Isikhokelo sakho esipheleleyo kwiCandelo leMedare D

Umxholo

• Yintoni i-Medicare Icandelo D?
• Iinyani ezikhawulezileyo malunga neCandelo leMedicare D
• Ngawaphi amayeza agqunywe kwiCandelo leMedicare D?
• ICandelo D kufuneka ligubungele
• Kutheni ufuna iCandelo leMedicare D
• Ngubani olungeleyo kwiCandelo leMedare?
• Zeziphi izicwangciso ze-Medicare Icandelo D ezikhoyo?
• Ixabisa malini icandelo le-Medicare?
• Yintoni umngxuma wedonut?
• Imibuzo yokubuza ngaphambi kokubhalisa kwiCandelo leMedicare D
• Icandelo leMedicare D lithelekiswa njani nezinye iiplani?
• Iingcebiso zokukhetha isicwangciso
• Ungabhalisa nini kwi-Medicare Part D?
• Ngaba kukho isohlwayo esisigxina ukuba ubhalisa kade?
• Ungabhalisa njani kwiCandelo leMedicare D
• Ukuthatha

• I-Medicare Icandelo D kukugubungela amayeza kagqirha.
• Unokuthenga isicwangciso se-Medicare Part D ukuba ufanelekile kwi-Medicare.
• Izicwangciso zeCandelo D zinoluhlu lweziyobisi abazigubungelayo ezibizwa ngokuba ziifomula, ukuze uxele ukuba ngaba isicwangciso siquka imigqaliselo yakho.
• Ezinye izicwangciso ze-Medicare Part D zifakiwe kwizicwangciso ze-Medicare Advantage.

Ukukhetha isicwangciso esifanelekileyo seMedare kubalulekile. Ngeendlela ezahlukeneyo zokugubungela, ii-copays, iipremiyamu kunye nezinto ezinokutsalwa, kunokuba nzima ukuba ufumane olona khetho lwakho.

I-Medicare sisicwangciso se-inshurensi yezempilo exhaswa ngurhulumente kubantu abangama-65 nangaphezulu eMelika. Inamacandelo aliqela agubungela iintlobo ezahlukeneyo zempilo kunye nezonyango.

Yintoni i-Medicare Icandelo D?

Icandelo le-Medicare Icandelo D likwabizwa ngokuba kukugubungela amayeza kagqirha. Kuyanceda ukuhlawula amayeza angakhankanywanga kumacandelo A okanye B.

Nangona urhulumente womanyano ahlawule ama-75 eepesenti kwiindleko zamayeza kwiCandelo D, abantu abagutyungelweyo kusafuneka bahlawule iipremiyamu, ii-copays kunye nokuncitshiswa.

Umyinge kunye namaxabiso ayahluka ngokuxhomekeke kwisicwangciso osikhethileyo. Kubalulekile ukujonga zonke iinketho ngaphambi kokukhetha isicwangciso seMedicare Part D.

Iinyani ezikhawulezileyo malunga neCandelo leMedicare D

• Sisicwangciso seyeza sokufumana amayeza kwabo banelungelo lokufumana iMedicare.
• Kuya kufuneka ubhalise kwiCandelo leMedicare A okanye kwiCandelo B ukuze ufaneleke.
• Icandelo le-Medicare Icandelo D likhethwa ngokuzithandela.
• Kuya kufuneka ubhalise kwiCandelo D phakathi kuka-Okthobha u-15 ukuya ku-Disemba 7. Ukuhlawulwa akuyonto izenzekelayo kwaye isohlwayo sobhaliso emva kwexesha sinokusebenza.
• Uncedo lobhaliso lukarhulumente luyafumaneka.
• Amayeza agutyungelweyo asekwe kwisicwangciso somntu ngamnye (uluhlu lwamayeza agqunyiweyo).

Ngawaphi amayeza agqunywe kwiCandelo leMedicare D?

Zonke izicwangciso kufuneka zigubungele amayeza "asemgangathweni" agqitywe nguMedicare. Umyinge usekwe kwinto uninzi lwabantu kwi-Medicare abayithathayo. Isicwangciso ngasinye sinoluhlu lwaso lwamayeza olucwangcisiweyo.

Uninzi lwezicwangciso zigubungela uninzi lwezitofu zokugonya kungekho kopayi.

Kubalulekile xa ukhetha isicwangciso se-Medicare Part D ukuqinisekisa ukuba amayeza owathathayo ayogqunywa. Oku kubaluleke ngakumbi ukuba uthatha naziphi na izinto ezizodwa okanye ezibiza kakhulu ngegama lonyango.

