I-Medicare vs. Medicaid: Uyini umehluko?

Inkampani

Ukuzulazula ngezinketho zokunakekelwa kwezempilo kungaba inqubo ekhohlisayo futhi edidayo. Akukhona nje ukuthi kunezinketho ezingapheli zomshuwalense wezempilo, kepha kukhona nezinhlelo ezilawulwa nguhulumeni I-Medicaid futhi Imithi .

Zombili lezi zinhlelo ziyinkimbinkimbi ngokumangazayo futhi kungaba nzima ukuzihambela wedwa. Uma ufuna ukubhaliswa kunoma yikuphi, kubalulekile ukuthola umthombo othembekile ongakuqondisa kule nqubo. Nge-Medicare, thintana noHlelo Lwe-State Health Assistance Program, noma i-SHIP, esifundazweni sakho lapha noma ushayele i-Medicare Rights Center ku-1-800-333-4114. Ungavakashela futhi cms.gov ukuthola usizo ngokubhaliswa kweMedicare noma iMedicaid nokufaneleka.

Ngenkathi ingapheli, lapha sibheka ukuthi yini ehlukanisa iMedicare vs. Medicaid.

Yimuphi umehluko obalulekile phakathi kweMedicare neMedicaid?

Ngenkathi iMedicare neMedicaid zombiliephethwe nguhulumeniizinhlelo zomshuwalense wezempilo ukusiza ngezindleko zokunakekelwa kwempilo, zisebenza ngezinhloso ezahlukene kanye nabantu.

Imithi

Imithi ihlanganisa abantu abadala abaneminyaka engama-65 nangaphezulu kanye nabantu abangaphansi kweminyaka engama-65 abanokukhubazeka okuthile. Inani lezintela ze-Medicare olikhokhele uhulumeni wesifundazwe ngenkathi uqashiwe lizonquma ukuthi uzokhokhiswa malini ngeNgxenye A (bheka ngezansi). Kodwa-ke, usengafanelekela iMedicare uma ungakhokhi intela yeMedare. Kunezingxenye ezine ezihlukene zeMedicare.

• Ingxenye A ihlanganisa ukunakekelwa kwezibhedlela ezingalaliswanga, ukunakekelwa kwendawo yabahlengikazi abanamakhono, ukunakekelwa kwempilo yasekhaya nokunakekelwa kwabagula kakhulu
• Ingxenye B ihlanganisa ukuvakashelwa odokotela nezinsizakalo eziningi zeziguli ezingalaliswayo. Ingxenye B ibuye ihlanganise imishini yezokwelapha ehlala isikhathi eside, izinsizakalo ze-ambulensi, izinsizakalo zezempilo yengqondo, nezinye izinsizakalo eziningana zeziguli ezigula ngaphandle. Qaphela: Izindabuko, imali ekhokhelwa insizakalo ye-Medicare Parts A no-B zivame ukubizwa ngokuthi yi-Original Medicare.
• Ingxenye C , okubizwa nangokuthi izinhlelo zeMedicare Advantage (noma i-MA), kuyindlela yokuzikhethela enikezwa yinkampani yomshuwalense yangasese esikhundleni sokuvela ngqo kuhulumeni wesifundazwe. Le ngenye indlela yokuthola iMedicare. Kwesinye isikhathi ihlanganisa izinto i-Original Medicare engazenzi, njengokunakekelwa okuvamile kwamazinyo nokubona. Kungabandakanya nemithi kadokotela nokungeziwe njengokulethwa kokudla noma ukuthuthwa lapho kuvakashelwa odokotela.
• Ingxenye D yingxenye yokuzikhethela yeMedicare enikezela ngemithi kadokotela, futhi itholakala kuphela kubanikezeli bomshuwalense abazimele abavunyelwe yiMedicare. (Ngemininingwane engaphezulu ngezindleko zikadokotela ezihambisana neNgxenye D, funda kabanzi mayelana ne- Imbobo yedonathi yedatha .

