Yintoni isiCwangciso seMfuno eziZodwa eziLungelekileyo zoNyango?

Umxholo

• Yintoni isiCwangciso seMfuno eziZodwa eziLungelekileyo zoNyango (D-SNP)?
• Ngubani ofanelekileyo kwii-SNPs eziLungele ukuSebenza eziManyeneyo?
• Ukulungela iMedicare
• Ukulungela iMedicaid
• Ubhalisa njani kwi-SNP efanelekileyo yokuSebenza?
• Yintoni efihliweyo eyi-SNP efanelekileyo?
• Ixabisa ntoni indleko ezifanelekileyo ze-SNP?
• Iindleko eziqhelekileyo ze-D-SNPs ngo-2020
• Ukuthatha

• Isicwangciso seMedical Eligible Eligible Special Needs Plan (D-SNP) sisicwangciso seMedicare Advantage esenzelwe ukubonelela ngokukhethekileyo kubantu ababhalise kwiiMedicare (iinxalenye A no-B) kunye neMedicaid.
• Ezi zicwangciso zinceda abantu abaneemfuno eziphezulu zokugubungela iindleko eziphuma epokothweni abanokuthi babe noxanduva lwazo phantsi kweenkqubo zemveli zonyango.

Ukuba ungaphezulu kweminyaka yobudala engama-65 okanye uneemeko ezithile zempilo- kwaye unemali encinci yokuhlawula ukhathalelo lwakho- unokuwela kwiqela elikhethiweyo elilungele zombini iinkqubo zomshuwalense wezempilo nezikarhulumente. Ngapha koko, phantse i-12 yezigidi zabantu baseMelika banelungelo lokufumana i-Medicare kunye neMedicaid, ngokuxhomekeke kubudala babo kunye neemeko zempilo. Ukuba ungomnye wabo, unokufanelekela i-D-SNP.

Funda ngokufunda ukuba yintoni i-D-SNP nokuba ulungele na.

Yintoni isiCwangciso seMfuno eziZodwa eziLungelekileyo zoNyango (D-SNP)?

Isicwangciso seMfuno eziKhethekileyo zeMedicare (i-SNP) luhlobo lwesicwangciso seMedicare Advantage (Icandelo C) esibonelela ngohlobo lokugubungela iMedicare. Ezi zicwangciso zabucala zinceda ukulungelelanisa ukhathalelo kunye nezibonelelo phakathi kweMedare, eyinkqubo yomdibaniso, kunye neMedicaid, eyinkqubo karhulumente.

Ii-D-SNPs zezona zinzima kakhulu kwii-SNP ngokwemiqathango yokugubungela kunye nokufaneleka, kodwa zibonelela ngeyona nto ibalulekileyo kubantu abanezidingo eziphezulu.

Ukulungela i-D-SNP, kuya kufuneka ungqine ukuba uyafaneleka. Kuya kufuneka kuqala ubhalise kuzo zombini iiMedicare kunye nenkqubo zikarhulumente zeMedicaid, kwaye kufuneka ubenakho ukubhala uxwebhu.

Idalwe ngo-2003 yiCongress, ii-Medicare SNPs ziyafumaneka kwabo sele benamacandelo e-Medicare A kunye no-B. I-SNPs ziluhlobo lwesicwangciso se-Medicare Part C (Advantage) esilawulwa ngurhulumente womanyano kwaye sinikezelwa ziinkampani zeinshurensi zabucala. Badibanisa izinto ezininzi ze-Medicare: Icandelo le-A lokungeniswa esibhedlele, Icandelo B lokufumana iinkonzo zonyango, kunye neCandelo D lokugubungela amayeza kagqirha.

Ayingawo onke amazwe anikezela ngee-SNP zeMedare. Ukusukela ngo-2016, ama-38 athi kunye neWashington, DC, kunye nePuerto Rico banikezela nge-D-SNPs.

I-SNPs zahlulwe zangamacandelo amathathu ngokusekwe kuhlobo lwabantu abafanelekileyo kubo.

• IziCwangciso zeZidingo eziZodwa eziLungelekileyo (D-SNPs). Ezi zicwangciso zezabantu abakulungeleyo zombini i-Medicare kunye nenkqubo yabo yeMedicaid yelizwe.
• IziCwangciso zeMfuno eziZodwa zeMeko yoKuhlala (C-SNPs). Ezi zicwangciso zeAdvantage zenzelwe abantu abaneemeko zempilo ezingapheliyo ezinje ngokusilela kwentliziyo, umhlaza, isifo sesibindi sokugqibela, ukuxhomekeka kwiziyobisi kunye notywala, i-HIV kunye nokunye.
• IziCwangciso zeZidingo eziZodwa zaMaziko (I-SNPs). Ezi zicwangciso zeAdvantage ziyilelwe abantu abafuna ukuhlala kwiziko okanye indawo yokhathalelo lwexesha elide ngaphezulu kweentsuku ezingama-90.

