Kukwidziridzwa Kwakawanda Kwokutarisira Kunoda Chikwata Chekushandisa Chinozivikanwa
Kunyora hutano hwehutano hwehuwandu hwevhareji yeAmerica yakaoma zvakakwana pasina dambudziko rakawedzerwa rechirwere chisingaperi. Zviri pachena kuti, kune vanhu vanorarama neHIV, zvinetso zvikuru zvakapiwa mari yakakura yezvinodhaka zveHIV, chido chekuchengetedza kwakakwana kurapa , uye chido chekuenderera mberi, kurapwa kwehupenyu hwose uye kutarisira.
Chimbofunga, somuenzaniso, kuti wega wega, mari yehupenyu hwehutachiwana hweHIV inopfuura $ 400,000-uye izvi kune vanhu vanotanga kurapwa kare uye zvikurukuru kudzivisa zvirwere zvinosangana nedambudziko rekupedzisira (kana kuti risina kutorwa) .
Zvino kuwedzera kune izvi mari yekurapa kweHIV, iyo inotakura mutengo wekutengo wemari inopfuura $ 2,000 pamwedzi, uye zvipingamupinyi zvinokura zvakajeka. Kunyange nemishonga inorayira zvinodhaka, dzakawanda dzemishonga iyi haigoni kusinganzwisisiki nekuda kwe "zvinotambudza tiering" maitiro ayo inshuwarisi inogona kuda chero kupi zvako kubva pamapfumbamwe kusvika ku50 mubhadharo yekubhadharwa kwemishonga kune imwe neimwe mishonga yemishonga.
Izvi zvinoreva kuti munhu ane "pasi" 20 muzana mari inobatsirwe inogona kubhadhara nyore nyore pakati pe $ 440 kusvika ku $ 480 pamwedzi kuti utore Triumeq , imwe yakasiyana, imwe piritsi yekusarudza. Uye izvozvo hazvibvumi kutora mari yezvokuderedza uye zvimwe zvisiri zvepahomwe zvinogona kuwedzera kusvika kune zviuru zvemadhora usati wanyatsobatsirwa.
Asi zvisinei nekutarisira matambudziko angave-kunyanya kune vanoita mari yepakati-kati vasingakwanisi kubhadhara-kubhadharwa kana kuwana rubatsiro rwakapiwa mapoka emari mashoma-kune mishonga.
Vamwe vangaita kuti iwe uchinje mararamiro ako iyezvino yveshuwarisi, asi vamwe vanogona kukubvumira kuwana mazano ekubatsira iwe ungave usina kumbofunga iwe usina kukodzera.
Kune avo vanotsvaka rubatsiro, heanoi nzira 4 dzakadzika dzokuderedza mari yakakwirira yehutachiona hweHIV uye kutarisirwa.
1. Tanga Nokuziva Kufanirwa Kwako Kubatsira
Imwe nzira yakakurumbira yekusaziva ndeyokuti mapurogiramu ehutachiona hweHIV anorongedzerwa kubatsira vese vanobhadhara mari muAmerica.
Uye kunyange zvazvo chiri chokwadi kuti mapurogiramu akawanda ehurumende nehurumende anogadzirisa kusvikirwa kune avo vanorarama kana kuti pasi pehurumende inotarisirwa hurombo, haisi nguva dzose.
Zvichipa mari yakakwirira yekurapa kweHIV uye kutarisira, nhamba inoshamisa yezvipo inowanikwa kune vanhu vane mari yegore negore inosvika $ 65,000 kana mhuri dzine mari yegore negore inodarika madhora 80 000. Izvi ndezvokuti zvipo zvinowanzopiwa kune avo vakagadziriswa mari yakawanda yakagadziriswa iri pasi pe200% kusvika 500 muzana ye federal poverty level (kana FPL).
