Kunze kwe-Pocket Max: Kushanda Kwaro uye Kuti ACA Inodzora Sei
Utano hwehutano hwehutano huri kunze kwehomwe huwandu hwemari huchafanira kubhadharira kune mari yehutano hwako gore rega roga, uchifunga kuti unogamuchira kutarisirwa kwakafukidzwa neshuwarisi yako uye kushandisa in-network zvipatara uye vanachiremba.
Mushure mokunge makabhadhara zvakakwana mukudzvora , mushandira pamwe nekubhadharisa kuti uwane huwandu hwenyu hwemutokisi, kambani yenyu yehutano inshuwarima inokweretesa zvimwe zvose zve-in-network, kurapa kwehutano hwehutano hwakasara kune zvakasara zvegore iroro.
Asi, haisi nguva dzose kushanda nenzira iyo. Kunyange zvazvo huwandu hwenyika huri kunze kwegadziriro hugadzirirwa kuvhara mari yako yekutengesa kana uine hutano hwakawanda hwekutarisira , inotsanangurira kambani yako yehutano inshuwarisi kuti uwane mari yakawanda. Saka, makambani einishuwarenzi ehutano akagadzira nzira dzekugadzira kuderedza dambudziko iroro. Iyi nzira inokonzera kuvhiringidzika pamusoro pezvinokosha kuti uende kunzvimbo yako yepamusoro-pfupa, iyo yako yehutano wehutano inopa mari yako mushure mekunge waiwana, uye kuti zviyero zvakadini zvepakati pehomwe yako ndeyechokwadi.
Maitiro Ekunze Kwemafukiti Anowanzoshanda
Ngatitarisei muenzaniso: Iwe une deductible ye $ 1 000, mari yekubhadhara ye20 kubva muzana, uye yekunze kwemahomwe ye $ 5,000 pagore.
Iwe unoputsa gumbo rako. Iwe unotorwa kuvhiya usiku ihwohwo. Nzvimbo yako yekuvhiya inotapukirwa. Iwe uri muchipatara kwemavhiki maviri, uvhiya maviri, uye uwane ma antibiotics emisha kumba kuburikidza nekuchengetwa kwehutano kwemamwe vhiki matatu.
Hezvino kuti mabheji ako aizowedzera sei kunze kwekunze kwemahombekiti akaenzaniswa nehuwandu hwemapurisa ye $ 5,000:
- Imhosva yako yepakamuri yekukurumidzira iri $ 4,000.
Pasina muganhu wekunze, unobhadhara $ 1 000 inokonzerwa uye $ 600 mu coinsurance.
Nokukwereti kwekunze kwekunze, iwe unobhadhara imwechete $ 1 000 inokonzerwa uye $ 600 mu coinsurance.
- Chipatara chako chiri $ 40,000.
Pasina muganhu wekunze, unobhadhara $ 8,000 coinsurance (20 muzana).
Nekunze kwekunze kwekodzero, iwe unobhadhara $ 3 400 chete. Iwe wakasvika paunenge uri kunze kwehomwe yako uye iwe unobva urega kubhadhara (iyo $ 5,000 inosvika kubva ku $ $ 1000 inokwana, $ 600 coinsurance nokuda kweE ER kushanyira, uye $ 3 400 coinsurance kuchipatara chikwereti). - Bhiriro rekuchengetwa kwehutano hwemusha uri $ 3,000.
Pasina mutezo wekunze, unobhadhara $ 600 coinsurance.
Nekuda kwekunze kwepakona, iwe haubhadhara chero chinhu. Mushandi wako wehutano huripa mari yose yehutano hwehutano hwemusha nekuda kwako kwawakasvika kare. - Zvose zvinokonzerwa nemakumbo ako akaputsika ndeye $ 47,000.
Pasina muganhu wekunze, unobhadhara $ 10,200; mubhadhari wako anokwereta $ 36,800.
Nekuda kwekunze kwepahomwe, iwe unobhadhara $ 5,000; mubhadhari wako anokwereta $ 42,000. - Iwe unoda mamwe mabasa ehutano hwehutano gare gare mugore.
Pasina muganhu wekunze, iwe unogona kubhadhara 20% yemari.
