Yintoni amayeza?

Umxholo

• Isebenza njani iMedicare?
• Zithini iinxalenye zonyango?
• Icandelo A (ukungeniswa esibhedlele)
• Icandelo B (lonyango)
• Icandelo C (Uncedo ngamayeza)
• Icandelo D (imigqaliselo)
• Unyango lweMedare (iMedigap)
• Uyifumana njani iMedicare
• Iingcebiso zokukhetha isicwangciso seMedare
• Ukuthatha

• I-Medicare i-inshurensi exhaswa ngemali ngabantu abangama-65 okanye nangaphezulu kunye nabantu abaneemeko ezingapheliyo okanye abakhubazekileyo.
• I-Medicare ibonelela ngeendlela ezahlukeneyo ze-inshurensi ukukunceda ukuhlangabezana neemfuno zakho.
• Ukwenza uluhlu lweemeko onazo, amayeza owathathayo, kunye noogqirha ozibonayo banokukunceda ukhethe izicwangciso zeMedare.

I-inshurensi inokuba lixabiso, kwaye ukuzama ukufumana zonke iinketho zokhathalelo lwempilo onokuzifumana kunokuba nzima kwaye kuphazamise.

Nokuba umtsha kwiMedicare okanye unomdla wokuhlala unolwazi, nantsi into ekufuneka uyazi malunga neziseko zenkqubo yeinshurensi yezempilo.

Isebenza njani iMedicare?

I-Medicare yinkqubo ye-inshurensi yezempilo exhaswa ngurhulumente ebonelela ngonyango kubantu abangaphezulu kweminyaka engama-65.

• unokukhubazeka kwaye bebefumana izibonelelo zokukhubazeka kwezentlalo kangangeminyaka emibini
• ubenomhlala-phantsi okhubazekileyo ovela kwiBhodi yoMhlala-phantsi yoLoliwe
• ndinesifo sikaLou Gehrig (ALS)
• ukusilela kwezintso (isifo sesibindi sokugqibela) kwaye ufumane idialysis okanye wenze utyando lwezintso

Le inshurensi yezempilo inokusetyenziswa njenge-inshurensi ephambili okanye njengesongezelelo, ukogquma ukhuseleko. I-Medicare ingasetyenziselwa ukunceda ukuhlawulela ukhathalelo lonyango kunye nokhathalelo lwexesha elide, kodwa ayinakukugubungela zonke iindleko zonyango.

Ixhaswa ngerhafu kwaye, kwezinye iimeko, iipremiyamu ezikhutshelwa kuhlolo lwakho lokhuseleko lwentlalo okanye ohlawulayo.

Zithini iinxalenye zonyango?

I-Medicare yenzelwe ukujongana neemfuno zakho zonyango, ezinje ngokuhlala esibhedlele kunye notyelelo kugqirha. Inkqubo yenziwe ngamacandelo amane: Icandelo A, Icandelo B, Icandelo C, kunye neCandelo D.

Icandelo A kunye neCandelo B ngamanye amaxesha kuthiwa yiMedicare yoqobo. La macandelo mabini abonelela uninzi lweenkonzo ezibalulekileyo.

Icandelo A (ukungeniswa esibhedlele)

Icandelo leMedicare A ligubungela ukhathalelo lwakho lasesibhedlele, kubandakanya neenkonzo ezahlukeneyo ezinxulumene nesibhedlele. Uninzi lwenkathalo yakho enxulumene nonyango ihlawulwa yiCandelo A ukuba kufuneka uye esibhedlele njengesigulana. Icandelo A likwagubungela ukhathalelo lwe-hospice kwabo bagulela ukufa.

Uninzi lwabantu abanengeniso encinci, aziyi kubakho iipremiyamu. Abantu abanemivuzo ephezulu banokuhlawula imali encinci inyanga nenyanga ngesi sicwangciso.

