I-HMO vs PPO: Ukwazi umohluko kwizicwangciso zokhathalelo lwempilo

Inkampani

Ukukhetha isicwangciso seinshurensi yezempilo efanelekileyo kunye nosapho lwakho ngumsebenzi onzima. Ngeendleko ezikhulayo zononophelo lwempilo, kunokuba nzima ukulinganisa ukufumana isicwangciso esilixabiso kunye nesicwangciso esibonelela ngononophelo olufanelekileyo. Inyathelo lokuqala lokuthatha isigqibo kukuqonda ukuba isicwangciso ngasinye sisebenza njani. Kule nqaku, siqhathanisa iintlobo ezimbini ezidumileyo zezicwangciso-i-HMO vs PPO-kwaye ujonge kwiimpawu nganye.

Yintoni i-HMO?

AnI-HMO, emfutshane kuMbutho woLondolozo lwezeMpilo, luhlobo lwesicwangciso sezempilo esiqhele ukusebenzisa oononophala abaphambili (i-PCPs) ukunceda ukulungelelanisa ukhathalelo lwezigulana. Basebenzisa inethiwekhi yoogqirha, izibhedlele kunye nabanye ababoneleli ngezempilo. Xa ukhetha isicwangciso se-HMO, ukhetha iPCP kwinethiwekhi yabo. I-PCP yakho ihlala ilungelelanisa iinkonzo zakho zonyango ezifunekayo, ukubonelela ngokudluliselwa kuvavanyo kunye notyelelo lwengcali yenethiwekhi, kunye nokufumana iingxelo kunye neziphumo zovavanyo. Azihlali zigubungela ukhathalelo lwangaphandle kwenethiwekhi, ngaphandle kweemeko ezingxamisekileyo.

Yintoni iPPO?

I-PPO, emele umbutho wababoneleli abakhethiweyo, luhlobo lwesicwangciso sezempilo esinothungelwano loogqirha, izibhedlele kunye nabanye ababoneleli ngezempilo; Nangona kunjalo, banikezela ngakumbi xa befuna ukhathalelo. Bahlawula ukhathalelo lweenkonzo zononophelo lwangaphandle kwenethiwekhi, kodwa bahlala bekwenza oko ngexabiso eliphantsi kwaye umntu okhuselwe nge-inshurensi unoxanduva lwesahlulo sendleko zizonke. Awudingi ukuthunyelwa ukuze ubone ingcali.

I-HMO vs. PPO: Uyintoni umahluko?

Ukongeza kwi-network kunye nangaphandle kwenethiwekhi umahluko onxulunyaniswa nee-HMOs kunye nee-PPOs, kukho izinto ezahlukeneyo ezinxulumene neenkampani zeinshurensi yezempilo. Oku kulandelayo kuthelekisa ezinye zeempawu.

Ii-PPO zinenethiwekhi enkulu yababoneleli

Zombini ii-HMOs kunye nee-PPOs zinenethiwekhi yoogqirha, izibhedlele kunye nabanye ababoneleli ngezempilo. Iindleko zakho zokuphuma epokothweni zincinci xa usebenzisa ababoneleli bezonyango kule nethiwekhi.

Ii-HMOs zifuna ukuba ukhethe umboneleli okhathalelayo ophambili kulawulo lwenethiwekhi. Oku kuhlala kuyeyona mpazamo inkulu kwisicwangciso-sokuba uhlala uthintelwe kwinani lababoneleli. Ukongeza, kuya kufuneka ukuba ubone iPCP ngaphambi kokubona iingcali. Inye into eqhelekileyo eyahlukileyo kwiimfuno zokudluliselwa kukhathalelo lwe-gynecologic / ye-obstetric. Awudingi ukuthunyelwa ukuze ubone aba gqirha, kodwa kusafuneka babe ngaphakathi kwenethiwekhi yakho yomboneleli.

