Ngaba amayeza ayakhusela iinkonzo zezeMpilo?

Umxholo

• Ukugubungela amayeza kunye nefowuni
• Yintoni i-Medicare Part B egubungela ngayo?
• Yintoni i-Medicare Part C egubungela ngayo?
• Ingaba isebenza kanjani?
• Iindleko
• Itekhnoloji
• Ndazi njani ukuba ndiyafaneleka ukufumana ingxelo?
• Izibonelelo ezivunyiweyo
• Indawo
• Inkqubo yolawulo lwempilo engapheliyo (CCM)
• Ukwandisa ukhuseleko kwi-Medicare ye-telehealth
• I-ESRD
• Ukubetha
• Imibutho yoxanduva olunoxanduva (ACOs)
• Ukungena okwenyani kunye nokutyelelwa ngu-E
• Izibonelelo zethekhnoloji
• Ukuthatha

I-Medicare igubungela uluhlu lweenkonzo zonyango kunye nezempilo, kubandakanya ne-telehealth. I-Telehealth isebenzisa iteknoloji yonxibelelwano ngekhompyutha ukuvumela ukutyelelwa kwezempilo kunye nemfundo ekude. Qhubeka ufunda ukuze ufunde okungakumbi malunga ne-telehealth, zeziphi iinxalenye ze-Medicare ezigubungelayo, kunye nokunye.

Ukugubungela amayeza kunye nefowuni

I-Medicare yenziwe ngamacandelo aliqela anika uhlobo olwahlukileyo lokugubungela. Iindawo eziphambili zibandakanya:

• Icandelo le-Medicare Icandelo A (iinshurensi yesibhedlele)
• Icandelo le-Medicare Icandelo B (i-inshurensi yonyango)
• Icandelo le-Medicare Icandelo C (izicwangciso eziluncedo)
• Icandelo le-Medicare Icandelo D (ukugubungela amayeza amayeza)

I-Telehealth igutyungelwe ngamacandelo e-Medicare B kunye no-C. Siza kuyiphula apha ngezantsi.

Yintoni i-Medicare Part B egubungela ngayo?

Icandelo lonyango i-Medicare Icandelo B ligubungela ezinye iinkonzo zempilo. Ngokudibeneyo, icandelo leMedicare A kunye neCandelo B ngamanye amaxesha kuthiwa yiMedicare yoqobo.

Utyelelo lwe-telehealth luphathwa ngokufanayo nokuba uye kutyelelo lomntu ongalaliswayo. Iindidi zenkonzo ye-telehealth ezibandakanyiweyo zibandakanya:

• utyelelo eofisini
• thethwano
• Unyango ngengqondo

Eminye imizekelo yeengcali zezempilo ezinokubonelela ngeenkonzo ze-telehealth zibandakanya:

• oogqirha
• abancedisi boogqirha
• Abongikazi
• oogqirha bengqondo
• umongikazi oqinisekisiweyo
• Iingcali zokutya ezibhalisiweyo
• iingcali zokutya
• oonontlalontle bezonyango

Ngamanye amaxesha, unokufumana iinkonzo zetelefowuni ekhayeni lakho. Kwabanye, kuyakufuneka uye kwiziko lokhathalelo lwempilo.

Yintoni i-Medicare Part C egubungela ngayo?

Icandelo leMedicare C likwabizwa ngokuba yiMedicare Advantage. Iinkampani zeinshurensi zabucala zithengisa izicwangciso zeCandelo C. Icandelo C libandakanya ukugubungela okufanayo ne-Medicare yoqobo kodwa linokubandakanya izibonelelo ezongezelelweyo.

Ngo-2020, kwenziwa utshintsho kwiCandelo C elinokuthi livumele ukuba libonelele ngezibonelelo zeterehealth ngakumbi kuneMedicare yoqobo. Olu tshintsho lubandakanya ukwanda kokufikelela kwizibonelelo zetekhnoloji evela ekhaya endaweni yokufuna utyelelo kwiziko lokhathalelo lwempilo.

Izibonelelo ezongezelelekileyo zinokwahluka ngokuxhomekeke kwisicwangciso sakho seCandelo C. Jonga isicwangciso sakho esithile ukuze ubone ukuba loluphi uhlobo lwezibonelelo zonikezelo ngethelevishini ezinikezelwayo.

