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I-HMO vs. EPO vs. PPO: Uyini umehluko?

Inkampani

Umbono womshuwalense wezempilo ulula: Kuyasiza ukumboza izindleko zakho zokwelashwa uma ulimele noma ugula. Kepha iqiniso lomshuwalense wezempilo eMelika liyinkimbinkimbi ngokwengeziwe. Kunama-acronyms amaningi abandakanyekayo — i-HMO vs. EPO vs. PPO vs. POS vs. HSA vs. PCP. Ukuthola ukuthi yiluphi uhlelo lomshuwalense olungcono kakhulu kuwe kungadideka.

Izinhlobo ezintathu ezijwayelekile zezinhlelo zomshuwalense wezempilo yizinhlelo ze-HMO, EPO, ne-PPO. Isinqumo sakho sizosuselwa kumholo wakho, indlela ophila ngayo, nomsebenzi, kanye nempilo yomndeni wakho jikelele, ezezimali kanye nezidingo zakho zezokwelapha.

Into ebaluleke kakhulu ukuhlola zonke izinto ngaphambi kokukhetha uhlelo, kunokucabanga ukuthi leli qembu lezincwadi lingcono kunelinye iqembu lezincwadi, kusho uVincent Plymell, umsizi kaKhomishani weColorado Division of Insurance. Mayelana nokukhetha phakathi kwama-HMO, ama-EPO, nama-PPO, eminyakeni edlule lezi zinhlobo zezinhlelo seziya ngokuya zifana, ngakho-ke kuba kuncane ngegama lecebo nokuningi mayelana nezinsizakalo ezikulolo hlelo.

HMO Vs. I-EPO vs. I-PPO

Inhlangano enakekela impilo, noma I-HMO , uhlobo lohlelo lokunakekelwa kwezempilo olunikeza ukufinyelela kunethiwekhi yabahlinzeki, izibhedlela, kanye nabahlinzeki bezempilo endaweni yakho. Imvamisa, izinhlelo ze-HMO zidinga ukuthi ukhethe udokotela wokunakekela oyinhloko (PCP). Lo ngudokotela wakho, lowo obonisana naye kuqala mayelana nanoma yiziphi izinkinga zezempilo. Uma udinga izinsizakalo ezengeziwe zokunakekelwa kwezempilo, i-PCP yakho izokuthumela kuchwepheshe ongaphakathi kwenethiwekhi ye-HMO. Uma uya kudokotela ongaphandle kwenethiwekhi noma esibhedlela, cishe kuzofanele ukhokhe ephaketheni ngezindleko ezingezona eziphuthumayo.

Inhlangano yomhlinzeki ekhethekile, noma i-EPO, kufana ne-HMO ngoba zombili ziqukethe inethiwekhi yabahlinzeki bezempilo kanye nezinsiza. Yize kufanele ukhethe udokotela wokunakekela oyinhloko onama-EPO amaningi, awudingi ukuthunyelwa ukuze ufinyelele ongoti — ngokungafani ne-HMO. Inethiwekhi ye-EPO nayo ingaba banzi kakhulu kunenethiwekhi ye-HMO. Ngaphandle kokuthi kuyisimo esiphuthumayo, ama-HMO nama-EPO ngokuvamile adinga ukuthi ukhokhe zonke izindleko nganoma yikuphi ukunakekelwa okungaphandle kwenethiwekhi.

Ngenhlangano yomhlinzeki oyithandayo, noma I-PPO , uhlelo lwakho lomshuwalense wezempilo lunenethiwekhi yabahlinzeki bezokunakekelwa kwempilo nezinsiza endaweni yangakini nasezweni lonke elisebenza nalo futhi elingathanda ukuthi ulifune. Uma uya kulaba bahlinzeki, ingxenye enkulu yezindleko zakho izokhokhelwa ngohlelo. Ngokungafani nama-EPO nama-HMOs, ama-PPO azokhokha ezinye izindleko ezingaphandle kwenethiwekhi inqobo nje uma zenzelwe izinsizakalo ezihlanganisiwe. Inethiwekhi ye-PPO imvamisa ifaka abahlinzeki ezifundazweni ezahlukahlukene, futhi, njenge-EPO, ngeke udinge ukuthunyelwa kusuka kudokotela wokunakekelwa okuyinhloko ukuze ubone uchwepheshe.