Zonke izicwangciso ngokubanzi zinamayeza amabini ubuncinci kwaye zihlala zininzi ngakumbi kwiiklasi zamachiza amiselweyo kunye neendidi.

Ukuba ugqirha wakho ukumisela amayeza engekho kuluhlu, kufuneka bacacise ukuba kutheni kufuneka okungafaniyo. I-Medicare ifuna ileta esemthethweni eya kwinkampani yeinshurensi echaza ukuba kutheni iyeza lifuneka. Akukho siqinisekiso sokuba ngaphandle kuya kuvunyelwa. Ityala ngalinye ligwetywa ngokwahlukeneyo.

Ukususela ngoJanuwari 1, 2021, ukuba uthatha i-insulin, i-insulin yakho inokuxabisa i-35 yeedola okanye ngaphantsi kunikezelo lweentsuku ezingama-30. Sebenzisa i-Medicare's fumana isixhobo sesicwangciso ukuthelekisa izicwangciso ze-Medicare Part D kunye neendleko ze-insulin kwimeko yakho. Ungabhalisa kwisicwangciso seCandelo D ngexesha lobhaliso oluvulekileyo (nge-15 ka-Okthobha ukuya kuDisemba 7).

Isicwangciso samayeza sinokutshintsha amayeza okanye amaxabiso kuluhlu lwabo nangaliphi na ixesha ngenxa yezizathu ezininzi, ezinje:

• Uhlobo oluqhelekileyo lophawu luyafumaneka
• Ixabiso lebhrendi linokutshintsha ukuba igeneric iyafumaneka
• iyeza elitsha liye lafumaneka okanye kukho idatha entsha malunga nonyango okanye amayeza

ICandelo D kufuneka ligubungele

Izicwangciso zeCandelo D kufuneka zigubungele onke amayeza kwezi ndidi:

• amayeza onyango lomhlaza
• amayeza antidepressant
• iyeza le-anticonvulsive lokuphazamiseka ekubanjweni
• iyeza lokuzikhusela emzimbeni
• Amayeza e-HIV / AIDS
• amayeza antipsychotic

Ngaphezulu kwamayeza ekhawuntareni, iivithamini, izongezo, izithambiso, kunye nelahleko Akunjalo egutyungelwe iCandelo D.

Amachiza amiselweyo hayi egqunywe liCandelo leMedicare D ibandakanya:

• iziyobisi zokuchuma
• amayeza asetyenziselwa ukunyanga i-anorexia okanye okunye ukunciphisa umzimba okanye ukuzuza xa le meko ingeyonxalenye yolunye uvavanyo
• amayeza amiselwe kuphela iinjongo zokuthambisa okanye ukukhula kweenwele
• amayeza amiselwe ukukhululeka kweempawu zokubanda okanye zokukhohlela xa ezi zimpawu aziyonxalenye yolunye uvavanyo
• amayeza asetyenziselwa ukunyanga ukungasebenzi kakuhle kwe-erectile

Kutheni ufuna iCandelo leMedicare D

Amayeza ayabiza kwaye iindleko zihlala zikhula. NgokweZiko leMedicare kunye neMedicaid (CMS), inkcitho kumayeza kagqirha inyuke ngomyinge we-10.6 yeepesenti minyaka le phakathi ko-2013 no-2017.

Ukuba uneminyaka yobudala engama-65 kwaye ufanelekile kwi-Medicare, iCandelo D yenye yeendlela zokunceda ukuhlawula iindleko zamayeza kagqirha.

Ngubani olungeleyo kwiCandelo leMedare?

Ukuba ukulungele ukufumana i-Medicare, ulungele iCandelo D. Ukuze ufaneleke kwi-Medicare, kufuneka:

• ubuncinci uneminyaka engama-65 ubudala
• ufumene iintlawulo zokukhubazeka koKhuseleko lweNtlalo ubuncinci iminyaka emi-2, nangona eli xesha lokulinda liyekisiwe ukuba ufumana isifo se-amyotrophic lateral sclerosis (ALS) kwaye uya kufaneleka kwinyanga yokuqala ufumana intlawulo yokukhubazeka
• Ufumene isifo sesifo se-renal (ESRD) okanye ukungaphumeleli kwezintso kwaye kufuneka ube ne-dialysis okanye ukufakelwa kwezintso
• ube ngaphantsi kweminyaka engama-20 nge-ESRD kwaye ubuncinci umzali afaneleke ukufumana izibonelelo zoKhuseleko lweNtlalo

Zeziphi izicwangciso ze-Medicare Icandelo D ezikhoyo?