Kujekesa, kugadziriswa kwemari yakawanda gore negore (kana MAGI) haisi mari yakawanda iwe iwe nemumwe wako munharaunda yegore. Asi iyo ndiyo yakagadziriswa mari yakawanda (AGI) inowanika pamutero wako wegore wegore rega (mutsara 37 pane 1040, mutsara 21 pane 1040A, uye mutsara 4 pane 1040EZ) pamwe nekuwedzera kwekuwedzera:
- Kwete-kutengesa Social Security benefits (mutsara 20a mutsara 20b pane 1040)
- Mutero-usina kubhadhara (mutsetse 8b pane 1040)
- Usatora (mutsara 45 uye 50 kubva kuRIM fomu 2555)
Nezviwero zviri muruoko, iwe unogona kuverenga MAGI yako uye uone kana ichiwira pasi peFPL threshold inorayirwa nehurumende, hurumende, kana purogiramu yemari inobhadharwa.
Ingowedzera MAGI yako nenzira yakatarwa (semuenzaniso, pasi pe300 muzana yeFPL) kuti uone kana iwe uchikodzera.
Iyo federal poverty level (FPL) , panguva iyi, inenge yakatorwa neDhipatimendi reMweya weUnited States uye Human Services (DHHS) kuti ione kana munhu kana mhuri akakodzera zvirongwa zvekubatsira zvehurumende seMedicaid . Muna 2016, DHHS yakaisa mirayiridzo inotevera yeFPL kuvanhu nemhuri:
- $ 11,880 pamunhu mumwe nomumwe
- $ 16,020 yemhuri ye 2
- $ 20,160 yemhuri yevanhu vatatu
- $ 24,300 yemhuri yechina
- $ 28,440 yemhuri yevashanu
- $ 32,580 yemhuri ye6
- $ 36,730 yemhuri yevanomwe
- $ 40,890 yemhuri ye8
(FPL yeAlaska neHawaii yakanyanya kudarika.)
Uchishandisa aya mazano, munhu uyo MAGI ari pasi pe 138 muzana yeFPL angave akakodzerwa neMedicaid zvichienderana nemari chete. Saizvozvowo, rubatsiro runogona kuwanika kune uyu ane MAGI yakaderera se 200 muzana kana yakakwirira se500 muzana yeFPL. Ihwo huwandu hwakawanda hunoita kuti huve nemigumisiro kumhuri yakapfuma yakawanda inorarama neHIV.
Iwe unobvunza zvakakwirira sei?
Mumashoko akaoma emadhora, vamwe vanozvishanda muMassachusetts vachinyora pamwe chete nemari yakawanda yegore rose ye $ 90,000 uye yehutano inshuwarhu yehutano inogona kuva neM MAGI inenge $ 76,000. MuMassachusetts, kupinda kune hutachiona hweHIV Drug Assistance Program (HDAP) yakazaruka kune vakaroorana vane MAGI vasingapfuuri 500 muzana yeFPL (kana kuti $ 80,100 muna 2016). Mukati yezviyero izvi, vaviri ava vanogona kukodzera HDAP.
Kusiyana neizvi, ivo vaviri vakaroorana vangave vasina kukodzera kuTexas maererano nehutano hwehurumende hunotarisirwa hunenge pa200% yeFPL (kana $ 32.040 muna 2016). Asi zvakadaro, purogiramu dzinoverengeka dzakabhadharwa nemari ( ona pasi apa ) inogona kuwanika avo vane mabhadharo epamusoro.
2. Tora Nzira Yakakosha Pakusarudza Purogiramu yeInishuwarenzi
Kushanda kunze kwekuti mitemo yakanakisisa iwe nemhuri yako inowanzofanana nekuisa pamwe pikicha isina kunaka. Kana iwe uri munhu anogara neHIV, iwe unowanzoverenga chikwama chako chegore negore pamwe chete negore rako rekudzikinura pamwe negore rako rekushandisa kwemishonga yekubhadhara mari yekufungidzira kushandiswa kwako kwehutano hwehutano hwako. A nyore nyore equation, inogona kuonekwa.
Kana kuti?
Zvichipa mari yakakosha yezvinodhaka zveHIV, hazvisi zvisiri izvo kuzviwana iwe uchibhadhara zvimwe-kana-zvishoma kune imwechete mari yemwedzi pasinei nokuti iwe unowana purogiramu yepamusoro / yakaderedzwa / yakaderera purogiramu yekubhadhara mari kana pasi yakaderera / yakanyanya kubviswa / yakakwirira co-kubhadhara mutemo.
