Ungayikhokhela kanjani imiyalo ngaphandle komshwalense

Inkampani

Noma ngabe ulahlekelwe ngumsebenzi wakho (kanye nezinzuzo eza nawo), noma uboshwe ngohlelo lokunciphisa olungenayo imishanguzo oyidingayo, kwesinye isikhathi ungazithola ugcwalisa imiyalo umshuwalense. Ngenkathi amanani kadokotela yedwa angaba phezulu, izindleko zemithi ngaphandle komshuwalense empeleni zingabiza cishe 25% zesikhathi. Yini enye? Kunezindlela eziningi zokuthola ukonga okuningi ekhemisi.

OKUSHIWO: Awukho umshuwalense wezempilo? Zama lezi zinsiza ze-2020

Udinga umshuwalense ukuze uthole incwadi kadokotela?

Ukuzulazula ohlelweni lokunakekelwa kwezempilo ngaphandle komshuwalense wezempilo kungaba nzima, kepha akufanele kukuvimbe ekufuneni ukunakekelwa kwezokwelapha. Ungakwazi bonana nodokotela bese uthola incwadi kadokotela ngaphandle komshwalense -Kodwa uzodinga ukukhetha umhlinzeki wezokunakekelwa kwezempilo ngokuhlakanipha ukuze ugcine izindleko ziphansi. Imitholampilo yezempilo yomphakathi iyindlela enhle yezinsizakalo zamahhala noma ezingabizi kakhulu, eziningi zinikela ngamanani entengo ashibilikayo asuselwa kumholo wakho. Imitholampilo yokuhamba kanye nezikhungo zokunakekelwa okuphuthumayo zivumela iziguli ukuthi zikhokhe ngemali, kepha amanani azo angahluka kakhulu. Ngokolunye uhlangothi, imithi yezokwelapha —Ukubonisana nodokotela ngocingo noma nge-portal ye-web - kuvame ukushibhile kunokuvakashela ehhovisi. Ucwaningo lwango-2017 olushicilelwe ku- Ezempilo ithole ukuthi iziguli zokuphefumula zisebenzise imali elinganiselwa ku- $ 79 ukuvakashela i-telehealth kuqhathaniswa ne- $ 146 ukuvakashelwa kwehhovisi (yize kutholakale nokuthi ukutholakala kwe-telehealth kungakhuphula imali esetshenziswayo).

Izindleko zokuvakashelwa kwehhovisi ngomshuwalense uma kuqhathaniswa ngaphandle kunzima ukuzibala, njengoba izinto eziningi — kufaka phakathi indawo nesikhathi sokuvakasha — konke kudlala indima. Isibonelo, ukuvakashelwa kwemizuzu engu-15 ehhovisi lesiguli esiseSeattle, kuphakathi kuka- $ 128 no- $ 398 kanti uhlobo olufanayo lokuvakashelwa kwesiguli eNew York lubiza phakathi kuka- $ 138 no- $ 430, ngokusho I-Healthcare Blue Book . Okwamanje, ama-copay wokuvakashelwa udokotela ojwayelekile ngokuvamile aphakathi kuka- $ 15 no- $ 25, ngokusho isikweletu.org .

Ukwahluka okufanayo kuya kwemithi kadokotela nayo. Umuthi wegama lomkhiqizo ILyrica , ngokwesibonelo, amabanga entengo kusuka ku- $ 460 kuya ku- $ 720 ngenyanga ngaphandle komshwalense. Amakhophi we-Prescription ayahluka ngokuya ngabahlinzeki, kepha ama-copay aphakathi nendawo avela ku- $ 11 kuya ku- $ 105 kuye ngesigaba sezidakamizwa, ngokusho kocwaningo lwango-2018 oluvela kuKaiser Family Foundation .

Ibiza malini imithi kadokotela ngaphandle komshwalense?

