Yintoni iNkqubo yokuthintela isifo seswekile?

Umxholo

• Yintoni iNkqubo yokuthintela isifo seswekile?
• Loluphi ukhuselo olunikezelwa nguMedicare kwezi nkonzo?
• Icandelo le-Medicare Icandelo B
• Uncedo lweMedicare
• Zeziphi iinkonzo ezinikezelwa ngale nkqubo?
• Isigaba 1: Iiseshoni ezingundoqo
• Isigaba 2: Iiseshoni zolondolozo olungundoqo
• Isigaba 3: Ukuqhubeka kweeseshoni zolondolozo
• Ngubani ofanelekileyo kule nkqubo?
• Ndibhalisa njani kule nkqubo?
• Ndingalufumana njani uninzi lwenkqubo?
• Yintoni enye egutyungelweyo kukhathalelo lweswekile phantsi kweMedare?
• Ukuthatha

• Inkqubo yokuthintela isifo seswekile inokunceda abantu abasemngciphekweni wohlobo lweswekile 2.
• Le yinkqubo yasimahla yabantu abafanelekileyo.
• Iya kukunceda ulandele indlela yokuphila esempilweni kwaye wehlise umngcipheko wesifo seswekile.

Isifo seswekile yenye yezona zinto zixhaphake kakhulu eMelika. Ngapha koko, abantu abadala baseMelika babenesifo seswekile ukusukela ngo-2010. Kubantu abaneminyaka engama-65 okanye ngaphezulu, elo nani liqela ngaphezulu kwe-1 kwaba-4.

I-Medicare, kunye neminye imibutho yezempilo efana namaZiko oLawulo noKhuseleko lweZifo (i-CDC), ibonelela ngenkqubo ebizwa ngokuba yiNkqubo yokuThintela isifo seSwekile (i-MDPP). Yenzelwe ukunceda abantu abasemngciphekweni wesifo seswekile ukusithintela.

Ukuba ufanelekile, unokujoyina inkqubo simahla. Uya kufumana iingcebiso, inkxaso, kunye nezixhobo ozifunayo ukukhokela indlela yokuphila esempilweni kunye nokunciphisa ithuba lakho lokufumana isifo seswekile.

Yintoni iNkqubo yokuthintela isifo seswekile?

I-MDPP yenzelwe ukunceda abaxhamli be-Medicare abaneempawu zesifo seswekile bahlakulela imikhwa esempilweni yokuthintela uhlobo lweswekile yesi-2. Amaziko e-Medicare kunye neeNkonzo zeMedicaid (i-CMS) ijongene nenkqubo kwinqanaba lomdibaniso.

Ukususela ngo-2018, i-MDPP inikwe abantu abafanelekileyo kwi-Medicare. Yaqulunqwa ngokuphendula kwinani elikhulayo labantu baseMelika abanesifo seswekile.

Amanani aphezulu kakhulu phakathi kwabantu baseMelika abaneminyaka engama-65 nangaphezulu. Ngapha koko, ngo-2018, iipesenti ezingama-26.8 zabantu baseMelika abangaphezu kweminyaka engama-65 babenesifo seswekile. Eli nani kulindeleke ukuba liphindwe kabini okanye liphindwe kathathu.

Isifo seswekile sisigulo esinganyangekiyo- kwaye siyabiza. Ngo-2016 kuphela, i-Medicare yachitha i-42 yezigidigidi ekunyamekeleni isifo seswekile.

Ukunceda abaxhamli kunye nokonga imali, inkqubo yokulinga ebizwa ngokuba yiNkqubo yesifo seswekile (DPP) yaphuhliswa. Ivumela i-Medicare ukuba ichithe imali kuthintelo lwesifo seswekile, ngethemba lokuba oku kuya kuthetha imali encinci echithwe kamva kunyango lweswekile.

I-DPP ijolise kwisikhokelo se-CDC sokunciphisa umngcipheko wesifo seswekile kubantu abane-prediabetes. Iindlela zibandakanya ukufundisa abantu ababhalise kwi-DPP ukuba:

• batshintshe ukutya kwabo
• ukwandisa umsebenzi wabo ngokwasemzimbeni
• yenza ukhetho lokuphila ngendlela esempilweni ngokubanzi

Inkqubo yoqobo yaqhuba iminyaka emi-2 kwiindawo ezili-17 kwaye yaba yimpumelelo iyonke. Incede abathathi-nxaxheba ukuba banciphise ubunzima, banciphise amathuba abo okuba nesifo seswekile, kwaye babe nokulaliswa esibhedlele okumbalwa. Kwaye igcine imali yeMedicare kunyango.