Kukho amakhulu ezicwangciso onokukhetha kuzo ezinikezelwa ziinkampani zeinshurensi zabucala. Izicwangciso zinokubonelela ngokugubungela amayeza amayeza okanye ukhetho olugubungela iinkonzo ezininzi ezinje ngeMedicare Advantage.

Esona sicwangciso silungileyo kuwe sixhomekeke:

• amayeza owathathayo ngoku
• naziphi na iimeko zempilo ezingapheliyo onazo
• Ufuna ukuhlawula malini (iipremiyamu, ii-copays, ii-deductibles)
• ukuba ufuna amayeza athile agutyungelweyo
• ukuba uhlala kumazwe ahlukeneyo enyakeni

Ixabisa malini icandelo le-Medicare?

Iindleko zixhomekeke kwisicwangciso osikhethileyo, sokugubungela, kunye neendleko zokuphuma epokothweni. Ezinye izinto ezichaphazela into onokuyihlawula zibandakanya:

• indawo okuyo kunye nezicwangciso ezikhoyo kwindawo yakho
• uhlobo lokugubungela olufunayo
• izithuba zokugubungela zikwabizwa ngokuba yi "hole donut"
• umvuzo wakho, onokumisela ipremiyamu yakho

Iindleko zikwaxhomekeke kumayeza nakumanqanaba okucwangcisa okanye “kumanqanaba”. Iindleko zamayeza akho ziya kuxhomekeka kweliphi inqanaba amayeza akho phantsi kwawo. Inqanaba elisezantsi, kwaye ukuba ngaba zenziwe generic, isezantsi ikopi kunye neendleko.

Nayi imizekelo embalwa yokuqikelelwa kweendleko zepremiyamu yenyanga ye-Medicare Icandelo D lokugubungela:

• ENew York, NY: $ 7.50- $ 94.80
• IAtlanta, GA: $ 7.30- $ 94.20
• IDallas, TX: $ 7.30- $ 154.70
• IDes Moines, IA: $ 7.30- $ 104.70
• Los Angeles, CA: $ 7.20- $ 130.40

Iindleko zakho ezithile ziya kuxhomekeka apho uhlala khona, isicwangciso osikhethayo, kunye namayeza amayeza owathathayo.

Yintoni umngxuma wedonut?

Umngxunya wokunikezela sisithuba sokugubungela esiqala emva kokuba udlulise umda wokuqala wokugubungela isicwangciso sakho seCandelo D. Ukutsalwa kwakho kunye nokuhlawulwa kweemali ezihlawulelwayo kubalwa kulo mda wokugubungela, njengoko kusenziwa nguMedicare. Ngo-2021, umda wokuqala wokugubungela uyi- $ 4,130.

Urhulumente womdibaniselwano ebesebenza ukuphelisa lo msantsa kwaye, ngokweMedicare, uyakuhlawula kuphela iipesenti ezingama-25 zeendleko zamayeza agutyungelweyo xa ukwisithuba sokugubungela ngo-2021.

Kukho nesaphulelo seepesenti ezingama-70 kumayeza egama lophawu ngelixa usemngxunyeni we donut ukunceda ukuhlawula iindleko.

Nje ukuba iindleko zakho zokuphuma epokothweni zifikelele kwisixa esithile, i-6,550 yeeRandi ngo-2021, uyafaneleka ukufumana ingxelo eyintlekele. Emva koku, uya kuhlawula kuphela ipesenti eyi-5 yepayipi yamayeza akho amiselweyo unyaka wonke.

Imibuzo yokubuza ngaphambi kokubhalisa kwiCandelo leMedicare D

Xa uthatha isigqibo ngesicwangciso, gcina la manqaku engqondweni:

• Ngaba amayeza endiwathathayo ngoku agutyungelweyo?
• Zithini iindleko zenyanga zamayeza am kwisicwangciso?
• Yimalini amayeza angakhange agqitywe kwisicwangciso sendleko?
• Zithini iindleko zokuphuma epokothweni: ikopi, ipremiyamu kunye nezinto ezitsaliwe?
• Ngaba isicwangciso sinika ukhuselo olongezelelweyo kuzo naziphi na iziyobisi ezinexabiso eliphezulu?
• Ngaba ikhona imida yokugubungela enokundichaphazela?
• Ngaba ndinokhetho lweekhemesti?
• Ndingathini ukuba ndihlala kwiindawo ezingaphezu kwenye apha enyakeni?
• Ngaba isicwangciso siyabonelela ngokugubungela ngokubanzi?
• Ngaba ikhona inketho yoku-odola imeyile?
• Lithini inqanaba lesicwangciso?
• Ngaba ikhona inkonzo yabathengi ngesicwangciso?

