Thola Ikhava ND
Izisekelo Zokunakekelwa Kwezempilo
Umshwalense wezempilo uyasiza ekukhokheleni izindleko uma udinga ukunakekelwa
Akekho ohlela ukugula noma ukulimala, kodwa impilo yakho ingashintsha ngokuphazima kweso. Abantu abaningi badinga ukunakekelwa kwezokwelapha ngesikhathi esithile. Umshwalense wezempilo uyasiza ukukhokhela lezi zindleko futhi ukuvikele ezindlekweni eziphakeme kakhulu.
UYINI UMSHUWALENSE WEZEMPILO
Umshwalense wezempilo uyinkontileka phakathi kwakho nenkampani yomshwalense. Uthenga uhlelo, futhi inkampani iyavuma ukukhokha ingxenye yezindleko zakho zokwelashwa lapho ugula noma ulimele.
Zonke izinhlelo ezihlinzekwa endaweni Yemakethe zihlanganisa lezi zinzuzo zezempilo ezibalulekile eziyi-10:
- Izinsizakalo zeziguli eziphuthumayo (ukunakekelwa kweziguli okwelashwa ngaphandle kokuthola esibhedlela)
- Izinsizakalo eziphuthumayo
- Ukulaliswa esibhedlela (njengokuhlinzwa nokuhlala ubusuku bonke)
- Ukukhulelwa, ukubeletha nokunakekela izingane ezisanda kuzalwa (kokubili ngaphambi nangemuva kokuzalwa)
- Izinsizakalo zezempilo yengqondo nokusetshenziswa kwezidakamizwa, okuhlanganisa nokwelashwa kokuziphatha (lokhu kuhlanganisa ukwelulekwa nokwelashwa kwengqondo)
- Imithi yokwelashwa
- Izinsiza zokuvuselela nezokuhlala (izinsiza namadivayisi okusiza abantu abalimele, abakhubazekile, noma abanezimo ezingapheli bathole noma bathole amakhono engqondo nawomzimba)
- Imisebenzi yaselebhu
- Izinsizakalo zokuvimbela kanye nempilo enhle kanye nokuphathwa kwezifo ezingamahlalakhona
- Izinsizakalo zezingane, ezihlanganisa ukunakekelwa komlomo nokubukwa (kodwa ukunakekelwa kwamazinyo nokubona kwabantu abadala akuzona izinzuzo ezibalulekile zezempilo)
Umshwalense wezempilo uyinkontileka phakathi kwakho nenkampani yomshwalense. Uma uthenga uhlelo, inkampani iyavuma ukukhokha ingxenye yezindleko zakho zokwelashwa lapho ugula noma ulimele.
UKUNAKEKELA KWAMAHHALA OKUVIMELA
Iningi lezinhlelo zezempilo kumele ziphathe isethi yezinsizakalo zokuvimbela, njengokuthwebula izithombe nokuhlolwa, ngaphandle kwenkokhiso kuwe. Lokhu kuyiqiniso ngisho noma ungazange uhlangabezane ne-deductible yakho yaminyaka yonke. Izinsizakalo zokuvimbela zivikela noma zithole ukugula kusenesikhathi lapho ukwelashwa kungenzeka kusebenze kahle kakhulu. Lawa masevisi amahhala kuphela uma uwathola kudokotela noma komunye umhlinzeki kunethiwekhi yohlelo lwakho.
Nazi ezinye izinsiza ezijwayelekile kubo bonke abantu abadala:
- Ukuhlolwa komfutho wegazi
- Ukuhlolwa kwe-cholesterol: iminyaka ethile + leyo esengozini enkulu
- Ukuhlolwa kokucindezeleka
- imigomo
- Ukuhlolwa kokukhuluphala nokwelulekwa
Vakashela I-Healthcare.gov/coverage/preventive-care-benefits/ ukuze uthole uhlu olugcwele lwezinsizakalo zokuvimbela zabo bonke abantu abadala, abesifazane, nezingane.
KUSIZA UKUKHOKHELA UKUNAKEKELA
Ubuwazi ukuthi izindleko ezimaphakathi zokuhlala esibhedlela izinsuku ezintathu ngu-$30,000? Noma ukuthi ukulungisa umlenze ophukile kungabiza kufika ku-$7,500? Ukuba nomshwalense wezempilo kungakusiza ekuvikeleni ezindlekweni eziphezulu, ezingalindelekile njengalezi.
Inqubomgomo yakho yomshwalense noma isifinyezo sezinzuzo kanye nokufakwa kuzokukhombisa ukuthi yiziphi izinhlobo zokunakekelwa, ukwelashwa, kanye nezinsizakalo ezikhava uhlelo lwakho, okuhlanganisa nokuthi inkampani yomshwalense izokhokha malini ngokwelashwa okuhlukile ezimeni ezahlukene.
- Izinqubomgomo zomshuwalense wezempilo ezahlukene zinganikeza izinzuzo ezahlukene.