Nechokunze kwekunze kwehomwe, haubhadhari.
Kunze Kwema-Pocket Mitemo Yakasiyana Zvikuru Gore ra2014
Muganhu wako wekunze-we-pocket we $ 5,000 wakakununura iwe mari yakawanda, asi yakabhadhara yako yehutano inshuwarisi kambani sezvazvakakuponesa iwe. Pamberi peNhepfenyuro Yekubatsira Inotengeswa yakatanga kutonga mitemo ye-out-of-pocket, vamwe vashandi vehutano vakashandisa nzira dzakasiyana-siyana kuti varambe vachibhadhara mari (uye miriyamisi) sepashoma sezvinobvira.
Izvi zvigadziriswa zvakashandura mari yakawanda yehutano hwako pane iwe: iwe unobhadhara zvakawanda, uye vanobhadhara zvishoma. Vashandi vanoshandisa nzira nhatu dzinokosha dzekuita izvi, hapana kana ipi inobvumirwa zvakare, nekuda kweAACA:
- Nzira yekutanga yakaita kuti zvive zvakaoma kuti iwe usvike kumuganhu nekurega kubhadhara zvose zvaunoshandisa kuti uende kunze kwepamusoro pehomwe. Anishuwarenzi angave akasarudza kusatora chikwereti chimwe kana zvimwe kune izvi:
- Deductible
- Copayments
- Coinsurance yemishonga
- Coinsurance kune miedzo
- Coinsurance ye -out-of-network kutarisira
- Munzira yechipiri, iyo inshuwarisi haina kubhadhara 100 muzana yehutano hwako hwekutarisira mushure mekunge wasvika pamutengo wako wekunze.
Semuenzaniso, urongwa hwehutano hunogona kunge hwakada kuti urambe uchibhadhara copay nguva dzose paunoona chiremba kunyange iwe watove wakasvika pane kunze kwehomwe. Muchiitiko ichi, kusvika pahuwandu ingadai yakakudzivirira kubva pakubhadhara coinsurance kwegore rose, asi kwete kubhadhara copays.
Dzidza kusiyana kwakaita copays uye coinsurance .
Zvimwe zvirongwa zvehutano zvisingabatanidzi mishonga yemishonga inokonzerwa nemishonga inobva kune imwe kunze kwehomwe. Muchiitiko ichi, iwe unofanirwa kuramba uchibhadhara chikamu chako chemari yezvinyorwa kunyange mushure mokunge wawana muganhu wako wekunze. Kana iwe waive ne coinsurance ye 30 muzana yezvinodhaka, uye iwe wakanga uri pamutengo unorema-biologic unodhura madhora makumi matatu nemakumi matatu pagore, iwe unogona kubhadhara $ 9,000 nokuda kwechirwere ichocho kunyange zvazvo iwe waive ne $ 5,000 kunze kwehomwe. - Nzira yechitatu yakasika zvakasiyana-siyana-zve-pocket maximums kune zvikamu zvakasiyana zvehutano hwehutano inshuwarheni. Muenzaniso wakajairika waiva nehuwandu hwepamusoro pehomwe yemishonga yemishonga uye imwe yakasiyana yepamusoro pehomwe yezvimwe zvose.
Mushure mokunge musvika kumiganhu yekunze kwemishonga yemishonga , iyo inshuwarheni yakavhara 100 kubva muzana yemari yemitemo yenyu, asi makaramba muchibhadhara chikamu chenyu chisina kushandisa zvinodhaka. Mushure mokunge mava nepamusoro pepamusoro pepamusoro kune zvimwe zvikamu zvose , iyo inshuwarheni yakavhara 100 muzana yemari yenyu isiri yemishonga yekuchengetedza utano, asi wakaramba uchibhadhara chikamu chako chezvinodhaka zvinodhaka kunze kwekuti iwe ungasangana nekunze kwe- chikwata chikuru chemishonga.
Kambani yveshuwarhu yehutano haisati yavhara 100 muzana yehutano hwehutano hwako kusvikira wapedza zvose zviri kunze kwehomwe. Kana muganhu wega wega waiva $ 5,000, iwe wakabhadhara $ 10 000 musati urongwa hwehutano hwakatanga kupa 100 muzana.
