Yini umkhawulo ophuma ephaketheni?

Ukuchazwa Kwezempilo Kenkampani

Umshuwalense wezempilo unzima, unamagama ahlukahlukene adidayo okungaba nzima ukuwaqonda. Kepha ukwazi nokuqonda imininingwane yohlelo lwakho lomshuwalense wezempilo kungasiza kakhulu, ikakhulukazi maqondana nokonga imali. Enye yale mininingwane ebalulekile ubukhulu bakho obuphuma ephaketheni.

Isamba esivela ephaketheni sohlelo lwakho lomshuwalense wezempilo ngumkhawulo wonyaka lapho wena, njengekhasimende, uzodinga ukukhokhela izinsizakalo zezempilo ezihlanganisiwe. Inani lomkhawulo wakho ophuma ephaketheni linqunywa yizinto ezahlukahlukene, kufaka phakathi izindleko zohlelo nokuthi bangaki abantu emndenini wakho abamboziwe ngaphansi kohlelo lwakho.

Umqondo wokukhishwa okuphuma ephaketheni ungabonakala udidekile njengamanye amagama izinkampani zomshuwalense ezikulahlela wona, njenge ukuqinisekiswa kwemali , ikopay , premium, futhi ebanjwayo . Kepha umehluko phakathi kwabo ubalulekile futhi ungathinta kokubili ukumbozwa kwakho kwezempilo nesikhwama sakho semali.

Lo mhlahlandlela unakho konke odinga ukukwazi mayelana nokungena nokuphuma kwama-maximum aphuma ephaketheni.

Yini ebalulekile ekuphakameni okuphuma ephaketheni?

Lapho usuchithe imali eyanele emisebenzini yezokwelapha ukufinyelela umkhawulo wakho ophuma ephaketheni wonyaka, inkampani yakho yomshuwalense wezempilo izongena ukuze ikhave konke izindleko ezihlanganisiwe unyaka wonke. Kepha yiziphi izindleko zezokwelapha ezibalwa empeleni kumkhawulo wakho ophuma ephaketheni? Kuzinhlelo eziningi, ama-out-of-pocket-maximums afaka imali esetshenziswe kwezinye izingxenye zohlelo lwakho lokunakekelwa kwezempilo, njenge:

• Okudonswayo
• Coinsurance
• Amakhophi

Izindleko ezinkulu ezingabheki inani lakho eliphuma ephaketheni yi-premium yakho yanyanga zonke. Lokhu kusho ukuthi noma ngabe i-premium yakho ingakanani, ukuze ugcine umshuwalense wakho wezempilo usebenza, kuzodingeka uqhubeke nokuwukhokha njalo ngenyanga, noma ngabe usuthole imali oyikhiphile.

Esinye isigaba esingabaleki kubukhulu bakho obuphuma ephaketheni yizinsizakalo zokunakekelwa kwezempilo ezingamboziwe uhlelo lwakho lomshuwalense, njengabahlinzeki abathile abaphuma kunethiwekhi kanye neminye imishanguzo noma imishanguzo engamboziwe. Izindleko eziphuma ephaketheni zemithi kadokotela oyikhokhela ukuyisebenzisa Okufanayo amakhuphoni futhi awabheki ubukhulu bakho obukhipha ephaketheni, noma ungakwazi ukubuyiselwa ngumhlinzeki wakho womshuwalense ekupheleni konyaka wakho wohlelo.

Ubuningi obudonswayo obuphuma ephaketheni

Uma ucabanga ukuthi ama-maximum aphuma ephaketheni azwakala afana nokudonswayo, awunephutha. Kepha zihluke kancane, futhi lo mehluko ubalulekile ekuqondeni ukuthi izindleko zakho zokunakekelwa kwezempilo zivelaphi.

Sesivele sisungule ukuthi inani eliphakeme kakhulu ephaketheni lapho inqubomgomo yakho yomshwalense ifinyelela iningi lemali oyichitha minyaka yonke yokunakekelwa kwezempilo. Ngemuva kokufinyelela kule mali ebekiwe, umshwalense wakho uzongena futhi abhekane nezinye izindleko ezihlanganisiwe phakathi nalo lonke unyaka wohlelo.

Okudonswayo kwakho, ngakolunye uhlangothi, inani lemisebenzi yakho yokunakekelwa kwezempilo okufanele uyikhokhele ngokugcwele ngaphambi kwezinyathelo zakho zokwabelana ngezindleko zohlelo lwakho, ezinjenge-coinsurance, ngena. Ngamanye amazwi, uma ushaye imali yakho ekhishwayo umshwalense wakho uzoqala ukukusiza ukukhokhela izinsizakalo, kepha kungenzeka ukuthi usazoqhubeka nokuthola ezinye izindleko i-coinsurance noma ama-copayments. Lokho, kuze kube yilapho ushaya umkhawulo wakho ophume ephaketheni. Ngemuva kwalokho uzoba nesibopho sokukhokhela i-premium yakho yanyanga zonke, ngezinsizakalo ezingamboziwe, noma ngezinzuzo ezithile zenethiwekhi.

OKUSHIWO: Izinsizakalo zezempilo ezi-5 okufanele uzenze ngemuva kokuhlangabezana nokudonswa kwemali yakho

Kwenzekani ngemuva kokuhlangatshezwa komkhawulo ophume ephaketheni?