- Kungase kudingeke ukhokhe imali edonswayo unyaka ngamunye wepulani ngaphambi kokuba inkampani yakho yomshuwalense iqale ukukhokhela ukunakekelwa kwakho.
- Kungase kudingeke ukhokhe i-coinsurance noma i-copayment lapho uthola usizo lwezokwelapha.
- Inkontileka yezinhlelo zomshuwalense wezempilo namanethiwekhi ezibhedlela, odokotela, amakhemisi, nabahlinzeki bezempilo.
OKUKHOKHAYO
Ngokuvamile uzokhokha i-premium njalo ngenyanga ukuze uthole usizo lwezempilo, futhi kungase kudingeke uhlangabezane nemali edonswayo unyaka ngamunye. Imali edonswayo yinani olikweletayo ngezinsizakalo zokunakekelwa kwezempilo ezikhavwe ngaphambi kokuba umshwalense wakho wezempilo noma uhlelo luqale ukukhokha. Imali edonswayo ingase ingasebenzi kuwo wonke amasevisi.
Ukuthi ukhokha malini nge-premium yakho kanye ne-deductible kusekelwe ohlotsheni lwekhava onayo. Ipholisi eneprimiyamu eshibhe kakhulu ingase ingafaki izinsiza eziningi nokwelashwa.
Okubaluleke kakhulu njengezindleko zeprimiyamu kanye nokudonswa kwemali ukuthi kufanele ukhokhe malini lapho uthola izinsizakalo.
Izibonelo zifaka:
- Lokho okukhokha ngaphandle kwe-pocket ngezinsizakalo ngemuva kokukhokha imali edonswayo (i-coinsurance noma izinkokhelo)
- Yimalini isiyonke okufanele uyikhokhe uma ugula (ubuningi obuphuma ephaketheni)
LUNGELE UKUBHALISA
IZINTO EZINHLANU ONGAZENZA UKUZE ULUNGELE UKUBHALISA
- Hlangana netilosi yangakini Noma vakashela ImpiloYakho.gov. Funda kabanzi mayelana Nendawo Yemakethe Yomshuwalense Wezempilo, nezinye izinhlelo ezifana ne-Medicaid, kanye Nohlelo Lomshwalense Wezempilo Wezingane (CHIP).
- Buza umqashi wakho uma enikeza umshwalense wezempilo. Uma umqashi wakho engakunikezi umshwalense wezempilo, ungathola usizo ngeMakethe noma eminye imithombo.
- Yenza uhlu lwemibuzo ngaphambi kokuthi kufike isikhathi sokukhetha uhlelo lwakho lwezempilo. Isibonelo, "Ngingakwazi ukuhlala nodokotela wami wamanje?" noma “Ingabe lolu hlelo luzongikhokhela izindleko zempilo yami lapho ngihamba?”
- Qoqa ulwazi oluyisisekelo mayelana neholo lomndeni wakho. Uzodinga ulwazi lwemali engenayo kusuka ku-W-2 yakho, ama-stubs okukhokha, noma ukubuyiswa kwentela.
- Hlela ibhajethi yakho. Kunezinhlobo ezahlukene zezinhlelo zezempilo ukuhlangabezana nezidingo nezabelomali ezahlukene. Uzodinga ukuthola ukuthi yimalini ongakwazi ukuyisebenzisa kumaphrimiyamu njalo ngenyanga, nokuthi ufuna ukukhokha malini uphuma ephaketheni ukuze uthole imiyalelo noma izinsiza zezokwelapha.
1. YIBE IMPILO YAKHO PHAMBILI
- Ukuhlala unempilo kubalulekile kuwena nomndeni wakho.
- Gcina impilo enempilo ekhaya, emsebenzini nasemphakathini.
Thola ukuhlolwa kwakho kwezempilo okunconyiwe futhi ulawule izimo ezingamahlalakhona. - Gcina lonke ulwazi lwakho lwezempilo endaweni eyodwa.
2. UKUQONDA NGEMPILO YAKHO
- Hlola ngohlelo lwakho lomshwalense noma izwe
- Uhlelo lwe-Medicaid noma lwe-CHIP ukuze ubone ukuthi yiziphi izinsizakalo ezihlanganiswayo.
- Yazi izindleko zakho (amaphrimiyamu, izinkokhelo ezikhokhelwayo, izimali ezidonswayo, umshwalense obambisane).
- Yazi umehluko phakathi kwe-in-network kanye ne-out-of-network.
3. YAZI LAPHO UNGAYONA KHONA
- Sebenzisa umnyango wezimo eziphuthumayo esimweni esisongela ukuphila.
- Ukunakekelwa okuyisisekelo kuyakhethwa uma kungesona isimo esiphuthumayo.
- Yazi umehluko phakathi kokunakekelwa okuyisisekelo nokunakekelwa kwezimo eziphuthumayo.