Ngo-2017, inkqubo yandiswa yaya kwi-MDPP yangoku.

Loluphi ukhuselo olunikezelwa nguMedicare kwezi nkonzo?

Icandelo le-Medicare Icandelo B

Icandelo leMedicare B yinshurensi yezonyango. Kunye neMedicare Icandelo A (i-inshurensi yesibhedlele), yenza into eyaziwa ngokuba yiMedicare yoqobo. Icandelo B ligubungela iinkonzo ezifana notyelelo logqirha, iinkonzo zonyango, kunye nokhathalelo lokuthintela.

Unonophelo lothintelo lugutyungelwe ngokupheleleyo kubantu ababhalise kwi-Medicare. Oku kuthetha ukuba awuyi kufuna ukuhlawula iipesenti ezingama-20 zezi ndleko, njengokuba unokwenza kwiinkonzo ezininzi zeCandelo B.

Unonophelo lubandakanya iinkqubo ezahlukeneyo kunye neenkonzo zokukunceda uhlale usempilweni, kubandakanya:

• Ukutyelela impilo
• ukuyeka ukutshaya
• isitofu
• ukuhlolwa komhlaza
• Uvavanyo lwempilo yengqondo

Njengazo zonke iinkonzo zokuthintela, i-MDPP ayizukubiza nantoni na ukuba nje uhlangabezana neemfuno zokufaneleka (ezixoxwe ngezantsi) kwaye usebenzise umboneleli ovunyiweyo.

Ufanelekile kuphela kwi-MDPP kube kanye ngexesha lokuphila kwakho; I-Medicare ayizukuyihlawula okwesibini.

Uncedo lweMedicare

Uncedo lweMedicare, ekwabizwa ngokuba yiMedicare Part C, lukhetho olukuvumela ukuba uthenge icebo kwinkampani yeinshurensi yabucala enesivumelwano neMedicare. Zonke izicwangciso ze-Medicare Advantage ziyafuneka ukuba zibonelele ngokugubungela okufanayo ne-Medicare yoqobo.

Izicwangciso ezininzi zokuNceda zongeza ukongezwa okongeziweyo, okufana:

• ukhathalelo lwamazinyo
• ukhathalelo lombono
• izixhobo zokuva kunye novavanyo
• amayeza amiselweyo
• izicwangciso zokomelela

Izicwangciso ze-Medicare Advantage zikwabonelela ngeenkonzo zokuthintela zasimahla. Kodwa ezinye izicwangciso zinenethiwekhi, kwaye kuyakufuneka uhlale kwinethiwekhi ukuze ufumane ingxelo epheleleyo. Ukuba indawo ye-MDPP onomdla kuyo ayikho kwinethiwekhi, kungafuneka uhlawule ezinye okanye zonke iindleko ziphuma epokothweni.

Ukuba kukuphela kwendawo ye-MDPP kwindawo yakho, isicwangciso sakho sinokuyigubungela ngokupheleleyo. Ukuba unokhetho lwasekhaya lwenethiwekhi, nangona kunjalo, indawo engaphandle kwenethiwekhi ayizukugutyungelwa. Ungabiza umniki-nkonzo wakho ngokuthe ngqo ngeenkcukacha zokugubungela.

NjengeCandelo B, unokufumana i-MDPP kube kanye kuphela.

Zeziphi iinkonzo ezinikezelwa ngale nkqubo?

Iinkonzo ozifumanayo kwi-MDPP ziya kufana nokuba yeyiphi na indawo oyisebenzisayo ye-Medicare.

Le nkqubo yeminyaka emi-2 yahlulwe yangamanqanaba amathathu. Ngexesha lesigaba ngasinye, uya kuba usete iinjongo kwaye uza kufumana inkxaso yokukunceda uzihlangabeze.

Isigaba 1: Iiseshoni ezingundoqo

Isigaba 1 sihlala kwiinyanga ezi-6 zokuqala ubhalisile kwi-MDPP. Ngeli nqanaba, uya kuba neeseshoni ezili-16 zeqela. Nganye iya kwenzeka kube kanye ngeveki malunga neyure.

Iiseshoni zakho ziya kukhokelwa ngumqeqeshi we-MDPP. Uya kufunda iingcebiso ngokutya okunempilo, ukomelela, kunye nokunciphisa umzimba. Umqeqeshi uya kulinganisa ubunzima bakho kwiseshoni nganye ukujonga inkqubela yakho.