Ngubani ofanelekileyo kwii-SNPs eziLungele ukuSebenza eziManyeneyo?

Ukuqwalaselwa kuyo nayiphi na i-SNPs, kufuneka kuqala ubhalise kumacandelo e-Medicare A no-B (i-Medicare yoqobo), egubungela ukulaliswa esibhedlele kunye nezinye iinkonzo zonyango.

Kukho iintlobo ze-D-SNP ezikhoyo. Ezinye zeenkqubo zoLondolozo lwezeMpilo (HMO), kwaye ezinye zinokuba ziinkqubo zeMibutho yababoneleli abakhethiweyo (PPO). Izicwangciso ziyahluka ngokusekwe kwinkampani yeinshurensi oyikhethileyo kunye nendawo ohlala kuyo. Inkqubo nganye inokuba neendleko ezahlukeneyo.

Ungatsalela umnxeba i-800-MEDICARE ngolwazi oluthe kratya okanye ubuze imibuzo malunga ne-D-SNPs kunye nezinye izibonelelo zeMedicare.

Ukulungela iMedicare

Ufanelekile kwi-Medicare kwiminyaka engama-65 okanye ngaphezulu. Unenyanga ezi-3 ngaphambi nasemva kwenyanga apho ujika khona ama-65 ukubhalisela ukhuseleko lokuqala lweMedare.

Ufanelekile kwi-Medicare, nokuba ungakanani na ubudala, ukuba unemeko efanelekileyo okanye ukhubazekile, njengokuphela kwesifo se-renal okanye i-amyotrophic lateral sclerosis, okanye ukuba ubukwi-Inshurensi yokuKhubazeka kweNtlalo iinyanga ezingama-24 okanye nangaphezulu.

Ukuba ufanelekile, ungabhalisa kwi-D-SNP ngexesha elifanelekileyo lokubhaliswa kwe-Medicare, okoko nje ii-D-SNP zinikezelwa kwindawo yakho.

• Ubhaliso lokuqala. Eli xesha liqala kwiinyanga ezi-3 ngaphambi kosuku lwakho lokuzalwa lwama-65 kwaye lide liye kwiinyanga ezi-3 emva kosuku lwakho lokuzalwa lwama-65.
• Ubhaliso lweMedicare. Oku kusuka ngoJanuwari 1 ukuya kuMatshi 31. Ngeli xesha, ungabhalisa okanye utshintshe isicwangciso sakho seMedicare Advantage. Unga hayi tshintsha ukusuka kwi-Medicare yoqobo ukuya kwisicwangciso seNzuzo ngeli xesha; Unokwenza oku kuphela ngexesha lokubhalisa okuvulekileyo.
• Ubhaliso ngokubanzi lweMedicare. Eli xesha liqala ngoJanuwari 1 ukuya ku-Matshi 31. Ukuba awuyibhaliselanga iMedicare yoqobo ngexesha lokubhalisa kwakho okokuqala, ungabhalisa ngeli xesha.
• Ubhaliso oluvulekileyo. Oku kusuka ngo-Okthobha u-15 ukuya ku-Disemba 7. Nabani na ofanelekela i-Medicare angabhalisa ngeli xesha ukuba akakafumani. Ungatshintsha ukusuka kwi-Medicare yasekuqaleni uye kwisicwangciso seNzuzo, kwaye unokutshintsha okanye ushiye i-Advantage yakho yangoku, iCandelo D, okanye isicwangciso seMedigap ngeli xesha.
• Amaxesha obhaliso olulodwa. Ezi ziyafumaneka unyaka wonke kwaye zisekwe kutshintsho kwimeko yakho, njengokufaneleka okutsha kweMedicare okanye iMedicaid, intshukumo, utshintsho kwimeko yakho yezonyango, okanye ukuyekiswa kwesicwangciso sakho sangoku.

Ukulungela iMedicaid

Ukufaneleka kweMedicaid kusekelwe kwizinto ezininzi, kubandakanywa umvuzo wakho, iimeko zempilo, nokuba ngaba ufanelekile ukufumana iNgeniso yoKhuseleko. Ukufumanisa ukuba unelungelo lokugubungela iMedicaid kwilizwe lakho kwaye ufumane isiqinisekiso sokufaneleka kwakho, nxibelelana neofisi yaseburhulumenteni yaseMedicaid.

Ubhalisa njani kwi-SNP efanelekileyo yokuSebenza?