The Affordable Care Act & Out-Of-Pocket Maximums
Haisi kungoita matanho ekugadzirisa matambudziko okuvhiringidza vatengi, asi vakasiyawo vanhu kunzwa sokuti vakanga vatapwa zvisina kururama. Pashure pezvose, dai waive nehomwe yepamusoro ye $ 5,000, nei uchifanira kubhadhara $ 9,000 kunze kwechikwata chemishonga yemishonga iyo yakafukidzwa neurongwa hwehutano hwako? Vatsigiri vemitemo vakapindura mutengi uyu kuvhiringidzika nekugadzirisa hutano hwehutano huri kunze kwehomwe.
The Affordable Care Act inoita-in-pocket maximums zvishoma zvakaoma. Inogadzirisa muganhu wehuwandu hwehuwandu hwemutokari hunogona kuva gore negore. Zvinoda kuti kuderedzwa, copays, uye coinsurance vese vawane chikwereti kumiganhu yekunze-ye-pocket. Izvi zvinoda kubvisa vatsigiri vehutano 'njodzi yekudzikisa nzira nhamba imwe.
IAACA inoda zvirongwa zvehutano kubhadhara zana muzana yemari yekuchengetedzwa kubva kune in-network providers kwegore rose mushure mokunge muganhu wekunze kwepakona wasvika. Ichi chinodiwa chinobvisa nzira nhamba mbiri.
Muna 2017, zvirongwa zvehutano zvisingabatsiri hazvikwanisi kuva ne-out-of-pocket maximums inopfuura $ 7,150 kune mumwe chete, kana kuti $ 14,300 yemhuri (uye mimwe mitemo isina kunze inofanira kuiswa muzvirongwa zvehutano hwemhuri , naizvozvo nhengo yemhuri haigoni kudiwa kubhadhara mari inopfuura $ 7150).
Muna 2018, miganhu iyi ichawedzera kusvika madhora mazana manomwe nemakumi matatu nemakumi matatu nemakumi mashanu nemadhora emhuri. Sezvakagara zvakadaro, zvirongwa zvehutano zvichakwanisa kuva nemiganhu yekunze-ye-pocket zvakanaka pasi pezviyero izvi (uye vazhinji vacha), asi kwete pamusoro pavo.
IAACA yakaumbawo rubatsiro rwehutano rwehutano hwehutano huchideredza huwandu hwemahombekiti evanhu vakakodzera nenzira dzinoderera, uye izvo zvicharamba zvichishanda muna 2018.
Kubhadhara uye zvizhinji zvekudzivirirwa kwevatengi kweAACA zvakatanga musi waJanuary 1, 2014. Zvisinei, mamwe mapoka makuru ezvirongwa zvehutano haafaniri kuita maererano neurongwa hwemakore kutanga kana kana mushure meJanuary 1, 2015 (kana vaizopa kurapwa kwemishonga uye kurapa zvakasiyana, ivo vakabvumirwa kuva nemiganhu yakasiyana-siyana-ye-pocket muna 2014). Uye zvirongwa zvakakura zvisingabvumirwi kutevedzera mitemo yose yeAACA, saka vanogona kuramba vachishandisa mitemo yavo yekare pamusoro pekubuda kwemahombekombe. Mune zvinyorwa zvinoramba zvichivabvumira kuti zvivepo, zvirongwa zvekurukuru zvinogonawo kuramba zvichiri kushandisa ma-AC-preA-out-of-pocket maximums, asi mapurogiramu makuru achafanirwa kupedzisa pakupera kwe 2018.
Ndinozvidzivirira Sei?
Usazununguka kuti urege kunetseka nokuti kuchengetedzwa kwevatengi kuri munzvimbo. Icho chiripo zvimwe mari yaunenge uine mhaka yekubhadhara mushure mekunge uchinge uchitarisana nechokunze chehomwe. Izvi zvinosanganisira:
- Zvinhu izvo chirongwa chako chehutano chinosarudza hachisi chirwere chinodiwa.
- Chikamu chekurima-chikwereti uye kugovana-mari-kutengesa kwekunze kwehutano hwehutano .
- Zvinhu zvisingafukidzwi nehutano hwehutano hwako sekuvhiyiwa kwezvokuzora.