2. UKUQONDA NGEMPILO YAKHO
- Hlola ngohlelo lwakho lomshwalense noma izwe
- Uhlelo lwe-Medicaid noma lwe-CHIP ukuze ubone ukuthi yiziphi izinsizakalo ezihlanganiswayo.
- Yazi izindleko zakho (amaphrimiyamu, izinkokhelo ezikhokhelwayo, izimali ezidonswayo, umshwalense obambisane).
- Yazi umehluko phakathi kwe-in-network kanye ne-out-of-network.
3. YAZI LAPHO UNGAYONA KHONA
- Sebenzisa umnyango wezimo eziphuthumayo esimweni esisongela ukuphila.
- Ukunakekelwa okuyisisekelo kuyakhethwa uma kungesona isimo esiphuthumayo.
- Yazi umehluko phakathi kokunakekelwa okuyisisekelo nokunakekelwa kwezimo eziphuthumayo.
4. THOLA UMNIKEZI
- Buza abantu obathembayo kanye/noma wenze ucwaningo ku-inthanethi.
- Hlola uhlu lohlelo lwakho lwabahlinzeki.
- Uma wabelwe umhlinzeki, xhumana nohlelo lwakho uma ufuna ukushintsha
- Uma ubhalisele i-Medicaid noma i-CHIP, xhumana ne-Medicaid yesifunda sakho noma uhlelo lwe-CHIP ukuze uthole usizo.
5. YENZA ISIQEPHU
- Yisho uma uyisiguli esisha noma uke waba lapho ngaphambilini.
- Nikeza igama lohlelo lwakho lomshwalense bese ubuza ukuthi bayawuthatha yini umshwalense wakho.
- Batshele igama lomhlinzeki ofuna ukumbona nokuthi kungani ufuna i-aphoyintimenti.
- Cela izinsuku noma izikhathi ezikusebenzelayo.
4. THOLA UMNIKEZI
- Buza abantu obathembayo kanye/noma wenze ucwaningo ku-inthanethi.
- Hlola uhlu lohlelo lwakho lwabahlinzeki.
- Uma wabelwe umhlinzeki, xhumana nohlelo lwakho uma ufuna ukushintsha
- Uma ubhalisele i-Medicaid noma i-CHIP, xhumana ne-Medicaid yesifunda sakho noma uhlelo lwe-CHIP ukuze uthole usizo.
5. YENZA ISIQEPHU
- Yisho uma uyisiguli esisha noma uke waba lapho ngaphambilini.
- Nikeza igama lohlelo lwakho lomshwalense bese ubuza ukuthi bayawuthatha yini umshwalense wakho.
- Batshele igama lomhlinzeki ofuna ukumbona nokuthi kungani ufuna i-aphoyintimenti.
- Cela izinsuku noma izikhathi ezikusebenzelayo.
6. LUNGISELELA UKUHAMBA KWAKHO
- Yiba nekhadi lakho lomshwalense.
- Yazi umlando wezempilo womndeni wakho futhi wenze uhlu lwanoma yimiphi imithi oyiphuzayo.
- Letha uhlu lwemibuzo nezinto ozoxoxa ngazo, futhi ubhale amaphuzu phakathi nokuvakasha kwakho.
- Letha nomuntu ozokusiza uma uludinga.
7. Nquma UKUTHI UMNIKEZI UKULUNGELE
- Ingabe uzizwe ukhululekile ngomhlinzeki ombonile?
- Ukwazile ukuxhumana futhi waqonda umhlinzeki wakho?
- Ingabe uzizwe sengathi wena nomhlinzeki wakho ningenza izinqumo ezinhle ndawonye?
- Khumbula: kulungile ukushintshela kumhlinzeki ohlukile!
8. IZINYATHELO EZILANDELAYO EMVA KOKUQOKWA KWAKHO
- Landela imiyalelo yomhlinzeki wakho.
- Gcwalisa noma yiziphi iziqondiso ozinikiwe, futhi uzithathe njengoba uqondisiwe.
- Hlela ukuvakasha kokulandelela uma ukudinga.
Buyekeza incazelo yakho yezinzuzo futhi ukhokhe izikweletu zakho zezokwelapha. - Xhumana nomhlinzeki wakho, uhlelo lwezempilo, noma i-ejensi yezwe ye-Medicaid noma ye-CHIP nganoma yimiphi imibuzo.
Umthombo: Umhlahlandlela Wakho Wezempilo. Izikhungo zeMedicaid & Medicare Services. Septhemba. 2016.
Lokhu kushicilelwa kusekelwa i-Centers for Medicare and Medicaid Services (CMS) yoMnyango Wezempilo Nezinsizakalo Zabantu wase-US (HHS) njengengxenye yomklomelo wosizo lwezezimali onesamba esingu-$1,200,000 ngamaphesenti angu-100 axhaswe yi-CMS/HHS. Okuqukethwe okwababhali futhi akumele ngempela imibono esemthethweni, noma ukuqinisekiswa, kwe-CMS/HHS, noma uHulumeni wase-US.