Ndechipi musiyano pakati pekubhadhara mari uye kubhadhara mari? Vose copayand coinsurance kubatsira makambani emishuwarenzi ehutano uchengetedze mari (uye saka chengetedza miriyamu yako pasi) nekuita kuti uve nehanya kune chikamu chemari yako yehutano yehutano. Zvose izvi ndedzimwe mari yekugovana , kureva kuti iwe unobhadhara chikamu chemari yekutarisira kwako uye kambani yehutano inshuwarima inobhadhara chikamu chemari yekutarisira kwako.
Kusiyana pakati pe copay uye coinsurance iripo
- kuti chikamu chezvikwereti chinopatsanurwa pakati pako nekambani yehutano inshuwarisi.
- iyo yakawanda yemari yematambudziko yega yega inokutsanidza iwe.
Maitiro eCopay
Imba yebhadharo ndiyo mari yakatarwa iwe unobhadhara pose paunoshandisa rudzi rwupi rwehutano hwehutano. Somuenzaniso, iwe unogona kunge uine $ 40 copay kuti uone chiremba wekubatsira vana uye $ 20 copay kuti uzadze chiremba. Iwe unobhadhara mari yepa copay; kambani yveshuwarhu yehutano yehutano inobhadhara chikamu chese musara. Ikopa yako yebasa iri yakashandura haina kuchinja pasinei nokuti chiremba anokweretesa zvakadini, kana kuti yakawanda inotengeswa nemishonga.
Kusiyana ne deductible iyo inobhadharwa chete kamwechete pagore, iwe unobhadhara copay nguva imwe neimwe yaunoshandisa iyo yehutano hwehutano. Saka, kana iwe une copay ye $ 40 kuhofisi yechiremba achishanyira uye iwe ukaona chiremba katatu pamakumbo ako akaputika, iwe unofanira kubhadhara $ 40 imwe neimwe kushanyira, kwese $ 120.
Nzira yekuti Coinsurance Inoshanda Sei
Nekubhadhara mari, iwe unobhadhara chikamu chemari yebasa rekuchengetedza hutano (kazhinji mushure mokunge wawana zvakakosha iwe, uye iwe unofanira kungoramba uchibhadhara coinsurance kusvikira wapedza chirongwa chako chekubuda kwepakona kwegore). Kambani yako yveshuwarisi yehutano inobhadhara zvimwe zvese zvinodhura.
Somuenzaniso, kana iwe une 20% coinsurance yekupatara, izvi zvinoreva kuti iwe unobhadhara 20% yemari yekurapa, uye wako wehutano wehutano anobhadhara vamwe 80%.
Sezvo makambani einishuwarenzi ehutano anotaurirana kuti adzidzise mitengo kubva kune in-network providers , iwe unobhadhara coinsurance pamutengo wakaderedzwa . Somuenzaniso, kana uchida MRI, nzvimbo yeMRI inogona kuva nemari yakakwana ye $ 600. Asi, sezvo kambani yako yehutano inshuwarheni yakataurirana nekutengesa muda we $ 300, mari yako yekutengeswa mari inenge iri 20% ye $ 300 rekudhura, kana $ 60. Kubhadhara coinsurance pamusoro pechikwata chakazara panzvimbo yekuderedzwa kwehuwandu ndiyo inowanzobhadhara kukanganisa iyo inokubhadhara kupfuura iwe unofanirwa kuripa. Kana hurongwa hwako huchishandisa coinsurance, iwe unoda kuve nechokwadi chokuti mari yacho inotumirwa kuhutano hwehutano inshuwarisi kune chero zvigadziriswa zvinoshandiswa, uye ipapo chikamu chako chinotengeswa iwe (asi chinopesana nekubhadhara chikamu chako kumusoro-mberi panguva yebasa).
Pros uye Cons of Copay vs. Coinsurance
Kubudirira kwepa copay ndeyekuti hapana kushamisika pamusoro pekuti mari yakawanda inobhadhara iwe. Kana ako copay iri $ 40 kuti uone chiremba, iwe unoziva kuti iwe uchabhadhara mari yakawanda sei iwe usati waita sarudzo.
Kune rumwe rutivi, kana basa iri rinodhura zvishoma kudarika copay, iwe unotofanira kubhadhara copay yakazara (izvi zvinogona dzimwe nguva kuva mhaka yezvinyorwa zvemauto, izvo zvingave zvine mari yekutengesa zvakaderera zvakanyanya zvokuti copay yako yepirinhe yepfungwa yeChipiri 1 zvinodhaka zvinogona kuva zvakakwirira kudarika zvinodhura zvemadhiragi). Kana uri kuona chiremba kakawanda kana kuzadza mishonga yakawanda, zvikwereti zvinogona kuwedzera nokukurumidza.
