Iinkcazo ezibalulekileyo zokukunceda uhambe ngeMedare

Umxholo

• I-Amyotrophic lateral sclerosis (ALS)
• Ukugubungela intlekele
• Amaziko eMedicare kunye neeNkonzo zeMedicaid (CMS)
• Kleyima
• UQinisekiso
• ICopay
• Isithuba sokufunda
• Ukutsalwa
• Umngxuma wedonathi
• Izixhobo zonyango ezihlala ixesha elide (i-DME)
• Ukuphela kwesifo sezintso (ESRD)
• Uncedo olongezelelweyo
• Ifomula
• Ixesha lokubhalisa ngokubanzi
• Izicwangciso zoMbutho wezeMpilo (HMO)
• Ingeniso yohlengahlengiso yenyanga (IRMAA)
• Ixesha lokubhalisa lokuqala
• Isohlwayo sokubhalisa emva kwexesha
• Unyango
• Uncedo lweMedicare (Icandelo C)
• Isixa esivunyiweyo sonyango
• Icandelo lezaMayeza A
• Icandelo leMedare B
• Icandelo lonyango Medic C
• Icandelo leMedare D
• Iiakhawunti zokonga amayeza
• Izicwangciso zeMedigap
• Ixesha lokubhalisa elivulekileyo
• Ubhaliso loqobo
• Amayeza okuqala
• Iindleko eziphuma epokothweni
• Ubuninzi bepokotho
• Umboneleli othabatha inxaxheba
• Izicwangciso zoMbutho woMboneleli okhethiweyo (PPO)
• INkulumbuso
• Umboneleli ngenkathalelo yokuqala (PCP)
• Izicwangciso zabucala zokuNika iiNkonzo (PFFS)
• Izicwangciso zemfuno ezizodwa (SNP)
• Ixesha elithile lobhaliso (SEP)
• Ulawulo loKhuseleko loLuntu (SSA)
• Ixesha lokulinda leminyaka emibini
• Iikhredithi zomsebenzi

Ukuqonda imigaqo kunye neendleko ze-Medicare kunokukunceda ucwangcise iimfuno zakho zokhathalelo lwempilo. Kodwa ukuze uyiqonde ngokwenyani iMedicare, kuqala kufuneka uqhelane nezinye izinto ezibalulekileyo - {textend} kodwa zihlala zidida- {textend} amagama.

Nokuba ubukhe wajongana ne-inshurensi kwixa elidlulileyo, iMedicare inolwimi lwayo kwaye isebenzisa amagama akhethekileyo kunye namabinzana asebenza kuphela kwizicwangciso kunye nokugubungela. Ukwazi ukuba la magama athetha ntoni kwaye asebenza njani kwiMedicare anokukunceda ukuba uhlele ngolwazi, uhambe ngendlela, kwaye wenze olona khetho lufanelekileyo lokunyamekela impilo.

Nantsi imigaqo eqhelekileyo onokuyibona xa ujonga ukhetho lwakho lweMedare:

I-Amyotrophic lateral sclerosis (ALS)

I-ALS yimeko ebangela ukonakala kwemisipha kwaye ekugqibeleni ikhokelele ekufeni. Kukwabizwa ngokuba sisifo sikaLou Gehrig, esathiywa ngegama lomdlali ophambili weligi baseball uLou Gehrig, owasweleka nge-ALS ngo-1941.

Ukuba unayo i-ALS, ufanelekile kwi-Medicare nokuba awunayo iminyaka engama-65 ubudala. Kwaye ufanelekile kwangoko - {textend} ngaphandle kwexesha lokulinda elineminyaka emi-2 elifunekayo ukuze afaneleke kwi-Medicare xa ungaphantsi kweminyaka engama-65 ubudala kwaye unokukhubazeka okungapheliyo.

Ukugubungela intlekele

Uqala ukufumana into ebizwa ngokuba kukugubungela intlekele wakufikelela ubuninzi bokuchitha imali epokothweni iziyobisi zakho zonyaka.