I-Medicaid

IMedicaid wuhlelo lomphakathi olunikeza umshuwalense wezempilo kubantu abathile abanemali ephansi futhi luxhaswe nguhulumeni wezwe ngaphezu kukahulumeni wobumbano. IMedicaid ihlanganisa abantu abadala asebekhulile, abantu abakhubazekile, izingane, abesifazane abakhulelwe, abazali kanye nabanakekeli bezingane.

Abantu bangaba neMedicare neMedicaid ngasikhathi sinye.

Ngubani ofanelekela iMedicare vs. Medicaid?

Akuwona wonke umuntu ofanele ukutholakala kwe-Medicare kanye / noma ukumbozwa kweMedicaid. Nazi iziqu zohlelo ngalunye lukahulumeni.

Imithi

Izidingo zokufaneleka zalawo 65+ zifaka:

• Wena (noma oshade naye) uthola noma ufanelekele ukuthola umhlalaphansi we-Social Security noma i-Railroad Retirement Board (RRB). NOMA
• Ungaba:
  • isakhamuzi saseU.S. NOMA
  • umuntu ohlala unomphela osemthethweni ohlala e-US okungenani iminyaka emihlanu ngaphambi kokufaka isicelo.

Kungenzeka futhi ukuthi ufaneleke kwirekhodi lomsebenzi womlingani oshonile noma ohlukanisile. Ukuze ufaneleke ukuthola izinzuzo ezigcwele zeMedicare ezingaphansi kweminyaka engama-65:

• Uthole izinkokhelo zeSocial Security Disability Insurance (SSDI) okungenani izinyanga ezingama-24. NOMA
• Unesifo esifanelekayo
  • I-Amyotrophic lateral sclerosis (ALS) ebizwa nangokuthi isifo sikaLou Gehrig bese uthola i-SSDI (akudingeki ulinde izinyanga ezingama-24)
  • Isifo sezinso sokugcina edinga i-dialysis ephindaphindekayo noma uma uke wafakelwa izinso KANYE
    • ufanelekile ukuthola Izinzuzo ze-SSDI noma ze-Railroad Retirement OR
    • Ukhokhe intela ye-Medicare ngesikhathi esithile njengoba kuchaziwe yi-Social Security Administration

Uma uhlangabezana neziqu ezingenhla, futhi uyisakhamuzi noma uke waba ngumhlali osemthethweni okungenani iminyaka emihlanu, kepha ungenawo umlando womsebenzi ukuze ufanelekele ukubhaliswa mahhala kwi-Medicare Part A, kusengenzeka ukuthi ufaneleke ukuthola izinzuzo ze-Medicare uma uhola kancane. Kufanele uxhumane neMedicare, iSocial Security Administration, noma iqembu lendawo lokukhuthaza ukuthola usizo olwengeziwe.

Ngokuphathelene nokubhaliswa, abanye abantu babhaliswa ngokuzenzekelayo kwi-Medicare Part A, umshwalense wesibhedlela, lapho befika kuma-65. Labo abathola izinzuzo zomhlalaphansi ku-Social Security noma i-RRB babhaliswa ngokuzenzekelayo kwi-Medicare Part A naku-B.

Uma ungaqiniseki ukuthi ufanelekile noma awuzange ubhaliswe ngokuzenzakalela, shayela Ukuphepha Komphakathi ku-800-772-1213. I-Medicare nayo inayo umshini wokubala ukukusiza ukunquma ukufaneleka kwakho noma ubale i-premium yakho.