Coinsurance ndeye riskier kwauri sezvo iwe usingazivi kuti iwe uchabhadhara zvakadini kusvikira basa rapera. Somuenzaniso, unogona kuwana kuongororwa kwe $ 6000 nokuda kwekuvhiya kwako kuri kuuya. Sezvo iwe uine coinsurance ye 20%, chikamu chako chemari chinofanira kuva $ 1200.
Asi, zvakadini kana chiremba anovhiya achiona dambudziko risingatarisirwi panguva yokuvhiyiwa uye anofanira kugadzirisa izvozvo, zvakare? Kuvhiya kwako kubhadharo kunogona kubuda kune $ 10 000 panzvimbo yepakutanga $ 6000 kuongororwa. Sezvo kubhadhara mari yako ndeye 20% yebhadharo, iwe zvino unokwereta $ 2000 panzvimbo ye $ 1200 wawakaronga (chirongwa chako chezvehutano chiri kunze kwechikwata chinotora chikwereti chaunokwereta, saka ichi hachisi ngozi isina kukwana).
Makambani eInishuwarenzi anofarira mari yekugadzirira nokuti vanoziva kuti iwe unofanira kutakura chikamu chakawanda chezvinhu zvinodhura zvinhu zvinodhura pasi pesangano rekutendesa kupfuura iwe waizoita kana iwe uri kubhadhara copay. Vanotarisira kuti inokukurudzira kuti uone kuti iwe unonyatsoda muedzo iwoyo unodhura kana nzira sezvo chikamu chako chemari chinogona kuva mari yakawanda, kunyange kana iri 20% chete kana 30% yemutemo.
Iyo Deductible Inoshandiswa Rini?
Zvikwereti zvehutano zvehutano zvakagadziriswa zvinofanira kusangana pamberi pekubhadharwa kwekodzero kunopinda mukati. Izvi zvinoreva kuti iwe uchabhadhara zana kubva muzana remari yekutaurirana yepurogiramu yekurapa kwako kusvika iwe uchisvika pakudhakwa, uye ipapo kuparadzaniswa kwemari inoshandiswa kuchashanda kusvikira iwe unosangana nehuwandu hwenyu hwepamusoro pegore.
Copays inowanzoshanda kubva pakutanga, kunyange kana iwe usati wasangana nehurukuro yako yakadaro, sezvo inowanzoshanda kumasangano akaparadzana kubva ku deductible. Saka urongwa hwako hunogona kunge hwakabhadharwa uye humwe hutano hunoshandiswa kune vakwegura, asi copays inoshanda kuhofisi yekushanyira uye mitemo.
Iyo Copay uye Coinsurance Inoshandiswa Pamwe Chete
Iwe kazhinji haufaniri kubhadhara zvose copay uye coinsurance kune imwechete yehutano hwehutano. Semuenzaniso, zvingave zvisina kujairika kubhadhara $ 40 copay kuti chiremba ashanyire, uyezve anofanira kubhadhara mari yekubhadhara kwe20% yebhadharo pakushanyira ikoko. Zvisinei, hazvisi pamutemo kune vatsigiri vehutano kuti vaite izvi. Verenga chidimbu chekubatsira zvakanaka paunenge uchisarudza chirongwa chehutano kuitira kuti uzive kana urongwa hwehutano hunoda iyi miviri yekubhadhara kugovana.
Iwe unogona kugumisa panguva imwe chete uchibhadhara copay uye coinsurance kune zvikamu zvakasiyana zvehutano hwehutano hwakaoma. Hezvino kuti izvi zvingashanda sei. Ngatiti iwe une $ 50 copay yekushanyira vanachiremba paunenge uri muchipatara uye 30% coinsurance yekupatara. Kana chiremba achikushanyira kanomwe muchipatara, iwe waizoguma uchinge wawana $ 50 copay kune imwe neimwe yevakashanyira, iyo inokwana madhora mazana maviri mumakwereti epa copay. Iwewo uchatora chikwereti chibhadharo che 30% chekubhadharwa kwemari kune chikamu chako chechipatara chipatara. Zvinogona kuita seuri kubvunzwa kubhadhara zvose copay uye coinsurance yezvimwe zvipatara zvakagara. Asi, uri kunyatsobhadhara copay nokuda kwebasa rechiremba, uye coinsurance yebasa rechipatara, izvo zvinobhadharwa zvakasiyana.
