Ngaba utyando lweMedicare lwegxa lokuTshintsha indawo?

Umxholo

• Zeziphi iindawo zonyango lweMedare ezigubungela amagxalaba?
• Icandelo le-Medicare Icandelo
• Icandelo le-Medicare Icandelo B
• Icandelo le-Medicare leC
• Icandelo le-Medicare Icandelo D
• Inkcazo yeMedigap
• Zithini iindleko ezingaphandle kweepokotho zenkqubo egqunyiweyo?
• Iindleko zoqobo zoNyango
• Icandelo leMedare C iindleko
• Icandelo leMedare D iindleko
• Ndilindele ntoni kutyando olwenziwa egxalabeni?
• Ngaphambi kwenkqubo
• Umhla wenkqubo
• Emva kwenkqubo
• Ezinye iindlela zotyando
• Inaliti yeCortisone
• Ulungiso lwenyama
• Ukuphelisa iintlungu
• Unyango lwesitem
• Ukuthatha

• Utyando olwenziwe emagxeni lunokuthomalalisa iintlungu kwaye lonyuse ukuhamba.
• Le nkqubo igutyungelwe yiMedicare, ukuba ugqirha wakho uyangqina ukuba kunyanzelekile ngokwezonyango.
• Icandelo leMedicare A ligubungela utyando lokunyanga ngaphakathi, ngelixa i-Medicare Icandelo B ligubungela iinkqubo zonyango.
• Kuya kufuneka uhlawule iindleko zokuphuma epokothweni zotyando olwenziwa egxalabeni, nangokhuselo lweMedare.

Igxalaba lakho lilungu eliguqukayo elisengozini yokwenzakala kunye nokunxiba kunye nokukrazuka. Igxalaba elonakaliswe kakubi linokuchaphazela umgangatho wobomi bakho. Nangona kunjalo, utyando lokubuyiselwa kwamagxa kuhlala kudweliswa njengokhetho.

Ngenxa yokuba i-Medicare ayigubungeli utyando olukhethiweyo, unokukhathazeka ukuba kuya kufuneka uphile neentlungu okanye uhlawule utyando oluphuma epokothweni. Kodwa i-Medicare, enyanisweni, iya kuhlawula isahlulo seendleko ukuba ugqirha wakho uthi utyando lwamahlombe luyafuneka endaweni yakho.

Zeziphi iindawo zonyango lweMedare ezigubungela amagxalaba?

Ungadinga utyando lokubuyisela egxalabeni ukulungisa igxalaba lakho okanye ukunciphisa umonakalo ongaphezulu kwilungu.

Ugqirha wakho kuya kufuneka aqinisekise ukuba utyando lwakho luyafuneka ukuphilisa okanye ukuthintela umonakalo oqhubekayo obangelwa sisifo, esifana nesifo samathambo. Lo gqirha kufuneka abhalise kwaye avunywe yiMedicare.

Uhlobo lotyando olifunayo luya kuxhomekeka kwizinto ezininzi, kubandakanya ubungakanani bomonakalo osegxalabeni lakho. Ezinye iintlobo eziqhelekileyo zotyando lwamagxa zibandakanya:

• Utyando lwenqanawa yeRotator. Ukulungiswa kwekhafu yeRotator kunokwenziwa nge-arthroscopically okanye njengotyando oluvulekileyo.
• Utyando oluqhekekileyo. Oku kudla ngokwenziwa ngokuthambeka.
• Utyando lweArthritis. Oku kwenziwa rhoqo nge-arthroscopically kodwa kunokufuna utyando oluvulekileyo ukuba umonakalo egxalabeni unzima.
• Ukulungiswa kwamagxa aphukileyo. Uhlobo lotyando olufunekayo luya kuchongwa yindawo kunye nobukrakra bokwaphuka okanye ukwaphuka.

Emva koko, siza kujonga into egqunywe phantsi kwenxalenye nganye ye-Medicare.

Icandelo le-Medicare Icandelo

Utyando oluvulekileyo lukhetho olungenelelayo olufuna ukuba ugqirha enze isicatshulwa esikhulu ukuze alungise okanye atshintshe igxalaba lakho.

Ukuba ukutshintsha kwamagxa akho okuvulekileyo kuyimfuneko kwezonyango, icandelo leMedicare A liya kugubungela isahlulo seendleko. Icandelo A yinxalenye yonyango lokuqala.

Icandelo A liza kugubungela nawaphi na amayeza okanye unyango olufumanayo xa uhlala esibhedlele, iziko labongikazi abanezakhono, okanye iziko lokuvuselela. Kodwa kubalulekile ukwazi ukuba kukho imida ukuba i-Medicare iyakugubungela ukuhlala kulo naluphi na uhlobo lwendawo yokunyanga.

