Izicwangciso zeCalifornia Medicare ngo-2021

Umxholo

• Yintoni amayeza?
• Icandelo A (isigulana kunye nesibhedlele)
• Icandelo B (izigulana ezingalaliswayo kunye nezonyango)
• Icandelo D (ukumiselwa kweziyobisi ngugqirha)
• Uncedo lweMedicare
• Zeziphi izicwangciso eziluncedo kuMayeza ezifumanekayo eCarlifonia?
• I-HMO
• I-PPO
• SNP
• Ababoneleli eCarlifonia
• Ngubani ofanelekileyo kwi-Medicare eCalifornia?
• Ndingabhalisa nini kwiMedicare eCalifornia?
• Ixesha lokuqala lokubhalisa
• Ixesha lonyulo lonyaka
• Uncedo lweMedicare lubhaliso oluvulekileyo
• Ixesha lokubhalisa ngokubanzi
• Amaxesha obhaliso olulodwa
• Iingcebiso zokubhalisa kwi-Medicare eCalifornia
• Izibonelelo zeCalifornia Medicare
• Inkqubo yeNgcebiso nge-Inshurensi yezeMpilo kunye neNkqubo yoLuleko (HICAP)
• Unyango
• Inkxaso exhaswa ngumqeshi
• Ndifanele ndenze ntoni ngokulandelayo?

Yintoni amayeza?

I-Medicare yinkonzo yeinshurensi yezempilo kubantu abaneminyaka engama-65 nangaphezulu. Unokufanelekela kwi-Medicare ukuba ungaphantsi kweminyaka engama-65 kwaye uhlala nokukhubazeka okuthile okanye iimeko zempilo.

Izicwangciso zeMedicare eCalifornia zibandakanya:

• I-Medicare yoqobo: Inkqubo yeinshurensi yezempilo elawulwa ngamaZiko eeNkonzo zeMedare kunye neMedicaid Services (CMS)
• Uncedo lwamayeza: izicwangciso ezinikezelwa ziinkampani zeinshurensi zabucala ezenza isivumelwano neCMS
• Izicwangciso zonyango lwamayeza amayeza: Izicwangciso ze-inshurensi ezihlawula iindleko zonyango

Icandelo A (isigulana kunye nesibhedlele)

Icandelo A ligubungela ukhathalelo olufumanayo ngelixa uhlala ezibhedlele, ezibhedlele ezibaluleke kakhulu, kunye nexesha elilinganiselweyo kumaziko abongikazi abanezakhono Uninzi lwabantu aluhlawuli i-premium yenyanga kwizicwangciso zeCandelo A, kodwa kukho ukuncitshiswa ukuba ungeniswe esibhedlele.

Icandelo B (izigulana ezingalaliswayo kunye nezonyango)

Icandelo B ligubungela ukhathalelo ngaphandle kwesibhedlele kwizinto ezinje:

• utyelelo loogqirha
• ukuhlolwa koxilongo
• iimvavanyo zelebhu
• izixhobo zonyango ezizinzileyo

Uya kuhlawula ipremiyamu eyongezelelweyo kwizicwangciso zeCandelo B. Iipremiyamu zibekwa yi-CMS kwaye zitshintsha unyaka nonyaka ngokusekwe kwiindleko jikelele zonyango.

Icandelo D (ukumiselwa kweziyobisi ngugqirha)

Wonke umntu kwi-Medicare ufanelekile (Icandelo D), kodwa kufuneka uyifumane nge-inshurensi yabucala. Kubalulekile ukuthelekisa ezi zicwangciso kuba iindleko kunye nokugubungela kuyahluka.

Uncedo lweMedicare

Izicwangciso ze-Medicare Advantage (Icandelo C) zinikezelwa nge-inshurensi yabucala eqokelela lonke ukhuselo lwakho kumacandelo A no-B, kwaye ngamanye amaxesha ukumiselwa kweziyobisi ngugqirha kwisicwangciso esinye. Ngezicwangciso ze-Medicare Advantage, uhlawula i-premium ye-Medicare Part B.

Izicwangciso ze-Medicare Advantage kufuneka zigubungele izinto ezifanayo njengamacandelo e-Medicare A kunye no-B, kodwa ezinye zinegalelo elongezelelweyo (kunye nepremiyamu eyongezelelweyo) yezinto ezinje:

• Iinkonzo zamazinyo okanye umbono
• Iirampu zabakhubazekile
• ukuhanjiswa kwesidlo
• ukuthuthwa ukuya nokubuya kwizithuba zonyango

Zeziphi izicwangciso eziluncedo kuMayeza ezifumanekayo eCarlifonia?

ECarlifonia, izicwangciso zeMedicare Advantage ziwela kumanqanaba amathathu: Imibutho yoLondolozo lwezeMpilo (HMOs), Imibutho yababoneleli abakhethiweyo (ii-PPOs), kunye neZicwangciso zeeMfuno eziZodwa (SNPs).

