Ngabe i-Medicare izokhokha isihlalo sokuphakamisa?

-Delile

• Ngabe i-Medicare ihlanganisa izihlalo zokuphakamisa?
• Ngifanelekile ukuthola lezi zinzuzo?
• Izindleko nokubuyiselwa kwemali
• Izindleko zeMedicare Part B
• Odokotela nabahlinzeki ababhalise kwi-Medicare
• Kusebenza kanjani ukubuyiselwa kwemali
• Okunye ukucatshangelwa
• Siyini ngempela isihlalo sokuphakamisa?
• Ukuthatha

• Ukuphakamisa izihlalo kukusiza ukusuka endaweni yokuhlala uye endaweni yokuma kalula.
• I-Medicare izosiza ukukhokhela ezinye zezindleko uma uthenga isihlalo sokwehla.
• Udokotela wakho kufanele anikeze isihlalo sokuphakamisa futhi kufanele usithenge kumhlinzeki ovunyelwe yi-Medicare ukuqinisekisa ukumbozwa.

I-Medicare izokhokha ezinye izindleko zemishini yezokwelapha, kufaka phakathi isihlalo sokuphakamisa. Lezi izihlalo ezikhethekile ezisiza ukukuphakamisa usuke endaweni yokuhlala uye endaweni yokuma. Zingasiza kakhulu lapho unezinkinga zokuhamba nobunzima bokuma usendaweni ohleli kuyo.

Kule ndatshana, sizophendula imibuzo yakho mayelana nokuthakwa kweMedicare ngezihlalo zokuphakamisa nokuthi ungaqiniseka kanjani ukuthi ubuyiselwa inani eliphakeme lokuthenga kwakho.

Ngabe i-Medicare ihlanganisa izihlalo zokuphakamisa?

IMedicare inikela ngokutholakala kwezihlalo zokuphakamisa, inqobo nje uma udokotela ekusho ngesizathu sezokwelapha. Kodwa-ke, iMedicare ayihlanganisi zonke izindleko zesihlalo. Indlela yokuphakamisa imoto ibhekwa njengemishini yezokwelapha ehlala isikhathi eside (i-DME), embozwe ngaphansi kweNgxenye B. Ezinye izingxenye zesitulo (ifreyimu, ukubopha, okokufaka izinto) azimboziwe futhi uzokhokha ephaketheni ngalengxenye yesitulo izindleko.

Ukuhlangabezana nenqubo yokubuyiselwa kwemali ye-Medicare, i-DME kumele ihlangabezane nalezi zindlela ezilandelayo:

• ihlala isikhathi eside (ungayisebenzisa kaninginingi)
• edingekayo ngenhloso yezokwelapha
• esetshenziswa ekhaya
• imvamisa ihlala okungenani iminyaka emithathu
• ivame ukuba lusizo kumuntu ogulayo noma olimele

Ezinye izibonelo ze-DME zifaka izinduku zokuhamba, izihlalo zokuhamba, kanye nabahamba ngezinyawo.

Ingxenye yesihlalo yesihlalo sokuphakamisa ayithathwa njengeyimfuneko kwezokwelapha, futhi yingakho ingamboziwe.

Ngifanelekile ukuthola lezi zinzuzo?

Ufanelekile ukumbozwa ngesihlalo sokuphakamisa uma ubhalise kwi-Medicare Part B. Ukuze ufanelekele ukuthola iMedicare, kufanele okungenani ube neminyaka engama-65 noma ube nezinye izimo zezempilo ezifanelekayo. Lezi zimo zingabandakanya ukukhubazeka okukhulu, isifo sezinso sesigaba sokugcina, noma i-ALS (amyotrophic lateral sclerosis).

Uma une-Medicare Advantage, usakulungele ukuthola isihlalo sokuphakamisa. I-Medicare Advantage noma i-Medicare Part C yilapho ukhetha inkampani yomshuwalense yangasese ukumboza izinzuzo zakho ze-Medicare. Ngoba izinkampani ze-Medicare Advantage kufanele zihlanganise zonke izici ezenziwa yi-Medicare yasekuqaleni, kufanele uthole okungenani inani elifanayo lokumbozwa, uma kungenjalo izinzuzo ezingeziwe.

Udinga futhi ukuhlolwa ngudokotela ukuze uthole incwadi kadokotela esihlalweni. Nazi ezinye zezinto udokotela wakho azozihlola lapho ecubungula ukuthi ngabe isihlalo sokuphakamisa siyadingeka yini kwezokwelapha:

• uma une-arthritis enamandla emadolweni noma ezinqeni
• ikhono lakho lokusebenzisa isihlalo
• amandla akho okusukuma esihlalweni ngaphandle kosizo
• ikhono lakho lokuhamba, noma ngosizo oluhamba kumuntu ohamba ngezinyawo, ngemuva kokuthi isihlalo sikuphakamisile (uma uthembele kusikuta noma kumhambahamba ekuhambeni kwakho okuningi, lokhu kungakwenza ungafaneleki)
• ungahamba uma umile
• uke wazama ezinye izindlela zokwelapha (njengokulashwa ngokomzimba) ukukusiza ukusuka ekuhlaleni phansi ume ngaphandle kwempumelelo

Uma uyisiguli esingalalisiwe esibhedlela noma ohlala esikhungweni sabahlengikazi, ngeke ukwazi ukuthola izihlalo zelift. Kufanele uhlale ekhaya lokuhlala ukuze ufanelekele lo mhlomulo.

