Uyini umehluko phakathi kwesilinganiso esikhokhelwayo nesiphumile ephaketheni?

Inkampani

Uthole inqubo yokwelashwa bese uyayibona inkokhelo — ukweleta imali. Kodwa awukhokhi imali yenyanga yomshuwalense wezempilo ukuze ungakhokhi izindleko zokwelashwa? Akunjalo impela.

Unyaka nonyaka, abaninimigomo abaningi kumele basebenzise inani elithile ukuphuma ephaketheni kwizinsizakalo zokwelashwa ezifanelekile ngaphambi kokuthi uhlelo lwabo lomshuwalense luqale ukukhokhela noma yini. Lapho sebefinyelele kulelo nani ledola, elibizwa ngokuthi yi-deductible, inkampani yomshuwalense wezempilo yabelana ngezindleko kuze kube yilapho umninipholisi efinyelela inani lakhe eliphuma ephaketheni, imali okufanele uyisebenzise ukuze umshwalense ukhokhele zonke izindleko zokunakekelwa kwezempilo ezifanelekile. Funda ukuze uqonde umehluko phakathi kwalokhu okubili.

Uyini umshuwalense wezempilo odonswayo?

Unyaka nonyaka ebanjwayo inani lemali okufanele ulisebenzise ekuhlinzekweni kwezinsizakalo zezempilo ngaphambi kokuba uhlelo lwakho lomshuwalense wezempilo luqale ukukhokha noma yiziphi izindleko. Lokhu kungezwe kwiprimiyamu yanyanga zonke ukuze ube sohlelweni. Imvamisa, amaphrimiyamu aphezulu ahumushela ekwehliseni imali edonswayo, kanti amaphrimiyamu aphansi ajwayele ukusho ukudonswa imali ephezulu. Izinhlelo eziningi zomshuwalense, kufaka phakathi umshuwalense wezempilo womuntu ngamunye kanye nomqashi, kudonswa imali. Kodwa-ke, ezinye izinhlelo zenhlangano yokulondolozwa kwezempilo (i-HMO) zinokudonswa okuphansi noma azidonswa nhlobo.

Yini umkhawulo ophuma ephaketheni?

Unyaka nonyaka okuphezulu ephaketheni umkhawulo umninipholisi kuzofanele akhokhele izinsizakalo zezempilo, kungafaki izindleko zeprimiyamu yohlelo. Ngemuva kokuthi umninipholisi efinyelele kulelo nani (lapho kudonswa khona futhi ikopisha , phakathi kwezinye izindleko,neqhaza), uhlelo lomshuwalense luzobe seluhlanganisa zonke izindleko zokunakekelwa kwezempilo ezifanelekile zalowo nyaka.

Ubuningi obudonswayo obuphuma ephaketheni

Ngokuyinhloko, kudonswa imali umninipholisi akhokhela ukunakekelwa kwezempilo ngaphambi kokuthi uhlelo lomshuwalense luqale ukumboza noma yiziphi izindleko, kuyilapho inani eliphakeme elikhishwa ephaketheni liyimali umninipholisi okufanele ayisebenzise ezindlekweni zokunakekelwa kwezempilo ezifanelekile ngokusebenzisa ama-copay, i-coinsurance, noma imali ekhishwayo ngaphambi kokuthi umshwalense uqala ukumboza zonke izindleko ezihlanganisiwe. Ngenxa yalokhu, ukudonswa komninipholisi kuzohlala kungaphansi kobukhulu obuphuma ephaketheni.

Isibonelo, umuntu angahle abe ne- $ 2,000 ekhishwayo kanye ne- $ 5,000 ephezulu ephaketheni, kusho UDavid Belk , MD, umbhali we Izindleko Zangempela Zokunakekelwa Kwezempilo . Bangathola ukunakekelwa okwelashwa okungabiza u- $ 10,000, bathi, ukulaliswa esibhedlela, ukuhlinzwa nokunakekelwa kwangemva kokuhlinzwa. I- $ 2,000 yokuqala ikhokhwa ngokuphelele yisiguli. Ngemuva kwalokho, isiguli kungadingeka ukuthi sikhokhe i-copay engaguquki— $ 20, $ 50, $ 100 enqunywe kusengaphambili yinkampani yomshuwalense, futhi kuye ngenkonzo — noma iphesenti lenkokhelo isiyonke yenkonzo ngayinye emboziwe, okuyi-coinsurance.

Lapho ingqikithi yamakhophi alowo muntu nezimali zemali kanye nemali ebanjwayo isifinyelele ku- $ 5,000, abasayikweleta imali ngalowo nyaka nganoma yikuphi ukunakekelwa kwabo kwezokwelapha ngoba umshwalense wabo uzokhokhela zonke ezinye izindleko, uyachaza.

Ama-maximum aphuma ephaketheni angafinyelela phezulu kangakanani ngo-2020?