Izvi ndezvokuti mishonga yeHIV ichasvika nguva dzose ichiiswa kune yakakwirira-inotengeswa "unyanzvi" hwemishonga tier kana iwe une mitemo yakaderera. Uye, kunyange kana zvisina kudaro, gore raunotora rinenge rawedzerwa zvakanyanya kuti iwe unopedzisa kushandisa mari yakawanda usati wawana chero mazano.
Asi haisi nguva dzose. Heano mazano mashomanana, akajeka ekusarudza iyo yeruzhinji yeruzhinji kana uri munhu anorarama neHIV:
- Usazvidzivirira pamishonga yakakura yemishonga. Kazhinji isu tinogadziriswa pakuderedza zvinodhaka zvemishonga zvatinongosiya mitemo ine mishonga yemishonga inobhadhara zvinodhaka kubva kune makumi maviri kusvika ku50 muzana. Uye izvozvo zvingava kukanganisa. Pane kudaro, yeuka kugara uchitsvaga kunze kwe-pocket zvakanyanya zvakanyorwa pamutemo. Mune zvimwe zviitiko, denga rinogona kugadziriswa (semuenzaniso, $ 2,000 mhuri / $ 1 000 munhu mumwechete) kuti iwe uchasvika pamiganhu yako yegore negore kana maviri kubva pakutanga. Mushure meizvozvo, 100 muzana yehutano hwehutano huchafukidzwa nekambani yenyu yveshuwarenzi, kusanganisira zvose zvinodhaka, maitiro emabara, kushanyira chiremba, uye kunyange zvirwere zvekurapa.
- Tarisa kuti uone kana pane zvinodhaka zvakabviswa. Nepo vazhinji vedu tinonzwisisa kuti deductible chii, vamwe vangave vasina kuziva kuti dzimwe nguva vanobviswa zviviri muhurongwa mumwechete: imwe chete yemishonga yemishonga uye imwe yezvimwe zvinhu zvose zvezvemishonga. Mumamiriro ezvinhu akadaro, zvinodhaka zvinodzingwa zvinogara zvichitsvaga zvishoma zvakaderedza zvakagadziriswa, zvichireva kuti iwe unokwanisa kuwana zvizere zvemishonga inobatsira kare kare kupfuura pane imwe chete yakagadzirwa. Izvi zvinonyanya kubatsira kana mishonga yako yeHIV inorongwa pamadhura emishonga akaderera.
- Chengetedza mushonga wezvinodhaka unogona kuchengetedza. Zvinodhaka zvinowanikwa gore roga roga nemakambani einishuwarenzi kuti aone kuti chii chimwe chirwere chinowira pasi . Uye inogona kusiyana zvikuru kubva kune inshuwarisi kune imwe inotevera. Mune zvimwe zviitiko, mapiritsi akabatanidzwa angave akanyorwa pane imwe yepamusoro, apo mishonga yechipatara ichi yakanyorwa pamusana muduku unodhura. Izvi zvinogona kuita kuti iwe uwane kana mishonga iyi, somuenzaniso, inodhura zvishoma kudarika imwe chete yemapiritsi chisarudzo-kunyanya kana kusanganiswa kwemishonga kuchida kubhadhara uye mapiritsi chete anongoda kubhadhara kubhadhara . Munenge mamiriro ezvinhu ose, kubhadharwa kwekubhadhara ndiyo inoshandiswa kushandiswa kana iri kuuya kune zvinodhaka zveHIV.