Icandelo le-Medicare Icandelo B

Utyando lwamagxa lusenokwenziwa ngearthroscopically. Olu hlobo lotyando lungena kancinci kwaye lwenziwa esibhedlele okanye kwiklinikhi ezimeleyo kwindawo yokunyanga.

Ukuba unokutshintshwa kwegxala le-arthroscopic, ugqirha wakho uya kwenza incinci egxalabeni lakho kwaye abeke ikhamera encinci apho. Ngomnye umgubo omncinci, ugqirha uya kulungisa okanye abuyisele iinxalenye zamagxa akho.

Ukuba utyando lweearthroscopic olwenziwe ngugqirha luyimfuneko kunyango, icandelo leMedicare B liya kugubungela isahluko seendleko. Icandelo B lelinye icandelo leMedicare yoqobo.

Icandelo B likwagubungela ezi zinto kunye neenkonzo ngokunjalo, ukuba ziyafuneka:

• lonke ixesha lokuqeshwa koogqirha ngaphambi nasemva kotyando
• Unyango lomzimba emva kotyando, oya kuludinga nokuba ungaluhlobo luni lwenkqubo
• nasiphi na isixhobo esihlala ixesha elide esifunekayo emva kotyando, esifana nesilingi

Icandelo le-Medicare leC

Ukuba unayo i-Medicare Part C (i-Medicare Advantage), isicwangciso sakho siya kugubungela zonke iindleko ezihlawulwa yi-Medicare yoqobo (icandelo A no-B). Kuxhomekeke kwisicwangciso sakho, inokugubungela amayeza amiselweyo.

Ukugcina iindleko zakho zokuphuma epokothweni ziphantsi, kubalulekile ukusebenzisa ababoneleli benethiwekhi kunye neekhemesti ukuba unesicwangciso seCandelo C.

Icandelo le-Medicare Icandelo D

Nawaphi na amachiza omiselweyo ukuba uwathathe emva kotyando, njengamayeza eentlungu, aya kugutyungelwa yiCandelo le-Medicare Icandelo D. ICandelo D kukugubungela amayeza okunyanga anikezelwa ngeMedicare.

Isicwangciso seCandelo D ngasinye sibandakanya i-formulary. Olu luluhlu lwamayeza olugqityiweyo sisicwangciso kunye nepesenti yokugubungela onokuyilindela.

Inkcazo yeMedigap

Ukuba unayo iMedicare yoqobo, unokuba nesicwangciso seMedigap. Kuxhomekeka kwisicwangciso sakho, iMedigap inokugubungela ezinye zeepokotho ezisezantsi zeendleko zoqhaqho olwenziwe endaweni yakho. Oku kunokubandakanya iikopi zakho, ukuqinisekiswa kweemali, kunye nokuncitshiswa.

I-Medigap ihlala igubungela ukukopishwa kwamayeza ngeCandelo D. Qaphela, nangona kunjalo, uninzi lwezicwangciso azivumelekanga ukuba zigubungele ipremiyamu yeCandelo B.

Zithini iindleko ezingaphandle kweepokotho zenkqubo egqunyiweyo?

Kunokuba nzima ukuqikelela iindleko zakho zangaphandle epokothweni ngaphambi kwenkqubo yakho. Iofisi yakho yokuhlawula ugqirha kufuneka ikwazi ukukunika uqikelelo olubhaliweyo lwento onokuyilindela. Oku kuhlala kubandakanya uluhlu lweendleko ezinokubakho, ngokusekwe kwiinkonzo onokuzifuna ngexesha nangoko emva kwenkqubo.

Iindleko zoqobo zoNyango

Kukho iindleko ezingaphandle kweepokotho onokuzilindela, nokuba unayo iMedicare. Oku kubandakanya:

• Kuqhaqho lwangaphakathi, icandelo lakho A esibhedlele esibhedlele linciphise i $ 1,408. Oku kugubungela iintsuku ezingama-60 zokuqala zokunyamekela esibhedlele esibhedlele esibhedlele esibhedlele.
• Ukuba ufuna ukuhlala ixesha elide, uya kuhlawula imali-mboleko yesixa semali esiyi- $ 352 yonke imihla ukususela ngomhla wama-61 ukuya kumhla wama-90 ngexesha lokuxhamla kunye ne- $ 704 mihla le ngalo naluphi na usuku lokugcina olisebenzisayo.
• Ukuba uhlala kwiziko labongikazi elinobuchule, iindleko zakho zemihla ngemihla zeendleko ukusuka kumhla wama-21 ukuya kosuku lwe-100 ngexesha lesibonelelo liya kuba yi- $ 176 ngosuku.
• Utyando lwangaphandle, unoxanduva lokudibana neCandelo B lonyaka elitsaliwe le- $ 198, kunye nepremiyamu yakho yenyanga, eyi- $ 144.60 kubantu abaninzi ngo-2020.
• Uya kuhlawula iipesenti ezingama-20 zeendleko ezivunyiweyo ze-Medicare zenkqubo yezigulana ezingalaliswayo.
• Uya kuhlawula kwakhona iipesenti ezingama-20 zeendleko kuso nasiphi na isixhobo esomeleleyo sonyango kunye nokuqeshwa.

Icandelo leMedare C iindleko

Ukuba unayo i-Medicare Part C, iindleko zakho ziya kwahluka ngokuxhomekeka kuhlobo lwesicwangciso onaso. I-inshurensi yakho inokukunika ingxelo ethile kunye neenkcukacha zepopay ngaphambi kwexesha. Ngokwesiqhelo, unokulindela ukuhlawula uhlobo oluthile lwepopay.

Nokuba ungaluphi na uhlobo lwesicwangciso seCandelo C, ngokomthetho kufuneka ukuba isicwangciso sakho sigubungele ubuncinci njengeMedicare yoqobo. Oku kubandakanya iindleko zoqhaqho olungalaliswayo okanye olungalaliswayo.

Icandelo leMedare D iindleko

Ukuba unayo i-Medicare Part D, iindleko zakho ziya kwahluka ngokuxhomekeke kwisicwangciso onaso. Ngokuqinisekileyo uya kuba neendleko zokuhlawula nayiphi na imishanguzo emiselweyo kuwe.

Iindleko kwichiza ngalinye zibekwe kwinkqubo yesicwangciso sakho se-formulary kunye ne-tier system. Umboneleli wakho wesicwangciso unokukwazisa ukuba ulindele ukuhlawula iyeza ngalinye ngaphambi kwexesha.

I-Medicare inenkqubo yokujonga ixabiso, enokukunceda ekuboneni indleko zoqhaqho olungalaliswayo. Ukufumana ezona ziphumo zichanekileyo, cela ugqirha wakho elona gama lichanekileyo lenkqubo okanye ikhowudi yolo hlobo lotyando.

Ndilindele ntoni kutyando olwenziwa egxalabeni?

Ngaphambi kwenkqubo

Inyathelo lokuqala kukuqinisekisa ukuba uphilile ngokwaneleyo ukuba ungatyandwa endaweni yamagxa. Kwiiveki ezimbalwa ngaphambi komhla wotyando, ugqirha wakho uya kucwangcisa uvavanyo lomzimba ukuvavanya intliziyo yakho kunye nempilo iyonke. Ngelo xesha, ugqirha wakho unokucebisa ukuba uyeke ukuthatha amayeza athile, njengabacoci begazi.

Ukulindela utyando kunokuba luxinzelelo kubantu abaninzi. Zama ukuphumla kangangoko kunokwenzeka kwaye ufumane ubuthongo obuhle phezolo.

Umhla wenkqubo

Ugqirha wakho uya kukwazisa xa kufuneka uyeke ukutya nokusela ngaphambi kotyando. Ukuba uhlala uthatha amayeza emihla ngemihla kusasa, buza ugqirha wakho ukuba kufuneka uwathathe na ngosuku lwenkqubo.

Ukuba wenza utyando oluvulekileyo, kuya kufuneka ulungele ukuchitha iintsuku ezininzi esibhedlele. Yiza nantoni na enokukwenza uzive ukhululekile, njengencwadi elungileyo ukuba uyifunde, ifowuni kunye netshaja yefowuni.

Malunga neyure ngaphambi kwenkqubo, ugqirha oza kubulala iintlungu uza kukuvavanya. Uya kuphinda udibane nogqirha wakho, oya kukuchazela inkqubo ngokunzulu. Sebenzisa eli xesha ukubuza nayiphi na imibuzo onayo.

Ixesha elifunekayo lotyando lokubuyisela egxalabeni liyahluka, kodwa ihlala ithatha iiyure ezimbini ukuya kwezintathu. Uya kuvuka kwigumbi lokuchacha, apho uya kuhlala ixesha elithile.

Ukuba utyando lwakho lwenziwe ngokunyanga, uya kusiwa kwigumbi lakho emva kokuchitha iiyure ezininzi uchacha. Ukuba utyando lwakho lwenziwe ngaphandle kwesigulana, uyakufuna umntu oza kukuphakamisa emva kokuba ukhutshiwe.