OKUSHIWO: Umhlahlandlela wakho esikhathini sokubhalisa esivulekile seMedicare

I-Medicaid

Ukufaneleka kweMedicaid kuyahlukahluka kuye ngezwe, noma ngabe uhulumeni wesifundazwe ubeka izindinganiso zokufaneleka okufanele izwe ngalinye lizilandele. I-Medicaid ngokuvamile isuselwa ezingeni lemali engenayo, ubukhulu bendlu, ukukhubazeka, nezinye izinto njengokukhulelwa, kepha lezi zici zingahlukahluka phakathi kwezifundazwe. Umthetho Wokunakekelwa Ongabizi futhi wenza ukuthi kube nokufaneleka okwandisiwe kweMedicaid, kwezinye izindawo, ezisebenzisa kuphela isimo semali engenayo. Uma imali engenayo yomndeni ingaphansi kwe-133% yezinga lobuphofu bombuso (kepha empeleni 138% ngenxa yendlela ebalwe ngayo) umuntu angafanelekela lokhu kufakwa kweMedicaid okunwetshiwe. Izifundazwe eziningana zisebenzisa umkhawulo ohlukile wokuthola imali.

Ukubona ukuthi ngabe izwe lakho liyandisile yini i-Medicaid nokubona ukuthi uyafaneleka yini, vakashela lapha . Ukuze uqinisekise imali oyitholayo lapho ufaka isicelo seMedicaid, kuzodingeka unikeze ubufakazi. Lokhu kungaba nge-stub yokukhokha, isheke lokuthola imali yokuphepha komphakathi, noma incwadi evela kumqashi wakho, isibonelo. Kunezinye izinto eziningi, inqubo yokufaneleka, kanye nezicelo zemininingwane eyengeziwe engadingeka lapho ufaka isicelo seMedicaid.

Uma ngabe izwe lakho lingenayo i-Medicaid, vakashela izwe lakho Iwebhusayithi yeMedicaid ukubona ukuthi ufanelekile yini. Umbuso imakethe yezempilo ingakutshela nokuthi yiziphi izinhlelo ezingcono kakhulu kuwe ngokususelwa kuzici zakho zomuntu siqu.

Kungenzeka uthole izinzuzo Zokuvikeleka Komphakathi ngenkathi uneMedicaid.

Ingabe i-Medicaid imahhala? Kuthiwani nge-Medicare?

I-Medicaid kumahhala noma kubiza kancane kuye ngesifundazwe.

I-Medicare iyinkohliso ethe xaxa. Ngaphandle kokuthi unemali engenayo ephansi, kukhona ukuqinisekiswa kwemali, ama-copayments, ama-premium kanye nokudonswayo okufanele kuhlangatshezwane nakho.