Unokuthi, phantsi kweemeko ezithile, ubhalise ngokuzenzekelayo kumacandelo e-Medicare A no-B xa uneminyaka engama-65. Kodwa awuyi kubhaliswa ngokuzenzekelayo kwi-D-SNP kuba luhlobo lweSicwangciso seMedicare Advantage (Icandelo C).

Unokuthenga izicwangciso ze-Medicare Advantage, kubandakanya i-D-SNPs, ngexesha lokubhaliswa kwamkelweyo: utshintsho kwimeko yakho nganye.

Ukubhalisa kuso nasiphi na isicwangciso se-Medicare Advantage, kubandakanya i-D-SNPs, landela la manyathelo:

• Khetha isicwangciso kwindawo yakho (jonga isixhobo sokufumana isicwangciso seMedicare sezicwangciso kwikhowudi yakho ye-ZIP).
• Ukubhalisa kwi-Intanethi okanye ucele iphepha ukuba ubhalise ngeposi, ndwendwela iwebhusayithi yenkampani yeinshurensi ngesicwangciso osikhethileyo.
• Tsalela umnxeba kwi-800-MEDICARE (800-633-4227) ukuba ufuna uncedo.

• ikhadi lakho leMedicare
• umhla oqalise ngawo ukuqala kwamayeza e-Medicare A kunye / okanye ku-B
• ubungqina bokubhengezwa kweMedicaid (ikhadi lakho leMedicaid okanye ileta esemthethweni)

Yintoni efihliweyo eyi-SNP efanelekileyo?

I-D-SNPs zizicwangciso ze-Medicare Advantage, ke zigubungela zonke iinkonzo ezifanayo njengezinye izicwangciso ze-Medicare Advantage. Oku kubandakanya:

• Iiprimiyamu zenyanga eziyi- $ 0
• iinkonzo zonxibelelaniso
• Icandelo leMedare D
• ezinye izinto ezikhawuntareni kunye namayeza
• ukuthuthwa kwiinkonzo zonyango
• impilo
• umbono kunye neendlebe zokuva
• ukufaneleka kunye nokuba lilungu lomthambo

Uninzi lwezicwangciso ze-Medicare Advantage, uhlawula inxenye yesicwangciso sakho sendleko epokothweni. Nge-D-SNP, i-Medicare kunye neMedicaid zihlawula uninzi okanye zonke iindleko.

I-Medicare ihlawula isabelo seendleko zonyango kuqala, emva koko iMedicaid ihlawula naziphi na iindleko ezinokushiyeka. I-Medicaid yaziwa ngokuba yi "ndlela yokugqibela" yokuhlawula iindleko ezingagutyungelwanga okanye ezingagqitywanga kuphela yiMedicare.

Ngelixa umthetho womdibaniso ubeka imigangatho yengeniso yeMedicaid, ilizwe ngalinye linemilinganiselo yokufaneleka kweMedicaid kunye nemida yokugubungela. Isicwangciso sokugubungela siyahluka ngurhulumente, kodwa kukho ezinye izicwangciso ezibandakanya zonke izibonelelo zeMedare kunye neMedicaid.

Ixabisa ntoni indleko ezifanelekileyo ze-SNP?

Ngokwesiqhelo, ngesiCwangciso seZidingo eziZodwa (SNP), uya kuhlawula isabelo esifana nento obuya kuyihlawula phantsi kwaso nasiphi na isicwangciso seMedicare Advantage. Iipremiyamu, iintlawulo ezikhutshelweyo, iimali ezihlawulwayo, kunye nokutsalwa kungahluka ngokuxhomekeke kwisicwangciso osikhethileyo. Nge-D-SNP, iindleko zakho ziphantsi ngenxa yokuba impilo yakho, ukukhubazeka, okanye imeko yezemali ikulungele ukufumana inkxaso eyongezelelweyo evela kurhulumente nakarhulumente.

Iindleko eziqhelekileyo ze-D-SNPs ngo-2020

Ukuthatha

• Ukuba uneemfuno zempilo okanye ukhubazeko olubanzi kwaye umvuzo wakho ulinganiselwe, unokulungela inkxaso yombuso kunye neyaseburhulumenteni.
• IziCwangciso zeZidingo eziZodwa eziLungelekileyo (D-SNPs) ziluhlobo lwesicwangciso seMedicare Advantage esigubungela ukulaliswa kwakho esibhedlele, ukhathalelo lonyango, kunye nemigqaliselo; Iindleko zesicwangciso zigutyungelwe yimali zombuso kunye nezikarhulumente.
• Ukuba ulungele zombini i-Medicare kunye nenkqubo yakho ye-Medicaid yenkqubo, unokuba nelungelo lokufumana ukhathalelo lwempilo oluphantsi okanye olungenaxabiso phantsi kwe-D-SNP.