Apha ngezantsi kukho imizekelo yokuba ingasetyenziswa nini i-telehealth:

• uqeqesho okanye imfundo, enje ngeendlela zokufunda zokujonga eswekile
• ucwangciso lokhathalelo lwempilo enganyangekiyo
• ukufumana ukubonisana neengcali ezingekhoyo kwindawo yakho
• Unyango ngengqondo
• ukuhlolwa, njengaleyo yoxinzelelo okanye ingxaki yokusebenzisa utywala
• ukuceba ukhathalelo kwangaphambili
• unyango lwezondlo
• ukufumana uncedo lokuyeka ukutshaya
• ukufumana uvavanyo lobungozi empilweni

Ingaba isebenza kanjani?

Ke ngoku umsebenzi we-telehealth usebenza njani nge-Medicare? Makhe sihlolisise oku kwiinkcukacha ezithe kratya.

Iindleko

Ukuba uneCandelo B, uya kuba noxanduva lokuhlawula i-coinsurance ye-20 yepesenti yeendleko zeenkonzo zetelehealth ozifumanayo. Gcina ukhumbule ukuba kufuneka uqale uhlangane neCandelo B elincitshisiweyo, eliyi- $ 198 ngo-2020.

Izicwangciso zeCandelo C ziyafuneka ukuba zibonelele ngokugubungela okusisiseko njengonyango lokuqala. Nangona kunjalo, uya kufuna ukunxibelelana nomboneleli wesicwangciso sakho ngaphambi kokusebenzisa iinkonzo zetelehealth ukuqinisekisa ukuba inkonzo ethile iyagutyungelwa.

Itekhnoloji

Unokufumana rhoqo iinkonzo zeterehealth kwiziko lokhathalelo lwempilo. Nangona kunjalo, ngamanye amaxesha banokusetyenziswa ekhaya.

Ukuze usebenzise iinkonzo zethekhnoloji ekhaya, kuyakufuneka uqiniseke ukuba unetekhnoloji eyimfuneko, kubandakanya:

• ukufikelela kwi-intanethi okanye idatha yeselula
• ikhompyuter, ilaptop, i-smartphone, okanye ithebhulethi
• Idilesi ye-imeyile yobuqu ukuze umboneleli wakho wezempilo akwazi ukunxibelelana nawe kwaye athumele ikhonkco kwiwebhusayithi yenkomfa yevidiyo okanye isoftware efunekayo

Ezi zixhobo ziya kuvumela ixesha lokwenyani, iindlela ezimbini, ukunxibelelana ngeaudiyo / nevidiyo kunye nomboneleli wakho wezempilo.

Vavanya ubuchwephesha betekhnoloji yokunxibelelana ngefowuni kunye nomhlobo okanye ilungu losapho ngaphambi kokuqeshwa kwakho okokuqala ngocingo. Oku kuya kukunceda usombulule naziphi na iingxaki ezinokubakho ngaphambi kokuba uzame ukusebenzisa ezi nkonzo ngengcali yezempilo.

Ndazi njani ukuba ndiyafaneleka ukufumana ingxelo?

Nje ukuba ubhalise kwi-Medicare yoqobo, uya kulungelwa iinkonzo ze-telehealth.

Unokufanelekela kwi-Medicare ukuba uneminyaka engama-65 nangaphezulu, unesifo se-renal (ESRD) okanye i-ALS, okanye ukuba awukwazi ukusebenza ngenxa yokukhubazeka okufunyenweyo.

Izibonelelo ezivunyiweyo

Abantu abaneCandelo B lokugubungela bahlala befuna ukuya kwiziko lokhathalelo lwempilo ngeenkonzo zetekhnoloji. Jonga ngesicwangciso sakho ukufumanisa ukuba kuyafuneka uye kwiziko elamkelweyo kutyelelo lwakho. Ezi ntlobo zoncedo zibandakanya:

• iiofisi zikagqirha
• ezibhedlele
• izibonelelo zabongikazi
• amaziko empilo yengqondo yoluntu
• iikliniki zasemaphandleni
• ezibhedlele ezibalulekileyo
• Izibonelelo zedialysis esekwe esibhedlele
• amaziko ezempilo afanelekileyo, afumana inkxaso-mali kurhulumente kwabo babonelela ngeenkonzo zonyango kwabo bangenako ukuzifumana

Indawo

Uhlobo lweenkonzo ze-telehealth onokulufumana nge-Medicare yoqobo inokuxhomekeka kwindawo okuyo. Oku kuthetha ukuba kuya kufuneka ubekwe kwisithili esingaphandle kweMetropolitan Statistical Area okanye indawo yasemaphandleni yokuNqongophala kwezeMpilo.

Ezi ndawo zimiselwe ziiarhente zikarhulumente. Ungajonga ukufaneleka kwendawo yakho kwiZiko lezeMpilo kunye neeNkonzo zoLawulo lweeNkonzo.

