Ngaba i-Medicare igubungela ukubuyiswa kwemiphunga?

Umxholo

• Unyango lwe-Medicare lokuhlaziywa kwe-pulmonary
• Zeziphi iimfuno endidinga ukuhlangabezana nazo?
• Zeziphi iindleko endinokuzilindela?
• Icandelo leMedare B
• Icandelo lonyango Medic C
• IMedigap
• Ngaba ukulungiswa kwemiphunga kulungile kum?
• Ukuthatha

• Ukuhlaziywa kwePulmonary yinkqubo yezigulana ezingalaliswayo ebonelela ngonyango, imfundo kunye nenkxaso kubantu abaneCOPD.
• Ukufunda iindlela ezifanelekileyo zokuphefumla kunye nokuzilolonga zizinto eziphambili ekubuyiselweni kwempumlo.
• Kukho iindlela ezithile ekufuneka uhlangane nazo kwi-Medicare yokugubungela iinkonzo zakho zokuvuselela ipulmonary.
• Icandelo leMedicare B liya kuhlawula ama-80% eendleko kwezi nkonzo, ukuba ngaba ukulungele ukufumana ingxelo.

Ukuba unesifo esinganyangekiyo sesifo semiphunga (COPD) esinganyangekiyo, i-Medicare Icandelo B iya kugubungela uninzi lweendleko zokubuyiselwa kwemiphunga.

Ukuhlaziywa kwePulmonary yinkqubo ebanzi, esezigulana ezingalaliswayo edibanisa imfundo noqeqesho kunye nenkxaso yoontanga. Ngexesha lokuvuselelwa kwepulmonary, uya kufunda ngakumbi malunga neCOPD kunye nomsebenzi wamaphaphu. Uya kufunda kwakhona imithambo eyilelwe ukukunceda ufumane amandla kwaye uphefumle ngokufanelekileyo.

Inkxaso yoontanga yinxalenye ebalulekileyo yokuvuselela imiphunga. Ukuthatha inxaxheba kwiiklasi zeqela kunika ithuba lokunxibelelana kunye nokufunda kwabanye abantu ababelana ngemeko yakho.

Inkqubo yokubuyisela kwimeko yesiqhelo yemiphunga ingenza umahluko obonakalayo kumgangatho wobomi kubantu abane-COPD.

Unyango lwe-Medicare lokuhlaziywa kwe-pulmonary

Abamkeli be-Medicare bagqunyiwe ngenxa yezigulana ezingalaliswayo ezifumana iinkonzo zokubuyisela kwimeko yesiqhelo kwi-Medicare Part B. Ungafikelela kwiinkonzo zokubuyisela kwimo yesiqhelo kwimiphunga kwiofisi kagqirha wakho, kwiklinikhi ekhululekileyo, okanye kwisibonelelo sezigulana ezingalaliswayo esibhedlele.

Ukuba unesicwangciso seMedicare Advantage (Medicare Part C), ukukhutshwa kwakho kwe-pulmonary rehab kuya kuba lilingana noko uza kufumana nge-Medicare yasekuqaleni. Nangona kunjalo, iindleko zakho zinokwahluka, kuxhomekeke kwisicwangciso onaso. Kuya kufuneka ukuba usebenzise oogqirha okanye amaziko athile ngaphakathi kwenethiwekhi yesicwangciso sakho.

I-Medicare ihlala igubungela ukuya kuma-36 iiseshoni zokubuyisela kwimeko yesiqhelo. Nangona kunjalo, ugqirha wakho unokukwazi ukucela ukukhutshwa kwiiseshoni ezingama-72 ukuba zibonakala ziyimfuneko yonyango ekunyamekeleni.

Zeziphi iimfuno endidinga ukuhlangabezana nazo?

Ukuze uvumeleke ukuba unikwe ingxelo yokubuyiswa kwenkqubo yemiphunga, kufuneka uqale ubhalise kwi-Medicare yoqobo (icandelo A no-B) kwaye ube usexesheni ngentlawulo yakho yeprimiyamu. Ungabhaliswa kwisicwangciso seMedicare Advantage (Icandelo C).

Ugqirha onyanga i-COPD kufuneka akuthumele kwi-pulmonary rehab kwaye uchaze ukuba ezi nkonzo ziyimfuneko ukunyanga imeko yakho.

Ukulinganisa ukuba inzima kangakanani i-COPD yakho, ugqirha wakho uya kugqiba iGOLD yakho (Initiative yeHlabathi yeZigulo eziNgapheliyo zezifo zemiphunga). Amanqanaba okubekwa kweCOPD GOLD ngala:

• Inqanaba 1 (limnene kakhulu)
• Inqanaba 2 (eliphakathi)
• Inqanaba 3 (eqatha)
• Inqanaba 4 (kakhulu)

I-Medicare ikuthathela ingqalelo ukuba uyakufanelekela ukuvuselelwa kwepulmonary ukuba i-COPD yakho yinqanaba 2 ukuya kwinqanaba lesine.

