Ngaba ndingatshintsha ukusuka kwi-Medicare Advantage ndiye kwi-Medigap?

Umxholo

• Uthini umahluko phakathi kwe-Medicare Advantage kunye neMedigap
• Yintoni i-Medicare Advantage?
• Izibonelelo zesiCwangciso seNzuzo ye-Medicare
• Ukungancedi kwesiCwangciso seNzuzo yokuNyanga
• Yintoni iMedigap?
• Izibonelelo zesicwangciso seMedigap
• Ukungancedi kwesicwangciso seMedigap
• Ndingasitshintsha nini isiBonelelo seMedare ukuya eMedigap?
• Iingcebiso zokukhetha isicwangciso seMedare
• Ukuthatha

• Uncedo lweMedicare kunye neMedigap zombini zithengiswa ziinkampani zeinshurensi zabucala.
• Banikezela ngezibonelelo zeMedicare ukongeza kwinto egubungela i-Medicare yoqobo.
• Awunakho ukubhaliswa kuzo zombini i-Medicare Advantage kunye neMedigap, kodwa ungatshintsha phakathi kwezi zicwangciso ngexesha elithile lobhaliso.

Ukuba okwangoku unayo i-Medicare Advantage, ungatshintshela kwiMedigap ngexesha elithile lobhaliso windows. Uncedo lweMedicare kunye neMedigap yimizekelo yeentlobo ezahlukeneyo zeinshurensi onokuthi ube nayo- hayi ngexesha elinye.

Ukuba ufuna ukutshintshela kwi-Medicare Advantage ukuya eMedigap, nantsi into ekufuneka uyazi ukuba yenzeke.

Uthini umahluko phakathi kwe-Medicare Advantage kunye neMedigap

Uncedo lweMedicare kunye neMedigap zombini zizicwangciso zeinshurensi zeMedare ezibonelelwa ziinkampani zeinshurensi zabucala; Nangona kunjalo, zibonelela ngeendlela ezahlukeneyo zokugubungela.

Uncedo lweMedicare (Icandelo C) lithatha indawo yokugubungela iMedicare (iinxalenye A kunye no-B), ngelixa iMedigap (isongezelelo seMedare) ibonelela ngezibonelelo ezibandakanya iindleko zonyango lwezempilo ezinje ngee-copays, i-coinsurance, kunye ne-deductibles.

Ungabhaliswa kuphela kwi-Medicare Advantage okanye kwi-Medigap-hayi zombini, ke ukuqonda umahluko kwezi nkqubo zimbini ze-Medicare kubaluleke ngakumbi xa uthenga i-Medicare yakho.

Yintoni i-Medicare Advantage?

Eyaziwa nangokuthi yi-Medicare Part C, iiplani ze-Medicare Advantage zibonelela ngokudibanisa endaweni ye-Medicare yasekuqaleni-i-Medicare Part A (isibhedlele okanye isigulana sokuhlala ngaphakathi), kunye ne-Medicare Part B (iinkonzo zonyango kunye nokubonelela nge-inshurensi). Izicwangciso ze-Medicare Advantage zingabandakanya i-Medicare Part D yokugubungela iziyobisi kunye nokugubungela okungaphezulu kwezinto ezinje ngamazinyo, umbono, ukuva, kunye nokunye.

Abanye abantu bafumana iinkonzo zokuqokelela kwintlawulo enye yenyanga kulula ukuyiqonda kwaye ihlala ixabisa ngakumbi, kwaye abantu abaninzi bonwabela iinkonzo ezongezelelweyo ezinye izicwangciso zeMedicare Advantage.

Ngokuxhomekeka kwinkampani kunye nesicwangciso osikhethayo, uninzi lwezicwangciso zeMedicare Advantage zinciphisa ababoneleli ngezempilo onokufikelela kubo kuphela kwinethiwekhi yabo. Uncedo lweMedicare lunokuba nzima ngakumbi kuneMedicare yoqobo ukuba umntu onesicwangciso seMedicare Advantage ufuna ukubona iingcali zonyango.

Izibonelelo zesiCwangciso seNzuzo ye-Medicare

• Izicwangciso ze-Medicare Advantage zinokubandakanya ezinye iinkonzo zeMedare ayisebenzi, njengombono, amazinyo, okanye iinkqubo zempilo.
• Ezi zicwangciso zinokubonelela ngeephakeji ezilungiselelwe abantu abaneemeko ezithile ezinganyangekiyo zonyango abafuna iinkonzo ezithile.
• Ezi zicwangciso zibandakanya ukumiselwa kweziyobisi ngugqirha.
• Izicwangciso ze-Medicare Advantage zinokungabizi kakhulu xa umntu efuna kuphela ukubona uluhlu lwababoneleli bezonyango abamkelweyo kwisicwangciso seMedicare Advantage.