Khumbula ukuba ziindidi ezithile kuphela zabanikezeli bonyango kunye nokuqeshwa okugutyungelweyo. Ukuba awuqinisekanga ukuba ikhona into egqunyiweyo, jonga kumboneleli wakho weinshurensi ngaphambi kokuba uqalise iinkonzo zetelehealth.

Inkqubo yolawulo lwempilo engapheliyo (CCM)

Inkqubo yeCCM iyafumaneka kubantu abaneMedicare yoqobo abanemigangatho emibini okanye nangaphezulu yezempilo enganyangekiyo ekulindeleke ukuba ihlale iinyanga ezili-12 okanye nangaphezulu.

Iinkonzo zeCCM zikuvumela ukuba wenze isicwangciso sokhathalelo olwenzelwe wena. Esi sicwangciso siqwalasele:

• iimeko zakho zempilo
• uhlobo lokhathalelo olufunayo
• ababoneleli bakho bezempilo
• amayeza owasebenzisayo
• iinkonzo zoluntu ozifunayo
• iinjongo zakho zempilo
• isicwangciso sokuququzelela ukhathalelo lwakho

Iinkonzo ze-CCM zibandakanya uncedo kulawulo lwamayeza kunye nokufikelela kwi-24/7 kwingcali yezempilo. Oku kunokubandakanya iinkonzo zempilo. Unxibelelwano ngomnxeba, nge-imeyile, okanye ngezigulana eziguli nazo ziyinxalenye yesi sicwangciso.

Ukuba unomdla wokusebenzisa iinkonzo ze-CCM, cela ababoneleli bakho bezempilo ukuba bayakunika.

Kukho kwakhona kukho umrhumo wenyanga kwezi nkonzo ukongeza kwiCandelo B lokutsalwa kunye nokuqinisekiswa kweemali, ke jonga kwisicwangciso sakho esithile. Ukuba unayo i-inshurensi eyongezelelweyo, inokukunceda ekuhlawuleni umrhumo wenyanga.

Ukwandisa ukhuseleko kwi-Medicare ye-telehealth

Umthetho wohlahlo-lwabiwo mali lwe-Bipartisan ka-2018 wandise ukogqitywa kwe-telehealth kwabo banamayeza Kukho iimeko ezithile ngoku apho unokuxolelwa kwimithetho yesiqhelo ye-Medicare enxulumene ne-telehealth. Makhe sijonge ngakumbi:

I-ESRD

Ukuba unayo i-ESRD kwaye ufumana i-dialysis yasekhaya, unokufumana iinkonzo zetelefowuni nokuba sekhaya okanye kwindawo yakho yokudayala. Izithintelo zendawo ezinxulumene ne-telehealth nazo ziyasuswa.

Nangona kunjalo, kuya kufuneka utyelele umntu kunye nomnikezeli wakho wezempilo emva kokuqala kwidayalysis yasekhaya. Olu tyelelo kufuneka lwenziwe kube kanye ngenyanga kwiinyanga ezintathu zokuqala emva koko rhoqo emva kweenyanga ezi-3 ukuya phambili.

Ukubetha

Iinkonzo zeTelehealth zinokukunceda ufumane uvavanyo olukhawulezileyo, isifo, kunye nonyango lwesifo. Ke ngoko, iinkonzo ze-telehealth zinokusetyenziselwa ukubetha ngokungakhathali nokuba uhlala phi na.

Imibutho yoxanduva olunoxanduva (ACOs)

Ii-ACO ngamaqela ababoneleli ngezempilo abasebenza kunye ukulungelelanisa ukhathalelo lwabantu abane-Medicare. Olu hlobo lokhathalelo olulungelelanisiweyo luya kuqinisekisa ukuba ukuba uyagula okanye uneemeko zempilo ezingapheliyo, uya kufumana inkathalo oyifunayo.

Ukuba unayo i-Medicare kwaye usebenzisa i-ACO, ngoku uvumelekile ukufumana iinkonzo zetelefowuni ekhaya. Izithintelo zendawo azisebenzi.

Ukungena okwenyani kunye nokutyelelwa ngu-E

I-Medicare ikwagubungela ezinye iinkonzo ezongezelelweyo ezifanayo kakhulu kutyelelo lwezefowuni. Ezi nkonzo ziyafumaneka kubo bonke abaxhamli be-Medicare kulo lonke ilizwe, ngaphandle kwendawo.

• Ukungena okwenyani. Olu lunxibelelwano olufutshane lomsindo okanye lwevidiyo olucela kumboneleli wakho wezempilo ukunqanda utyelelo lweeofisi ngokungeyomfuneko.
• Utyelelo nge-E. Oku kukunika enye indlela yokunxibelelana nomboneleli wakho wezempilo ngesango lesigulana.