- Kugovana-kugovana kwezvinhu zvisingafungi kuti zvakakosha zvoutano. Izvi zvisingabatsiri zvakakosha zvinowedzera zvinotora chirongwa chako chehutano hachifaniri kupa asi chinosarudza.
- Zvikwereti zvemishonga yehutano yehutano
Chirongwa chega chega chehutano chinopa Chidimbu cheBatsiro neKubatsira kana chidimbu Chirongwa Chitsanangudzo chinonyatsojekesa icho chiri kunze kwechikwata chiripo pamwe chete uye chinorevei uye hachikwanisi kubhadharwa nacho. Cherechedza izvi paunenge uchifananidza zvirongwa panguva yekunyora kuzarura, kana paunenge uchitenga inshuwalhu yehutano . Iwe unogonawo kudana chirongwa chako chehutano uye kubvunza.
Hapana chakaipa pamusoro pehutano hwehutano vanoedza kuvhara dambudziko ravo chero bedzi vari kuita mukati memutemo uye vanopa tsananguro yakajeka yemashoko emitemo. Mutoro uri pamusoro pako kuti uve nechokwadi chokuti unonyatsonzwisisa mitemo yeurongwa hwehutano hwako. Iwe unofanirwa kunzwisisa kuti unogona kunge uri pachikwereti gore rega rega kuitira kuti iwe ugone kuronga zvakakodzera uye uite zvirongwa zvekugadzirisa zvinhu zvakanyanya kuitika.
Ko HCA yaizochinja sei mitemo?
IAmerican Health Care Act (AHCA) yakapfuura Imba muna May . Senate iri kunyora ivo pachavo, asi havana kumbova nekunzwa kana kupikisana kwevanhu, saka hatizivi kuti yakawanda yeIndaneti iyo yavari kuronga kuchengeta.
Asi iyo imba iyo yebhadhiro inochengetedza maAACA ari kunze kwemapuranga munzvimbo. Kunyange zvakadaro, iyo inobvumirawo nyika kuti dzitsvake zvisizvo pasi apa zvingagona kujekesa izvo zvinoonekwa sezvinokosha zvehutano . Uye iyo ACA iri kunze kwemiganhu inoshandiswa inoshanda chete kune zvinodiwa zvehutano hunokosha. Saka kana hurumende yaibvumidza, somuenzaniso, vatsigiri vehutano kuti vape mapurogiramu ega emakambani asina kuvhara kuberekwa (nokudzorerazve mararamiro ehutano anokosha uye kusanganisira kubata pamuviri pabhuku), mari yekubata pamuviri ichave yakakwana- e-ehomwe yevabereki vatsva, uye havadi kuverenga kune yavo inshuwarano hurongwa huri kunze kwehomwe.
Seneti inogona kana kuti isingachengetedzi hurumende inobvumira kuti nyika dzidzorezve zvigaro zvehutano hunokosha, asi kana dzikadaro, dzichadzivirira kuchengetedzwa kunowanikwa neAACA's cap pazvinenge zvisingabhadharwi.
Sources:
Nzvimbo dzeMedare uye Medicaid Services, Affordable Care Act Kushandisa FAQs Set 18.
Dhipatimendi reHutano neHuman Services . > Mushonga Kuchengetedzwa uye Kutengeswa Kwekutarisira Mutemo; Maitiro akaenzana neEntential Health Health Benefits, Actuarial Value, uye Accreditation . February 25, 2013.
> Federal Register, Mutevedzeri > Kudzivirirwa > uye Inotengeswa Care Care Act; HHS Chinyorwa cheBatsiro neZokubhadhara Zvikamu zve 2018; Kushandurwa Kwekunyorwa Kunokosha Kwemakore uye Mutengi Akashandiswa uye Akarongeka Zvirongwa Purogiramu >. December 22, 2016.
United States Department of Labor. FAQs pamusoro pekutengeswa kwekutarisira Mutemo Kuita Chikamu XII. February 20, 2013.
United States Department of Labor. FAQs pamusoro pekutengeswa kwebasa rekuchengeta basa (Chikamu XVIII) uye Mental Health Parity Kuitwa, January 9, 2014.