Ngo-2020, ukugubungela intlekele kuqala kwi-6,350 yeedola. Nje ukuba ufikelele kwesi sixa, uya kuhlawula kuphela ikopi encinci okanye isiqinisekiso semali kunyaka ophelileyo.

Amaziko eMedicare kunye neeNkonzo zeMedicaid (CMS)

I-CMS yiarhente yomanyano ejongene neMedare kunye neMedicaid, kunye nezixhobo ezinesivumelwano kunye nabo. Imigaqo epapashwe yi-CMS iqinisekisa ukuba onke amaziko amkela iMedare kunye neMedicaid yokuhlawula ahlangabezana nemigangatho ethile.

Kleyima

Ibango sisicelo sentlawulo esithunyelwe kwisicwangciso seinshurensi njengeMedicare. Emva koko, nokuba yiMedicare okanye inkampani yeinshurensi ebonelela ngogqatso iya kulungisa ibango kwaye ihlawule umboneleli (ingcali yezempilo okanye indawo) I-Medicare okanye inkampani ye-inshurensi iyakwala ibango ukuba inkonzo ayigutyungelwanga okanye ayifuneki imeko engafakwanga.

UQinisekiso

Iindleko zokuqinisekisa ngeenkonzo yipesenti yeendleko ezipheleleyo ojongene nazo. I-Medicare Icandelo B linesiqinisekiso semali engama-20 eepesenti yemali evunyiweyo ye-Medicare yeenkonzo ezininzi ezigqunyiweyo. Oku kuthetha ukuba i-Medicare iya kuhlawula iipesenti ezingama-80 zeendleko kwaye uya kuhlawula iipesenti ezingama-20 ezisele.

ICopay

I-copay, okanye i-copayment, isixa esimiselweyo ohlawulela inkonzo ethile. Isicwangciso sakho sigubungela iindleko ezishiyekileyo. Umzekelo, isicwangciso sakho se-Medicare Advantage sinokuba ne- $ 25 ye-copay kutyelelo lonke lukagqirha.

Isithuba sokufunda

Isithuba sokugubungela, esikwabizwa ngokuba ngumngxunya wokunikela, sibhekisa kwixesha apho ungahlawula ngaphezulu amayeza akho amiselweyo. Ngo-2020, xa wena kunye ne-Medicare Part D icebo lakho lihlawule i-4,020 eyi-4,020 kwimigqaliselo yakho, usemthethweni kwi-gap gap. Eli xesha liphela nje ukuba ufikelele kwi-6,350 yeedola efunekayo ukuze ufumane ingxelo eyintlekele.

Kwixesha elidlulileyo, lo msantsa ushiye abaxhamli be-Medicare behlawula ipokotho kuwo onke amayeza abo amiselweyo. Kodwa utshintsho lwakutshanje kwimithetho yeinshurensi nguMthetho woKhathalelo ongenakufikeleleka wenze ukuba kube lula ukulawula lo msantsa.

Ukususela ngoJanuwari 1, 2020, kunokuba uhlawule iipesenti ezili-100 epokothweni, uya kuhlawula iipesenti ezingama-25 zeendleko zokufumana amayeza e-generic kunye negama lophawu ngelixa ukwisithuba sokugubungela.

Ukutsalwa

Ukuxhuzulwa yimali ekufuneka uyihlawule epokothweni ngenkonzo ngaphambi kokuba isicwangciso sakho seMedicare sihlawule naziphi na iindleko. Ngo-2020, i-Medicare Part B inokudityaniswa yi- $ 198.

Ke, uyakuhlawula i $ 198 yokuqala epokothweni yeenkonzo zononophelo lwempilo. Emva koko, isicwangciso sakho seMedare siya kuqala ukuhlawula.

Umngxuma wedonathi

Umngxunya wokunikela lelinye igama elisetyenziselwa ukuchaza umsantsa wokugubungela phakathi kwecandelo D lokuhlawula umda kunye nentlawulo ephezulu yonyaka.