Isigaba 2: Iiseshoni zolondolozo olungundoqo

Ngexesha leenyanga ze-7 ukuya kwi-12, uya kuba kwisigaba 2. Uya kuya kwiiseshoni ezintandathu ubuncinci kwesi sigaba, nangona inkqubo yakho inokubonelela ngakumbi. Uya kufumana uncedo oluqhubekayo ngokuphuhlisa imikhwa esempilweni, kwaye ubunzima bakho buya kuqhubeka nokulandelwa.

Ukuhambisa isigaba 2 esidlulileyo, kuya kufuneka ubonise ukuba wenza inkqubela phambili kwinkqubo. Ngokubanzi, oku kuthetha ukuya kwiseshoni enye ubuncinci kwinyanga ye-10 ukuya kwe-12 kunye nokubonisa ukwehla kobunzima beepesenti ezi-5 ubuncinci.

Ukuba awenzi nkqubela phambili, i-Medicare ayizukuhlawulela ukuba udlulele kwisigaba esilandelayo.

Isigaba 3: Ukuqhubeka kweeseshoni zolondolozo

Isigaba 3 linqanaba lokugqibela lenkqubo kwaye lihlala unyaka omnye. Lo nyaka wohlulwe waba ngamaxesha amane aneenyanga ezintathu nganye, ebizwa ngokuba ngamakhefu.

Uya kudinga ukuya kwiiseshoni ezimbini ubuncinci kwixesha ngalinye kwaye uqhubeke nokudibana neenjongo zokunciphisa umzimba ukuze uqhubeke kwinkqubo. Uya kuba neeseshoni ubuncinci kube kanye ngenyanga, kwaye umqeqeshi wakho uya kuqhubeka ekunceda njengoko ulungelelanisa nendlela otya ngayo kunye nendlela ophila ngayo.

I-Medicare ivumela ababoneleli ukuba banikeze iiseshoni zokuzenzela kodwa ayifuni. Oku kuthetha ukuba kuya kumboneleli wakho.

Umboneleli wakho we-MDPP kufuneka akwazise xa ubhalisa ukuba zeziphi iindlela onokukhetha kuzo ukuba uphose iseshoni. Abanye ababoneleli banokukuvumela ukuba ujoyine elinye iqela ngobusuku obahlukileyo, ngelixa abanye benokunika umntu ngamnye okanye iiseshoni ezibonakalayo.

Ngubani ofanelekileyo kule nkqubo?

Ukuqala i-MDPP, kufuneka ubhalise kwi-Medicare Part B okanye kwiCandelo C. Kuya kufuneka ke uhlangane nezinye iikhrayitheriya ezongezelelweyo. Ukubhalisa, ngekhe ube:

• ufunyaniswe unesifo seswekile, ngaphandle kokuba sisifo seswekile sokukhulelwa
• ukufumanisa ukuba unesifo se-renal ekupheleni (ESRD)
• ababhalise kwi-MDPP ngaphambili

Ukuba uyazifezekisa ezi mfuno, kuyakufuneka ubonakalise ukuba uneempawu zesifo seswekile. Oku kubandakanya isalathiso sobunzima bomzimba (BMI) esingaphezulu kwama-25 (okanye ngaphezulu kwama-23 abathathi-nxaxheba abachonga njengeAsia). I-BMI yakho iya kubalwa ngokobunzima bakho kwiiseshoni zakho zokuqala.

Uya kudinga umsebenzi waselebhu obonisa ukuba une-prediabetes. Ungasebenzisa esinye seziphumo ezintathu ukuze ufaneleke:

• Uvavanyo lwehemoglobin A1c ngeziphumo zeepesenti ezi-5.7 ukuya kwiipesenti ezi-6.4
• Uvavanyo lweplasma lweglucose kunye neziphumo ze-110 ukuya kwi-125 mg / dL
• Uvavanyo lokunyamezelana ngeswekile yomlomo kunye neziphumo ze-140 ukuya kwi-199 mg / dL

Iziphumo zakho ziya kudinga ukusuka kwiinyanga ezili-12 ezidlulileyo kwaye kufuneka ube nengqinisiso kagqirha wakho.

Ndibhalisa njani kule nkqubo?

Elinye lamanyathelo akho okuqala obhaliso kufuneka uthethe nogqirha wakho malunga neempawu zakho zesifo seswekile. Ugqirha wakho unokuqinisekisa i-BMI yakho yangoku kwaye u-odole umsebenzi waselebhu oya kuwufuna ngaphambi kokujoyina inkqubo.