Icandelo B (lonyango)

Icandelo leMedicare B ligubungela ukhathalelo lonyango ngokubanzi kunye nokunyamekela abaguli ukuba ungafuna ukuhlala usempilweni, kubandakanya:

• inxalenye enkulu yeenkonzo zokuthintela
• Izinto zonyango (ezaziwa ngokuba zizixhobo zonyango ezomeleleyo, okanye i-DME)
• Iindidi ezininzi zovavanyo kunye novavanyo
• iinkonzo zempilo yengqondo

Kukho i-premium yolu hlobo lwe-Medicare, ngokusekelwe kwingeniso yakho.

Icandelo C (Uncedo ngamayeza)

Icandelo leMedicare C elaziwa ngokuba yiMedicare Advantage, ayisiyiyo isibonelelo sonyango esahlukileyo. Sisibonelelo esivumela iinkampani zeinshurensi zabucala ezivunyiweyo ukuba zibonelele ngezicwangciso zeinshurensi kubantu ababhalise kwiCandelo A no-B.

Ezi zicwangciso zigubungela zonke izibonelelo kunye neenkonzo ezifunyanwa ziinxalenye A no-B. Banokubonelela ngezibonelelo ezongezelelekileyo, ezinje ngokugqunywa ngamayeza amayeza, amazinyo, umbono, ukuva, kunye nezinye iinkonzo. Izicwangciso ze-Medicare ze-Advantage zihlala zineemali ezongezelelweyo ezinje ngee-copays kunye nezokutsalwa. Ezinye izicwangciso azinazo iipremiyamu, kodwa ukuba isicwangciso osikhethileyo sinepremiyamu, inokutsalwa kwitshekhi yakho yokhuseleko lwentlalo.

Icandelo D (imigqaliselo)

Icandelo leMedicare D ligubungela amayeza amiselweyo. Indleko okanye ipremiyamu yesi sicwangciso ixhomekeke kumvuzo wakho, kwaye iimali zakho ezikhutshiweyo kunye nokutsalwa kuxhomekeke kuhlobo lwamayeza owafunayo.

I-Medicare ibonelela ngoluhlu, olubizwa ngokuba yi-formulary, lweziyobisi Icandelo ngalinye lesicwangciso se-D ligubungela ukuze uyazi ukuba amayeza owafunayo agutyungelwe sisicwangciso ocinga ngaso.

Unyango lweMedare (iMedigap)

Nangona i-Medicare supplement ayibizwa ngokuba "yinxalenye," yenye yeentlobo ezintlanu eziphambili ze-inshurensi ye-Medicare ekufuneka uyiqwalasele. IMedigap isebenza ngeMedicare yoqobo kwaye iyanceda ukuhlawula iindleko ezingaphandle kweepokotho ezingafunwa yiMedicare yoqobo.

IMedigap ithengiswa ziinkampani zabucala, kodwa iMedicare ifuna ukuba uninzi lwamazwe lubonelele ngokugubungela okufanayo. Kukho izicwangciso ezili-10 zeMedigap ezikhoyo: A, B, C, D, F, G, K, L, M, noN. Isicwangciso ngasinye sahluke kancinane kwizinto ezithile esizigubungelayo.

Ukuba ubunelungelo lokuqala kwi-Medicare emva kweJanuwari 1, 2020, awufanelanga ukuthenga izicwangciso C okanye F; kodwa, ukuba ubulungele ngaphambi kwalo mhla, ungazithenga. Isicwangciso seMedigap D kunye noCwangciso G okwangoku sibonelela ngokugubungela okufanayo njengezicwangciso C no-F.

Uyifumana njani iMedicare

Uya kubhaliswa ngokuzenzekelayo kule nkqubo ukuba sele ufumana izibonelelo zokhuselo loluntu. Ukuba awukazifumani izibonelelo, ungaqhagamshelana neofisi yokhuseleko lwentlalo ukuya kuthi ga kwiinyanga ezintathu ngaphambi kosuku lwakho lokuzalwa lwama-65 ukubhalisa.

Ulawulo loKhuseleko lwezeNtlalontle luphatha ubhaliso lweMedicare Zintathu iindlela ezilula zokufaka isicelo:

• usebenzisa isicelo seMedicare kwi-Intanethi kwiwebhusayithi yoLawulo loKhuseleko loLuntu
• ukubiza uLawulo loKhuseleko loLuntu ngo-1-800-772-1213 (TTY: 1-800-325-0778)
• Ndwendwela i-ofisi yoLawulo loKhuseleko loLuntu

Ukuba ungumqeshi kaloliwe odla umhlala-phantsi, nxibelelana neBhodi yoRhwebo yoMhlala phantsi ku-1-877-772-5772 (TTY: 1-312-751-4701) ukubhalisa.