Izixhobo zonyango ezihlala ixesha elide (i-DME)

I-DME ibandakanya izinto zonyango onokuzifuna ekhayeni lakho ukulawula imeko. I-DME ibandakanya izinto ezinje ngeetanki zeoksijini zasekhaya kunye nezinto zoncedo okanye izinto zokuhamba ezinjengezihamba. Isicwangciso sakho seMedicare Part B sigubungela i-DME oyalelwe ngugqirha ukuba ayifumane.

Ukuphela kwesifo sezintso (ESRD)

I-ESRD sisigaba sokugqibela sesifo sezintso, esibizwa ngokuba sisifo sezintso. Izintso zabantu abane-ESRD ayisasebenzi. Bafuna unyango lwe-dialysis okanye ukufakelwa kwezintso.

Ukuba unayo i-ESRD, unokufumana iMedare ngaphandle kwexesha lokulinda leminyaka emibini, nokuba ungaphantsi kweminyaka engama-65.

Uncedo olongezelelweyo

Uncedo olongezelelekileyo yinkqubo ye-Medicare enceda abathathi-nxaxheba ukuhlawula iindleko zeCandelo le-Medicare Icandelo D. Iinkqubo zoncedo ezongezelelweyo zisekwe kwingeniso yakho kwaye zinokukunceda nge-coinsurance okanye kwi-premium iindleko.

Ifomula

I-formulary luluhlu lwamayeza athi acwangciswe kwiCandelo D elithile. Ukuba uthatha amayeza angekho kwifomula yesicwangciso sakho, kuya kufuneka uhlawule epokothweni okanye ubuze ugqirha wakho ukuba anike amayeza afanayo acwangciswa sisicwangciso sakho.

Ixesha lokubhalisa ngokubanzi

Ungabhalisa kwiMedicare yoqobo (icandelo A no-B) minyaka le phakathi kukaJanuwari 1 noMatshi 31. Oku kwaziwa njengexesha lokubhalisa ngokubanzi. Ukusebenzisa le festile, kuya kufuneka ukuba ulungele i-Medicare kodwa ungafumani nkxaso.

Izicwangciso zoMbutho wezeMpilo (HMO)

Uncedo lweMedicare (Icandelo C) kunokubonelelwa ngeendlela ezahlukeneyo, kuxhomekeka kwindawo okuyo. Ii-HMOs ziluhlobo lwesicwangciso sokuNceda. Nge-HMO, uyacelwa ukuba usebenzise uthungelwano olusetwe ngabanikezeli bezempilo kunye namaziko ukuba ufuna isicwangciso sakho seMedicare sokugubungela iindleko. Kuya kufuneka ukuba ukhethe ugqirha oyintloko kwaye ufumane ukuthunyelwa kulo gqirha ukuba ufuna ukubona iingcali.

Ingeniso yohlengahlengiso yenyanga (IRMAA)

Abaxhamli be-Medicare abenza ngaphezulu kwe- $ 87,000 baya kuhlawula ngaphezulu kwe-standard ye-144.60 yecandelo B ipremiyamu yenyanga. Le nyuso yonyuso ibizwa ngokuba yi-IRMAA. Ukunyuka komvuzo wakho, kokukhona i-IRMAA yakho iya kuba, ukuya kuthi ga kwi-491.60 ephezulu.

Ixesha lokubhalisa lokuqala

Ixesha lakho lokuqala lokubhalisa lifestile leenyanga ezi-7 eliqala kwiinyanga ezi-3 ngaphambi kwenyanga yokuzalwa kwakho kwama-65. Yilapho uqala khona ukubhalisela i-Medicare. Ixesha lokubhalisa liphela kwiinyanga ezi-3 emva kwenyanga yakho yokuzalwa.

Umzekelo, ukuba ujika iminyaka engama-65 ubudala ngo-Agasti 2020, ixesha lakho lokuqala lokubhalisa liza kuqala ngoMeyi 2020 ukuya kuNovemba 2020.

Isohlwayo sokubhalisa emva kwexesha

Ukuba awubhalisi kwiCandelo B xa uqala ukufumana i-Medicare, unokufuna ukuhlawula isohlwayo sokubhalisa emva kwexesha xa ubhalisa.

