Ngaba amayeza ayakugubungela ukuvavanywa kwegazi?

Umxholo

• Ngawaphi amalungu eMedicare agubungela uvavanyo lwegazi?
• Ixabisa malini uvavanyo lwegazi?
• Icandelo leMedicare A iindleko
• Amayeza eendleko zeCandelo B
• Iindleko zeMedicare
• Iindleko zeMedigap
• Ndingaya phi kuvavanyo?
• Zeziphi iintlobo zovavanyo lwegazi oluqhelekileyo ezigutyungelweyo?
• Zeziphi ezinye iintlobo zovavanyo lwelebhu eziqhelekileyo ezigutyungelweyo?
• Ukuthatha

• I-Medicare igubungela uvavanyo lwegazi oluyimfuneko ngokuyalelwa ngugqirha ngokusekwe kwizikhokelo zeMedicare.
• Izicwangciso zeMedicare Advantage (Icandelo C) zinokugubungela ezinye iimvavanyo, kuxhomekeke kwisicwangciso.
• Akukho mrhumo wahlukileyo wovavanyo lwegazi phantsi kwonyango lokuqala.
• Isicwangciso sokuncedisa (iMedigap) sinokukunceda kwiindleko ezingaphandle kweepokotho ezinjengezinto ezitsaliweyo.

Uvavanyo lwegazi sisixhobo esibalulekileyo sokuchonga oogqirha abasisebenzisayo ukukhusela iimeko zomngcipheko kunye nokujonga imeko zempilo. Ngokuqhelekileyo yinkqubo elula yokulinganisa indlela umzimba wakho osebenza ngayo kwaye ufumane naziphi na iimpawu zokulumkisa kwangaphambili.

I-Medicare igubungela uninzi lweendlela zokuvumela umboneleli wakho wezempilo ukuba alandelele impilo yakho kunye nescreen sothintelo lwezifo. Umyinge unokuxhomekeka kwintlanganiso eqinisekisiweyo yokuvavanywa kwe-Medicare.

Makhe sijonge ukuba ngawaphi amalungu e-Medicare agubungela uvavanyo lwegazi kunye nolunye uvavanyo lokuqonda isifo.

Ngawaphi amalungu eMedicare agubungela uvavanyo lwegazi?

Icandelo leMedicare A libonelela ngokuvavanywa kwegazi okuyimfuneko. Uvavanyo lunoku-odolwa ngugqirha kwisibhedlele esingalaliswayo, ubuhlengikazi abanezakhono, i-hospice, impilo yasekhaya kunye nezinye iinkonzo ezinxulumene noko.

I-Medicare Icandelo B ligubungela uvavanyo lwegazi olungalaliswayo oluyalelwe ngugqirha ngokuxilongwa okuyimfuneko kwezonyango ngokusekwe kwizikhokelo zokugubungela iMedicare. Imizekelo iya kuvavanya uvavanyo lwegazi ukufumanisa okanye ukulawula imeko.

Uncedo lweMedicare, okanye iCandelo C, izicwangciso zikwagubungela uvavanyo lwegazi. Ezi zicwangciso zinokugubungela iimvavanyo ezongezelelweyo ezingagutyungelwanga yi-Medicare yoqobo (icandelo A no-B). Isicwangciso ngasinye se-Medicare Advantage sinikezela ngezibonelelo ezahlukeneyo, ke jonga kwisicwangciso sakho malunga novavanyo oluthile lwegazi. Kwakhona cinga ngokuya koogqirha be-inethiwekhi kunye neelebhu ukufumana izibonelelo eziphezulu.

Icandelo lonyango i-Medicare Icandelo D libonelela ngogqirha ngokugubungela amayeza kwaye alifihli naluphi na uvavanyo lwegazi.

Ixabisa malini uvavanyo lwegazi?

Iindleko zovavanyo lwegazi kunye nolunye uvavanyo lwelebhu okanye uvavanyo lokuqonda isifo zinokwahluka. Iindleko zisekwe kuvavanyo oluthile, indawo okuyo, kunye nelebhu esetyenzisiweyo. Uvavanyo lunokuqhutywa ukusuka kwiidola ezimbalwa ukuya kumawaka eedola. Kungenxa yoko le nto kubalulekile ukuba ujonge ukuba ngaba uvavanyo lwakho luyagutyungelwa na phambi kokuba ulugqibe.

Nazi ezinye zeendleko zovavanyo lwegazi onokuzilindela ngamacandelo ahlukeneyo eMedare.

Icandelo leMedicare A iindleko

Umsebenzi wegazi wasesibhedlele oyalelwe ngugqirha wakho ugqunywe ngokupheleleyo phantsi kweCandelo leMedicare A. Nangona kunjalo, kusafuneka uhlangane nenciphiso yakho.