- Funga inshuwarisi yega yega pamusoro pemashandi-based coverage. Uchenjeri hunowanzowedzera kuti mushandi-based ("boka") inshuwarhu yehutano inshuwarisi ndiyo nguva dzose chisarudzo chakanaka, chii chine rubatsiro rwekambani inonyanya kuderedza mishonga yemwedzi pamwedzi. Uye kunyange zvazvo chiri chechokwadi kuti purogiramu yevashandi vepambani purogiramu yeboka ine 143 muzana pasi pasi peyomunhu purogiramu yega, mari shoma yepamutambo inowanzoshandura kusvika kune yakanyanya kushandisa mari, kunyanya kune vanhu vanogara neHIV. Ita mathemoni usati waita kune chero hurongwa uye funga kusarudza kunze kwekuti chirongwa cheboka hachigadziri zvaunoda uye bhajeti yako.
3. Shandisa Zvakanakisisa ADAP Mafaro
Dambudziko reAIDS Drug Assistance Program (ADAP) rave rakatora nguva refu richionekwa semishonga yekutanga yemishonga yeHIV kune vashoma kusvika pakati-vamwe veAmerica. Kubvira pakuvambwa kwayo muna 1987, kuwanda kwepurogiramu kwawedzera zvakanyanya, nedzimwe nyika zvichinyanya kubatanidza kurapwa, mazano ebazi, rubatsiro rwehushuwarenzi, uye kunyange utachiona hwehutachiona hweHIV mune zvavanowana purogiramu.
Sezvo nedzimwe hurongwa hwakabhadharwa nehurumende, kukodzera kwakavakirwa zvikuru pamusana pemari, miviri inogona kusiyanisa zvikuru kubva kune imwe nyika kuenda kune imwe nyika. Uchapupu hwekugara uye zvinyorwa zvehutachiona hweHIV zvinotarisirwa.
Kunyange zvazvo hurumende dzakawanda dzichagadzirisa kukodzera kune vagari venyika yeUnited States uye vagari vemuzvinyorwa chete, vamwe vakaita saMassachusetts neNew Mexico vakabva vawedzera rubatsiro rweAdap kune vasina kunyorwa kune dzimwe nyika, zvakare.
Panguva iyi, nhanhatu dzeUnited States dzinoita kuti vanhu kana mhuri dzive nemigumisiro yehupfumi hwehupfumi hunowa pasi pechimwe chikumbaridzo, kubva kubva pasi pe $ 25,000 muNew York State kusvika pasi pe $ 4 500 muGeorgia.
Ikozvino ADAP yemari yekukodzero yekuwana mari inotsanangurwa seinotevera:
- Pasi pe200% yeFPL: Arkansas, Iowa, Nebraska, Oklahoma, Puerto Rico, Texas
- Pasi pe 250% yeFPL: Alabama
- Pasi pane 300% yeFPL: Georgia, Illinois, Indiana, Kansas, Louisiana, Missouri, Mississippi, North Carolina, Ohio, South Carolina, South Dakota, Wisconsin
- Pasi pasi pe400% yeFPL: Alaska, Arizona, Colorado, Connecticut, Florida, Hawaii, Minnesota, Nevada, New Hampshire, North Dakota, Rhode Island, Tennessee, Virginia, Washington, West Virginia
- Pasi pe 431% yeFPL: Montana
- Inopfuura 435% yeFPL: New York
- Pasingapfuuri 450% yeFPL: Michigan
- Pasi pe500% yeFPL: California, District of Columbia, Kentucky, Maine, Maryland, Massachusetts, New Jersey, Oregon, Pennsylvania, Vermont
- Kubva pamari yegore negore: Delaware (pasi pe $ 50,000), Wisconsin (inowanikwa nehurumende)
ADAP inowanzoonekwa somubhadhari wekupedzisira kushandura, kureva kuti, kunze kwekuti iwe wakakodzera kuMedicaid kana Medicare, iwe uchada kunyoresa mune imwe nzira yega yega kana yevashandi-based insurance. (Zvishoma zvehurumende zvinopa rubatsiro rwekubatsira kune avo avo vasingakwanisi kubhadhara uye / kana kuti havana kukodzera kuMedicaid.)
Usati wazvipira kune chero yunishuwarenzi chigadzirwa, taura nemupepeti we ADAP wehurumende kuti uone kana iwe unokodzera rubatsiro. Kubva pamhando dzezvikomborero zvaunokwanisa kuwana, unogona kusarudza inshuwarisi yekugovera yakakodzera kune umwe neumwe unoda.