Ukungancedi kwesiCwangciso seNzuzo yokuNyanga

• Ezinye izicwangciso zinganciphisa oogqirha ozibonayo, ezinokubangela iindleko ezingaphandle kweepokotho ukuba ubona ugqirha ongekho kwinethiwekhi.
• Abanye abantu abagula kakhulu banokufumana i-Medicare Advantage ibiza kakhulu ngenxa yeendleko zokuphuma epokothweni kwaye bafuna ukubona ababoneleli abangafanelekanga phantsi kwesicwangciso esithile.
• Ezinye izicwangciso zinokungafumaneki ngokusekwe kwindawo yomntu.

Unokujoyina i-Medicare Advantage emva kweminyaka engama-65 kwaye emva kokuba ubhalisile kwi-Medicare Part A kunye no-B. Ukuba unesifo sokugqibela sesifo (ESRD), unokuhlala ujoyina isicwangciso esikhethekileyo seMedare esibizwa ngokuba sisiCwangciso seZidingo eziZodwa ).

Yintoni iMedigap?

Izicwangciso zokuncedisa kwiMedare, ekwabizwa ngokuba yiMedigap, lukhetho lweinshurensi olunceda ekuhlawuleni iindleko zokhathalelo lwempilo epokothweni ezinje nge-coinsurance, ii-copays, kunye ne-deductibles.

Izicwangciso zeMedigap zithengiswa ziinkampani zabucala zeinshurensi, kwaye ngaphandle kokuba uthenge isicwangciso sakho seMedigap ngaphambi komhla kaJanuwari 1, 2006, azibandakanyi iziyobisi. Ukuba ukhetha iMedigap, kuya kufuneka ubhalise kwicandelo le-Medicare Part D ukuze ube nokufumana iziyobisi.

Umgaqo-nkqubo weMedigap kukuncedisa kwiCandelo lakho leMedare A kunye nezibonelelo zeCandelo B. Usaya kuhlawula ipremiyamu yakho ye-Medicare Part B ukongeza kwi-premium yakho yeMedigap.

Izibonelelo zesicwangciso seMedigap

• Izicwangciso zeMedigap zimiselwe emgangathweni, oko kuthetha ukuba xa ushukuma, usengagcina ingxelo yakho. Akunyanzelekanga ukuba ufumane isicwangciso esitsha njengoko uhlala usenza ngeMedicare Advantage.
• Izicwangciso zinokukunceda ukongeza iindleko zokhathalelo lwempilo ezingahlawulwa yiMedicare, nto leyo enciphisa umthwalo wezemali womntu.
• Ngelixa izicwangciso zeMedigap zihlala zixabisa ngaphezulu ngaphambili kunokuba nezicwangciso zeMedicare Advantage, ukuba umntu uyagula kakhulu, banokunciphisa iindleko.
• Izicwangciso zeMedigap zihlala zamkelwa kuwo onke amaziko athatha i-Medicare, ibenza ukuba bangathinteleki ngakumbi kuneeplani ze-Medicare Advantage.

Ukungancedi kwesicwangciso seMedigap

• Izicwangciso zeMedigap zifuna ukuhlawula ipremiyamu eyongezelelweyo, enokudideka kwabanye abantu.
• I-premium yenyanga ihlala iphezulu kune-Medicare Advantage.
• Isicwangciso F, esinye sezona zicwangciso zidumileyo zeMedigap, sigubungela uninzi lweendleko eziphuma epokothweni. Iyahamba ngo-2020 kubamkeli abatsha beMedical. Oku kunokuchaphazela ukuthandwa kwezicwangciso zeMedigap.

Imigaqo-nkqubo yeMedigap ibekwa emgangathweni yiMedicare. Oku kuthetha ukuba unokukhetha kwimigaqo-nkqubo emininzi efanayo kwilizwe liphela. Nangona kunjalo, iinkampani zeinshurensi zinokubiza amaxabiso ahlukeneyo kwimigaqo-nkqubo yeMedigap. Kungenxa yoko le nto ihlawula ukuthelekisa iinketho xa uthenga iMedigap. Izicwangciso zokuncedisa kwi-Medicare zisebenzisa iileta njengamagama. Izicwangciso ezili-10 ezikhoyo ngoku zibandakanya: A, B, C, D, F, G, K, L, M, no-N.

Ngaphandle kokuba uthenge isicwangciso sakho seMedigap ngaphambi kowama-2020, uyakufuna i-Medicare Part D ngokunjalo ukuba ufuna ukumiselwa kweziyobisi ngugqirha.

Ndingasitshintsha nini isiBonelelo seMedare ukuya eMedigap?