Akunakuphikwa ukuthi izintengo zemithi kadokotela ziyaqhubeka nokukhuphuka. Kulo nyaka nje, Intengo yokuthengisa yemithi engama-460 inyuke ngo-5.2%, ngokusho kwenkampani yocwaningo lwezempilo i-3 Axis Advisors. Ngokwesilinganiso, abantu baseMelika basebenzisa cishe ama- $ 1,200 unyaka nonyaka kukhemisi, ngokusho kwedatha evela ku- Inhlangano Yezokusebenzisana Kwezomnotho Nentuthuko . Kwabaningi abangaqinisekisiwe, lezo zindleko ezikhuphukayo zisho ukuthi kufanele bakhethe phakathi kokuthatha imithi abayidingayo nokukhokhela izidingo ezifana nerenti nokudla. Eqinisweni, i- Ucwaningo luka-2016 ithole ukuthi ama-14% abantu baseMelika abangaqinisekisiwe kungenzeka beqe imithamo noma abangagcwalisanga incwadi kadokotela ngenxa yezindleko. Ngamafuphi: Izintengo zezidakamizwa zibiza abantu baseMelika ngaphezu kwama-dollar nje kuphela — zibiza nempilo yethu futhi.

Ziningi izinto ezidlalwayo uma kukhulunywa ngezindleko zemithi kadokotela. Ngezinga elikhudlwana, abakhiqizi bathi izindleko eziphezulu zomuthi owodwa ngokuvamile zisiza ukuqeda izindleko zokucwaninga nezentuthuko zomunye. (Noma kunjalo, kuningi izindleko zemithi ezingabaliwe kule ncazelo .)

Ngezinga elincane, futhi uma unomshuwalense, izindleko zizonqunywa yi-formulary yohlelo (eyaziwa nangokuthi uhlu lwezidakamizwa), echaza igama lomkhiqizo nemithi ejwayelekile embozwe uhlelo lwakho lomshuwalense. Ukusuka lapho, i-formulary ivame ukuhlukaniswa ngama-tiers (ngokususelwa ezintweni ezifana nezindleko, ukutholakala, njll.), ngezindleko ezithile eziphuma ephaketheni ezinikezwe isigaba ngasinye. Ngakho-ke ukukhokhelwa ngokubambisana komuthi we-tier 4, ngokwesibonelo, kungahluka kakhulu ekukhokheni ngokubambisana komuthi owodwa we-tier.

Okunye okuthinta i-copay yakho umdlali wasembonini abambalwa baseMelika okungenzeka ukuthi bake bezwa-kubizwa ngokuthi yi-Pharmacy Benefits Manager (PBM). Ngokuyinhloko umuntu ophakathi nendawo, i-PBM isebenza namakhemisi, izinkampani zomshuwalense, nabakhiqizi bezidakamizwa ukwenza lula ukuthengiswa kwempahla. (Empeleni, i-PBM isiza inkampani yomshuwalense ukuthi inqume ukuthi izobandakanya ziphi izidakamizwa (isb., Formulary yayo) nokuthi bazokhokhela malini umenzi wazo.)

Kungani eminye imiyalo ishibhile ngaphandle komshwalense?

Izintengo zemithi ngaphandle komshwalense zingabiza ama-25% wesikhathi. Kodwa kungenzeka kanjani lokho? Ezweni eliphelele, i-PBM ingafuna ukuthola intengo ephansi kakhulu yenkampani yomshuwalense, kepha imvamisa, umenzi wezidakamizwa uzophonsa emuva ukuze i-PBM ikhethe umkhiqizo wayo wegama kunohlobo olujwayelekile. Lokhu kudonswa emuva, okubizwa ngezinzipho emkhakheni wemithi, ikakhulu lapho ama-copay akho andisiwe agcina khona. Nakhu ukuthi kusebenza kanjani:

• Unikezwe umuthi owawuyi- $ 30 kuphela ngonyaka owedlule, kodwa i-copay yakho eyandisiwe manje isho ukuthi ingama- $ 75.
• Ikhemisi lithola ukukhokhelwa kwakho okungama- $ 75 futhi ungacabanga ukuthi bathola inzuzo enhle ngoba kubabiza ama- $ 15 kuphela ukuthenga lesi sidakamizwa.
• Ongakwazi ukuthi i- $ 50 yakho engu- $ 75 ibuyela ku-PBM ngendlela ye-clawback.