I-HMO

Nge-HMO, ukhetha ugqirha wokhathalelo oluphambili olungelelanisa ukhathalelo lwakho kwaye akuthumele kwiingcali njengoko kufuneka. Uninzi lwezicwangciso zifuna ukuba ufumane unonophelo kubaboneleli kwinethiwekhi ye-HMO.

Inkathalo ngaphandle kwenethiwekhi ye-HMO ihlala ingagutyungelwanga ngaphandle kokuba kukukhathalelwa okungxamisekileyo, ukukhathalelwa okungaphandle kwendawo, okanye i-dialysis engaphandle kwendawo.

Ezinye izicwangciso ze-HMO zifuna ukuba uthenge ngokwahlukeneyo iziyobisi (Icandelo D).

Ukufumaneka kwezicwangciso ze-HMO eCalifornia kuyahluka ngokwasekhaya, kwaye azifumaneki kuyo yonke indawo.

I-PPO

Nge-PPO, unokufumana ukhathalelo oluvela kuthungelwano loogqirha kunye namaziko abonelela ngeenkonzo ezigqunywe kwisicwangciso sakho.

Unokufumana ukhathalelo kumboneleli wezonyango ngaphandle kwenethiwekhi yakho, kodwa iindleko zakho zokuphuma epokothweni zihlala ziphakama.

Uninzi lwe-PPOs aludingi ukuthunyelwa ukuze lubone ingcali.

ICarlifonia ayinaso nasiphi na isicwangciso seMedicare Advantage PPO, kodwa izithili ezingama-21 zinezicwangciso zePSO zasekhaya ezikhoyo.

SNP

I-SNP ziyafumaneka kubantu abafuna inqanaba eliphezulu lolondolozo kunye nolawulo lokhathalelo. Unokwazi ukufumana i-SNP ukuba:

• unesifo esinganyangekiyo okanye esikhubazayo, esifana neswekile okanye ukusilela kwentliziyo okungapheliyo
• "bafanelekile kabini" kwiMedare kunye neMedicaid
• Ndihlala kwikhaya labongikazi okanye kwiziko elifanayo okanye ndihlala ekhaya kodwa ndifumana inqanaba lokunyanyekelwa njengomntu okwikhaya lokugcina abantu abalupheleyo

Ababoneleli eCarlifonia

Ezi nkampani zibonelela ngezicwangciso zeMedicare Advantage eCarlifonia:

• I-Aetna Medicare
• Ukulungelelaniswa kweSicwangciso seMpilo
• Umhobe iBlue Cross
• IBlue Cross yaseCalifornia
• Usuku olutsha khaca
• Isicwangciso soNyango lwezeMpilo
• Isicwangciso seMpilo yoKhathalelo
• Urhulumente weGolide
• Health Health Community Solutions, Inc. zitshintshi e zeedola imbali yamanani, ishati ukususela ekuqaleni kokuthengisa
• Impilo yeNet yaseCalifornia
• Humana
• IsiCwangciso sezeMpilo seCalifornia, Inc.
• UKaiser Permanente
• Skena iSicwangciso seMpilo
• Ukhathalelo lweZempilo
• Ukhathalelo

Ayizizo zonke izinto ezihambisa izithuthi kwilizwe lonke, ke ukhetho onalo luya kwahluka ngokuxhomekeka kwindawo ohlala kuyo.

Ngubani ofanelekileyo kwi-Medicare eCalifornia?

Abahlali baseCalifornia banelungelo lokufumana izicwangciso zeMedicare kunye neMedicare ukuba:

• ungummi waseUnited States okanye umhlali ngokusemthethweni kule minyaka mi-5 nangaphezulu idlulileyo
• Uneminyaka engama-65 okanye ngaphezulu, kwaye wena okanye iqabane lakho lihlangabezana neemfuno zomsebenzi oxhaswe nguMedicare

Abantu abangaphantsi kweminyaka engama-65 banokufaneleka ukuba:

• ukhubazekile kwaye ufumana i-Inshurensi yokuKhubazeka kweNtlalo (i-SSDI) okanye iintlawulo zokukhubazeka kwiBhodi yoLoliwe
• une-amyotrophic lateral sclerosis (ALS) okanye isifo sesibindi sokugqibela (ESRD)

Ukuba usenemibuzo malunga nokuba uyafaneleka na, ungasebenzisa isixhobo seMedicare sokufaneleka kwi-Intanethi.

Ndingabhalisa nini kwiMedicare eCalifornia?

Ixesha lokuqala lokubhalisa

Ixesha lokubhaliswa kwe-inshurensi yokuqala (i-EIP) lixesha leenyanga ezisi-7 eliqala iinyanga ezintathu ngaphambi kokuzalwa kwakho kwama-65 kwaye liphele kwiinyanga ezi-3 emva kokuba uneminyaka engama-65 ubudala. Ukuba uyabhalisa, ikhava yakho iya kuqala eyokuqala inyanga oza kuba neminyaka engama-65 ubudala.