Kana, somuenzaniso, mari yemishonga ndiyo yako yakanyanya mari uye iwe haugoni kuona zvimwe zvekushandiswa kwemari kwegore negore, iwe unogona kusarudza bhizinesi yemuchuwarisi nebhadharo yepamwedzi yepamwedzi uye yakanyanya kubviswa uye kunze kwe- pocket maximum. Nenzira iyi, iwe unogona kungobhadhara iwe kamwechete-gore rimwechete kuongororwa ropa uye kushanya kwachiremba, hapana chimwe chinhu.
Kune rumwe rutivi, kana iwe une mamwe mamiriro akange aripo kana kuti ona zvisati zviripo zvekurapa mari yegore, iwe ungada chirongwa chinopa chechidiki chakaderedzwa kana chekunze kwehomwe. Muchiitiko ichi, ADAP inogona kukanganisa zvakanyanya mari yakakura yekurapa uye inogona, mune dzimwe nguva, kupa ruzivo rwemishonga inoshandiswa kurapa zvirwere zvinotarisana neHIV.
Chinhu ichi ndecheku: shanda pamwe nemumiririri wenyu ADAP uye mumuperekedze zvakakwana pamusoro pematongerwo emitemo yenyu uye ikozvino remishonga inorapwa. Nenzira iyi, iwe unogona kuita chisarudzo chakanaka chakanyatsotarisana nebhajimenti yako pachako uye zvido zvehutano hwehutano hwako.
4. Tora Mukana Wakakwana Wekushandisa Mishonga Inodhaka
Kana zvasvika pakugadzirisa zvinodhaka zvezvemishonga zveHIV, tinowanzotarisa zvakanyanya kuhurongwa hwehurumende / hurumende uye tinokanganwa kuti rubatsiro runowanikwa nyore nyore kuburikidza nehutachiona hwehutachiona hukuru hweHIV. Izvi zvinowanzopiwa semu inshuwarisi yekubhadhara-kubhadhara rubatsiro kana zvirongwa zvekubatsira varwere zvakakwana (PAPs).
HIV inobhadhara rubatsiro (co-pay) inowanikwa kune vanhu vanochengeteka pachedu uye inopa mari chero ipi zvayo kubva $ 200 pamwedzi kuenda kune rubatsiro rusingagumi mushure mekutanga kubhadhara $ 5 kubhadhara (sekunge nemishonga Edurant, Intelence, uye Prezista).
Nzira yekushanda iri nyore, uye kazhinji haigadziri mitemo inobva pamari inowanikwa. Izvi zvinogona kuva zvakakosha kune avo vanotenga kutenga inshuwarisi itsva, vachivabvumira kusarudza mari shoma shoma iyo iyo inoshandiswa nemishonga yavo yekubhadhara zvinodhaka kana mari yekubhadhara mari inowira pasi pezvakatarisirwa gore negore nekubhadhara kwemwedzi.
Ngatitii, somuenzaniso, kuti uri pamudzvinyiriri Triumeq, iyo iyo muiti anopa gore rekubhadhara kubhadhara mari ye $ 6,000 pagore. Kana Triumeq ichiiswa pamushonga wezvinodhaka unoda kubhadhara kubhadhara, kazhinji kubatsirwa kwakakwana zvakakwana kubhadhara mari yekubhadhara mari.
Asi, kune rumwe rutivi, chii chaungaita kana Triumeq ikapinda mukati memuti inoda 20 muzana, 30 muzana, kana 50 muzana kubvumira? Mukudaro, unogona kuwana sarudzo nepamusoro-soro wepamusoro pehomwe. Iwe unogona kushandisa iko kubhadhara mari yekubhadhara kuvhara zvose zvinodhaka zvinodhaka kusvika panguva iyo iwe paunosvika pakusvika kwegore rako rose, mushure mekunge mari yese-madhiragi, X-rays, chiremba anoshanyira-akavharwa zana kubva muzana nemuteri wako.
