Yintoni umahluko phakathi kwe-Medicare Advantage PPO kunye ne-HMO Plans?

Umxholo

• Yintoni i-Medicare Advantage PPO?
• Ingaba isebenza kanjani
• Oko ikugubungelayo
• Iindleko eziphakathi
• Ezinye iintlawulo
• Yintoni i-Medicare Advantage HMO?
• Ingaba isebenza kanjani
• Oko ikugubungelayo
• Iindleko eziphakathi
• Ezinye iintlawulo
• Itshathi yokuthelekisa ye-PPO kunye ne-HMO
• Ugqiba njani ukuba yeyiphi engcono kuwe
• Ababoneleli
• Ukufunda
• Iindleko
• Ukufumaneka
• Ukuthatha

Uncedo lweMedicare (Icandelo C) lukhetho oludumileyo lweMedare kubaxhamli abafuna zonke iindlela zokugubungela iMedicare phantsi kwesicwangciso esinye. Kukho iintlobo ezininzi zezicwangciso ze-Medicare Advantage, kubandakanywa iMibutho yoLondolozo lwezeMpilo (HMOs) kunye neMibutho yababoneleli abakhethiweyo (PPOs).

Zombini izicwangciso ze-HMO kunye ne-PPO zixhomekeke ekusebenziseni ababoneleli benethiwekhi. Nangona kunjalo, iiplani ze-PPO zibonelela ngokuguquguquka ngokugubungela ababoneleli beenethiwekhi ngaphandle kweendleko eziphezulu. Kukho unokubakho umahluko ekufumanekeni, ekusetyenzisweni kweendaba, kunye neendleko phakathi kwezi ndidi zimbini zezicwangciso.

Kule nqaku, siza kuphonononga umahluko phakathi kwezicwangciso ze-Medicare Advantage PPO kunye ne-HMO kunye nendlela yokujonga ukuba loluphi uhlobo lwesicwangciso olunokuba lolona lulungileyo kwiimfuno zakho.

Yintoni i-Medicare Advantage PPO?

Izicwangciso ze-Medicare Advantage PPO zibonelela ngomboneleli othile kwabo bafuna, nangona ngexabiso eliphezulu.

Ingaba isebenza kanjani

Izicwangciso ze-PPO zigubungela inethiwekhi kunye nabaphumeleli kwinethiwekhi, oogqirha nezibhedlele. Uya kuhlawula Ngaphantsi yeenkonzo ezivela kubanikezeli benethiwekhi kunye Kaninzi yeenkonzo ezivela kubanikezeli bangaphandle kwenethiwekhi. Ngaphantsi kwesicwangciso se-PPO, ukukhetha ugqirha wokhathalelo oluphambili (i-PCP) akufuneki kwaye akukho nokuhanjiswa kutyelelo lweengcali.

Oko ikugubungelayo

Izicwangciso ze-PPO ngokubanzi zigubungela zonke iinkonzo ezigutyungelwa zizicwangciso zeMedicare, kubandakanya:

• i-inshurensi yesibhedlele
• i-inshurensi yezonyango
• Ukukhutshwa kweziyobisi ngugqirha

Ukuba ufumana isibhedlele okanye iinkonzo zonyango phantsi kwesicwangciso se-PPO, ukusebenzisa ababoneleli benethiwekhi kunokukunceda ungahlawuli imali ephezulu. Kuba isicwangciso ngasinye se-Medicare Advantage PPO sahlukile, kuyakufuneka ukuba uphande ngezicwangciso ezithile ezinikezelwa kwindawo yakho ukuze ufumane ukuba yintoni enye egqunywe kwisicwangciso ngasinye.

Iindleko eziphakathi

Izicwangciso ze-Medicare eziluncedo ze-PPO zineendleko zilandelayo:

• Isicwangciso esikhethekileyo sepremiyamu. Ezi ziqendu ziqala kwi- $ 0 ukuya kwi-avareji ye- $ 21 ngenyanga kwi-2021.
• Icandelo le-B yiprimiyamu. Ngo-2021, iPrimiyamu yesiGaba B sakho yi- $ 148.50 ngenyanga okanye ngaphezulu, kuxhomekeke kumvuzo wakho.
• Inethiwekhi inokubanjwa. Le ntlawulo ihlala i-0 yeedola kodwa inokuphakama njenge- $ 500 okanye nangaphezulu, kuxhomekeke kwisicwangciso osibhalisileyo.
• Ukutsalwa kweziyobisi. Ezi zinto zinokutsalwa zingaqala kwi- $ 0 kwaye zonyuke ngokuxhomekeke kwisicwangciso sakho se-PPO.
• Iikopi. Ezi ntlawulo zinokwahluka ngokuxhomekeke ekubeni ubona ugqirha wokhathalelo oluphambili okanye ingcali kwaye ukuba ezo nkonzo zikwi-network okanye ngaphandle kwenethiwekhi.
• UQinisekiso. Le ntlawulo iipesenti ezingama-20 zeendleko zakho ezivunyiweyo ze-Medicare emva kokuba kudityanisiwe.