Esikhundleni sokukhokha imali engu- $ 30 futhi uvumele ikhemisi ukuthi lifake u- $ 15 ngemuva kokukhokhela umuthi, ukuletha ama-PBM kule ngxube kubangela ukuthi amanani entengo kadokotela anyuke ngokungekho ukuze nabo bathole isabelo sabo. Ingxenye embi kunazo zonke? Osokhemisi abavunyelwe ukukutshela ngalolu hlelo , ngoba ukwenza njalo kungasongela ubudlelwano babo nabathwali bomshuwalense nama-PBM.

Ingabe i-SingleCare isebenza ngaphandle komshwalense?

Noma ngabe unomshuwalense futhi ubhekene ne-copay enkulu noma awunawo umshwalense futhi wesaba izindleko eziphezulu zokuphuma ephaketheni, ikhadi le-SingleCare kungaba yimpendulo ekunciphiseni ingqikithi yerisidi yakho.

I-SingleCare ayilona uhlobo lomshwalense, kepha kunalokho yikhadi lesaphulelo likadokotela elimahhala kuwo wonke amakhasimende ekhemisi e-United States, kufaka phakathi nalabo abangaqinisekisiwe. I-SingleCare isebenza ngaphandle komshwalense, njengoba isaphulelo sisetshenziswa kunani lemali kadokotela. (Funda: Ngeke ukwazi ukusebenzisa ikhadi lakho le-SingleCare futhi umshwalense wakho kumuthi owodwa.)

Ngakho-ke ungonga malini ngentengo yemithi kadokotela nge-SingleCare? Kancane kancane, empeleni . Isibonelo, ngo-2019, intengo yemali emaphakathi yemithi ye-ADHD i-amphetamine-dextroamphetamine yayingu- $ 131.67. Intengo emaphakathi ye-SingleCare? Ngu- $ 47.57 nje. Abasebenzisi bekhadi le-SingleCare babone ukonga okufanayo kumuthi wehlisa i-cholesterol e-atorvastatin calcium. Ngaphandle kwekhadi intengo emaphakathi ibingu- $ 105.68. Ngekhadi: $ 29.06.

Ngaphezu kwekhadi le-SingleCare, kunezindlela eziningana zokunciphisa intengo yemithi yakho kadokotela:

• Buza udokotela wakho ukuthola uhlobo olujwayelekile: Izidakamizwa ezinamagama cishe zibiza kakhulu njalo kunemithi ejwayelekile. Ukubuyela esibonelweni seLyrica, ngenkathi umuthi wegama lomkhiqizo ubiza u- $ 460 kuya ku- $ 720 ngenyanga, inguqulo ejwayelekile iba phakathi kuka- $ 140 no- $ 370 ngenyanga.
• Buza udokotela wakho umuthi ohlukile: Ingabe intengo yemali yomunye umuthi womfutho wegazi iphansi kakhulu kunaleyo okuyo njengamanje? Buza udokotela wakho ukuthi ungashintsha yini.

Cwaninga izinhlelo zosizo lweziguli: Abakhiqizi abaningi bezidakamizwa nezinhlangano ezingenzi nzuzo zinikela ngezinhlelo zesaphulelo kubantu abangakwazi ukukhokhela imiyalo yabo, okungasho imithi ephansi noma ngisho yamahhala. Izidingo zokufaneleka ziyahlukahluka, ngakho-ke kuzodingeka uhlole inkampani yezidakamizwa ukubona ukuthi uyafaneleka yini.