Ngo-2020, iCandelo A lincitshisiwe li- $ 1,408 kubaxhamli abaninzi ngeli xesha lesibonelelo. Ixesha lokuxhamla lihlala ukusukela kumhla wokungena kwakho esibhedlele kwiintsuku ezingama-60 ezizayo. Kuyenzeka ukuba ube namaxesha amaninzi enzuzo ngonyaka.

Amayeza eendleko zeCandelo B

Icandelo leMedicare B likwagubungela uvavanyo lwegazi oluyimfuneko lwezonyango. Kuya kufuneka uhlangane nenciphiso yakho yonyaka yokufumana le ngxelo. Ngo-2020, i-deductible yi- $ 198 kubantu abaninzi. Khumbula, kuya kufuneka uhlawule iprimiyamu yakho yenyanga yeNxalenye B, eyi- $ 144.60 ngo-2020 uninzi lwabaxhamli.

Iindleko zeMedicare

Iindleko ngesicwangciso se-Medicare seNzuzo sixhomekeke kwisicwangciso somntu ngamnye. Hlola ngesicwangciso esithile kwindawo yakho malunga neepopay, iideductibles kunye nezinye iindleko ezingaphandle kwe-pocket.

Ezinye izicwangciso ze-Medicare Advantage zinokubonelela ngokubanzi, ngoko akudingeki ukuba uhlawule nantoni na epokothweni.

Iindleko zeMedigap

I-Medigap (i-Medicare yokuncedisa i-inshurensi) izicwangciso zinokukunceda ekuhlawuleni iindleko ezingaphandle kweepokotho njengesiqinisekiso semali, ukuncitshiswa, okanye ukukhutshelwa kovavanyo kunye nezinye iimvavanyo zokuqonda isifo.

Isicwangciso ngasinye se-11 esifumanekayo seMedigap sinezibonelelo ezahlukeneyo kunye neendleko, ke phanda ezi ngononophelo ukuze ufumane elona xabiso libalaseleyo kwiimfuno zakho.

Kukho iimeko ezithile apho iindleko zovavanyo lwegazi zinokuphakama kunesiqhelo, kubandakanya xa:

• undwendwela ababoneleli okanye iilebhu ezingamkeli ukwabiwa
• unesicwangciso seMedicare Advantage kwaye ukhethe ugqirha ongaphandle kwenethiwekhi okanye indawo yeelebhu
• Ugqirha wakho uyalela ukuba kuvavanywe igazi ngokufuthi kunokuba kugqunyiwe okanye ukuba ngaba uvavanyo aluzange lufakwe yiMedicare (uvavanyo oluthile aluqwalaselwa ukuba akukho zimpawu okanye zifo okanye akukho mbali)

Iwebhsayithi ye-Medicare inezixhobo zokukhangela onokuzisebenzisa ukufumana oogqirha kunye neelebhu ezithatha inxaxheba.

Ndingaya phi kuvavanyo?

Unokwenza uvavanyo lwegazi olwenziwe kwiindidi ezininzi zeelebhu. Ugqirha wakho uya kukwazisa ukuba ungalwenza phi uvavanyo. Qiniseka nje ukuba indawo okanye umboneleli uyalwamkela ulwabiwo.

Iindidi zeelebhu ezigutyungelwe yiMedicare zibandakanya:

• iiofisi zoogqirha
• Iilebhu zasesibhedlele
• Iilebhu ezizimeleyo
• Iilebhu zeziko labongikazi
• ezinye iilebhu zamaziko

Ukuba ufumana okanye uceliwe ukuba utyikitye iSaziso soMxhamli we-Advance (i-ABN) evela kwilebhu okanye kumnikezeli ngenkonzo, unokuba noxanduva lokuhlawula iindleko zenkonzo kuba ayifakwanga. Buza imibuzo malunga noxanduva lwakho malunga neendleko ngaphambi kokuba utyikitye.

Zeziphi iintlobo zovavanyo lwegazi oluqhelekileyo ezigutyungelweyo?

Izicwangciso zokuqala zeMedare kunye neMedicare zigubungela iintlobo ezininzi zovavanyo kunye novavanyo lwegazi. Kukho imida malunga nokuba i-Medicare iya kugubungela kangaphi iimvavanyo ezithile.

Unokufaka isibheno kwisigqibo sokugubungela ukuba wena okanye ugqirha wakho uziva ukuba kufuneka kuvavanywe uvavanyo. Uvavanyo oluthile lokuvavanywa kwegazi, njengalezo zesifo sentliziyo, zigutyungelwe ngokupheleleyo ngaphandle koqinisekiso lwemali okanye ukuncitshiswa.