Izicwangciso ze-PPO zinemiqobo embalwa kuthungelwano lwababoneleli. Unokuba bhetyebhetye ngakumbi, kwaye iinethiwekhi ze-PPO zihlala zikhulu kunee-HMOs. Uninzi aludingi ukuba ukhethe ugqirha wokhathalelo oluphambili xa ubhalisela isicwangciso, kwaye bayahlawulela ezinye ukhathalelo lwangaphandle kwenethiwekhi , ihlala ine-copay ephezulu okanye inqanaba lokufumana imali. Kukho ngokubanzi amanqanaba ababoneleli, kunye nenqanaba 1 lokuba ngabanikezeli bakho benethiwekhi, i-tier 2 ihlawulwe ngesixa esincinci (kunye neendleko eziphezulu zabathengi), kunye nenqanaba 3 elihlawulwe kwelona zinga lisezantsi (kunye neendleko eziphezulu zabathengi).

Ii-HMO zineendleko eziphantsi zokuphuma epokothweni

Xa usenza isigqibo ngeendleko zakho ze-inshurensi yezempilo, kufuneka ubandakanye iindleko eziphuma epokothweni. Oku kubandakanya iipremiyamu, iimali ezixhuzuliweyo, ukuqinisekiswa kwemali kunye neentlawulo ezikhutshiweyo.

INkulumbuso

UKUYA ipremiyamu sisixa esimiselweyo osibhatalayo ngenyanga ukuze ube neinshurensi yezempilo nokuba uyayisebenzisa na kuloo nyanga. Izicwangciso zepremiyamu ezisezantsi zihlala zinokutsalwa okuphezulu kwaye ngokuchaseneyo. Ukuba unayo i-inshurensi yezempilo ngomqeshi wakho, le mali inokuthi itsalwe kumvuzo wakho kwaye ihlawulwe kumboneleli weinshurensi.

Ii-HMOs zihlala zineeprimiyamu ezisezantsi kunee-PPOs kodwa umahluko awunakubaluleka.

Ukutsalwa

Ukutsalwa kwemali kunyaka ngamnye yimalini ekufuneka uyichithe epokothweni kwiindleko zokhathalelo lwempilo ngaphambi kokuba inkampani yeinshurensi ihlawule amabango. Unokuba neentlawulo ezahlukileyo ezahlukileyo zesahlulo sonyango kunye nenxalenye yesicwangciso sesicwangciso sakho. Ukuxhuzulwa kwemali kunokuba yinxalenye yesicwangciso-njengokulaliswa esibhedlele okanye ukumiselwa-ekufuneka konelisiwe ngaphambi kokuba bahlawule naziphi na izicelo.

Ii-HMOs zihlala zinokutsalwa okuncinci kunezinye iintlobo zezicwangciso, kubandakanya ii-PPOs. Ezinye ii-HMOs azinazo naziphi na izinto ezitsalwayo.

UQinisekiso

UQinisekiso yipesenti yeendleko zonyango onoxanduva lokuhlawula emva kokuba udibene nokutsalwa kwakho. Umzekelo, ukuba unayo i-20% ye-coinsurance kwaye ufumana i-bill ye-dollar eyi-1 000, unoxanduva lwe-200, kwaye inkampani ye-inshurensi iya kuhlawula enye.

Ii-HMO zihlala zingenaso isiqinisekiso semali.

ICopay

Ikopi, okanye ikopi , isixa semali osibhatalayo xa ubona ugqirha okanye ufumana iphepha likagqirha; ihlala ihluka ngokusekwe kwinkonzo yokhathalelo lwempilo. Umzekelo, xa undwendwela ugqirha wakho wokhathalelo, i-copay yakho inokuba yi- $ 20; $ 40 yengcali; okanye i- $ 250 yotyelelo kwigumbi likaxakeka. Imibhalo ekhutshelweyo yesiqhelo ikhokhelwa ngokusekwe kumachiza enziwe afana nalawo enziwa ngumenzi nanjengegama lesiqhelo.

Ii-HMOs ngokubanzi zifuna ukukopishwa kukhathalelo olungathinteli kwaye ii-PPOs zifuna iikopi zeenkonzo ezininzi. Qaphela: iiCopays azisetyenziswanga kutsalwa ngonyaka.

