Kana uri kuedza kusarudza urongwa hwako hwehutano kana kuenzanisa urongwa hwehutano hwehutano muUnited States, unoda kunzwisisa simbi-tier system. Iko Inogadziriswa Care Act inomira kuti zvirongwa zvehutano zvakakosha sei. Kubva muna 2014, mapoka ose evanhu vatsva uye mapoka ehutano akafanirwa kuwirirana mune chimwe chezvikamu zvina: bronze, sirivha, goridhe kana platinum (pane zvimwe zvirongwa zvakashata zvinotengeswa mumusika mumwe nomumwe ).
Isimbi yakasimba inokuudza iwe kukosha kwezvinodiwa zve chirongwa chehutano. Iyo nzira yakajeka yekuenzanisa kukosha kwechirongwa chimwe chehutano kune umwe kuitira kuti iwe uone kuti ndeipi chirongwa chinokupa iwe wese bang buck yako. Zvose zvirongwa zvehutano pane imwechete yesimbi inenge yakafanana neyozvinoarial kukosha, kunyange zvazvo inogona kusiyaniswa nehuwandu huwandu hwepakati.
Chii Chinokosha Chaicho Chinoreva?
Ikozvino kukosha kwepurogiramu inokuudza kuti zviyero zvipi zvehutano zvinotarisirwa kuti inshuwarisi yehutano urongwa inotarisirwa kuribhadhara avo vanobhadhara. Chirongwa chine kukoshesa kwemazana makumi matanhatu kubva muzana inotarisirwa kubhadhara anenge makumi matanhatu kubva muzana emari yehutano yevashandi vayo. Vaya vanogadzirisa zvirongwa vachabhadhara vamwe 40 muzana yehutano hwavo hwehutano nenzira yekuderedza , kubhadhara , uye kubhadhara mari .
Actuarial value inorongwa nokuda kwehutano hwehutano hwakazara (zvichienderana ne "inowanikwa pasi" yevamwe) kwete kumunhu mumwe nomumwe.
Saka, pachiyero kune vose vanoona nezvehutano hwehutano, huwandu hunofanirwa hunojekesa huwandu hwehutano hwemari huchabhadharwa neurongwa. Zvisinei, chikamu chekuchengetedza kwako hutano izvo hurongwa huripo huchasiyana zvichienderana nekushandisa kwaunoita utano hwako hwehutano.
Mienzaniso
Semuenzaniso, ngatiti chirongwa chako cheutano chine kukosha kwemazana makumi mapfumbamwe, asi zvinoreva kuti chirongwa chegoridhe.
Kana iwe uchingoshandisa inshuwarhu yako yehutano kamwe chete kwegore rose, zvichida kuti ushanyire kliniki inokurumidzirwa kutarisira chirwere chekurwara, unogona kuwana kuti chirongwa chako chehutano hachibhadhara chero chinhu chekutarisira mari yako yehutano gore iroro. Kana iwe usina kunge wakasangana negore rako rakabviswa, iwe ungangodaro wakaguma kubhadhara kurapa kwekukurumidza iwe pachako. Mari yawakabhadhara ingadai yakatarwa kune yako yakabviswa. Muchiitiko ichi, chirongwa chako chehutano hachina kubhadhara 80 muzana yehutano hwako hwekutarisira. Iwe wakabhadhara 100 muzana yehutano hwako hwekutarisira mari.
Zvisinei, pamusoro pehuwandu hwehutano hwehutano, humwe mamiriro ehumwe semuenzaniso wepamusoro unogona kuenzaniswa nezviitiko umo hurongwa hwehutano hwakabhadhara huwandu hwemitemo yemunhu wese. Somuenzaniso, munhu anoonekwa ane kenza uye anoguma ne $ 400,000 muzvikwereti zvezvokurapa zvegore zvichabhadhara mari inopfuura $ 7,350 ye-in-network kutarisira muna 2018 . Urongwa hwehutano hwehutano huripo huchabhadhara zvakasara, izvo zvichange zvingasvika kusvika 98 muzana yemutemo.
Uye dzimwe nhengo dzisingarwarwi panguva yose yegore dzichabatsirwa nekuti ACA-zvirongwa zvinogamuchirika zvinobhadhara zana muzana yemutero wekuchengetedza kwekuchengetedza semuedzo wegore negore nekudzivirira kuberekwa.
Vanhu ivavo havana kubhadhara chero chinhu pamusoro pehutano hwavo hwemari gore iroro.