Icandelo leMedicare D lithelekiswa njani nezinye iiplani?

Kukho ezinye iindlela ezininzi zokufumana unyango lwamayeza.

Iindleko zixhomekeke kumayeza akho, uluhlu lweziyobisi, kunye neendleko zokuphuma epokothweni. Ngumbono olungileyo ukuthelekisa izicwangciso zokukhetha eyona ndlela ikulungeleyo, kwaye uluhlu lwezonyango lukunceda ukuba ukhethe ngokusekwe kwimeko yakho.

Ngamanye amaxesha ukutshintsha izicwangciso kunokuba sengqiqweni kwaye konge imali. Abancedisi bamayeza banokukukhokela ekuthatheni isigqibo sokuba ngaba elinye icebo lingangcono kuneMedicare yoqobo kunye neCandelo D.

Iingcebiso zokukhetha isicwangciso

Nanga amanqaku ambalwa ekufuneka uwakhumbule xa ukhetha isicwangciso:

• Imigaqo yokutshintsha kwezicwangciso. Ungatshintsha kuphela izicwangciso zamachiza ngamaxesha athile naphantsi kweemeko ezithile.
• Izinketho zamagqala. Ukuba uligqala, I-TRICARE sisicwangciso se-VA kwaye ngokubanzi sisebenza ngokungabizi kakhulu kunecebo le-Medicare Part D.
• Izicwangciso zikagqirha ezisekwe kumqeshi. Jonga ukuze ubone ukuba yintoni egqunywe zizicwangciso zokhathalelo lwempilo lomqeshi wakho ukumisela iindleko eziphuma epokothweni xa kuthelekiswa nesicwangciso seCandelo D.
• Izicwangciso zonyango zeMedare (MA). Eminye iMibutho yoLondolozo lwezeMpilo (ii-HMOs) okanye iMibutho yababoneleli abakhethiweyo (ii-PPOs) Izicwangciso ze-Medicare zeNzuzo zihlawulela iindleko zamacandelo A, B, no-D, kwaye banokuhlawula ukhathalelo lwamazinyo kunye nombono. Khumbula, kusafuneka ubhalise kumacandelo A no-B.
• Iipremiyamu kunye neendleko zokuphuma epokothweni zinokwahluka. Unokuthelekisa izicwangciso ukuze ubone ukuba yeyiphi ekubonelela ngeyona nkxaso-mali ilungileyo kunyango lwakho kunye neemfuno zokhathalelo lwempilo. Izicwangciso zeMedare eziluncedo zinokuba noogqirha benethiwekhi kunye neehemesti. Khangela ukuqinisekisa ukuba ababoneleli bakho bezempilo bakwisicwangciso.
• Izicwangciso zeMedigap. IMedigap (i-inshurensi yokuxhasa i-Medicare) inceda ukuhlawula iindleko zokuphuma epokothweni. Ukuba uthenge isicwangciso sakho ngaphambi kukaJanuwari 1, 2006, unokufumana iyeza lokugubungela amayeza akho. Emva kwalo mhla, iMedigap khange ibonelele ngokugubungela amayeza.
• Unyango. Ukuba unayo iMedicaid, xa ufanelekile kwi-Medicare, uya kutshintshelwa kwisicwangciso seCandelo D ukuhlawulela amayeza akho.

Ungabhalisa nini kwi-Medicare Part D?

