Iyo maesterisks anoenda pamwe nekurambidzwa kwoupenyu hwose uye gore rinobatsira zvese
Chimwe chekudzivirirwa kwevatengi muAne Affordable Care Act inorambidzwa gore negore uye hupenyu hunobatsira maxums. Lifetime benefit maximums haichazobvumirwi zvachose, kunyange pazvirongwa zvakawanda. Gore negore - asi kwete upenyu - zvikwereti zvingabatsiri zvinogona kushandiswa kune zvirongwa zvakawanda zvevanhu, asi kwete zvirongwa zveboka.
Izvozvo zvinoreva kuti vatengi havasisiri pangozi yekuzviwana ivo vachida kenza mishonga nehutano hwehutano huine $ 300,000 yehupenyu hwekubhadhara.
Uye vanhu vane zvirwere zvisingagumi uye zvakaoma havasisiri pangozi yekudzingwa purogiramu yavo apo mishonga yavo yese yezvemishonga inosvika pane imwe chikumbaridzo.
Asi pane zvishoma zviduku zvakakosha kunzwisisa.
Inokosha hutano hunobatsira
Apo ACA yakanyorwa, vateereri vemutemo vakaona kuti kune marudzi ane gumi ekuchengetedza ayo aifunga seakakosha. Vaizviti zvipo zvinokosha zvehutano, uye boka rega roga neboka duku rinoronga nemazuva anobudirira aJanuary 2014 kana kuti gare gare inosanganisira kugoverwa kwavari (vanachiremba mazino ndechimwe chezvinhu zvinokosha zvehutano, asi mitemo yakasiyana yehutachiona hwehutano hwehutano).
Murairo wehupenyu hwose uye wegore rebasa remazuzo inoshanda chete kune zvinodiwa zvehutano hunokosha. Zvechokwadi, zvinenge zvese kutarisirwa kwemishonga-izvo zvinowira pasi pemaambura ekubatsira kwehutano hunokosha, sezvo mamwe emapoka acho akawandisa (somuenzaniso, kunze kwekuchengetedzwa ndeimwe yezvinokosha zvehutano, uye kurapwa kwepfungwa ndeimwe).
Asi semuenzaniso, mazano evanhu vakuru vemazino haafaniri kutaridzirwa kubatsirwa kwehutano pasi pe ACA. Hazviwanzoitiki kuwana chirongwa chehutano chinosanganisira kuiswa kwevanhu vakuru vemazino, asi ivo varipo. Zvisinei, zvirongwa zvakadaro zvinogona kugadzirisa chikwata chegore negore uye kubatsiro kwevanhu vakuru mazano emeno, sezvo ichi chisati chiri chimwe chezvinhu zvinokosha zvehutano.
Network nhau
Kurambidzwa kweAACA munguva yehupenyu uye kumiganhu yegore negore kunoshanda kune vose mu-network uye kunze kwe-network. Asi zvirongwa zvehutano hazvidi kutarisirwa kunze kwe-network. Kana vachiita zvakadaro, havagoni kuisa dhora pamari yegore negore kana yehupenyu hunobatsira.
HMO inowanzochengetedza kuchengetwa kwakagamuchirwa kubva mu-network network, kunze kwekuda kwekukurumidzira kunowanikwa kunze kwenzvimbo yebasa rebasa, kana kuti nzvimbo inoshandiswa pakudzvinyirirwa iri pedo haisi chikamu chehutano hweHMO. Asi nokuda kwekusava nehanya kwekukurumidzira kwakagamuchirwa kunze kwenhepfenyuro yeHMO, murwere anowanzove ane mutoro webhadharo rose.
PPO inoronga inowanzovhara kunze-kwe-network kuchengetedza, asi nepamusoro deductible uye yakawanda kunze kwe-pocket mutezo wemurwere. Mari yeAACA ye $ 6 850 yepamusoro yezvinyorwa zvekubuda kwemahomwe muna 2016 inoshanda chete kune in-network; varwere vanosarudza kuenda kunze kwenhare kana vasingazivi kuti vanoshandisa vasiri network vanogona kupedzisa nemari yakakwirira yakawanda kunze kweiyo. Zvichivawo zvakajairika zvePPO inoronga kuva nemagumisiro emagetsi ekugadziriswa kwemishonga inogamuchirwa kunze kwepurogiramu yemagetsi. Asi kana urongwa hunobudisa kunze kwe-network kuchengetedza hutano hunokosha, hahukwanisi kuisa hupenyu hwehupenyu kana hwegore rose huripo.
Cherechedza kuti zvakakosha kunzwisisa mutsauko pakati pekubhadhara zvikwata uye kunze kwemapokisi; chikamu chekubatsira ndicho chikamu chakanaka icho kambani yeinishuwarenzi ichabhadhara, uye ndizvo zvisingatenderwi zvakare. Izvo-kunze-muhomwe kapu ndiyo yakawanda iyo murwere aifanira kubhadhara mugore raakapiwa, pasinei nokuti yakakwirira sei zvido zvake zvose; Ndizvo zvakakonzerwa ne $ 6 850 muna 2016 kuitira mu-network kuchengetedza hutano hunokosha huripo (iyo kapu ichava $ 7,150 muna 2017; cherechedza kuti ichi ndicho chakanyanya kubvumidzwa - zvirongwa zvinogona uye zvine zvishoma zvishoma pasi pemapuranga kupfuura izvi).
Ikoko kunogona kuve nemiganhu, havagoni kuva mune madhora
Kurambidzwa kweAACA munguva yehupenyu uye kumiganhu yegore rose yezvipo zvehutano hunokosha kunoshanda kumiganhu inotaurwa maererano nemadhora.
Saka zvirongwa zvehutano hazvikwanisi kuva ne $ 3,000,000 zvigaro zvoupenyu zvese, somuenzaniso, kana $ 500,000 gore rekubatsira.
Asi zvirongwa zvehutano zvichiri-uye-zvinodzika mimwe miganhu pamusana pekutarisira kwavanozoita. Somuenzaniso, chirongwa chingareva kuti chichapa maitiro ekurapa maviri 20 gore, kana mazuva makumi matanhatu ekurapa ane unyanzvi pagore. Kunyangwe kana kutarisirwa mumubvunzo kuchiwira pasi peimwe yezvinhu zvinokosha zvehutano zvinoshandiswa, vatakuri vanogona kugadzirisa kugoverwa. Havangakwanisi kuzviita nemiganhu inotaurwa mumadhora. Saka havazokwanisi kutaura kuti iwe unogona kungova ne $ 2,000 yehutano hwepanyama mugore rimwe chete, pasinei nokuti vanogona kuti iwe unogona kungoona 20 kushanyira kunoonekwa kune chiremba wepanyama mukati megore.
Sources:
Federal Register, PPACA - HHS Zuva reKubatsirwa uye Kubhadhara Zvikamu zve 2017. Yakasvika 5/14/2016.
Yarbrough, Cassandra, MPP; Vujicic, Marko, PhD ;; Nasseh, Kamyar, PhD., Health Policy Institute uye American Dental Association, Dzimwe Dental Benefits Options muna 2015 Health Insurance Marketplaces. Yakawana 1/19/2016.