Manje njengoba usuyazi ukuthi yini, asebenza kanjani ama-maximum aphuma ephaketheni? Ama-maximum aphuma ephaketheni akusiza ekuvikeleni ekutheni ungadingi ukukhokhela ukunakekelwa kwezempilo okubizayo noma okungalindelekile (njengokuya egumbini lezimo eziphuthumayo) ngokubeka ikepisi lokuthi kulindeleke ukuthi ukhokhe malini ngonyaka. Lapho imali oyisebenzisela ukunakekelwa kwempilo unyaka owodwa wohlelo weqa inani elibekiwe lemali yakho engaphandle ephaketheni, uhlelo lwakho lwezempilo lukhokhela zonke izindleko zokunakekelwa kwezempilo okuqhubekayo — inqobo nje uma lezo zindleko ziyizinsizakalo uhlelo lwakho oluzihlanganisayo.

Uma usuhlangabezane nomkhawulo wakho ophuma ephaketheni, ngeke usadinga ukukhokha ama-copayments noma i-coinsurance ngokunakekelwa okuphakathi kwenethiwekhi. Izibonelo zokunakekelwa okuhlanganisiwe zingafaka ukuvakashelwa nodokotela wakho wokunakekelwa okuyisisekelo kwenethiwekhi noma izindleko zomuthi ohlanganisiwe. Kepha kusazodingeka ukhokhele izinsizakalo zezempilo ezingaphandle kwenethiwekhi ezingafakwanga uhlelo lwakho.

Ezinye izinhlelo zomshuwalense zinikeza ukumbozwa okulinganiselwe kwezindleko zokunakekelwa kwezempilo ezingaphandle kwenethiwekhi, futhi kungahle kubambe nokuthi udinga malini ukukhokha ukunakekelwa ngaphandle kwenethiwekhi unyaka nonyaka. Leli cap ngokujwayelekile lizohlukaniswa, futhi libe ngaphezulu, kunomkhawulo wakho ophuma ephaketheni okwinethiwekhi. Kepha ezinye izinhlelo eziningi azinayo imali engaphezulu ephaketheni yezinsizakalo ezingaphandle kwenethiwekhi, okusho ukuthi umshwalense wakho ngeke angene ukusiza ukukhokhela izinsizakalo ezingaphandle kwenethiwekhi, noma ngabe zibiza kanjani izindleko zezokwelapha. Naka kakhulu izinketho zokufakwa kwenethiwekhi ngaphandle kohlelo lwakho, bese uzama ukuhlala kwinethiwekhi lapho kungenzeka khona ukusizakala ngobukhulu becebo lakho eliphume ephaketheni.

Ngabe zonke izinhlelo zomshuwalense wezempilo zinokuphuma ephaketheni okuphezulu?

Zonke izinhlelo zomshuwalense ezihlangabezana nezindinganiso ze-Affordable Care Act (ACA) zinama-maximums aphuma ephaketheni. Okwe-2020, ama-maximum angaphandle kwamaphakethe wezinhlelo ezihambisana ne-ACA awanakuba ngaphezu koku Izinhlelo zama- $ 8,150 ngazinye ne- $ 16,300 yezinhlelo zomndeni . Ezinhlelweni eziningi, umkhawulo ophuma ephaketheni uzoba mncane kakhulu, yize amanye amapulani enziwe ngaphambi kokuba i-ACA izalwe ngemikhawulo yayo. Ungathola imininingwane eminingi mayelana nezinhlelo okufanelekile kuzo ezempilo.gov .

Ama-maximum angaphandle kwesikhwama we Imithi ziyahlukahluka kancane. Ngemali yendabuko yensizakalo ye-Medicare (Original Medicare), awukho umkhawulo enanini lemali olikhokhela izindleko zezokwelapha unyaka nonyaka. Uma une-Original Medicare, ungakwazi ukunciphisa izindleko zakho ezingaphandle kwesikhwama ngokuthenga uhlelo lweMedigap, noma ngokubhalisela inzuzo yomphakathi ephansi efana ne-Medicare Savings Program noma i-Extra Help for Medicare Part D Kodwa izinhlelo zeMedicare Advantage, ezinikezwa ngabashuwalense abazimele futhi zivunywe yiMedicare, kudingeka ukuthi zilandele imihlahlandlela efanayo nezinye izinhlelo ezihambisana ne-ACA futhi zingaba nenani eliphansi lokuphuma ephaketheni kunezinhlelo ze-ACA.

Izindleko ezingaphandle kwezikhwama zezinhlelo zeMedicaid ziyahlukahluka kuye ngezwe, kepha azivunyelwe ukudlula U-5% wemali engenayo yomndeni .

Ukuthola ukonga ukunakekelwa kwezempilo

Noma uhlelo lwakho lomshuwalense wezempilo lungangabali zonke izindleko zokwelashwa, kukhona okunye izindlela zokonga . I-SingleCare isiza ukuqeda ukudideka mayelana nokuqongelela izindleko ngokunikela ngamanani entengo kadokotela. Futhi yize imishanguzo eminingi ingabheki ubukhulu bakho obuphuma ephaketheni noma obudonswayo, amakhuphoni e-SingleCare angenza imithi oyidingayo ibize kakhulu.