Imwe nzira ndeye hurongwa hwehutachiona hweHIV (PAPs) . PAPs yakagadzirirwa kupa mishonga isina rusununguko kuvanhu vasina kubatsirwa vasina kukodzera kuMedicaid, Medicare, kana ADAP. Kubvumirwa kunowanzochengeterwa munhu kana mhuri dzine mari yegore rapfuura yaiva mazana mashanu pasi peFPL (kunyange zvisiri izvo zvinogona kuitwa pamhosva-ne-nyaya yeMedare Part D kana vanhu vasingakwanisi kuchengetwa nehutano hwehutano husina kugadziriswa).
PAPs inowanzove inoponesa vanhu vanogara muhurumende yakafanana neTexas, apo Medicaid neAdap zvinongororerwa kune vagari vepakati pekuwana mari (kureva, 200 muzana pasi peFPL). Nhasi, maPAP akawanda anowanikwa kune avo vanorarama 500 muzana pasi peFPL, pasina zvibvumirano zvinobva mumatare anokosha.
Uyezve, kana kuchinja muhutano hwehurumende nokukurumidza hakunakodzeri iwe ADAP, iwe unogona kunge uchikwanisa kupiwa rubatsiro rwePAP kunyange iwe ukasara kunze kwezvakatemerwa mari yechikwereti. Kazhinji, PAPs zviri nyore kwazvo kubata nadzo paunenge uchipa chikwata uchienzaniswa nemahofisi ehurumende, uye inogona kukuendesa kune dzimwe nyika dzisiri dzehurumende dzinopa rubatsiro rwakanangana neHIV.
Uye Rimwe Kupedzisira Kufunga
Kunyange zvazvo kukwanisika chinhu chinokosha pakubudirira kwekurapa, usambobvumira mutengo wega woga kuti utaure kusarudzwa kweutano. Nepo iwe ungakwanisa kuchengetedza madhora mashomanana pamusoro pekutanga-piritsi imwechete (sekuda, Atripla) yemunhu mumwe nemishonga yemishonga (Sustiva + Truvada), kuchinja kwakadaro hakufaniri kumboitwa pasina kubvunzurana zvakananga nachiremba wako kurapa.
Izvi zvinonyanya kuitika kana iwe ukasarudza kuchinja kune rimwe regimen iyo chero mishonga ipi zvayo yemishonga inopesana neyo iwe ikozvino uripo. Kusagadziriswa kwekuchinja kwerapi kunogona kuwedzera dambudziko rekurumidza kusagadzikana kwezvinodhaka , zvichikonzera kutanga kukanganisa kurapa .
Chinonyanya kukosha ndeichi: zviri nani kunyatsotsvaga nzira dzose dzekubatsira usati watarisa chero shanduko yerapi iyo inogona kukanganisa utano hwako. Kuti uwane mamwe mashoko, taura nevasiri-for-profit Partnership for Prescription Assistance (PPA), iyo inobatanidza varwere kune mapurogiramu anobatsira pasina mari, kana HarborPath, boka risina purogiramu iri muCharlotte, North Carolina iyo inosunungura pasina mishonga yeHIV kuti iwane , vanhu vasina kuvimbiswa.
> Sources:
> Farnham, P .; Gopalappa, C .; Sudzikinuro, S ..; et al. "Kuvandudzwa kweHupenyu hweMari yekuchengetedza uye hutano-hwe-hupenyu hunofungidzira vanhu vane hutachiwana hweHIV muUnited States: Kwapera Zvishoma Kufanorongedza Zvokutanga uye Kupindira Mukutarisira." Zvinyorwa zveAkawana Immune Defence Syndromes. October 2003; 64: 183-189.
> Kaiser Family Foundation (KFF). "Avhareji Single Premium kune Vashandi Vakanyoresa Kubhidhiyo Inoshandiswa Nehutano Hwevashandi - 2015." Oakland, California; yakasvika musi waDecember 8, 2016.
> KFF. "Avhareji yemwedzi miriyoni ega ega nemunhu pane imwe yemusika." 2013; yakasvika musi waDecember 8, 2016.