Actuarial value ndiyo imwe yehuwandu hwehutano hwekutarisira huripo huripo nehutano hwehutano inshuwarano. Yakave yakakosha zvikuru sezvo iyo ine mari yakagadziriswa Care Act yakagadziridzwa, nokuti ACA kutevera inoda kuti zvirongwa zvehutano zveboka rimwe nerimwe uye zviduku zvive mukati mezvikamu zvakasiyana maererano nehutano hwavo hwezvino.
Izwi iri pacharo rakananga zvakakwana: Chirongwa chehutano chinopa chikamu chimwe chezvikamu zvehutano hwekutarisira, uye urongwa huripo hunobhadhara zororo.
Asi zvinokosha kuti uzwisise kuti kukosha kwekugadziriswa hakukwanisi kuverengerwa pane zvese zvakanyorwa. Panzvimbo pacho, inotaridzwa kune imwe nyika inowanikwa ( huwandu hwehuwandu hwevanhu hunobva pane dhembedzwa yakagadzirwa kune mamiriyoni makumi matanhatu nemakumi mashanu anonyora muzvikamu zviviri zvehutano hwehutano hwehutano). Mune mamwe mazwi, kana imwe chirongwa ichi ine kukosha kwemazana makumi manomwe kubva muzana, ichabhadhara makumi manomwe kubva muzana yehuwandu hwehutano hwehutano hwehutano munyika yose yakawanda. Izvo hazvingavi , zvakadaro, inobhadhara 70 kubva muzana yemari yekubhadhara imwe neimwe .
Chimwe Chirongwa, Chimwe Chinyorwa Chekukosha, Zvitsva Zvakawandisa KwaMunhu Mumwechete
Semuenzaniso, funga chirongwa che $ 2,500 chinokonzerwa uye $ 5,000 kunze kwehomwe-pocket, iyo inongorongedza mabasa ekudzivirira musati yatorwa. Ngatitii Bob ane ruzivo pasi pegadziriro iyi, uye kurapwa kwake chete panguva yegore ndeye rwendo rwekukurumidzira kuchengetedza zvishoma zvishoma paanocheka ruoko rwake. Nokuda kwezviri nyore, tichataura kuti hurongwa hwekuchengetedza hurumende inodarika $ 1,500.
Izvo zvisingasviki pane zvakabviswa, saka Bob achazobhadhara mari yose ye $ 1,500. Nemamwe mazwi, iye ari kubhadhara 100 muzana yehutano hwake hwekutarisira kwegore-uye mubhadhari wake akabhadhara 0 muzana (achifunga kuti haana kugamuchira kuchengetedzwa kwekuchengetedza).
Iye zvino ngationgororei Alan, uyo ane chinyorwa pasi pesarudzo imwe chete. Alan anoonekwa kuti ane kenza munaFebruary, uye anokonzera purogiramu yacho kunze kwepamusoro pehomwe mwedzi iwoyo.
Pakupera kwegore, hurongwa hweAlano hwehutano hwehutano hwakabhadhara madhora mazana mana nemazana mana emadhora ekuchengetedza kwake, uye Alan akabhadhara $ 5,000 (rake kunze kwehomwe). Munyaya yaAlan, inshuwarisi yake yakabhadhara 98 muzana yemari yake, uye Alan akabhadhara 2 muzana chete yemari.
Asi Alan naBob vose vane chirongwa chimwe chete, uye nokuda kwemuenzaniso uyu, isu tichati ipulani yegoridhe , izvo zvinoreva kuti ine chido chezvinoarial chavanenge 70 muzana. Kutarisa pazviri kubva pane izvi, zviri pachena kuti pane mumwe munhu, pane zvakasiyana-siyana maererano nehuwandu hwemari yekubhadhara yega yega inotarisirwa nehutano hwehutano, sezvo zvichienderana nekutarisira kwehutano hunodiwa nomunhu wese panguva yegore. Asi zvachose, kune huwandu hwehuwandu hwevanhu, chirongwa chakuti Bob naAlan vakavhara chiyero chemazana makumi manomwe kubva muzana yemari.
IAACA uye Actuarial Value
Pasi pemitemo yeAACA, zvose zvitsva (zvinobudirira munaJanuary 2014 kana kuti gare) zvirongwa zveboka rimwe nerimwe uye zviduku zvinotarisirwa kuti zvikwanise kupinda mune rimwe resimbi ina dzesimbi, iyo inorongwa maererano nenyaya yezvinoarial (nheyo iyo zvirongwa zvinotyisa , zvisingakodzeri musimbi zvikamu zvepamusoro, zvinobvumidzwawo mumusika mumwe nomumwe, asi zvinogona kutengwa chete nevanhu vari pasi pezera remakore makumi matatu, kana avo vane dambudziko rakasunungurwa kubva kumutemo weAACA mumwe nomumwe ).