Ukufumana ukhuseleko oluphezulu, qiniseka ukuba ugqirha kunye nendawo yokubuyisela kwimeko yesiqhelo yamkela isabelo seMedicare. Ungasisebenzisa esi sixhobo ukukhangela ugqirha ovunyiweyo okanye indawo ekufutshane nawe.

Zeziphi iindleko endinokuzilindela?

Icandelo leMedare B

NgeCandelo leMedicare B, uya kuhlawula idonsi yonyaka eyi- $ 198, kunye nepremiyamu yenyanga. Ngo-2020, uninzi lwabantu luhlawula i-144.60 yeedola ngenyanga kwiCandelo B.

Emva kokuba udibene neCandelo B elichithwayo, uxanduva lwakho kuphela kwi-20% yeendleko ezivunyiweyo ze-Medicare kwi-pulmonary rehab yakho. Iinkonzo ozifumanayo kwizibhedlele ezingalaliswayo zingafuna ukubhatalwa kwemali esibhedlele kwiseshoni nganye oya kuyo.

Kwezinye iimeko, ugqirha wakho unokuncoma ukuba ube neeseshoni zokubuyisela kwakhona kunokuba i-Medicare ikulungele ukuhlawula. Ukuba kunjalo, unokufumana iindleko zonke zeeseshoni ezongezelelweyo.

Icandelo lonyango Medic C

Ukuba unesicwangciso se-Medicare Advantage, amaxabiso akho okutsalwa, ii-copays kunye neeprimiyamu zingahluka. Nxibelelana nesicwangciso sakho ngokuthe ngqo ukufumanisa ukuba uza kuhlawuliswa malini kwezi nkonzo ukuze ungothuki kamva.

IMedigap

I-Medigap (isongezelelo seMedicare) sinokugubungela ezinye zeendleko zokuphuma epokothweni kwiMedicare yoqobo. Ukuba unesifo esinganyangekiyo, iMedigap inokuba luncedo ekugcineni iindleko zokuphuma epokothweni ziphantsi. Ungathelekisa izicwangciso zeMedigap zokufumana ezisebenza ngokukuko kwimeko yakho.

Ngaba ukulungiswa kwemiphunga kulungile kum?

I-COPD liqela lezifo ezingapheliyo, eziqhubekayo zemiphunga. Izifo eziqhelekileyo eziwela phantsi kweCOPD zibandakanya i-bronchitis engapheliyo kunye ne-emphysema.

Ukuhlaziywa kwePulmonary kunezibonelelo ezininzi kwaye kunokukunceda ufunde ukulawula iimpawu zakho zeCOPD. Inokukunceda wenze utshintsho kwindlela yokuphila ukunciphisa iimpawu zakho okanye ukukhula kwesifo kancinci.

Ezi nkqubo zokubuyisela kwimeko yesiqhelo zenzelwe ukuphucula umgangatho wobomi kunye nokuzimela kwabo bahlala neCOPD. Bayacelwa ukuba babonelele ngenkxaso yomntu ngamnye, esekwe kubungqina, exhasa iinkqubo ezahlukeneyo ezibandakanya:

• ugqirha omiselweyo, ojongiweyo
• isicwangciso sonyango esenzelwe umntu ngamnye
• imfundo kunye noqeqesho kulawulo lweempawu, amayeza, kunye nokusetyenziswa kweoksijini
• uvavanyo lwengqondo
• uvavanyo lweziphumo

Ezinye iinkqubo zokubuyiselwa kwemiphunga zingabandakanya:

• izikhokelo zesondlo somntu
• ukunceda kulawulo loxinzelelo
• Inkqubo yokuyeka ukutshaya
• Ukuxhaswa koontanga kunye nokunxibelelana nezinye izigulana zeCOPD

Rehab inokukunika ithuba lokudibana kunye nokunxibelelana nabanye abantu abajongana neCOPD. Olu hlobo lwenkqubo yenkxaso lunokubaluleka.

Ukuthatha

• Ukuhlaziywa kwePulmonary kunokuba luncedo kakhulu kubantu abaneCOPD. Inika imfundo eyodwa, inkxaso, kunye neendlela zokulawula iimpawu zeCOPD.
• Uya kugqitywa ngeeseshoni zokubuyisela kwimeko yesiqhelo yemiphunga, ukuba ugqirha ovunyiweyo weMedicare akunika ukuhanjiswa okuyimfuneko kwezi nkonzo.
• Gcina ukhumbula ukuba iindleko ziyahluka ngokuxhomekeka kuhlobo lwesicwangciso seMedicare onaso.