Ngokungafaniyo neMedicare yoqobo, izicwangciso zeMedicare Advantage PPO zikwanazo neepokotho eziphezulu. Eli xabiso liyahluka kodwa ngokubanzi liphakathi kumawaka.

Ezinye iintlawulo

Ngesicwangciso se-PPO, uya kuhlawulwa imali eyongezelelweyo yokubona ababoneleli be-network. Oku kuthetha ukuba ukuba ukhetha i-PCP, ndwendwela isibhedlele, okanye ufune iinkonzo kumboneleli ongekho kwinethiwekhi ye-PPO, ungahlawula ngaphezulu kwexabiso eliphakathi elidweliswe apha ngasentla.

Yintoni i-Medicare Advantage HMO?

Izicwangciso ze-HMO ze-Medicare eziluncedo aziboneleli ngokubonelela ngombono, ngaphandle kweemeko zonyango likaxakeka.

Ingaba isebenza kanjani

Izicwangciso ze-HMO zigubungela ababoneleli benethiwekhi, oogqirha kunye nezibhedlele kuphela, ngaphandle kwemeko yokhathalelo lonyango olungxamisekileyo okanye ukhathalelo olungxamisekileyo olungaphandle kwendawo kunye nedialysis. Ngamanye amaxesha, unokusebenzisa abasebenzisi be-network, kodwa uya kuhlawula iipesenti ezili-100 zeenkonzo ngokwakho.

Ngaphantsi kwesicwangciso se-HMO, kuya kufuneka ukhethe i-PCP ekwinethiwekhi kwaye uya kucelwa ukuba ubhekise kutyelelo lweengcali ezikwi-network.

Oko ikugubungelayo

Njengezicwangciso ze-PPO, izicwangciso ze-HMO zigubungela zonke iinkonzo ezithi zisoloko zigutyungelwa zizicwangciso zeMedicare, kubandakanya:

• i-inshurensi yesibhedlele
• i-inshurensi yezonyango
• Ukukhutshwa kweziyobisi ngugqirha

Xa ufuna isibhedlele okanye iinkonzo zonyango, kuyakufuneka ukhethe kuluhlu lwabanikezeli benethiwekhi abaceba ukuceba i-HMO yakho. Ukuba ufuna iinkonzo ezingaphandle koluhlu lwakho lwababoneleli benethiwekhi, kungafuneka uhlawule isixa esipheleleyo sezo nkonzo.

Nangona kunjalo, kwiimeko zongxamiseko, njengaxa uhamba, unokugutyungelwa ngokuxhomekeke kwimiqathango ethile yesicwangciso sakho.

Iindleko eziphakathi

Izicwangciso ze-Medicare Advantage HMO zineendleko ezifanayo ezisisiseko njengezicwangciso ze-PPO, kubandakanya isicwangciso senyanga kunye neeprimiyamu zeCandelo B, ezikhutshiweyo, kunye neekopayments kunye ne-coinsurance. Njengoko kufunwa ngumthetho, isicwangciso sakho se-HMO siya kuba nokuphuma epokothweni ngonyaka kwiindleko ozityalayo.

Ezinye iintlawulo

Kuba iiplani ze-HMO zifuna ukuba ufune iinkonzo kwinethiwekhi, awuzukujongana nemirhumo eyongezelelweyo ngaphandle kokuba uthatha isigqibo sokusebenzisa ababoneleli abangaphandle kwenethiwekhi. Kwiimeko zonxunguphalo, unokufumana iindleko ezongezelelweyo, kodwa kuya kufuneka ujonge kwisicwangciso sakho ukuze ubone ukuba zeziphi ezi ntlawulo.

Itshathi yokuthelekisa ye-PPO kunye ne-HMO

Kukho ukufana okuninzi phakathi kwe-Medicare Advantage PPO kunye nezicwangciso ze-HMO, ezinje ngeendleko zepremiyamu, ezikhutshiweyo, kunye nezinye iifizi zesicwangciso. Uninzi lokwahluka phakathi kwezi ndidi zimbini zezicwangciso ikakhulu zisekwe kukugubungela kunye neendleko zenethiwekhi kunye neenkonzo ezingaphandle kwenethiwekhi.

Apha ngezantsi kukho itshathi yokuthelekisa into enikezelwa sisicwangciso ngasinye ngokubhekisele kwiindleko kunye neendleko.

Kungakhathaliseki ukuba uluhlobo luni lwesicwangciso soNyango lwe-Medicare olukhethayo, soloko ubeka ingqalelo ngokukodwa kwiinketho ezithile zokugubungela kunye neendleko ezihambelana nesicwangciso osikhethayo. Ngenxa yokuba izicwangciso zeAdvantage zinikezelwa ziinkampani zeinshurensi zabucala, zinokwahluka kwinto abanokuyinikela kwaye bagqiba kwelokuba babize ntoni.