Kana mari yevashandi vose vakagadziriswa pakupera kwegore, hurongwa hunoenderana nehuwandu hwemazana makumi mapfumbamwe kubva muzana hunenge huripo huripo 80 muzana yehutano hwehutano hwevashandi vose pamwe chete.
Actuarial kukosha kuverenga hakurevi mari yemishonga yemishuwarenzi yehutano kana zvinhu chirongwa chehutano hachifukidze. Somuenzaniso, kana inshuwarano yehutano isingabatsiri kurasikirwa nekurasikirwa, kurasikirwa kwekureruka kurasikirwa hakukwanisi kubatanidza kana uchiuya nekukosha kwerongwa hwehutano.
Ko Metal Metal Tier Inoenderana Neiko?
- Bronze-tier zvirongwa zvehutano zvine uwandu hunenge makumi matanhatu kubva muzana
- Sirivha-tier zvirongwa zvehutano zvine kukosha kwema70%
- Ndarama-tier zvirongwa zvehutano zvine uwandu hweanenge 80 muzana
- Platinum-tier zvirongwa zvehutano zvine kukosha kweenenge 90 muzana
Nokushandisa simbi-tier system, vanhu vasinganzwisisi kunyatsogadzirisa kwekuti basa rekushanda rinoshanda sei richiri kunzwisisa intuitively kuti chirongwa chegoridhe-chinangwa chinopa hupfumi hwakawanda pane urongwa hwemhangura-asi (sezvinotsanangurwa pasi apa, vanhu vane mari shoma vanosarudza sirivha yegoridhe inogona kuguma kuwana kuwana goridhe kana kuti platinum yekubatsira , semubairo weAACA rubatsiro iyo inoderedza mari-ye-podhaini mari ).
Ndinofanira Kusarudza Mhangura, Sirivha, Ndarama kana Platinum?
Isa sarudzo yako yesimbi kune imwe muyero yekuti iwe unoda kubhadhara mari yepayimusi nehuwandu hupi hwehuwandu hwaunoda. Mapurogiramu akakwirira ane mapurogiramu akakwirira, asi anobhadhara chikamu chepamusoro chehutano hwehutano hwako kudarika zvidhura-pasi, zvirongwa zvishoma.
Chimwe chezvikamu zviri pasi apa chinosanganisira zvikamu pamusoro pekufanirwa kufunga nezvazvo uye ndiani anofanirwa kudzivisa icho chesimbi yakasimba. Kana uri kusarudza hurongwa hwehutano, kana waona chirongwa chesimbi yeti, tiye nechokwadi kuti hausi pane urongwa hwevanhu vanofanirwa kudzivisa icho chidimbu.
- Urongwa Hwendarira-Chii?
- Sirivha-Chii?
- Kuronga Kwegoridhe-Chii?
- Platinum Plan-Chii? (ona kuti nzvimbo dzakawanda hadzina platinum zvirongwa zviripo)
Kufanirwa kwako kwehurumende rubatsiro kunogona kukanganisa kusarudza kwako kwesimbi yesimbi. Kana iwe uchikwanisa kupiwa rubatsiro rwehurumende yekubhadhara mari (aka, kugovana-kugovana-kugovana, kana CSR) kukubatsira kubhadhara mari yako yakabviswa, copays, uye coinsurance, haungatori mari kana iwe usingatengi Sirivha-tier yehutano urongwa uchishandisa hutano hwehutano hwehutano hwako . Kuti udzidze zvakawanda nezvebatsiro, verenga, " Ndingawana Rubatsiro Rokubhadhara Utano Woutano? "
Kana iwe uchikwanisa kubhadhara mari yekubhadhara mari uye iwe unotenga chirongwa chesirivha, unogona kupedzisa kuwana kugoverwa kunoenderana negoridhe kana platinum chirongwa, pamutengo wechirongwa chesirivha. Saka zvakakosha kubhadhara zvakadzama zvepurogiramu imwe neimwe iripo, pane kungofunga kuti imwe yezinga yesimbi inenge iri nani pane imwe.
Uye mune imwezve inoratidzika-intuitive twist, miriyamu yegoridhe zvirongwa kune dzimwe nzvimbo, kune vamwe vakanyoresa, inonyanya kuderera kupfuura zviyamu zvemapurani esirivha, kubva muna 2018. Izvi ndezvokuti Mutungamiri weTrump akamira kubhadhara makambani ehushuwarisi nokuda kwebhadharo ye CSR munguva pfupi 2017, uye mabhizimisi munyika dzakawanda vakawedzera mari yeCRR kumapurogiramu esirivha esirivha. Izvozvo zvakaguma nemari yepamusoro yekubhadharwa kwepamusoro kune dzimwe nzvimbo, uye nheyo-yepamusoro yematengo isingatevedzeri mitambo yakatarwa (kureva, kuvhara zviri nani kudhura zvakanyanya). Iwe unogona kuverenga zvakawanda pamusoro pekuti izvi zvinoshanda sei pano , asi pfungwa yekutora ndeyokuti kana iwe ukawana rubatsiro rwekubhadhara, unogona kuona kuti chirongwa chegoridhe hachina mari shoma kudarika chirongwa chesirivha, uye unogona kuona kuti chirongwa chemhangura hachina mari.