Nazi ezinye zeemeko ezivavanywa rhoqo kuvavanyo lwegazi kunye nokuba unokuzenza kangaphi ngokugubungela iMedicare:

• Isifo seswekile: kanye ngonyaka, okanye ukuya kabini ngonyaka ukuba unobungozi obukhulu
• Isifo sentliziyo: i-cholesterol, i-lipids, i-triglycerides yokuhlola kanye kwiminyaka emihlanu
• Intsholongwane kaGawulayo: kanye ngonyaka ngokusekwe kumngcipheko
• IHepatitis (B no-C): kanye ngonyaka kuxhomekeke kumngcipheko
• Umhlaza womzimba: kanye ngonyaka
• Umhlaza wedlala lobudoda (PSA [prostate specific antigen] test): kanye ngonyaka
• Izifo ezosulela ngokwabelana ngesondo: kanye ngonyaka

Ukuba ugqirha wakho ucinga ukuba ufuna ukuvavanywa rhoqo kuvavanyo oluthile lokuqonda isifo ngenxa yeemeko ezithile zomngcipheko, kuya kufuneka uhlawule ngokuvavanywa rhoqo. Buza ugqirha wakho kunye nelebhu ngolwazi olungaphezulu malunga novavanyo lwakho oluthile.

Kunokuba luncedo ukuba nesicwangciso esongezelelweyo sokuvavanywa rhoqo. Ungaya kwiwebhusayithi ye-Medicare Medigap ngolwazi malunga nazo zonke izicwangciso ze-2020 kunye noko kugutyungelweyo. Ungatsalela umnxeba isicwangciso ngokuthe ngqo ngolwazi oluthe kratya.

Zeziphi ezinye iintlobo zovavanyo lwelebhu eziqhelekileyo ezigutyungelweyo?

Icandelo leMedicare B ligubungela uninzi lwezigulana ezi-odokotela abagunyazisiweyo njengovavanyo lwe-urinalysis, uvavanyo lweesampuli zesampulu, kunye novavanyo lokuhlola. Akukho zikopi zolu vavanyo, kodwa okutshiweyo kusasebenza.

Imizekelo yeemvavanyo ezigutyungelweyo zibandakanya:

I-Medicare igubungela ii-mammograms zokuchonga rhoqo ukuba ugqirha uyayalela. Unoxanduva lokuhlawula iindleko zeepesenti ezingama-20.

Olunye uhlolo olungelulo olwe-laboratory lokuvavanywa kwe-Medicare kubandakanya ii-X-reyi, ukuskena kwe-PET, iMRI, i-EKG, kunye ne-CT scan. Kuya kufuneka uhlawule iipesenti ezingama-20 zakho zokuqinisekisa kunye nokutsalwa kwakho kunye nayo nayiphi na ikopi. Khumbula ukuya kubanikezeli abamkela ukwabiwa ukuthintela iintlawulo i-Medicare ayinakuyigubungela.

• I-Medicare ibonelela ngesixhobo onokuthi usisebenzise ukujonga ukuba zeziphi iimvavanyo ezigutyungelweyo.
• Unako nokuya apha ujonge kuluhlu lweemvavanyo ezigqunyiweyo ezivela kwiMedicare.
• Nalu uluhlu lweekhowudi kunye novavanyo olwenziwa yiMedicare hayi isiciko. Ngaphambi kokuba utyikitye i-ABN, buza malunga neendleko zovavanyo kunye nokuthenga. Amaxabiso ayahluka ngomboneleli nendawo.

Ukuthatha

I-Medicare igubungela uninzi lweemvavanyo eziqhelekileyo zegazi ezifunekayo ukufumanisa nokulawula iimeko zempilo ukuba nje ziyimfuneko kwezonyango. Nazi iingcebiso zokugqibela ekufuneka uziqwalasele:

• Buza ugqirha wakho ngolwazi malunga nohlobo oluthile lovavanyo lwegazi kunye nendlela yokulungiselela (ukuba kufanelekile okanye akufuneki utye kwangaphambili, njl.
• Ndwendwela ababoneleli abamkela isabelo ukunqanda ukuhlawula iindleko eziphuma epokothweni ngeenkonzo ezigqunyiweyo
• Ukuba unemeko efuna ukuvavanywa rhoqo, jonga isicwangciso esongezelelweyo njengeMedigap ukunceda ngeendleko zokuphuma epokothweni.
• Ukuba inkonzo ayigutyungelwanga, jonga ngeenxa zonke ukufumana umboneleli wexabiso eliphantsi.

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