Ngokubanzi, uya kuhlawula iipesenti ezili-10 ezongezelelweyo kunyaka ngamnye ongabhaliswanga. Imali yesohlwayo yongezwa kwintlawulo yakho yenyanga yepremiyamu.

Awuyi kuhlawula isohlwayo sokubhalisa emva kwexesha ukuba ulungele ixesha elithile lobhaliso.

Unyango

I-Medicaid yinkqubo yeinshurensi yezempilo eyenzelwe abantu abanengeniso encinci.Iinkqubo zeMedicaid zilawulwa ngurhulumente ngamnye, ke imigaqo kunye neenkcukacha ezichanekileyo ziyahluka.

Ukuba ufanelekile kwiMedicaid, ungayisebenzisa kunye neMedare kunye nokunciphisa okanye ukuphelisa iindleko zakho zokuphuma epokothweni.

Uncedo lweMedicare (Icandelo C)

Izicwangciso zeMedare eziluncedo zikwabizwa ngokuba zizicwangciso zeMedicare Part C. Banikezelwa ziinkampani zabucala ezenza isivumelwano neMedicare.

Izicwangciso eziluncedo zithatha indawo yonyango lwantlandlolo (Icandelo A kunye neCandelo B). Zonke izicwangciso ze-Medicare Advantage kufuneka zigubungele yonke into e-A kunye ne-B yokugubungela. Kwaye, uninzi lwezicwangciso zongeza ukogquma okongezelelekileyo kwizinto ezinjengokunakekelwa kwamazinyo, iinkonzo zombono, okanye amayeza.

Izicwangciso ze-Medicare Advantage zineepremiyamu zazo, ezitsalwayo, kunye nezinye iindleko eziphuma epokothweni.

Isixa esivunyiweyo sonyango

I-Medicare isete amaxabiso ezakuhlawula iinkonzo zononophelo lwempilo. Eli xabiso libizwa ngokuba lixabiso elivunyiweyo le-Medicare. Onke amaziko ezempilo amkela i-Medicare avumile ukubiza ezi mali zivunyiweyo ngeenkonzo.

Icandelo lezaMayeza A

Icandelo leMedicare A yinshurensi yesibhedlele. Ibandakanya ukuhlala kwakho esibhedlele, kunye nokuhlala kwindawo zononophelo lwexesha elide. Unokufumana ingxelo ethile yempilo yekhaya okanye ukhathalelo lwe-hospice.

Icandelo leMedare B

Icandelo leMedicare B yinshurensi yezonyango. Ibandakanya izinto ezinjengotyelelo logqirha, utyelelo lweengcali, impilo yengqondo, kunye nezixhobo zonyango ezizinzileyo. Icandelo B likwajonga ngononophelo olungxamisekileyo kunye notyelelo kwigumbi likaxakeka.

Icandelo lonyango Medic C

Maxa wambi i-Medicare Advantage ibizwa ngokuba yi-Medicare Part C. La magama mabini abhekisa kwinkqubo enye. Ke, isicwangciso seCandelo C sisicwangciso seNzuzo.

Icandelo leMedare D

Icandelo lonyango i-Medicare Icandelo D likwahlulahlula amayeza amiselweyo. Amayeza e-Medicare A kunye no-B abonelela kuphela ngesibhedlele esinganyanzelekanga, ke abanye abaxhamli bakhetha ukuthenga ukogquma olongezelelweyo ngesicwangciso seCandelo D. Isicwangciso sakho seCandelo D siya kuba nepremiyamu eyahlukileyo.

Iiakhawunti zokonga amayeza

Iakhawunti yokonga i-Medicare (i-MSA) luhlobo lwesicwangciso se-Medicare Advantage esinexabiso eliphezulu lokutsala kunye neakhawunti yokonga eqhotyoshelweyo. Izicwangciso ze-MSA zifaka imali kwiakhawunti yokonga, enokusetyenziselwa ukuhlawula iindleko zonyango ngaphambi kokuba uhlangane nokutsalwa.

Izicwangciso zeMedigap

Izicwangciso zeMedigap zizicwangciso zokuncedisa ekuncedeni ukuhlawulela iindleko ezingaphandle kweepokotho zoNyango lokuqala. Kukho izicwangciso ezili-10 ezahlukeneyo zeMedigap.