Kana Zvose Zvirongwa Zvakapiwa Ndizvo Zvazvakakosha, Sei Usingotori Pasi Pfupi?
Kunyange zvazvo zvirongwa zvose pamusoro pezvikamu zvakasara zvichave nezvakafanana zvinokosha, zvichasiyana mune dzimwe nzira. Tora kusawirirana uku kuve nehanya pakusarudza hurongwa; Saronga hurongwa hunoshanda zvakanaka nokuda kwehupenyu hwako.
Semuenzaniso, chirongwa chegoridhe chimwe chinogona kubhadhara mari ye $ 1,500 uye mari yekubvumira ye 15 muzana. Chimwe chirongwa chegoridhe chinogona kunge chakaderedzwa zvakaderera paired with coinsurance yakakura uye mishonga yemakadhi. Kana iwe usingakwanisi kubhadhara iyo yakakura deductible isati yako yehutano inshuwarse inopera, iwe ungasarudza chirongwa ichi nechezasi chinotengwa kunyange kana ine mari yepamusoro yakakwirira. Iwe unoziva kukosha kwekozvino kwezvinhu zvose zvegoridhe zvirongwa zvakangofanana, naizvozvo kusarudzwa kwako kuri kuitwa zvichienderana nekuti ungada sei kushandisa inshuwarheni kwete pane zvakakosha zvakakosha.
Mamwe mapeji ekuenzanisa anosanganisira urongwa hwehutano hwehutano . Ndiko chiremba wako mu-network pamwe nezvose zvezvirongwa zveutano uri kuenzanisa here? Chirongwa chega chega chevashandi chakakura zvakakwana kukupa sarudzo yevashandi kana ukasarudza iwe usingadi chiremba kana chipatara uye unoda kuchinja kune imwe?
Zvinyorwa zvinodhaka zvepiritsi (zvakaputirwa nemishonga inodhindwa) zvicharamba zvichisiyana kubva kune umwe mubhadhari kune imwe. Saka iwe unogona kunge uri kutarisa matanho matatu esirivha akasiyana, asi chimwe chete chazvo chinosangana nemumwe mushonga wauri kutora.
Pane imwe hurongwa inokupa rusununguko rwunosarudza kupfuura rumwe here? HMO kazhinji hazvikwanisi kubhadhara kuchengetedza iwe unowana kunze-kwe-network . Zvisinei, PPOs ichabhadharira kunze-kwe-network kuchengetedza, asi pamutengo wakaderera pane iwe wakanga wakagara mu-network. PPOs hazviwaniki munzvimbo dzose, asi kana dziripo, dzinowanzova pakati pezvinhu zvinodhura zvakasarudzwa. Iwe unoda kubhadhara miriyamu yakakwirira pane chirongwa chinokubvumira kuti uchengetedze kunze-kwe-network kana iwe uchida? Kana iwe ungasarudza kusiya rusununguko rwusarudzo, asi iwe unobhadhara mihora yakaderera?
Izvo huwandu hunoenderana nechirongwa chimwe chete zviri nani kudarika chirongwa chinopikisana here? Iko mari yepurogiramu imwe chete yakaderera kupfuura yepurogiramu yekukwikwidzana ine zvikamu zvakafanana zvakafanana here?
Kana uchitarisira kushandisa utano hwako hwehutano inshuwarani, eenzanisa ma -out-of-pocket maximums zvezvirongwa. Kana chirongwa chimwe chine zvakanyanya kudarika kunze kwepakona kupfuura mamwe mazano ari pamatare akafanana, unogona kuchengetedza mari kusarudza chirongwa ichi nechepasi chekunze kwehomwe. Uchawana rumwe ruzivo pamusoro pekuti nzira iyi inoshanda sei " Nzira yekuchengetedza paInishuwarenzi yehutano kana Unosvika kunze kwePocket Maximum ."
> Sources:
> Federal Register, Centers for Medicaid uye Medicaid Services, Dhipatimendi reZvipatano neHuman Services. 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.