Izindleko nokubuyiselwa kwemali

Izindleko zeMedicare Part B

I-Medicare Part B yingxenye yeMedicare ekhokhela indlela yokuphakamisa isitulo sokuphakamisa. NgeNgxenye B, kuzodingeka uqale uhlangane nemali yakho ebanjwayo, eyi- $ 198 ngo-2020. Uma usuhlangabezane nemali ebanjwayo, uzokhokha ama-20% wemali evunyelwe yi-Medicare yendlela yokuphakamisa. Uzobuye ukhokhe u-100% wezindleko ezisele zesihlalo.

Odokotela nabahlinzeki ababhalise kwi-Medicare

I-Medicare izokhokhela isihlalo sokuphakamisa kuphela uma udokotela oyinikezayo kungumhlinzeki weMedicare. I-Medicare nayo idinga ukuthi umphakeli abhaliswe kwi-Medicare. Uma ufuna izihlalo zokuphakamisa, kubalulekile ukubuza inkampani ukuthi ngabe zibhalisiwe yini kwiMedicare futhi zamukela ukwabiwa. Uma inkampani engusihlalo ingabambi iqhaza kwi-Medicare, ungakhokhiswa ngaphezu kwemali eyamukelwe ye-Medicare futhi kuzoba kuwe ukumela umehluko.

Kusebenza kanjani ukubuyiselwa kwemali

Uma uthenga isihlalo sakho sokuphakamisa kumhlinzeki weMedicare, cishe uzokhokhela izindleko eziphelele zesihlalo ngaphambili futhi ungabe usufuna ukubuyiselwa imali ngokwengxenye kwa-Medicare. Uma nje umphakeli ebamba iqhaza kwi-Medicare, imvamisa izokufakela isimangalo. Uma, nganoma yisiphi isizathu, umphakeli engafaki isimangalo, ungagcwalisa isimangalo ku-inthanethi. Ukuhambisa isimangalo, uzodinga izinto ezilandelayo:

• ifomu lesicelo
• ibhili efakwe ohlwini
• incwadi echaza isizathu sokufaka isicelo
• amadokhumende asekelayo ahlobene nesimangalo, njengomyalelo kadokotela wakho

Umphakeli noma kufanele ufake isicelo kungakapheli izinyanga eziyi-12 uthenge isihlalo selift.

Okunye ukucatshangelwa

Ezinye izinkampani zingakuvumela futhi ukuthi uqashe isihlalo sokuphakamisa. Lokhu kungathinta izindleko zakho ngaphansi kwe-Medicare. Kulesi sibonelo, kungcono ukuthi ubuze inkampani oyiqashile ukuthola incazelo yezindleko zakho zanyanga zonke ngaphansi kweMedicare.

Uma unenqubomgomo yeMedigap (eyaziwa nangokuthi yi-Medicare supplement yomshuwalense), inqubomgomo ingakusiza ukuthi ukhokhele izindleko zama-copayments esihlalweni. Hlola ngohlelo lwakho ngemininingwane ethile yokumbozwa.

Siyini ngempela isihlalo sokuphakamisa?

Isihlalo sokuphakamisa sisiza umuntu ukuthi asuke lapho ahleli khona aye endaweni yokuma. Isihlalo sijwayele ukubukeka njengesihlalo esihleli, kepha sinamandla okusukuma noma siphakamise ngokuthambeka lapho ucindezela inkinobho.

Kwesinye isikhathi, izihlalo zokuphakamisa zinezici ezengeziwe, njengokushisa noma ukubhucungwa. Ezinye izihlalo zingaguqulela esimweni esicaba ngokuphelele, esingakuvumela ukuba ulale nasesitulweni.

Njengoba kunezici eziningi ezingeziwe noma izinto zokuthuthuka ezithuthukisiwe ezitholakalayo, izindleko zezihlalo zokuphakamisa nazo ziyahlukahluka kakhulu. Izihlalo eziningi zisukela emakhulwini amadola kuya kwizinkulungwane zamadola.

Kubalulekile ukuqaphela ukuthi isihlalo sokuphakamisa asifani nesitebhisi, okuyisihlalo esikuthatha ukusuka phansi uye phezulu ezitebhisini ngokucindezela inkinobho. Futhi akusikho ukuphakamisa isiguli, okusiza abanakekeli ukukuguqula kusuka esihlalweni esinamasondo kuye embhedeni noma okuphambene nalokho.

Ukuthatha

• I-Medicare ibheka isihlalo sokuphakamisa njengezinto zokwelashwa ezihlala isikhathi eside (i-DME) futhi izokhokhela ezinye izindleko kusihlalo.
• Kufanele ube nomuthi kadokotela wesihlalo futhi uwuthenge kumhlinzeki ovunyelwe yi-Medicare.
• Uzokhokhela izindleko ezigcwele zikasihlalo ngesikhathi sokuthenga, bese iMedicare izokubuyisela ngo-80% wezindleko ezivunyiwe zengxenye yokuphakamisa imoto esihlalweni; uzokhokha u-100% wezindleko zesihlalo sonke.