Yize ama-deductibles kanye nama-maximum aphuma ephaketheni ehluka ngohlelo, wonke amacebo ahlangabezana namazinga we-Affordable Care Act (ACA) abeka umkhawulo waminyaka yonke wokuthi ama-maximum aphuma ephaketheni angahamba kanjani. Kulo nyaka, i- I-IRS iyachaza izinhlelo zezempilo ezikhokhelwayo eziphakeme njengalezo ezinokudonswa okungenani kwama- $ 1,400 kubantu ngabanye noma ngama- $ 2,800 emindenini. Okwe-2020 , ama-maximum aphuma ephaketheni awakwazi ukudlula u- $ 6,900 wecebo lomuntu ngamunye kanye no- $ 13,800 wohlelo lomndeni. Izindleko ezitholwe ngezinsizakalo zokunakekelwa kwezempilo ezingaphandle kwenethiwekhi azibalwa ngalezi zibalo.

Ngabe imali ekhishwayo isebenza kubukhulu obuphuma ephaketheni?

Okokuqala, kubalulekile ukuqonda ukuthi ungahlangabezana kanjani nokudonswa kwemali yakho. Izinsizakalo zokuvikela njengokuhlolwa konyaka zivame ukunikezwa ngaphandle kwezindleko ezengeziwe zabathengi. Ngakho-ke, azinikeli ekuhlangabezaneni nemali yakho engadonselwa imali. Yize kuyehluka ngohlelo, ama-copay wokuvakashelwa kwamahhovisi amboziwe ngokuvamile awabheki kokudonswayo ngenkathi imishanguzo kadokotela ingathembela kunzuzo ehlukile kadokotela ekhishwayo. Izindleko zokulaliswa esibhedlela, ukuhlinzwa, ukuhlolwa kwelebhu, ukuskena, kanye namanye amadivayisi wezokwelapha imvamisa kubalwa kudonswa.

In-network, izindleko eziphuma ephaketheni ezisetshenziselwa ukuhlangabezana nokudonswa kwakho nazo zisebenza kubukhulu obuphuma ephaketheni.

Iphrimiyamu yanyanga zonke ayisebenzi kumali ekhishwayo noma ephumayo ephaketheni. Noma ngabe ufinyelela inani lakho eliphuma ephaketheni, kusazodingeka ukuthi uqhubeke ukhokhe izindleko zenyanga zohlelo lwakho lwezempilo ukuze uqhubeke nokuthola ukumbozwa.

Izinsizakalo ezitholwa kusuka kubahlinzeki abangaphandle kwenethiwekhi nazo azibali ngokuya phezulu kakhulu ephaketheni, noma ezinye izindlela zokwelapha ezingamboziwe nemithi. Lapho sekuhlangatshezwane nesamba esiphezulu esikhwameni, abanikazi bezinqubomgomo akufanele bakhokhe noma yiziphi izindleko-kufaka phakathi ama-copayments kanye ne-coinsurance - nganoma yikuphi ukunakekelwa kwezempilo okuphakathi kwenethiwekhi.

Ubuningi obudonswayo obukhipha ephaketheni: Yini ebalulekayo?
	Ukubalwa	Akubalwa
Iyadonswa	Ukulaliswa esibhedlela Ukuhlinzwa Ukuhlolwa kwelebhu Izikrini Amanye amadivayisi wezokwelapha Imibhalo enqunyiwe — noma kunjalo, ingahle ibalwe iye kudonsi ehlukile	Izinsizakalo ezingaphandle kwenethiwekhi Amakhophi Izinkokhelo zanyanga zonke
Umkhawulo ophuma ephaketheni	Zonke izindleko eziphuma ephaketheni ezisetshenziselwe ukuhlangabezana nemali ebanjwayo Amakhophi	Izinsizakalo ezingaphandle kwenethiwekhi Izinkokhelo zanyanga zonke

Ungonga kanjani ezindlekweni zokunakekelwa kwezempilo

Ngabe unemali ephezulu ekhishwayo kanye / noma ephume ephaketheni? Kusekhona izindlela zokonga.

• Uma zonke izindleko zakho zokwelashwa ezingaphandle kwesikhwama — ngamanye amagama, izindleko ezingakhokhelwe ngohlelo lwakho lwezempilo — zonyaka onikeziwe zihlanganisiwe zenza ngaphezu kuka-10% wemali yakho engenayo yonyaka, ungakwazi ukuthatha ukudonswa kwezindleko zezokwelapha enteleni yakho engxenyeni ethile yezindleko zakho
• Setha i- i-akhawunti yokonga impilo (HSA) , lapho ungafaka khona imali ngaphandle kwentela ngezindleko zokunakekelwa kwempilo. Ngokungafani ne-akhawunti yokonga eguquguqukayo (i-FSA), izimali ze-HSA ziqhubeka unyaka nonyaka. Uma ungasebenzisi yonke imali ebekelwe eceleni ku-HSA yakho ngo-2020, uzoba nayo ngo-2021 nangaphezulu.
• Yonga ezindlekweni zokunakekelwa kwempilo ngokusebenzisa amakhuphoni e-SingleCare ngemithi kadokotela. Noma yiziphi izindleko zokuphuma ephaketheni ezisetshenziswe ngekhuphoni le-SingleCare ngeke zibheke ebunzimeni obudonswayo noma obuphuma ephaketheni kepha zizonga izindleko noma kunjalo.