Sisiphi esona sicwangciso siBalulekileyo seMedicare kuwe?

Umxholo

• Iindlela zokukhetha esona sicwangciso silungileyo kwiimfuno zakho
• Uphando lweCMS amanqaku
• Zazi ezona zinto zibalulekileyo kuwe
• Chonga iimfuno zakho zokhathalelo lwempilo
• Xoxa malunga nokuba ungabhatala malini
• Phonononga ezinye izibonelelo osele unazo
• Cinga ukubhalisela i-Medicare Part D kwangoko
• Ukuthatha

Ukuba uthengela isicwangciso se-Medicare Advantage kulo nyaka, unokuzibuza ukuba yintoni isicwangciso esihle kuwe. Oku kuya kuxhomekeka kwimeko yakho yobuqu, iimfuno zonyango, ukuba ungafikelela phi, kunye nezinye izinto.

Kukho izixhobo ezikhoyo zokukunceda ufumane izicwangciso ze-Medicare Advantage kwindawo yakho ezinokuhlangabezana nazo zonke iimfuno zakho zokhathalelo lwempilo.

Eli nqaku liza kuphonononga indlela yokufumana esona sicwangciso silungileyo seMedare kwimeko yakho, kunye neengcebiso malunga nendlela yokubhalisa kwiMedicare.

Iindlela zokukhetha esona sicwangciso silungileyo kwiimfuno zakho

Ngalo lonke utshintsho olwenziwe kwizicwangciso zeMedicare kwintengiso, kunokuba nzima ukunciphisa esona sicwangciso silungileyo kuwe. Nazi izinto ezimbalwa onokuzijonga kwisicwangciso seMedicare Advantage:

• iindleko ezilingana nohlahlo-lwabiwo mali kunye neemfuno
• Uluhlu lwababoneleli benethiwekhi abandakanya nabaphi na oogqirha (o) ungathanda ukubagcina
• ukugubungela iinkonzo kunye namayeza owaziyo ukuba uya kuwadinga
• Ukulinganiswa kweenkwenkwezi zeCMS

Funda ukuze ufunde enye into onokuthi uyiqwalasele xa uyokuthengela izicwangciso ze-Medicare Advantage kwindawo yakho.

Uphando lweCMS amanqaku

Amaziko e-Medicare kunye neeNkonzo zeMedicaid (i-CMS) iphumeze iNkqubo yokuLinganiswa kweNkwenkwezi ezintlanu ukulinganisa umgangatho weenkonzo zempilo kunye neziyobisi ezibonelelwa yiCandelo leMedare C (Advantage) kunye neCandelo D (izicwangciso zonyango). Unyaka nonyaka, i-CMS ikhupha la manqanaba eenkwenkwezi kunye nedatha eyongezelelweyo eluntwini.

Uncedo lweMedicare kunye neCandelo D ziyalinganiswa ngezinto ezahlukeneyo, kubandakanya:

• ukufumaneka kovavanyo lwempilo, iimvavanyo, kunye nezitofu zokugonya
• ulawulo lweemeko zempilo ezingapheliyo
• amava elungu ngesicwangciso sempilo
• ukusebenza kwesicwangciso kunye nezikhalazo zamalungu
• Ukufumaneka kwenkonzo yabathengi kunye namava
• Amaxabiso eziyobisi, ukhuseleko, kunye nokuchaneka

Isicwangciso ngasinye seCandelo leMedare C kunye no-D sinikwa inqanaba ngalinye kula macandelo, ukulinganiswa kwenkwenkwezi enye kwiCandelo C no-D, kunye nenqanaba lesicwangciso ngokubanzi.

Ukulinganiswa kwe-CMS kunokuba yindawo elungileyo ukuqala xa uthenga malunga nesona sicwangciso siNgcono seMedicare kwilizwe lakho. Cinga ngokuphanda ezi zicwangciso ngolwazi oluthe kratya malunga nokuba yeyiphi ingxelo ebandakanyiweyo kwaye ibiza malini.

Ukubona onke amanqaku e-Medicare Part C kunye no-D ka-2019, ndwendwela iCMS.gov kwaye ukhuphele i-2019 Icandelo C kunye no-D kwiDatha yokulinganiswa kweNkanyezi.

Zazi ezona zinto zibalulekileyo kuwe

Zonke izicwangciso ze-Medicare Advantage zigubungela ezona zigqubuthelo ze-Medicare-oku kubandakanya ukugubungela isibhedlele (iCandelo A) kunye nonyango (Icandelo B).

Xa ukhetha isicwangciso se-Medicare Advantage, uqala ngokufuna ukuqaphela ukuba loluphi uhlobo lokugubungela oludingayo ukongeza kwinkcazo engentla.