Ezi zicwangciso zibonelelwa ziinkampani ezenza isivumelwano neMedicare. Iindleko zakho zeMedigap zinokwahluka ngokuxhomekeke kwimeko yakho.

Ixesha lokubhalisa elivulekileyo

Amaxesha obhaliso avulekileyo enziwa ngexesha elimiselweyo minyaka le, ukusukela nge-15 ka-Okthobha ukuya nge-Disemba 7. Ngexesha lewindows evulekileyo, ungabhalisela isicwangciso seAdvantage, uthenge iMedigap, kunye nokunye.

Ubhaliso loqobo

Ixesha lakho lokuqala lokubhalisa kuxa uqala ukubhalisa kwi-Medicare. Oku kuhlala kwenzeka ngexesha lokubhalisa okokuqala, kwi-7-inyanga yewindows ejikeleze usuku lwakho lokuzalwa lwama-65. Ukuba ungaphantsi kweminyaka engama-65, inokuba yiminyaka emi-2 emva kokuba uqale ukufumana izibonelelo zoKhuseleko loLuntu.

Amayeza okuqala

Amalungu e-Medicare A kunye no-B kunye bahlala babizwa ngokuba yiMedicare yoqobo, okanye iMedicare yemveli. I-Medicare yoqobo ayibandakanyi iCandelo C (izicwangciso zoncedo), iCandelo D, okanye izicwangciso zeMedigap.

Iindleko eziphuma epokothweni

Iindleko zakho eziphuma epokothweni ziimali ozihlawulelayo kukhathalelo lwempilo yakho. Banokubandakanya ukuncitshiswa kwakho, ukuqinisekiswa kwemali, kunye nexabiso lokuhlawulwa.

Ubuninzi bepokotho

Esona sithuba siphezulu epokothweni sisixa semali oza kuyibhatala iinkonzo zononophelo lwempilo ezivunyiweyo kuwo nawuphi na unyaka othile. Nje ukuba ufike kule mali, i-Medicare iya kuthatha zonke iindleko kwezi nkonzo zivunyiweyo.

Ubuninzi beepokotho eziphuma ngaphandle zibandakanya ukukhutshwa kunye nokuhlawulwa kwemali. Kuphela zii-Medicare Advantage (Icandelo C) ezinezicwangciso zazo. Isicwangciso ngasinye se-Medicare Advantage sinokusetha le mali, ngoko kuyahluka. Ngo-2020, ukuphuma ngaphandle kwe-pocket akunakudlula i- $ 6,700 ngonyaka.

Umboneleli othabatha inxaxheba

Umboneleli othatha inxaxheba ngumboneleli wezempilo onesivumelwano neMedicare ukubonelela ngenkonzo okanye oyinxalenye yenethiwekhi yesicwangciso se-HMO okanye se-PPO. Ababoneleli abathathe inxaxheba bavumile ukwamkela isixa esivunyiweyo se-Medicare ngeenkonzo kunye nokunyanga abaxhamli be-Medicare.

Izicwangciso zoMbutho woMboneleli okhethiweyo (PPO)

Ii-PPO lolunye uhlobo oluthandwayo lwesicwangciso seMedareare. Njenge-HMO, ii-PPOs zisebenza nenethiwekhi ebekiweyo yababoneleli. Nge-PPO, nangona kunjalo, ungaphumela ngaphandle kwenethiwekhi ukuba ukulungele ukuhlawula imali eninzi okanye iimali ezihlawulelwa nge-coinsurance.

INkulumbuso

Ipremiyamu sisixa osibhatala ngenyanga kwi-inshurensi. Kuba uninzi lwabantu aluhlawuli mali kwi-Medicare Part A, uhlala uhlawula ipremiyamu yecandelo B kuphela xa une-Medicare yoqobo. Intlawulo yePrimiyamu ye-B ngo-2020 yi- $ 144.60.