Ukucwangciswa kobhaliso kuxhomekeke:

• ukubhaliswa okokuqala xa uneminyaka engama-65 (ukusuka kwiinyanga ezintathu ngaphambi kweenyanga ezintathu emva kokuba uneminyaka engama-65)
• ukuba ufanelekile ngaphambi kweminyaka engama-65 ngenxa yokukhubazeka
• ixesha lokubhalisa elivulekileyo (nge-15 ka-Okthobha ukuya ku-Disemba 7)
• ixesha lokubhaliswa ngokubanzi (ngoJanuwari 1 ukuya kuMatshi 31)

Unokwazi ukujoyina, ushiye, okanye utshintshe izicwangciso ukuba:

• uye kwikhaya labongikazi okanye kwiziko lokonga elinezakhono
• fuduka kwindawo yakho yokugubungela isicwangciso
• ukuphulukana namayeza
• Isicwangciso sakho asiboneleli ngeenkonzo zeCandelo D
• ufuna ukutshintshela kwisicwangciso esiphezulu seenkwenkwezi ezi-5

Unokutshintsha izicwangciso ngexesha lobhaliso oluvulekileyo unyaka nonyaka.

Ukuba sele unayo iyeza lokugubungela amayeza kwaye iyafaniswa nesicwangciso esisisiseko seCandelo leMedicare D, unokugcina isicwangciso sakho.

Ngaba kukho isohlwayo esisigxina ukuba ubhalisa kade?

Nangona iCandelo D likhethwa ngokuzithandela, ukuba ukhetha ukungabhaliseli isicwangciso sokuxhamla, unokuhlawula isohlwayo sokubhaliswa ngokukhawuleza ukujoyina kamva.

Nokuba awuthathi nawaphi na amayeza ngoku, kubalulekile ukuba ubhalisele isicwangciso esineepremiyamu ukuba ufuna ukuphepha esi sohlwayo. Ungasoloko utshintsha izicwangciso njengoko iimfuno zakho zitshintsha ngexesha lobhaliso oluvulekileyo unyaka nonyaka.

Ukuba awubhalisi xa uvumelekile okokuqala kwaye ungenayo enye into yokugubungela amayeza, isohlwayo sepesenti esi-1 sibalwa kwaye songezwa kwipremiyamu yakho ngenani leenyanga ongakhange usebenze xa kufanelekile. Le ntlawulo yongezelelweyo yongezwa kwiipremiyamu zakho okoko uneMedicare.

Kukho ezinye iindlela zonyango zokugubungela amayeza endaweni yeCandelo D. Kodwa ke kufuneka ukuba i-inshurensi ibenolona luluhlu lwe-D lusisiseko.

Unokuba nokugubungela kumqeshi wakho, isicwangciso soLawulo lweVeteran (VA), okanye ezinye izicwangciso zabucala. Uncedo lweMedicare lolunye ukhetho oluhlawulela amayeza.

Ungabhalisa njani kwiCandelo leMedicare D

Ungabhalisa kwisicwangciso se-Medicare Part D ngexesha lokubhaliswa kokuqala kwamacandelo e-Medicare A kunye no-B.

Ukuba isicwangciso sakho samachiza sokumisela asihlangabezani neemfuno zakho, ungalutshintsha ukhetho lwakho lwe-Medicare Part D ngexesha lokubhalisa okuvulekileyo. La maxesha obhaliso avulekileyo enzeka kabini ngonyaka.

Ukuthatha

Icandelo leMedicare D yinxalenye ebalulekileyo yezibonelelo zeMedare. Ukukhetha isicwangciso esifanelekileyo kunokunceda ukugcina iindleko zijongiwe.

Nje ukuba ukhethe isicwangciso, kuya kufuneka uhlale kuso de kube lixesha elilandelayo lokubhalisa elivulekileyo eliqala ngo-Okthobha 15. Kubalulekile ukuba ukhethe isicwangciso esihle esisebenzela iimfuno zakho.

I-Medicare yoqobo kunye neCandelo D ikuvumela ukuba undwendwele iingcali ngaphandle kokuthunyelwa. Izicwangciso ze-Medicare eziluncedo zinokuba nothungelwano kunye nemida yendawo yokugubungela, kodwa iindleko ezingaphandle kweepokotho zingaphantsi.

Ukukhetha esona sicwangciso silungileyo kwiimfuno zamayeza akho, jonga iindleko zakho kunye nokhetho ngononophelo. Sebenza nomncedisi ekukhetheni eyona ndlela ifanelekileyo nokuba uthathe isigqibo sokutshintsha izicwangciso.

Ukuba awunakho ukufikelela kwi-intanethi, ungatsalela umnxeba 800-MEDICARE ngoncedo ekukhetheni isicwangciso. Unokukhankanya isicwangciso osifunayo kwaye ubuze imibuzo malunga nokugubungela.

Eli nqaku lahlaziywa ngo-Novemba 17, 2020, ukubonisa ulwazi ngo-2021 lonyango.

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.

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