Njengotyelelo lwezefowuni, uya kuba noxanduva kuphela lweepesenti ezingama-20 zeendleko zokungena okanye ukutyelela i-E. Ukuseta ukungena ngokuchanekileyo okanye ukutyelelwa kwe-E, kufuneka uqale uthethe nomboneleli wakho wezempilo.

Ngo-Matshi 2020, uMbutho wezeMpilo weHlabathi kwaye wabhengeza ubhubhane we-COVID-19, isifo esabangelwa yinoveli ye-2019 yenoveli.

Ukukhanya koku, ezinye iinguqu zenziwe kwiinkonzo zethelevishini ezigutyungelwe yiMedicare. Olu tshintsho lwenziwe ukunceda ukuthintela ukusasazeka kwintsholongwane, ngakumbi abo basemngciphekweni wokugula kakhulu.

Ukuqala ngo-Matshi 6, 2020, olu tshintsho lulandelayo lusebenza okwethutyana:

• Abaxhamli be-Medicare banokufumana iinkonzo ze-telehealth kulo naluphi na uhlobo lwendawo evela kuyo, kubandakanya nasekhaya.
• Izithintelo kwindawo ziphakanyisiwe, ke abaxhamli be-Medicare naphina kwilizwe lonke banokusebenzisa iinkonzo zetelehealth.
• Ababoneleli ngezeMpilo ngoku banokurhoxisa okanye banciphise ukwabelana ngeendleko zeenkonzo zetelefowuni ezihlawulwa ziinkqubo zokhathalelo lwempilo ezifana neMedicare.
• Awusadingeki ukuba ube nobudlelwane obusekwe kunye nomboneleli othile wezempilo ukuze usebenzise iinkonzo zetekhnoloji.

Izibonelelo zethekhnoloji

I-Telehealth inezibonelelo ezininzi ezinokubakho. Okokuqala, inokunceda ukukhusela abaxhamli be-Medicare ngexesha leengozi. Oku kuyinyani ngokukodwa ngexesha lesifo se-COVID-19 kodwa kunokuba yinto elungileyo ngexesha lomkhuhlane.

I-Telehealth ikwanceda ukunciphisa iinkonzo zempilo. Umzekelo, izinto ezinje ngokulandela rhoqo kunye nokubeka iliso kwiimeko ezingapheliyo zihlala zenziwa kusetyenziswa i-telehealth. Oku kunokuba nakho ukunciphisa umndilili wokutyelelwa ngabantu ngaphakathi kwinkqubo yokhathalelo lwempilo esele luxinekile.

I-Telehealth inokuba luncedo ukuba usezilalini, kunzima ukufikelela kuzo, okanye kwiindawo ezinezixhobo ezisezantsi. Inika ukufikelela okulungeleyo kwiingcali ezahlukeneyo zonyango okanye iingcali ezinokuthi zingabikho kwindawo yakho.

Nangona i-telehealth inikezela ngezibonelelo ezininzi, ayinguye wonke umntu owaziyo ukuba lukhetho. Olunye uphononongo oluncinci lwe-2020 kwiziko le-dialysis lafumanisa ukuba kuphela iipesenti ezingama-37 zabathathi-nxaxheba bevile nge-telehealth. Oku kubonisa ukuba iinzame ziyafuneka ukwandisa ulwazi.

Ukuthatha

I-Telehealth kuxa iinkonzo zonyango ezide zikhutshwa kusetyenziswa itekhnoloji, enje nge-videoconferencing. I-Medicare igubungela ezinye iintlobo ze-telehealth, kwaye kujongeka ngathi le ngxelo iya kukonyusa ukuya phambili.

Icandelo leMedicare B ligubungela ubuchwephesha bonyango xa lisetyenziselwa ukutyelela iofisi, unyango lwengqondo, okanye ukubonisana. Kuphela ngabaqeqeshi bezempilo kunye neendawo ezigutyungelweyo. Icandelo le-Medicare Icandelo C linokunika ingxelo eyongezelelweyo, kodwa oku kuyahluka ngesicwangciso sakho esithile.

Ngokuqhelekileyo, kukho izithintelo zendawo kwiinkonzo ze-Medicare ezigutyungelweyo. Nangona kunjalo, ezi ziye zandiswa nguMthetho woHlahlo-lwabiwo mali lweBipartisan ka-2018 kunye nendyikityha ye-COVID-19.

Ukuba unomdla wokufumana iinkonzo ze-telehealth, thetha nomboneleli wakho wezempilo. Baza kukwazisa ukuba bayabonelela kwaye nendlela yokuhlela idinga.

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.