwa ezidonswayo
• ngaphakathi nangaphandle kwenethiwekhi ukuphuma ephaketheni max
• ama-copays kanye ne-coinsurance

Lezi zindleko zingahle zisuke ku- $ 0 ziye ku- $ 1,500 nangaphezulu, ngokuya ngesimo sakho sasekhaya, uhlobo lohlelo, kanye nezinzuzo zohlelo.

Ukuze uthole isilinganiso sokuqala sezindleko zakho zaminyaka yonke, cabanga nge-premium, ekhishwayo, nangaphandle kwephakethe. Noma ikuphi okubanjwayo okungabanjiswa yimali ozoyikweleta ngaphandle kwesikhwama ngaphambi kokuba umshwalense wakho uqale ukukhokha. Noma yimaphi ama-max aphuma ephaketheni afakwe kuhlu yisamba esiphezulu ozosikhokhela izinsizakalo unyaka wonke.

Lapho ulinganisela izindleko zohlelo lwakho lwe-Advantage, cabanga ngalezi zindleko nokuthi uzodinga kangaki ukugcwalisa imishanguzo kadokotela noma ukuvakashela amahhovisi.

Uma udinga ukuvakashelwa ngongoti noma ngaphandle kwenethiwekhi, faka lezo zindleko ezingaba khona kusilinganiso sakho. Ungakhohlwa ukucabanga ukuthi imali yakho ingaba ngaphansi uma uthola noma yiluphi usizo lwezezimali oluvela kuhulumeni.

Buyekeza ukuthi yiziphi ezinye izinzuzo osuvele unazo

Uma usuvele uthola ezinye izinhlobo zezinzuzo zokunakekelwa kwezempilo, lokhu kungahle kube uhlobo lohlelo lweMedicare Advantage oludingayo.

Isibonelo, uma usuvele uthola i-Medicare yoqobo futhi ukhethe ukungeza Ingxenye D noma iMedigap, izidingo zakho eziningi kungenzeka sezivele zimboziwe.

Kodwa-ke, ungahlala uqhathanisa ukuqhamuka ukuze unqume ukuthi uhlelo lweMedicare Advantage luzosebenza kangcono noma luzosebenzela wena kangcono.

Inqubo yokubhalisa ye-Medicare ingaqala ezinyangeni ezintathu ngaphambi kokuba wena noma othandekayo wakho abe neminyaka engama-65 ubudala. Lesi yisikhathi esihle kakhulu sokufaka isicelo, njengoba kuzoqinisekisa ukuthi uthola ukumbozwa ngeminyaka yakho engama-65^th usuku lokuzalwa.

Ungalinda ukufaka isicelo seMedicare kuze kube yinyanga yeminyaka engama-65 yakho^th usuku lokuzalwa noma izinyanga ezi-3 ezilandela usuku lwakho lokuzalwa. Kodwa-ke, ukumbozwa kungabambezeleka uma ulinda, ngakho-ke zama ukufaka isicelo kusenesikhathi.

Nalu ulwazi olubalulekile lomfakisicelo ozodinga ukuthi ube nalo ukufaka isicelo seMedicare:

• indawo nosuku lokuzalwa
• Inombolo yemedicaid
• umshuwalense wezempilo wamanje

Lapho usunemininingwane edingekayo ebhalwe ngenhla, yiya kuwebhusayithi Yezokuphepha Komphakathi ukuze ufake isicelo. Lapho nje wena noma isicelo sakho seMedicare somuntu omthandayo sicutshungulwa futhi samukelwa, ungaqala ukuthenga ezitolo ukuze uthole uhlelo lweMedicare Advantage ukuze luhambisane nezidingo zakho.

Cabanga ukubhalisela iMedicare Part D kusenesikhathi

Into ebalulekile okufanele uyiqaphele ukuthi uma usuvele ubhalise ezingxenyeni ze-Medicare A no-B kodwa ungabhalisile ku-Part C, Part D, noma okunye ukufakwa kwezidakamizwa kadokotela, ungahlangabezana nenhlawulo yokubhaliswa sekwedlule isikhathi.

Lesi sijeziso singena uma ungabhalisanga zingakapheli izinsuku ezingama-63 zesikhathi sakho sokuqala sokubhalisa. Lokhu kubhaliswa kuvamise ukuba usuku lwakho lokuzalwa lwama-65, kodwa kungaba ngaphambi kwesikhathi uma ukhubazekile noma uhlangabezana nezinye izindlela.

Uma uthola isijeziso sekwephuzile, sizosetshenziswa ku-premium D yakho yanyanga zonke unomphelo.

Uma unenkinga yokuthola uhlelo lwengxenye C, ungalindi ukuthenga ukumbozwa kwesigaba D, noma uzibeka engcupheni yokuba nenhlawulo engapheli ye-Plan D.

Ukuthatha

Kunezici eziningi ezingathonya ukuthi yiluphi uhlelo olukhethayo lwe-Medicare Advantage. Cabanga ngesilinganiso senkanyezi se-CMS, okubaluleke kakhulu kuwe nezidingo zakho zokunakekelwa kwezempilo, ukuthi ungakhokhela malini, nokuthi unhloboni yomshuwalense onayo njengamanje.

Kubalulekile ukubhalisa kwi-Medicare ngaphambi kokuba ube neminyaka engama-65 ukuqinisekisa ukuthi awuhambi ngaphandle kokutholakala kwezokwelapha. Ungakhohlwa ukuthi unamandla okuthenga ukuze uthole uhlelo oluhle kakhulu lweMedicare Advantage olufanela zonke izidingo zakho.

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.