Isimbi yesimbi yakagadzirwa sendarira, sirivha, ndarama, uye platinum. Zvigadziri zvegoridhe zvine kukosha kwezvinoenderana ne60 peresenti, purogiramu yesirivha 70 muzana, zvigadzirwa zvegoridhe makumi mapfumbamwe, uye platinum zvirongwa 90 muzana. Nokuti zvakaoma kuvatsigiri vekugadzira zvirongwa zvine zvakakosha zvinokosha, ACA inobvumira minimus range ye +/- 2. Izvozvo zvinoreva, somuenzaniso, kuti chirongwa chesirivha chinogona kuva nemari inoshandiswa kubva kune 68 kubva kuzana kusvika 72 muzana, uye chirongwa chegoridhe chinogona kuva nehuwandu hunokosha hunenge huri pakati pe78 ne 82 muzana.
Muna December 2016, HHS yakapedzisa mutemo unobvumira zvirongwa zvebhron (zvinoshandiswa zvinoenderana ne60 peresenti) kuti zvive neche minimus range ye -2 / + 5, kutanga muna 2018 (mune mamwe mashoko, pakati pe 58 muzana uye 65 muzana).
Zvadaro muna Kubvumbi 2017, HHS yakagumisa mitemo yakagadziriswa yemakemikari inobvumira kuti minimis yakwanise kuwedzera kusvika -4 / + 2 yegoridhe, yegoridhe, uye platinum zvirongwa, uyezve kuwedzera itsva ye minimus range nokuda kwezvirongwa zvendarira ku -4 / + 5 .
Pasi pemitemo mitsva, inoshanda muna 2018:
- Zvigadziri zvemhangura zvinogona kuva nezviitiko zvinoenderana pakati pe 56 nezana uye 65 muzana.
- Sirivha yegoridhe inogona kuva nezvikwereti zvinoenderana ne 66% ne 72 muzana.
- Zvigadziri zvegoridhe zvinogona kuva nezviitiko zvinokosha pakati pe 76 muzana uye 82 muzana.
- Platinum zvirongwa zvinogona kuva nezviitiko zvinoenderana pakati pezvikamu 86 nezvikamu 92 muzana.
Kuverenga Actuarial Value: Ndeye Mu-Network EHBs Inoverengwa
Hurumende yehurumende yakagadzira actuarial value calculator-iyo inoshandurwa gore negore-iyo inshuwarisi inoshandisa kugadzirisa kukosha kwezvinodiwa zvezvirongwa zvavanenge vaudza gore rinotevera (pano kutsanangurwa kwe 2017 actuarial value calculator).
Ndezvipi zvese zvinonzi zvinokosha hutano hunobatsira (EHBs) dzinowanikwa mukuverenga. Vatsigiri vanobvumirwa kuvhara mamwe mabasa, asi izvozvo hazvirevi kutaridzika kwechirongwa cherongwa.
Mukuwedzera, kukoshesa kwekukosha kwekuverenga kunoshanda chete mu--net coverage, saka kunze kwe-network inotarisirwa iyo chirongwa chinopa-kana chiripo-hachisi chikamu chekugadzirisa kwechirongwa chezvinoari.
Boka Guru uye Kuzvimiririra Zvirongwa Zvine Mimwe Mitemo
Ikozvino inoshandiswa inokosha inyanzvi yehuni yepamusoro muAACA inoshanda kumagadziro evanhu nemapoka maduku. Asi boka guru rinoronga ( mumatunhu akawanda, izvo zvinoreva vanopfuura 50 vashandi, asi mune zvishomanana zvese, zvinoreva vanopfuura vashandi vanopfuura 100 ) uye zvirongwa zvekuzvidzivirira zvine mitemo yakasiyana.
Kune boka guru uye zvirongwa zvehupfumi, zvinodiwa ndezvokuti urongwa hunopa huwandu hunokosha, hunotsanangurwa sehwuchivhara 60 muzana yemari yehuwandu hwevanhu. Pane huwandu hunokosha hwekugadzirisa iyo yakafanana neyo actuarial value calculator inoshandiswa kumagadzirirwo emapoka uye mapoka maduku, asi vaverengi vane zvishoma zvakasiyana zvakasiyana .