Zvimwe zvirongwa zvehutano zvine copays zvinoshanda mune dzimwe mamiriro ezvinhu asi zvinodziviswa mune vamwe. Muenzaniso unowanikwa ndewekuti copays inoshandiswa kune imwe nguva inoshanyira mukamuri asi anosunungurwa kana iwe wapedzisa kubvumirwa kuchipatara. Pasi pemhando iyi yeurongwa, kushanyira kuE ER isingakonzere kugamuchira chipatara kunogona kuva $ 100 copay. Asi kana mamiriro acho akakomba zvokuti iwe unopedzisira uri muchipatara, haufaniri kuripa $ 100 copay, asi iwe unotofanira kubhadhara yako deductible uye coinsurance (nokuda kwekushanyirwa zvipatara, kusanganisira nguva yako muE ER uye nguva yako sechirwere chakabvumirwa), kusvika kune imwe yepamusoro pehomwe yeurongwa hwako.
Copays uye Coinsurance yemishonga yemishonga
Misiyano pakati pe copay uye coinsurance inogona kunyanya kuvhiringidza nemishonga yekurapa zvinodhaka. Vakawanda vehutano vehutano vane chikwata chemishonga chinokuudzai mishonga ipi iyo chirongwa chehutano chinovhara , uye rudzi rwemari yekugoverana inotarisirwa. The formulary inoshandisa zvinodhaka muzvikamu zvakasiyana-siyana zvematengo, kana tier, uye inoda kugoverana kwemari yakasiyana-siyana kune mumwe nomumwe.
Semuenzaniso, iyo yakaderera pasi inogona kunge iri mishonga yakawanda uye yakajairika, yakwegura, inodhura madhiragi. Izvozvo zvingada chikwereti che $ 15 kwemazuva 90 ekugoverwa kwemishonga. Chipiri chechipiri chinogona kunge chinodhura mari-zita remishonga uye inoda kopay ye $ 35 kwemazuva 90 ekugoverwa. Asi hutano hwepamusoro (pane zvirongwa zvehutano hwakanyanya, izvi zvinogona kunge iri Tier 4 kana 5, asi dzimwe zvirongwa zvehutano zvinoshandisa zvinodhaka mumatare akawanda kusvika matanhatu) zvinogona kunge zvakadhura zvakanyanya madhiragi zvinodhura zviuru zvemadhora pamutengo.
Nokuda kweizvi, urongwa hwehutano hunogona kuregerera mari yepayinari-kugoverana kwayo inoshandiswa pamashure ezasi uye kuchinja kune coinsurance kune chero kupi zvako kubva pamakumi maviri kusvika ku40 muzana. Izvo zvinotsigirwa pamishonga inodhura-yepamusoro-soro inobvumira inshuwarisi kuti ipe mhindu yemari yadzo kuburikidza nekuchinja chikamu chikuru chemari yemishonga inodzokera kwauri. Izvi zvinogona kuvhiringidza sezvo zvizhinji zvezvirevo zvako zvichitsvaga copay yakasimbiswa, asi mitemo inodhura zvikuru, mishonga yepamusoro yepamusoro, inoda mari yekubhadharisa mari panzvimbo pekopi.
Kana iwe uri mumamiriro ezvinhu aya uye unotarisana nemukana wekubhadhara mashoma emadhora pamwedzi nekuda kwezvipatara zvinodhaka, iwe uchafara kuziva kuti kana wambosangana nepurogiramu yako yekunze-ye-pocket yegore, yako chirongwa chehutano chinotanga kutanga kubhadhara chikamu chezana chemari yemishonga yekusara kwegore. Kunze kwekuti urongwa hwako hukuru hukuru kana huri kuberekwa , huwandu hwenyika huripo huri hupamhi kupfuura $ 7,150 muna 2017, uye $ 7 350 muna 2018 (iyo miganhu inoshanda kune munhu mumwe chete; kana kupfuura munhu mumwe chete mumhuri yako achida kurapwa, pamwe chete muganhu wakapetwa kaviri kupfuura.
Coinsurance vs. copay inogona kuve yakavhiringidza, asi kunzwisisa mutsauko uri pakati pe copay uye coinsuranceiri zvinoreva kuti uri nani zvakagadzirirwa kusarudza hurongwa hwehutano hunosangana nezvamunotarisira, bhajeti yemari yekurapa, uye zvikanganiso zvekubata muzvikwereti zvako zvezvechiremba.
> Sources:
> Dhipatimendi Rezvoutano uye Human Services, Mutevedzeri Kudzivirirwa uye Anogadziriswa Care Care Act, HHS Chinyorwa Chekubatsira uye Kubhadhara Zvikamu zve 2017. March 8, 2016.
> Dhipatimendi Rezvoutano uye Human Services. Mucherechedzo Kuchengetedza uye Zvisingakwanisi Kuchengetedza Mutemo, HHS Chinyorwa Chekubatsira uye Kubhadhara Zvikamu zve 2018. December 22, 2016.