Amanye amazwe afuna iinkampani zeinshurensi ukuba zithengise ubuncinci uhlobo olunye lomgaqo-nkqubo weMedigap kwabo bangaphantsi kweminyaka engama-65 abafanelekileyo kwiMedicare. Amanye amazwe angabinazo izicwangciso zeMedigap ezifumanekayo kwabo bangaphantsi kweminyaka engama-65 abane-Medicare.

Ungathenga umgaqo-nkqubo weMedigap ngexesha lokubhaliswa kweenyanga ezi-6 ezivulekileyo ezenzeka emva kokuba uneminyaka engama-65 kwaye ubhalise kwi-Medicare Part B. Ukuba awubhalisi ngeli xesha, iinkampani zeinshurensi zinokunyusa iipremiyamu zenyanga.

Ungatshintsha kuphela kwi-Medicare Advantage uye kwiMedigap ngamaxesha abalulekileyo enyakeni. Kwakhona, ukuze ubhalise eMedigap, kuya kufuneka uphinde ubhalise kwi-Medicare yoqobo.

Amaxesha apho ungatshintsha ukusuka kwi-Medicare Advantage ukuya kwi-Medigap ibandakanya:

• Unyango lweMedicare ithuba lokubhalisa elivulekileyo (nge-1 kaJanuwari-Matshi 31). Esi sisiganeko sonyaka apho, ukuba ubhalisile kwi-Medicare Advantage, ungatshintsha izicwangciso ze-Medicare Advantage okanye ushiye isicwangciso se-Medicare Advantage, ubuyele kwi-Medicare yoqobo, kwaye ufake isicelo se-Medigap.
• Ixesha lokubhalisa elivulekileyo (nge-15 ka-Okthobha u-Disemba 7). Ngamanye amaxesha kuthiwa lixesha lokubhalisa lonyaka (AEP), ungabhalisa kuso nasiphi na isicwangciso seMedicare, kwaye ungatshintsha usuke kwiMedicare Advantage ubuyele kwiMedicare yoqobo kwaye ufake isicelo seMedigap ngeli xesha.
• Ixesha elithile lobhaliso. Unokwazi ukushiya isicwangciso sakho se-Advantage ukuba uhamba kwaye isicwangciso sakho se-Medicare Advantage asinikezelwa kwikhowudi yakho entsha ye-zip.
• Ixesha lokulinga ngeMedare. Iinyanga ezili-12 zokuqala emva kokubhalisa kwi-Medicare Advantage yaziwa ngokuba lixesha lokuvavanywa kwe-Medicare Advantage, ukuba eli lixesha lokuqala ukuba nesicwangciso se-Advantage, ungabuyela kwi-Medicare yoqobo kwaye ufake isicelo seMedigap.

Iingcebiso zokukhetha isicwangciso seMedare

• Sebenzisa iisayithi ezinje nge-Medicare.gov ukuthelekisa amaxabiso ezicwangciso.
• Tsalela umnxeba isebe leinshurensi yakho ukuze ufumanise ukuba ingaba isicwangciso osicingayo sinezikhalazo kusini na ngaso.
• Thetha nabahlobo bakho abane-Medicare Advantage okanye iMedigap kwaye ufumane ukuba bathanda ntoni kwaye abathandi ntoni.
• Nxibelelana nabanikezeli bakho bezonyango obukhethileyo ukuze ufumanise ukuba ngaba bathatha isicwangciso seMedicare seNzuzo osivavanyayo.
• Vavanya uhlahlo-lwabiwo mali lwakho ukufumanisa ukuba ungalindela ukuhlawula malini ngenyanga.

Ukuthatha

• Uncedo lweMedare kunye nezicwangciso zeMedigap ziyinxalenye yeMedareya enokuthi yenze ukuba impilo ingabizi kakhulu.
• Ngelixa ukhetha enye okanye enye ifuna ukuba kwenziwe uphando kunye nexesha, nganye inakho ukugcina imali kwiindleko zonyango ukuba kukho imfuneko yoko.
• Ukuba awuqinisekanga ukuba ungaqala phi, tsalela umnxeba u-1-800-MEDICARE kwaye abameli beMedicare banokukunceda ufumane izixhobo ozifunayo.

Ulwazi olukule webhusayithi lunokukunceda ekwenzeni izigqibo malunga neinshurensi, kodwa ayenzelwanga ukunika iingcebiso malunga nokuthengwa okanye ukusetyenziswa kwayo nayiphi na i-inshurensi okanye iimveliso zeinshurensi. I-Healthline Media ayihambelani neshishini leinshurensi nangayiphi na indlela kwaye ayinayo ilayisensi njengenkampani yeinshurensi okanye umvelisi kulo naliphi na igunya laseMelika. I-Healthline Media ayikhuthazi okanye ixhase nabani na onokuthi enze ishishini leinshurensi.