Boka rakakura uye zvirongwa zvehupfumi hazvifananidzi kuti zvienderane nematanho ematare anoshandiswa mumusika mumwe nomumwe uye muduku, kuitira kuti kuve nekusiyana kwakasiyana kubva kune rimwe chirongwa kune rimwe muboka guru uye misika yekuzvidzivirira. Izvo zvirongwa zvinofanira kuvhara zvinenge makumi matanhatu kubva muzana zvehuwandu hwemari yehuwandu hwehuwandu hwevanhu, asi dzinogona kuvhara chero zvikamu zvehuwandu hwezvinodarika pamusoro peyero iyo, pasina kuumbwa maitiro avo kuti akwanise mukati mezvidimbu zvakatsanangurwa.
Zvirongwa Zvakafanana Nezvakagadziriswa Zvinokosha Kazhinji Zvine Zvimwe Zvimwe Zvirongwa Zvirongwa
Ikozvinoarial value calculator inobvumira inshuwarisi kugadzira zvirongwa zvakasiyana-siyana izvo zvose zvinoguma mukati memamwechete actuarial value range. Ichi ndicho chikonzero iwe unogona kutarisa 10 mazano ezvesirivha akasiyana uye ona 10 zvakasiyana zvakarongwa zvirongwa, uye zvakasiyana-siyana zvezvikwereti, copays, uye coinsurance .
California's health insurance exchange inoda kuti zvirongwa zvevanhu nemapoka maduku zvive zvakarongeka , izvo zvinoreva kuti mune imwe nheyo yesimbi, zvese zvezvirongwa zviripo zvakangofanana zvakafanana nemabatsiro kubva kune rimwe chirongwa kune rimwe, kunyange zvazvo vose vane zvakasiyana-siyana vanopa mitambo . Kune humwe humwe hurumende hunoda humwe hurongwa hwakarongeka asi hubvumirawo zvirongwa zvisiri izvo zvakagadziriswa, uye HealthCare.gov yakaronga zvirongwa zvakarongeka (kunze kwezvirongwa zvisingaenzaniswi) muna 2017.
Asi urongwa hwekugadzirisa hutsika hahusi chinhu chimwe chete sekukosha kwezvino. Kana hurumende kana shanduro inoda zvirongwa zvekugadziriswa, zvirongwa zvese zviripo zvichave nezvikwaniso zvakanyatsofanana kune chero zvigadzirisiti zvinoshandiswa pakugadzirisa (kusvitsa, copays, coinsurance, kunze kwe-pocket guru, nezvimwewo). Izvi zvinopesana nezvinoarial kukosha zvinodiwa, izvo zvinobvumira kuchinja kwakakura maererano neurongwa hwokugadzirisa uye kubatsirwa, kunyange kune zvirongwa zvinenge zvakakosha zvinokosha.
Kusiyana kwezvirongwa kune imwechete yesimbi inogona kuitika kunyange kana zvirongwa zvine zvakakosha zvakafanana nekugadzirisa (semuenzaniso, zvirongwa zviviri zvine zvakasiyana-siyana zvinogadziriswa zvinogona kuita zvose zvinoenderana ne80%). Asi iyo de minimus yakareba yakabvumidza pane imwe nheyo yesimbi-uye kuwedzerwa kwemhando ye 2018-inowedzera kuwedzera kusiyirwa kunobvumirwa mukati mezinga rimwe resimbi. Kwegore ra2018, chirongwa chine kukosha kwemazuva ano makumi mashanu nemazana mashanu ndeye chirongwa chemhangura, uye ndizvo zvakaita urongwa huri nehuwandu hunosvika 65 kubva muzana. Zviri pachena, iyo zvirongwa zviviri zvichave zvakasiyana zvakasiyana siyana zvigadziro, asi zvose zvaizoonekwa sezvirongwa zvebhron.
> Sources:
> American Academy of Actuaries MV / AV Practice Note Work Group > Minimum Value uye Actuarial Value Kugadziriswa Pasi Pezvinhu Zvisingakwanisi Kuchengeta Mutemo . April 2014.
> Dhipatimendi Rezvoutano uye Human Services. Kuguma 2017 Actuarial Value Calculator Methodology . Musi waJanuary 21, 2016.
> Dhipatimendi Rezvoutano uye Human Services. Mucherechedzo kuchengetedzwa uye kutengesa zvakanyanya kuchengetedzwa kweMutemo, Market Market Stabilization . April 2017
> Federal Register. Murwere Anodzivirirwa uye Anogadziriswa Care Care Act; HHS Chinyorwa cheBatsiro neZokubhadhara Zvikamu zve 2018; Kugadziriswa Kunyoresa Kwemazuva Akazotevera uye Mutengi Akashandiswa uye Akarongeka Zvirongwa Purogiramu. December 22, 2016.