• Ingxenye yeMedicare A imahhala kulabo abafanelekile ngenxa yomlando womsebenzi. Kodwa-ke, labo abathengayo bangakhokha kuze kufike ku- $ 458 / ngenyanga ngo-2020. Kukhona ne- $ 1,408 edonselwa isikhathi ngasinye senzuzo (okuqala usuku owamukelwa ngalo esibhedlela njengesiguli esingalaliswayo, noma esikhungweni sabahlengikazi abanamakhono, futhi kuphela lapho usuphumile esibhedlela noma esikhungweni sabahlengikazi izinsuku ezingama-60 zilandelana), kanye nesibhedlela kanye nendawo yabahlengikazi abanamakhono okuthola imali nsuku zonke, okungaba ngamakhulu ama-dollar ngosuku ngaphandle komshwalense wokungezelela. Izibonelo zomshuwalense wokungezelela, noma wesibili, zifaka (kepha azikhawulelwanga) ekusetshenzisweni kokuthatha umhlalaphansi kwinyunyana, noma izinqubomgomo zeMedigap ezithengwe ngasese. Ungaxhumana nomnyango womshuwalense wombuso wakho ukuze ufunde kabanzi ukuthi yimaphi amapulani weMedigap atholakalayo kuwe, ukuthi azobiza malini, nokuthi yiziphi izinsizakalo nezindleko zeMedicare abazozikhokhela. Abanye abantu abane-Medicare nabo bayakufanelekela ukuthola iMedicaid, ezokhokhela kakhulu ukwabiwa kwezindleko kwe-Medicare Part A.
• Ingxenye yeMedare B amaphrimiyamu ngokuvamile angama- $ 144.60 ngenyanga, kodwa angahluka ngokuya ngemali engenayo, futhi kukhona ukuqiniseka ngemali engu-20% kwezinsizakalo zikadokotela, izinsizakalo zezokwelapha, nemishini yezokwelapha ehlala njalo (uma kuvunyelwe yi-Medicare). Njenge-Medicare Part A, umshuwalense wesibili, iMedigaps, neMedicaid kungasiza ukumboza izindleko eziningi zokwabelana ngezindleko zeMedicare Part B. Izinhlelo eziphethwe nguhulumeni ze-Medicare Savings, noma ama-MSP, afaka phakathi i-QMB, i-SLMB, ne-QI-1, azophinde akhokhele amaphrimiyamu e-Medicare Part B kulabo abafaneleka ngokwezimali. Xhumana nesifundazwe sakho noma uMnyango Wezinsizakalo Zomphakathi ukuze ufunde kabanzi ngama-MSPs.
• Ingxenye yeMedicare C , noma i-Medicare Advantage, ilawulwa ngomshwalense wangasese ngakho isakhiwo sezindleko sizohluka phakathi kwamasu.
• Ingxenye yeMedare D , njengengxenye C, ilawulwa ngemishwalense yangasese futhi izindleko zizohluka. Labo abafaneleka ngokwezimali ohlelweni lwe-Federal Extra Help banganciphisa izindleko zabo ze-Medicare Part D (ama-premium, ama-deductibles, ama-copay noma i-coinsurance). Iya ku ssa.gov ukufunda kabanzi ngosizo olungeziwe, nokufaka isicelo somhlomulo. Imihlahlandlela yokuthola imali kukho konke Ingxenye D Usizo Olungeziwe nama-MSPs inesandla esivulekile kakhulu kunaleso seMedicaid.
  • Ukuthola ukuthi yiluphi uhlelo lwe-Part C noma lwe-Part D Medicare olusebenza kangcono kuwe, vakashela i-medicare.gov bese usebenzisa ithuluzi le-Plan Finder.

OKUSHIWO: Izindleko ezihambisana nezinhlelo zeMedicare Part D

Yiziphi izinzuzo ezinkulu uMedicaid amboza ngazo uMedare?

Iningi lezinsizakalo ezihlinzekwa yiMedicaid neMedicare ziyahlangana. Kodwa-ke, kunezinsizakalo ezithile ezinikezwa yiMedicaid ezingamboziwe ngaphansi kweMedicare. Lezi zinsizakalo zifaka:

• Izinsiza zamehlo
• Ukunakekelwa kwamazinyo okuvamile
• Ukunakekelwa kwabazali (ukunakekelwa kwansuku zonke okungukuthi, usizo nge-Activities of Daily Living [ADLs] njengokudla, ukugeza)
• Ukunakekelwa kwasekhaya lasebekhulile

Izinsizakalo zeMedicaid zingahluka phakathi kwezifundazwe. Ngokuvamile izinzuzo zeMedicaid zifaka:

• Izinsizakalo zesibhedlela ezingalaliswayo nezigula ngaphandle, ukuvakashelwa odokotela, ukuhlolwa kwegazi, ama-X-ray, nokunakekelwa kwempilo ekhaya

Izinzuzo ze-Medicare ziyahluka phakathi kweNgxenye A no-Part B.

• Ingxenye A ihlanganisa ukunakekelwa kwezibhedlela ezingalaliswanga, ukuhlala isikhashana ezindaweni zabahlengikazi abanamakhono, i-hospice, kanye nezinye izinsizakalo zokunakekelwa kwezempilo ekhaya.

Ingxenye B ihlanganisa ukunakekelwa okungekho esibhedlela kufaka phakathi ukuvakashelwa yihhovisi likadokotela, ukuhlolwa, ukuhlolwa kwegazi, ama-X-ray, imishini, kanye nokunakekelwa kweziguli okuningi.