Izicwangciso zeMedare eziluncedo, izicwangciso zeCandelo D, kunye nezicwangciso zeMedigap zithengiswa ziinkampani zeinshurensi zabucala. Oku kunokuhlawulisa ipremiyamu eyahlukileyo ngokuxhomekeke kwinkampani okanye kwisicwangciso osikhethileyo.

Umboneleli ngenkathalelo yokuqala (PCP)

I-PCP yakho ngugqirha okubonayo kukhathalelo oluqhelekileyo kunye nokukhusela, njengakwimizimba yonyaka. Ngaphantsi kwezicwangciso ze-HMO ze-Medicare eziluncedo, kuyakufuneka usebenze kunye ne-PCP yenethiwekhi. Kwaye ukuba ufuna ukhathalelo olukhethekileyo, i-PCP yakho kuyakufuneka yenze ukuthunyelwa kwisicwangciso sakho sokugubungela olu khathalelo.

Izicwangciso zabucala zokuNika iiNkonzo (PFFS)

Isicwangciso se-PFFS luhlobo olungaqhelekanga lwesicwangciso seMedicare Advantage esingenayo inethiwekhi okanye esifuna ukuba ube nogqirha wokuqala. Endaweni yoko uya kuhlawula imali ebekiweyo kwinkonzo nganye oyifumanayo nakweliphi na iziko elamkelweyo lonyango.

Izicwangciso zemfuno ezizodwa (SNP)

Ezinye iinkampani zibonelela ngezicwangciso zeMedicare Advantage ezaziwa ngokuba zii-SNP. I-SNP yenzelwe abaxhamli abaneemfuno ezizodwa zemali okanye zokhathalelo lwempilo.

Umzekelo, unokubona ii-SNP ngokukodwa:

• abantu abahlala kumaziko okonga
• abantu abanengeniso encinci
• abantu abalawula imeko enganyangekiyo njengesifo seswekile

Ixesha elithile lobhaliso (SEP)

I-SEP yiwindow ekuvumela ukuba ubhalise kwi-Medicare ngaphandle kwamaxesha okuqala okanye abanzi obhaliso lwamaxesha. I-SEPs zenzeka xa unotshintsho olukhulu kubomi, njengokufudukela kwindawo entsha yokugubungela okanye ukuthatha umhlala phantsi emsebenzini owawukubonelele nge-inshurensi yakho yezempilo.

Emva kotshintsho lwakho okanye umcimbi wobomi, uya kuba nefestile yeenyanga ezi-8 ukuze ubhalisele i-Medicare. Ukuba ubhalisa ngeli xesha, awuyi kuhlawula isohlwayo sokubhalisa emva kwexesha.

Ulawulo loKhuseleko loLuntu (SSA)

Ulawulo loKhuseleko loLuntu (i-SSA) yiarhente yomanyano elawula izibonelelo zomhlala phantsi kunye nezokukhubazeka. Ukuba ufumana izibonelelo ze-SSA, unokufumana i-Medicare Part A-free-free. Ukuba ufumene izibonelelo zokukhubazeka kwezentlalo iminyaka emibini, uya kubhaliswa ngokuzenzekelayo kwi-Medicare, nokuba ungaphantsi kweminyaka engama-65.

Ixesha lokulinda leminyaka emibini

Unokufumana iMedicare ukuba ungaphantsi kweminyaka engama-65 kwaye unokukhubazeka okungapheliyo. Uzakufuna ukufumana umvuzo wokukhubazeka koKhuseleko lweNtlalo kwaye uyifumane iminyaka emi-2 ngaphambi kokuba ugqatso lweMedare luqale. Oku kwaziwa njengexesha lokulinda leminyaka emibini.

Kubalulekile ukuba uqaphele ukuba eli xesha lokulinda leminyaka emibini alisebenzi kubantu abane-ESRD okanye i-ALS.

Iikhredithi zomsebenzi

Iikhredithi zomsebenzi zimisela ukufaneleka kwakho kwezibonelelo zoKhuseleko lweNtlalo kunye nakwisigaba se-A. . Abasebenzi abancinci abakhubazekileyo banokufanelekela ukufumana iikhredithi ezimbalwa.

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.