Iingcebiso zokukhetha isicwangciso seMedare

Xa ukhetha iindlela zeMedareri ukuhlangabezana neemfuno zakho zokhathalelo lwempilo, kubalulekile ukuqaphela iimfuno zakho zokhathalelo lwempilo. Nazi iingcebiso ezimbalwa zokukhetha isicwangciso okanye indibaniselwano yezicwangciso zokusebenzela wena:

• Zama ukuqikelela ukuba uchithe malini kwezempilo kunyaka ophelileyo ngaloo ndlela unokuqikelela ngcono ukuba zeziphi izicwangciso eziza kukugcinela imali.
• Dwelisa iimeko zakho zonyango ukuze uqiniseke ukuba ziyagutyungelwa zizicwangciso oziqwalaselayo.
• Dwelisa oogqirha obabonayo ngoku kwaye ubabuze ukuba bayayamkela na iMedicare okanye yeyiphi na iMibutho yoLondolozo lwezeMpilo (HMO) okanye uthungelwano lweProvider Provider Organisation (PPO) abanokuthi babe kuyo.
• Dwelisa naluphi na unyango okanye izibhedlele onokuzifuna kunyaka ozayo.
• Qaphela nayiphi na enye i-inshurensi onayo, ukuba ungayisebenzisa ngeMedicare, kunye nendlela yokuyiphelisa le inshorensi ukuba kukho imfuneko.
• Ngaba uyafuna umsebenzi wamazinyo, nxiba iiglasi okanye izixhobo zokuva, okanye ungathanda ezinye izinto zokugubungela?
• Ngaba wena okanye uceba ukuhamba ngaphandle kwendawo yokugubungela okanye ngaphandle kwelizwe?

Zonke ezi zinto zinokukunceda uthathe isigqibo sokuba zeziphi iindawo zeMedicare ezinokuthi zihlangabezane neemfuno zakho kwaye zeziphi izicwangciso zomntu oza kuzijonga.

Ngelixa i-Medicare yoqobo ye-Medicare ibonelela ngenkonzo kwiinkonzo ezininzi, ayizizo zonke iimeko zonyango ezigutyungelweyo. Umzekelo, ukhathalelo lwexesha elide aluthathelwa ingqalelo njengenxalenye ye-Medicare. Ukuba ufuna ukhathalelo lwexesha elide, jonga isicwangciso seMedicare Advantage okanye iMedigap enokuthi ibonelele ngezibonelelo zokhathalelo lwexesha elide.

Kuba amayeza amiselweyo awagutyungelwanga yiMedicare yoqobo, ukuba ufuna ukugubungela amayeza kagqirha, kuyakufuneka ubhalise kwi-Medicare Part D okanye kwi-Medicare Advantage, enikezela ngezicwangciso ezigubungela amayeza amiselweyo.

Ukuthatha

• Ukwazi ukuba zeziphi izicwangciso ezifanelekileyo kuwe kuxhomekeke kumvuzo wakho, impilo yonke, ubudala, kunye nohlobo luni lokunyamekela oya kuyidinga. Kungcono ukuba ufunde ngeenkonzo kunye nezicwangciso ngononophelo kwaye ukhethe izicwangciso ezisebenza ngcono kuwe.
• Amaxesha okubhalisa anqunyelwe kwezinye izicwangciso, ke qiniseka ukuba uyasayina ukuze ungabinasithuba sokugubungela.
• Ukuba unenkxalabo malunga nokuba inkonzo oyifunayo igutyungelwe yiMedicare, ungathetha ubuze ugqirha wakho, ukhangele kwiDathabheyisi yokuGcina iMedare kwi-Intanethi ku-www.cms.gov/medicare-coverage-database/, okanye uqhakamshelane ne-Medicare ngo-1-800- IMISEBENZI (1-800-633-4227).