Ugqiba njani ukuba yeyiphi engcono kuwe

Ukukhetha esona sicwangciso siNcedo seMedicare kuxhomekeke ngokupheleleyo kwimeko yakho yezonyango kunye neyezemali. Yintoni esebenzela omnye umntu isenokungakusebenzeli, ke kubalulekile ukuba wenze uphando lwakho kwizicwangciso ezikwindawo yakho.

Nazi izinto ezimbalwa ekufuneka ziqwalaselwe xa ukhetha ukubhalisa kwisicwangciso se-PPO okanye se-HMO.

Ababoneleli

Ukuba uxabisa ukuba bhetyebhetye komnikezeli, isicwangciso se-PPO sinokuba semdleni wakho, njengoko sinikezela ngenkxaso kuzo zombini iinkonzo zenethiwekhi kunye nezangaphandle. Nangona kunjalo, oku kunokuba lukhetho kuwe kuphela ukuba unendlela yemali yokutyelela ababoneleli abangaphandle kwenethiwekhi, njengoko ezi ntlawulo zonyango zinokongeza ngokukhawuleza.

Ukuba ulungile ngokusebenzisa abanikezeli benethiwekhi kuphela, isicwangciso se-HMO siyakuvumela ukuba uhlale ngaphakathi kwenethiwekhi ngaphandle komthwalo owongezelelweyo wemali.

Ukufunda

Ngokomthetho, zonke izicwangciso ze-Medicare Advantage kufuneka zigubungele ubuncinci i-Medicare Icandelo A kunye neCandelo B. Ukongeza, phantse zonke izicwangciso ze-Advantage zikwabandakanya amayeza amiselweyo, umbono kunye neenkonzo zamazinyo. Ezi ndlela zokukhetha zichaphazela isicwangciso ngasinye, kodwa kuhlala kungekho mahluko mkhulu phakathi kokukhetha uninzi lwe-PPO kunye ne-HMO Advantage plans.

Enye into ekufuneka uyiqwalasele kukuba ingaba ukhuselo olunikezelwa zizicwangciso ze-PPO kunye ne-HMO ziya kuchaphazeleka kwimeko yakho yezonyango. Umzekelo, ucebisa ukuba abantu abaneemeko zempilo ezingapheliyo kunokwenzeka ukuba bangabhalisi kwizicwangciso ze-HMO kwaye babhalise kwezinye iintlobo zezicwangciso zezempilo, ezinje.

Iindleko

Izicwangciso ze-Medicare Advantage PPO kunye ne-HMO zingahluka ngokweendleko zabo kuxhomekeke ekubeni uhlala kweliphi ilizwe kwaye loluphi uhlobo lokugubungela olifunayo. Kungakhathaliseki ukuba yeyiphi isakhiwo osikhethayo, yonke iminikelo yesicwangciso inokuhlawulisa iiprayimari, ukutsalwa kwemali, ukukhutshwa kwemali kunye nokuqinisekiswa kwemali. Isixa semali nganye kwezi sixhomekeke kwisicwangciso osikhethileyo.

Kwakhona, cinga ukuba kunokubakho iindleko ezongezelelweyo ezinxulumene nesicwangciso sakho kuxhomekeke kubaboneleli obabonayo. Umzekelo, ukuba undwendwela umboneleli ongaphandle kwenethiwekhi kwisicwangciso se-PPO, uya kuhlawula ngaphezulu epokothweni kwezi nkonzo.

Ukufumaneka

Izicwangciso ze-Medicare ze-Advantage zisekwe kwindawo, oko kuthetha ukuba kuya kufuneka ubhalise kwimeko ohlala kuyo ngoku kwaye ufumane iinkonzo zonyango. Oku kuthetha ukuba izicwangciso ze-PPO kunye ne-HMO zinokwahluka ngokuxhomekeka apho uhlala khona.

Ezinye iinkampani zabucala ziya kubonelela kuphela ngohlobo olunye lwesicwangciso, ngelixa ezinye ziya kuba nezakhiwo ezininzi onokukhetha kuzo. Apho uhlala khona kuya kugqiba ukubakho kwesicwangciso, ukogquma, kunye neendleko zaluphi na uhlobo lwesicwangciso seMedare esiluncedo osikhethayo.

Ukuthatha

I-Medicare Inzuzo ye-PPO kunye nezicwangciso ze-HMO lukhetho olukhulu lwe-inshurensi kubantu abafuna ukufumana isigqubuthelo seMedare phantsi kwesicwangciso esinye seambrela.

Ngelixa kukho ukufana phakathi kwezi ndidi zimbini zezicwangciso, kukho umahluko kubukho, ukugubungela kunye neendleko. Xa ukhetha esona sicwangciso silungileyo se-Medicare Advantage kuwe, qiniseka ukuba uthathela ingqalelo ukhetho lwakho lomboneleli, imeko yezemali kunye neemfuno zonyango.

Nanini na xa ukulungele ukukhetha isicwangciso seMedicare Advantage, ndwendwela isixhobo sokufumana isicwangciso seMedicare solwazi malunga nezicwangciso kwindawo yakho.

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.