Ama-HMO ahlinzeka ngokuguquguquka okuncane kepha imvamisa anezindleko eziphansi kakhulu zenyanga. Ama-EPO aguquguquka kalula kepha imvamisa abiza ngaphezu kwama-HMO. Ama-PPO, ahlinzeka ngokuguquguquka okukhulu, imvamisa abiza kakhulu.

Yikuphi okungcono kakhulu: i-PPO, i-EPO, noma i-HMO?

Izidingo zokunakekelwa kwezempilo zawo wonke umuntu zehlukile. Abanye abantu badinga izinsizakalo ezijwayelekile zezokwelapha. Abanye banemiyalo edinga ukugcwaliswa. Futhi abantu abaningi banempilo njengoba kungaba njalo futhi abanazo izidingo zokunakekelwa kwezempilo nhlobo. Yingakho kungenzeki ukusho ukuthi yiluphi uhlobo lwecebo oluhamba phambili. Impendulo iyehluka kuye ngomuntu nomuntu, izwe ngesifundazwe, nomqashi kuye umqashi.

Ngesikhathi ukubhaliswa okuvulekile , kuzodingeka uzibuze imibuzo ethile ngaphambi kokukhetha inqubomgomo:

Ziyini izidingo zami zempilo nezidingo zomndeni wami?
Ngithatha miphi imiyalo?
Yiziphi izimo enginazo?
Yiziphi izingqinamba zezempilo engilindele mina noma ilungu lomndeni kulo nyaka ozayo? Cabanga: ukuhlinzwa okukhulu, ukubhekana nemarathon, ukukhulelwa, ukufinyelela usuku lokuzalwa olubalulekile, njll.
Ngabe ngifuna noma ngidinga ukubona umhlinzeki ongaphandle kwenethiwekhi?

Ngaphezu kwale mibuzo yezempilo, uPlymell uthi kufanele ubuze le mibuzo elandelayo yezezimali:

Ziyini izidingo zami zezezimali?
Ngingakwazi ukukhokhela imali ekhishwayo ephezulu uma ngishintshanisa i-premium ephansi?
Ngabe ngincamela ukuqagela ezindlekweni zokunakekelwa kwezempilo noma ngabe ngincamela ukuba namaphrimiyamu aphansi enyanga?

Qaphela: Uma uthola umshuwalense wezempilo ngomsebenzi wakho, ungahle ube nezinketho ezimbalwa zokuthi hlobo luni lomshuwalense olutholayo. Kunoma ikuphi, uvame ukugcina unenqubomgomo efinyeleleka kalula kunaleyo ethengwe ngawodwana.

I-HMO ingaba ngcono uma…

Labo abasebasha, abanempilo enhle, futhi okungenakwenzeka ukuthi badinge ukunakekelwa kwezokwelapha ngonyaka ozayo bavame ukukhetha izinhlelo ze-HMO nge-premium ephansi (inani olikhokhayo inyanga ngayinye) kanye ne-deductible ephezulu (inani okufanele ulikhokhe ngaphambi kokuba umshuwalense usize ukumboza Okunye). Lokhu konga imali ngaphandle kwalapho unokulimala noma ukugula, okulungele izinhlobo ezinobungozi obuncane, kepha akukuhle kuwo wonke umuntu.

I-EPO ingaba ngcono uma…

Kulabo abanezinkinga ezingapheli zezempilo futhi bazi ukuthi bazodinga ukubona ongoti, uhlelo lwe-EPO lungenza umqondo wezezimali kakhulu. Kususa isidingo sokuthola izinqumo zokunakekelwa kwezempilo ngokusebenzisa udokotela wokunakekelwa okuyisisekelo futhi imvamisa iba nodokotela nezinsiza ezingaphezulu kwenethiwekhi kune-HMO.