Emva kwenkqubo

Njengalo naluphi na utyando, ezinye iintlungu okanye ukungonwabi kunokulindeleka. Ugqirha wakho uya kukunika amayeza entlungu ukunceda. Unokuyalelwa ukuba uthathe amayeza akho ngamaxesha athile okanye ngaphambi kokuba inqanaba lentlungu lenyuke. Unokuxelelwa nokuba ufake iqhwa kuloo ndawo.

Uyakukhululwa ngengalo yakho kwisilingi, onokuxelelwa ukuba uyinxibe iiveki ezininzi.

Unyango lomzimba luhlala luqala kwangoko, ngamanye amaxesha nangomhla wenkqubo. Ukusebenzisa igxalaba lakho njengoko kuyalelwe kuya kukunceda ufumane ukuhamba ngokukhawuleza. Ugqirha wakho uya kukunika iyeza ukuze uqhubeke nonyango lomzimba okoko kufanelekile

Igxalaba lakho nengalo yakho ziya kuqala ukuphucula kancinci. Kwiiveki ezi-2 ukuya kwezi-6, unokulindela ukuziva kwaye ubone ukuphucuka okubonakalayo kwaye unokuphinda uqalise imisebenzi emininzi yempilo yemihla ngemihla.

Kungathatha ixesha elide ukuqhuba imoto okanye ukudlala imidlalo, nangona kunjalo. Usenokungakwazi ukuphatha iipakethe ezinzima kwiinyanga ezininzi. Inokuthatha iinyanga ezi-6 okanye ngaphezulu ngaphambi kokuba uhambe ngokukuko egxalabeni lakho.

Ukutshintshwa kwamagxa kunokuhlala iminyaka eli-15 ukuya kwengama-20.

Ezinye iindlela zotyando

Ngaphandle kokuba wenzakele efuna ukulungiswa kwangoko, njengokuphuka okanye ukwaphuka kwethambo lamagxa, ugqirha wakho unokuncoma ukuzama ezinye iindlela zotyando.

Inaliti yeCortisone

Ukudubula kweCortisone kunokusetyenziselwa ukunciphisa iintlungu kunye nokudumba kwilungu legxalaba. Zihlala zilawulwa kwiofisi kagqirha kwaye kufuneka zinikezwe ngugqirha ovunyiweyo weMedicare ukuze zikhuselwe.

Uninzi lweCandelo D kunye neCandelo C liceba ngenaliti ye-cortisone. Ezinye iinxalenye zetyala lakho, ezinjengeendleko zolawulo, zinokuhlawulwa yiCandelo B.

Ulungiso lwenyama

Unyango lomzimba lunokunceda ngentlungu, ukuhamba, kunye nokuzinzisa ngokudibeneyo. Iiseshoni zonyango ezifunekayo emzimbeni zigutyungelwa yiCandelo leMedicare B, ukuba unayo imigqaliselo evela kugqirha ovunyiweyo nguMedare. Kuya kufuneka uphinde usebenzise ugqirha wezonyango ovunyiweyo.

Ukuphelisa iintlungu

Amayeza amiselweyo entlungu agqunywe liCandelo D kunye nezahlulo C. Ezinye izicwangciso zeCandelo C zikwagubungela amayeza eekhawuntareni zentlungu.

Unyango lwesitem

Olu nyango lunokucetyiswa ngethenda ekhethekileyo okanye iinyembezi zemisipha. Inokucetyiswa kwakhona ngomonakalo we-cartilage. Kodwa okwangoku akuvunyelwanga yi-FDA, oko kuthetha ukuba ayigqutywanga yiyo nayiphi na indawo ye-Medicare.

Ukuthatha

• Utyando olwenziwe emagxeni lunokuba lolunye ukhetho lokunciphisa iintlungu kunye nokunyusa ukuhamba. Unokuzama unyango olungelonyango.
• I-Medicare igubungela inkqubo yezigulana ezingalaliswanga kunye nezingalaliswayo, ukuba nje zibonwa ziyimfuneko kwezonyango.
• Icandelo ngalinye leMedicare liza kubandakanya iinkqubo ezahlukeneyo, iinkonzo, amayeza, kunye nezinto onokuzidinga kuyo yonke inkqubo.
• Iindleko zokuphuma epokothweni nge-original Medicare coverage zilungile. NgeCandelo C, iCandelo D, okanye ukukhutshwa kweMedigap, unokufuna ukuqinisekisa iimali zokugubungela kunye neendleko kunye nomboneleli wakho wesicwangciso.