Uninzi lwezicwangciso ze-Medicare Advantage zibonelela enye, ukuba ayizizo zonke, kwezi ntlobo zongezelelweyo zokugubungela:

• Ukukhutshwa kweziyobisi ngugqirha
• Ukufakwa kwamazinyo, kubandakanya iimviwo zonyaka kunye neenkqubo
• ukugubungela umbono, kubandakanya iimviwo zonyaka kunye nezixhobo zombono
• ukugubungela ukuva, kubandakanya iimviwo kunye nezixhobo zokuva
• ubulungu bokuqina
• ukuthuthwa kwezonyango
• ezongezelelweyo zoncedo lwezempilo

Ukufumana esona sicwangciso siNcedo seMedicare kuthetha ukwenza uluhlu lokutshekisha lweenkonzo ofuna ukuzifumana. Emva koko ungathatha uluhlu lwakho lokujonga ukogquma isiXhobo seMedicare 2020 kwaye uthelekise izicwangciso ezigubungela into oyifunayo.

Ukuba ufumana isicwangciso esijongeka silungile kuwe, ungoyiki ukufowunela inkampani ibuze ukuba banikezela ngayo nayiphi na into eyongezelelweyo yokugubungela.

Chonga iimfuno zakho zokhathalelo lwempilo

Ukongeza ekuchongeni into oyifunayo kwisicwangciso sokhathalelo lwempilo, kukwabalulekile ukumisela into oyifunayo kwiimfuno zakho zokhathalelo lwempilo lwexesha elide.

Ukuba unesifo esinganyangekiyo okanye uhamba rhoqo, ezi zinto zinokudlala indima kuhlobo lwesicwangciso oza kusidinga. Izicwangciso ezahlukeneyo zibonelela ngezibonelelo ezahlukeneyo kuxhomekeka kwimeko yakho ebhalwe igama lakho.

Kwinkqubo yokulinganiswa kwe-CMS, unokufumana ukuba zeziphi izicwangciso ezilinganiswe kakhulu kwiimeko ezahlukeneyo zempilo ezingapheliyo. Izicwangciso zilinganisiwe kumgangatho wazo wokukhathalela i-osteoporosis, isifo seswekile, iswekile ephezulu yegazi, uxinzelelo lwegazi, isifo sezintso, isifo samathambo, iimeko zesinyi, kunye nokhathalelo lwabantu abadala (ukuwa, amayeza, iintlungu ezingapheliyo).

Uhlobo lwesicwangciso seMedicare Advantage nalo lubalulekile. Zintlanu iindidi zezakhelo zesicwangciso ofuna ukuzijonga xa ujonge isicwangciso:

• Izicwangciso zoMbutho wezeMpilo (HMO). Ezi zicwangciso zijolise ikakhulu kwiinkonzo zononophelo lwempilo kuthungelwano.
• Izicwangciso zoMbutho woMboneleli okhethiweyo (PPO). Ezi zicwangciso zibiza amaxabiso ahlukeneyo ngokuxhomekeke ekubeni iinkonzo zikunethiwekhi okanye azikho kwinethiwekhi. ("Uthungelwano" liqela lababoneleli abanesivumelwano sokubonelela ngeenkonzo zenkampani ethile yeinshurensi kunye nesicwangciso.) Ezi zinokubonelela ngeendlela ezininzi zokufumana ukhathalelo lwangaphandle kwenethiwekhi.
• Intlawulo yabucala yeNkonzo (PFFS)izicwangciso. Ezi zicwangciso zikuvumela ukuba ufumane ukhathalelo kuye nawuphi na umboneleli ovunyiweyo weMedicare oya kwamkela umrhumo ovunyiweyo kwisicwangciso sakho.
• IziCwangciso zeMfuno eziZodwa (SNP). Ezi zicwangciso zibonelela ngoncedo olongezelelweyo kwiindleko zonyango ezinxulumene neemeko ezithile zempilo ezingapheliyo.
• Iakhawunti yoLondolozo lwezoNyango kwiMedicare (MSA)izicwangciso. Ezi zicwangciso zidibanisa isicwangciso sezempilo esinokutsalwa okuphezulu kunye neakhawunti yokonga yonyango.

Isicwangciso ngasinye sinika iindlela zokukhetha iimfuno zakho zonyango. Ukuba uneemeko zempilo ezingapheliyo, ii-SNPs ziyilelwe ukunceda ukunciphisa iindleko zexesha elide. Kwelinye icala, isicwangciso se-PFFS okanye se-MSA kunokuba luncedo ukuba uhamba kwaye ufuna ukubona ababoneleli abangaphandle kwenethiwekhi.

Xoxa malunga nokuba ungabhatala malini

Enye yezona zinto zibalulekileyo ekufuneka uzithathele ingqalelo xa ukhetha esona sicwangciso silungileyo seMedicare kukuba iya kukuxabisa malini. Isixhobo sokuFumana isiCwangciso seMedicare sidwelise olu lwazi lweendleko zilandelayo ngezicwangciso:

• Intlawulo yanyanga le
• Icandelo le-B yiprimiyamu
• kuthungelwano lonyaka olutsalwayo
• Ukutsalwa kweziyobisi
• ngaphakathi nangaphandle kwenethiwekhi ukuphuma-epokothweni max
• Iikopi kunye noqinisekiso lwemali

Ezi ndleko zinokusukela kwi- $ 0 ukuya kwi-1,500 yeedola nangaphezulu, kuxhomekeke kwimeko yasekhaya, uhlobo lwesicwangciso, kunye nezibonelelo zesicwangciso.