Emva koko unokukhangela iinkqubo kwindawo yakho usebenzisa le mephu.

Qinisekisa ukuba nayiphina inkqubo oyisebenzisayo iyavunywa. Ukuba unesicwangciso seMedicare Advantage (Icandelo C), uya kufuna ukuqinisekisa ukuba inkqubo ikunethiwekhi.

Akufanele ufumane ibhilikhwe ngezi nkonzo. Ukuba uyakwenza oko, ungaqhagamshelana neMedicare ngoko nangoko ngokubiza 800-Medicare (800-633-4227).

Ndingalufumana njani uninzi lwenkqubo?

Kubalulekile ukuba ulungele utshintsho oluza kuza ne-MDPP. Kuya kufuneka wenze utshintsho kwindlela ophila ngayo, kubandakanya:

• ukupheka ukutya okungakumbi ekhaya
• ukutya iswekile encinci, amanqatha, kunye nee-carbohydrate
• ukusela isoda encinci kunye nezinye iziselo ezineswekile
• ukutya kakhulu inyama kunye nemifuno
• ukufumana umthambo ngakumbi kunye nomsebenzi

Akunyanzelekanga ukuba wenze lonke olu tshintsho ngaxeshanye. Utshintsho oluncinci ekuhambeni kwexesha lunokwenza umahluko omkhulu. Kwaye umqeqeshi wakho unokukunceda ngokubonelela ngezixhobo ezifana neeresiphi, iingcebiso kunye nezicwangciso.

Kungaluncedo ukuba neqabane lakho, ilungu losapho, okanye umhlobo azibophelele kolunye lolu tshintsho kunye nawe, nokuba abekho kwi-MDPP. Umzekelo, ukuba nomntu oza kuhamba naye imihla ngemihla okanye upheke naye kunokukugcina ukhuthazeka phakathi kweeseshoni.

Yintoni enye egutyungelweyo kukhathalelo lweswekile phantsi kweMedare?

I-MDPP yenzelwe ukuthintela isifo seswekile. Ukuba sele unesifo seswekile okanye usiphuhlise kamva, unokufumana ukogquma uluhlu lweemfuno zononophelo. Ngaphantsi kweCandelo B, ukugubungela kubandakanya:

• Uvavanyo lweswekile. Ufumana ukugubungela ukuhlolwa kabini ngonyaka.
• Ukuzilawula kweswekile. Ukuzilawula kukufundisa indlela yokujova i-insulin, ukubeka esweni iswekile yegazi lakho kunye nokunye.
• Izinto zeswekile. Icandelo B ligubungela izinto ezinje ngemicu yovavanyo, iimonitha zeswekile, kunye neempompo ze-insulin.
• Uvavanyo lweenyawo kunye nokhathalelo. Isifo seswekile sinokuchaphazela impilo yeenyawo zakho. Ngesi sizathu, uya kugutyungelwa uvavanyo lweenyawo rhoqo kwiinyanga ezi-6. I-Medicare iya kuhlawulela ukhathalelo kunye nokubonelelwa, ezinje ngezihlangu ezikhethekileyo okanye amalungu okufakelwa.
• Iimviwo zamehlo. I-Medicare iya kukuhlawulela ukuba uhlolwe i-glaucoma kanye ngenyanga, kuba abantu abanesifo seswekile basemngciphekweni owandayo.

Ukuba unayo i-Medicare Part D (ukumiselwa kweziyobisi), unokufumana ingxelo yoku:

• amayeza antidiabetic
• insulin
• iinaliti, iisirinji, kunye nezinye izinto

Nasiphi na isicwangciso se-Medicare Advantage siya kubandakanya zonke iinkonzo ezifanayo njengeCandelo B, kwaye uninzi lubandakanya ezinye zezinto ezigutyungelwe iCandelo D ngokunjalo.

Ukuthatha

Ukuba unesifo seswekile, i-MDPP inokukunceda uthintele uhlobo lweswekile yesi-2. Khumbula ukuba:

• Ukuthatha inxaxheba kwi-MDPP kukhululekile ukuba ufanelekile.
• Unokuba kwi-MDPP kube kanye.
• Kuya kufuneka ube nezalathi ze-prediabetes ukuze ufaneleke.
• I-MDPP inokukunceda wenze utshintsho kwindlela yokuphila esempilweni.
• I-MDPP ihlala iminyaka emi-2.

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.