Ubuninzi bepokotho

Ukongeza, kuya kufuneka uqaphele ngesicwangciso ukuphuma epokothweni ubuninzi . Ukuba ufikelela kwesi sixa kunyaka omnye, inkampani yeinshurensi ihlawula iinkonzo zakho ezigutyungelweyo nge-100% kwintsalela yonyaka wekhalenda.

Zonke izicwangciso zentengiso zinemida ephumayo epokothweni. Kwi-2020 Umda ophuma epokothweni yi- $ 8,150 yabantu kunye ne- $ 16,300 yeentsapho.

Ukuphindaphinda: I-HMO vs. PPO
	I-HMO	I-PPO
Iindleko	Iimali zanyanga le zisekwe kwizinto ezahlukeneyo, ezinje ngendawo ohlala kuyo, iminyaka yakho, nokuba unesicwangciso sosapho na. Ngokubanzi, iipremiyamu ze-HMO ziphantsi kunezinye izicwangciso (ezinje ngee-PPOs) ezikunika ubhetyebhetye ngakumbi. Ukongeza, ungahlawula imali encinci ngenxa yokuxhuzulwa, iikopi kunye nemigqaliselo yee-HMOs.	Iiprimiyam ze-PPO ziphezulu kunee-HMOs. Uhlala uhlawula ngakumbi iindleko ezingaphandle kweepokotho ezinje ngokutsalwa kunye neepopay.
Inethiwekhi	Kuya kufuneka uhlale kubanikezeli benethiwekhi ukonga iindleko.	Unokuba bhetyebhetye ekuphumeni kwenethiwekhi kwaye usafumana iindleko zonyango.
Ukuhanjiswa	Uzakufuna ukuthunyelwa ukuze ubone malunga nawuphi na ugqirha ongenguye ugqirha wakho wokunyamekela.	Awudingi zithunyelwe ukuze ubone abanye oogqirha / iingcali.

Kwaye Bhetele Than PPO HMO?

Ngokusekwe kubhetyebhetye kwii-PPOs, abantu abaninzi bakhetha olu hlobo lwesicwangciso. Amashumi amane anesine eepesenti abasebenzi ababhalise kwi-PPO, kunye ne-19% ababhalise kwi-HMO, ngokwe- Uphando lwezeMpilo loMqeshi ngo-2019 . Kodwa owona mbuzo ulungileyo ngulo, Loluphi uhlobo lwesicwangciso olulungele mna? Zombini ii-PPOs kunye nee-HMOs zinezibonelelo kunye nokungalunganga. Eyona ilungele wena ixhomekeke kuwe nakwimfuno yosapho lwakho yokhathalelo lwempilo.

Ngokubanzi, i-HMO inokuba nengqondo ukuba iindleko ezisezantsi zibaluleke kakhulu kwaye awukhathali ukusebenzisa iPCP ukulawula ukhathalelo lwakho. Nangona kunjalo, kuya kufuneka uphonononge iinkonzo zenethiwekhi zesicwangciso kuqala, njengoko ezinye zinokulinganiselwa. I-PPO inokuba ngcono ukuba sele unogqirha okanye iqela lezonyango ofuna ukuligcina kodwa alikho kwinethiwekhi yakho yesicwangciso.

Imibuzo yokubuza xa uqwalasela isicwangciso se-HMO siquka:

• Ngaba oogqirha bam bakwi-HMO network? Ukuba akunjalo, ngaba ndikulungele ukutshintsha ababoneleli?
• Zithini iindleko zezavenge zanyanga zonke?
• Zithini iindleko zecopay?
• Ndihamba kangaphi nosapho lwam siye kugqirha? Kunyaka oqhelekileyo, iindleko zam ziya kuba yintoni?
• Ngaba ukhona umntu kusapho lwam oneemeko ezinzima zempilo okanye ufuna unyango olunzulu?
• Ngaba ndikulungele ukuhanjiswa xa ndibona umboneleli wezonyango ngaphandle kwePCP yam?