Ukufumana uqikelelo lweendleko zakho zonyaka, jonga ipremiyamu, uxhuzulo, kunye nokuphuma epokothweni max.Nayiphi na imali exhuzuliweyo edwelisiweyo lixabiso oya kulityala ngaphandle epokothweni ngaphambi kokuba i-inshurensi yakho iqale ukuhlawula. Nawuphi na ophuma epokothweni max odwelisiweyo lelona xabiso liphezulu oza kulihlawula ngeenkonzo unyaka wonke.

Xa uqikelela iindleko zesicwangciso sakho seAdvantage, ziqwalasele ezi ndleko kunye nokuba kuya kufuneka kangaphi ukuzalisa amayeza amiselweyo okanye utyelele iofisi.

Ukuba ufuna iingcali okanye utyelelo lwangaphandle kwenethiwekhi, zibandakanye ezo ndleko zinokubakho kuqikelelo lwakho. Ungalibali ukuqaphela ukuba imali yakho inokuba sezantsi ukuba ufumana naluphi na uncedo lwezemali kurhulumente.

Phonononga ezinye izibonelelo osele unazo

Ukuba sele ufumana ezinye iintlobo zezibonelelo zokhathalelo lwempilo, oku kunokuba nefuthe kuhlobo luni lwesicwangciso seMedicare Advantage oya kuthi usidinge.

Umzekelo, ukuba sele ufumene i-Medicare yoqobo kwaye ukhethe ukongeza iCandelo D okanye iMedigap, uninzi lweemfuno zakho zinokuba sele zigqunyiwe.

Nangona kunjalo, uhlala usenza uthelekiso lokugubungela ukumisela ukuba isicwangciso seMedicare Advantage siza kusebenza ngcono okanye sisebenzise iindleko kuwe.

Inkqubo yobhaliso lwe-Medicare ingaqala kwangoko kwiinyanga ezintathu ngaphambi kokuba wena okanye umntu omthandayo ajike aneminyaka engama-65 ubudala. Eli lelona xesha lilungileyo lokufaka isicelo, njengoko iya kuqinisekisa ukuba ufumana ingxelo nge-65 yakho^th usuku lokuzalwa.

Unokulinda ukufaka isicelo seMedicare kude kube yinyanga engama-65 yakho^th usuku lokuzalwa okanye iinyanga ezi-3 ezilandela usuku lwakho lokuzalwa. Nangona kunjalo, ukugubungela kunokulibaziseka ukuba ulindile, ke zama ukufaka isicelo kwangoko.

Nalu ulwazi olubalulekileyo lomfaki-sicelo oya kuyidinga ukubanayo ukufaka isicelo seMedicare:

• indawo kunye nomhla wokuzalwa
• Inombolo yeMedicaid
• i-inshurensi yezempilo yangoku

Nje ukuba unolwazi oludwelisiweyo apha ngentla, yiya kwiwebhusayithi yoKhuseleko lweNtlalo ukufaka isicelo. Nje ukuba isicelo sakho seMedicare senziwe kwaye samkelwe, ungaqala ukuyokuthenga izicwangciso zeMedicare Advantage ukuze zilungele iimfuno zakho.

Cinga ukubhalisela i-Medicare Part D kwangoko

Enye into ebalulekileyo ekufuneka uyiqaphele kukuba ukuba sele ubhalisile kumacandelo e-Medicare A kunye no-B kodwa ungabhaliswanga kwiCandelo C, kwiCandelo D, okanye kolunye uhlobo lweziyobisi, unokujongana nesohlwayo sokubhaliswa kade.

Esi sohlwayo siyaqala xa ungabhalisanga kwiintsuku ezingama-63 zokuqala kokubhalisa kwakho. Olu bhaliso luhlala luyiminyaka yokuzalwa engama-65, kodwa kusenokuba ngaphambili ukuba ukhubazekile okanye uhlangabezana nezinye iindlela.

Ukuba ufumana isohlwayo esifike emva kwexesha, siyakusetyenziswa kwiPrimiyamu yakho yenyanga ngenyanga ngokusisigxina.

Ukuba unzima ukufumana isicwangciso seCandelo C, musa ukulinda ukuthenga isigubungelo seCandelo D, okanye usengozini yokuba nesohlwayo esisigxina sePlani D.

Ukuthatha

Zininzi izinto ezinokuchaphazela isicwangciso osikhethayo seMedare. Cinga umlinganiso weenkwenkwezi we-CMS, izinto eziphambili ngokubaluleka kunye neemfuno zokhathalelo lwempilo, ungafikelela phi, kwaye loluphi uhlobo lweinshurensi onayo ngoku.

Kubalulekile ukuba ubhalise kwi-Medicare ngaphambi kokuba ube neminyaka engama-65 ukuqinisekisa ukuba awuhambi ngaphandle kwezonyango. Ungalibali ukuba unamandla okuthenga ezona zicwangciso zilungileyo zeMedicare Advantage ezihambelana nazo zonke iimfuno zakho.

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.