Ukuba ulibazisa ukubhalisa kude kube yinyanga okanye emva komhla wokuzalwa kwakho, unokuba nesikhewu kwi-inshurensi yakho yezempilo.

Ixesha lonyulo lonyaka

Ungabhalisa kwizicwangciso zeMedicare Advantage phakathi Oktobha 15 noDisemba 7 ngonyaka nganye. Ukufundwa kuqala ngoJanuwari 1.

Uncedo lweMedicare lubhaliso oluvulekileyo

Ukuba sele ucwangcisile i-Medicare Advantage kwaye ufuna ukutshintshela kwelinye icebo le-Medicare Advantage okanye uye kwi-Medicare yoqobo, ungakwenza oko phakathi NgoJanuwari 1 noMatshi 31 ngonyaka nganye.

Ixesha lokubhalisa ngokubanzi

Ubhaliso ngokubanzi luphakathi NgoJanuwari 1 noMatshi 31 ngonyaka nganye. Ukuba unayo i-Medicare Part A kwaye ufuna ukubhalisa kwiCandelo B, isicwangciso se-Medicare Advantage, okanye i-Part D yokugubungela ungayenza ngeli xesha. Ukufunda kuyasebenza Julayi 1.

Amaxesha obhaliso olulodwa

Amaxesha obhaliso akhethekileyo akuvumela ukuba ubhalise ngaphandle kwamaxesha obhaliso aqhelekileyo phantsi kweemeko ezizodwa. Umzekelo, ixesha lokubhalisa elikhethekileyo likuvumela ukuba ubhalise kwisicwangciso esitsha ngaphandle kwesohlwayo ukuba ulahlekelwe sisicwangciso seinshurensi esixhaswe ngumqeshi kwaye kufuneka ubhalise kwiCandelo B, okanye uphume kwindawo yakho yenkonzo yangoku.

Iingcebiso zokubhalisa kwi-Medicare eCalifornia

Izicwangciso ze-Medicare kunye ne-Medicare Advantage eCalifornia zinokudideka, ke ngaphambi kokuba ubhalise kubalulekile ukuvavanya ukhetho lwakho kwaye uthelekise izinto ezinje:

• iindleko
• ukugubungela
• ababoneleli kunye nezixhobo kuthungelwano lwesicwangciso
• Ukulinganiswa kweenkwenkwezi ze-CMS kwiCandelo C kunye neCandelo D.

Ukuba ufuna uncedo lokumisela ukuba zeziphi izicwangciso ezilungileyo kwiimfuno zakho okanye unemibuzo malunga nezinto ezikhoyo onokukhetha kuzo, zininzi izibonelelo zokukunceda.

Izibonelelo zeCalifornia Medicare

Inkqubo yeNgcebiso nge-Inshurensi yezeMpilo kunye neNkqubo yoLuleko (HICAP)

ISebe lokuGuga laseCalifornia linika iingcebiso ngeMedicare ngeHICAP. Banikezela:

• ulwazi ngobhaliso lweMedicare
• iinkcazo zezahlulo A, B, no-C, kunye nendlela yokufumanisa ukuba yeyiphi na ingxelo oyifunayo
• iimpendulo kwimibuzo malunga necandelo D lokugubungela amayeza, iindleko kunye nokufaneleka

I-HICAP iyimfihlo kwaye isimahla kuye nabani na ofanelekileyo kwi-Medicare okanye malunga nokuba afaneleke. Unokukhangela iinkonzo ze-HICAP zalapha ngapha okanye ubize umnxeba ku-800-434-0222.

Unyango

Nxibelelana noMedicare ngokuthe ngqo ngoncedo lokubhalisa okanye ucwangcise imibuzo ngokubiza i-800-MEDICARE (800-633-4227) okanye undwendwelele Medicare.gov. Ungatsalela umnxeba iofisi yeCMS yengingqi eSan Francisco kwi-415-744-3501.

Inkxaso exhaswa ngumqeshi

Ukuba unenkxalabo okanye ufuna uncedo kwiMedare yaseCalifornia ethengwe ngumqeshi, nxibelelana neSebe laseCalifornia loKhathalelo lwezeMpilo ku-888-466-2219 okanye nge-imeyile [email protected].

Ndifanele ndenze ntoni ngokulandelayo?

Xa sele ukulungele ukubhalisela i-Medicare eCalifornia:

• misela ukuba yeyiphi na ingxelo oyifunayo kunye nophando ngezicwangciso ezikhoyo, ukhetho lokugubungela, kunye neendleko
• Nxibelelana ne-HICAP okanye i-Medicare ukuba unemibuzo malunga nokufaneleka okanye ukugubungela
• fumana ukuba ixesha elilandelayo lobhaliso liqala nini

Eli nqaku lahlaziywa ngo-Okthobha u-5, 2020 ukubonisa ulwazi nge-2021 ye-Medicare.

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.