Imibuzo oza kuyibuza xa uqwalasela isicwangciso se-PPO ibandakanya:

• Ngaba oogqirha bam kwinethiwekhi yesicwangciso? Ukuba akunjalo, ngaba ndikulungele ukuhlawula isiqinisekiso semali esiphezulu?
• Ngaba kukho ukurhoxiswa kukhathalelo lwangaphandle kwenethiwekhi?
• Zithini iindleko zezavenge zanyanga zonke?
• Ngaba iindleko zotyelelo eziqhelekileyo zoogqirha ziya kuba yintoni, ngokusekwe kwinqanaba le-coinsurance?
• Ngaba ndingayiqikelela inkcitho yam yonyaka epokothweni?
• Ngaba ukhona umntu osapho lwam onemeko yezonyango esebenze kakhulu ngabanikezeli bezonyango ngaphandle kweNqanaba 1 okanye esingakhange sikwazi ukubona ukuba sibhalisiwe kwi-HMO?

Yintoni ebiza kakhulu: HMO vs. PPO?

Ngokwesiqhelo, ii-HMO zineepremiyamu zenyanga eziphantsi kunee-PPOs, kodwa umahluko awusoloko ubalulekile. Le theyibhile ilandelayo inikezela uthelekiso lwe-avareji yanyanga zonke kunye neeprimiyamu zonyaka ze-inshurensi yezempilo enikezelwa ngumqeshi kwi-2019, ngokwe Kaiser Permanente Umqeshi woNyango lwezeMpilo ngo-2019 .

	I-HMO	I-PPO
Intlawulo yenyanga (engatshatanga)	$ 603	$ 640
Intlawulo yenyanga (usapho)	$ 1,725 ​​yeedola	$ 1,807
Intlawulo yonyaka (engatshatanga)	$ 7,238	$ 7,675
Intlawulo yonyaka (usapho)	$ 20,697	$ 21,683

Itshathi isekwe kumndilili welizwe lonke kwaye ayibandakanyi igalelo lomqeshi wakho. Ukuncitshiswa komvuzo wakho kunokwahluka kakhulu kuhlobo ngalunye lwesicwangciso. Isebe Lemicimbi Yabasebenzi linokubonelela ngamanani ngokusekwe kwizicwangciso ezibonelelweyo kunye nemirhumo yenkampani.

Zombini iiMedicare kunye neenkampani ezininzi zeinshurensi zibonelela ngee-HMOs nee-PPOs. Ukuba ubona umboneleli wezonyango ongaqhelekanga, jonga ukuba isicwangciso siyazigubungela ezi nkonzo. Ababoneleli ngezonyango abangengabo abendabuko kubandakanya iingcali zonyango, ii-acupuncturists, i-reflexologists, kunye ne-massage therapists. Jonga ngononophelo ngaphandle kwaye ubale iindleko zokhathalelo lwempilo ngexesha eliqhelekileyo lonyaka ukukunceda ubone ukuba yeyiphi eyona ilungele wena.

Ukulungele ukubhalisa?

Ukuba awunayo i-inshurensi ngomqeshi wakho, ufuna ukuqala kwezempilo.gov kwaye ubone ukuba loluphi ukhetho olufumanekayo kwindawo yakho, ucacisa uMat Woodley, umseki we creditinformative.com . Kulapho, unokuthelekisa ukhetho, kubandakanya ii-HMOs, ii-PPOs, ii-EPOs [Imibutho yababoneleli abakhethekileyo], kunye neepOS [Point of Service]. Kuya kufuneka ujonge isishwankathelo sezibonelelo kwisicwangciso ngasinye kunye nesalathiso esichaseneyo ngokuchasene neemfuno zonyango kunye nosapho lwakho. Kulabo banethiwekhi, unokuqinisekisa ukuba ugqirha wakho ophambili ukuluhlu kwaye, ukuba akunjalo, susa eso sicwangciso ukuba awufuni kutshintsha oogqirha.

Nokuba ungakhetha oluphi uhlobo lwesicwangciso, ngaphambi kokuhlawula amayeza, jonga i-SingleCare kumaxabiso endawo kunye nephetshana. Xa usebenzisa i-SingleCare, amayeza akho anokuba njalo ngaphantsi kunokuba ubuya kuhlawula nge-inshurensi .