I-PPO ingaba ngcono uma…

Uma uhamba kakhulu, ikakhulukazi uma unezinkinga ezingapheli zezokwelapha, mhlawumbe uzofuna ukubheka uhlelo lwe-PPO. Ama-PPO anenethiwekhi kazwelonke ebanzi yabahlinzeki bezokunakekelwa kwezempilo futhi ahlanganisa ezinye izindleko uma ukhetha umhlinzeki ongaphandle kwenethiwekhi.

OKUSHIWO: HMO vs. PPO

Yiluphi uhlelo lwezempilo olushibhile?

Uhlelo lwezempilo olushibhile, njalo ngenyanga, luzoba yilo olunemali ephansi kakhulu. Kepha lokho kuvame ukusho ukuthi kudonswa imali ephezulu, ngakho-ke lolu hlelo lungabiza ngokushesha okukhulu uma ugula noma ulimele. Yingakho igama elishibhile elingasetshenziswa uma kukhulunywa ngomshwalense wezempilo. Esikhundleni sokubheka kuphela izindleko zokuphuma ephaketheni, kubalulekile ukuthi ubheke inani ozolithola ngemali yakho.

Ngokusho kweKaiser Family Foundation , isilinganiso semali yomshwalense wezempilo womuntu wase-US sasingu- $ 7,188 ngonyaka. Emindenini, isilinganiso silinganiselwa ku- $ 20,576.Izindleko zomshuwalense wezempilo zingahluka ngokuya ngokuthi uhlala kuphi, kodwa uma umncane futhi unempilo, akunjalo kungenzeka kube lula ukuthola amaphrimiyamu nyangazonke ngaphansi kwe- $ 100. Kodwa-ke, lezi cishe ngeke zibe izinqubomgomo ezinhle. Ungaba sekhoneni lokudonswa imali enkulu uma ugula noma ulimele. Ngokujwayelekile, ama-premium akhokhelwa umshuwalense wezempilo azoba ngaphezulu kakhulu.

Okunye ukucatshangelwa ngama-copays. Ezinye izinqubomgomo, ikakhulukazi ama-HMO, zingaqala ukukhokha ingxenye yezindleko zezinto ezinjengokuvakasha kukadokotela ngaphambi kokuthi uhlangane nemali oyibanjelwe. Abanye ngeke, ikakhulukazi ama-PPO. Lokhu kusho ukuthi izindleko zokubona udokotela zingaba kusuka ku- $ 10 kuya ku- $ 200 kuya phezulu, kuya ngodokotela kanye nenqubomgomo yakho.

Enye indlela ongonga ngayo imali ukukhetha inqubomgomo efaka ukuqinisekiswa kwemali. Lezi zinhlobo zezinqubomgomo zingaba namaphrimiyamu aphansi. Kodwa-ke, kusazodingeka ukhokhe ingxenye ethile yezindleko zakho zokwelashwa ngisho nangemva kokuba uhlangane nemali oyibanjwayo. Inkampani yomshuwalense izokhokha iphesenti (imvamisa iphakathi kuka-75% no-90%) - futhi kuzofanele ukhokhe okusele. Umthetho Wokunakekelwa Ongabizi ulinganisela inani ongalisebenzisa uphuma ephaketheni ngonyaka onikeziwe ngezinqubomgomo ezinjalo. Okwe-2020, i- okuphezulu ephaketheni wezinhlelo zeMakethe kungama- $ 8,150 wabantu ngabanye kanye nama- $ 16,30 emindeni. Ungahle futhi ufanelekele i- Ukuxhaswa kwe-ACA lokho kuzokwehlisa izindleko zomshuwalense wezempilo ngokuya ngeholo lakho.

Kungakhathaleki ukuthi uyiphi inqubomgomo oyikhethayo, ungahlala ulondoloze imiyalo yakho ngekhadi lesaphulelo se-SingleCare.