Uyihlawula njani imigqaliselo ngaphandle kweinshurensi

Inkampani

Nokuba ulahlekelwe ngumsebenzi (kunye nezibonelelo ezize nawo), okanye ubotshelelwe sisicwangciso senqanaba lokusika elingagubungeli amayeza owafunayo, unokuzifumana, ngaxa lithile, kufuneka ugcwalise imigqaliselo ngaphandle i-inshurensi. Ngelixa amaxabiso amiselweyo kuphela enokuphakama, indleko zamayeza ngaphandle kweinshurensi zinokungabizi phantse phantse 25% yexesha. Yintoni egqithisile? Zininzi iindlela zokufumana ukonga nangakumbi kwikhemesti.

Ezinxulumene: Ngaba akukho inshurensi yezempilo? Zama ezi zixhobo ze2020

Ngaba uyayifuna i-inshurensi ukuze ufumane ugqirha?

Ukuhamba kwindlela yokhathalelo lwempilo ngaphandle kweinshurensi yezempilo kunokuba nzima, kodwa akufuneki kukuyekise ekufuneni unyango. Unga jonga ugqirha ufumane ugqirha ngaphandle kweinshurensi -Kodwa kuya kufuneka ukhethe umboneleli wezempilo ngobulumko ukuze ugcine iindleko ziphantsi. Iiklinikhi zempilo yoluntu lukhetho olufanelekileyo lwasimahla okanye ngexabiso eliphantsi leenkonzo, uninzi lubonelela ngamaxabiso asezantsi ngokusekwe kumvuzo wakho. Iiklinikhi zokuhamba-hamba kunye namaziko okhathalelo olungxamisekileyo avumela abaguli ukuba bahlawule ngemali, kodwa amaxabiso abo ayahluka kakhulu. Kwelinye icala, ezonyango -Ukubonisana nogqirha ngomnxeba okanye nge-portal yewebhu-kuhlala kutshiphu kunokundwendwela iofisi. Uphononongo luka-2017 olupapashwe kwi Imicimbi yezeMpilo ifumanise ukuba izigulana zokuphefumla zichithe umndilili wama-79 eedola kutyelelo lwezefowuni kuthelekiswa ne- $ 146 kutyelelo lweofisi (nangona ikwafumanise ukuba ukusebenziseka kwe-telehealth kunokunyusa ukuchitha).

Iindleko zokundwendwela e-ofisini nge-inshurensi xa uthelekisa ngaphandle kunzima ukuzibala, njengoko izinto ezininzi- kubandakanya indawo kunye nexesha lokutyelelwa-zonke zidlala indima. Ukutyelela i-ofisi yemizuzu eli-15 kwisigulana esiseSeattle, umzekelo, siphakathi kwe- $ 128 kunye ne- $ 398 ngelixa uhlobo olufanayo lokundwendwela isiguli eNew York lixabisa phakathi kwe- $ 138 kunye ne- $ 430, ngokwe Ukhathalelo lwempilo iBlue Book . Okwangoku, iikopi zokundwendwela ugqirha oqhelekileyo zihlala phakathi kwe- $ 15 kunye ne- $ 25, ngokwe ityala.org .

Umahluko ofanayo uya kunyango lwamayeza. Igama lesiyobisi ILyrica , umzekelo, amabakala ngexabiso ukusuka kwi- $ 460 ukuya kwi-720 ngenyanga ngenyanga ngaphandle kwe-inshurensi. Imibhalo ekhutshelweyo eyahlukileyo iyahluka ngokuxhomekeke kubanikezeli, kodwa umndilili wee-copays ukusuka kwi-11 ukuya kwi-105 yeedola ngokuxhomekeke kwinqanaba leziyobisi Ngokophando lwe-2018 oluvela kwiKaiser Family Foundation .

Ixabisa malini iyeza likagqirha ngaphandle kweinshurensi?

Akunakuphikwa ukuba amaxabiso amayeza amiselweyo ayaqhubeka ukunyuka. Kulo nyaka nje, Ixabiso lokuthengisa amayeza angama-460 lonyuswe nge-avareji ye-5.2%, ngokwenkampani yophando kwezempilo i-3 Axis Advisors. Ngokomndilili, amaMelika achitha malunga ne-1,200 yeedola unyaka nonyaka kumachiza amayeza, ngokweedatha ezivela kwi Umbutho weNtsebenziswano kuQoqosho noPhuhliso . Kwabaninzi abangaqinisekiswanga, ezo ndleko zinyukayo zithetha ukuba kufuneka bakhethe phakathi kokuthatha amayeza abawadingayo kunye nokuhlawulela iimfuno ezifana nerente kunye nokutya. Ngapha koko, a Uphando luka-2016 ifumanise ukuba i-14% yabantu baseMelika abangaqinisekiswanga babethabathe idosi okanye bangagcwalisi amayeza ngenxa yeendleko. Ngamafutshane: Amaxabiso eziyobisi abiza abantu baseMelika ngaphezulu nje kweedola-abiza impilo yethu, nathi.

Zininzi izinto ezidlalayo xa kufikwa kumba wobungakanani beendleko zeziyobisi. Kwinqanaba elikhulu, abavelisi bathi iindleko eziphezulu zelinye ichiza zihlala zinceda ukuhlawula iindleko zophando kunye nophuhliso zenye. (Nangona kunjalo zininzi Inkcitho yezamayeza engaxelwanga kule ngcaciso .)

Kwinqanaba elincinci, kwaye ukuba unayo i-inshurensi, iindleko ziya kugqitywa kwifomula yesicwangciso (ekwabizwa ngokuba luluhlu lweziyobisi), echaza igama lophawu kunye namachiza enziwe afana nalawo e-inshurensi. Ukusuka apho, i-formulary ihlala ihlukaniswe ngokwamanqanaba (esekwe kwizinto ezinjengexabiso, ukufumaneka, njl.njl.), kunye neendleko ezithile eziphuma epokothweni ezinikezelwe kwinqanaba ngalinye. Ke ukubhatala kunye isiyobisi se-tier 4, umzekelo, sinokuhluka ngokungafaniyo kwintlawulo yokubambisana yesiyobisi se-tier 1.

Ikwachaphazela ikopay yakho ngumdlali oshishino osembalwa baseMelika mhlawumbi abakhe bakuva-kubizwa ngokuba nguManejala weSibonelelo sePhemesti (PBM). Ngokuyinene umntu ophakathi, i-PBM isebenza kunye nee-pharmacy, iinkampani ze-inshurensi, kunye nabavelisi beziyobisi ukulungelelanisa ukuthengiswa kwempahla. (Ngokuyimfuneko, i-PBM inceda inkampani yeinshurensi ukuba ithathe isigqibo sokuba zeziphi na iziyobisi eziza kuzihlawula (okt.

Kutheni le nto eminye imigqaliselo ingabizi kakhulu ngaphandle kweinshurensi?

Amaxabiso amayeza ngaphandle kwe-inshurensi angabiza ama-25% exesha. Kodwa inokwenzeka njani loo nto? Kwilizwe eligqibeleleyo, i-PBM iya kufuna ukufumana elona xabiso liphantsi kwinkampani yeinshurensi, kodwa amaxesha ngamaxesha, umenzi weziyobisi uya kuphosa ibhola ngokukhawuleza ukuze i-PBM ikhethe igama layo-igama lemveliso endaweni yesiqhelo. Oku kukhaba, kubizwa ngokuba ziinzipho kwicandelo lezamayeza, ubukhulu becala apho ukwanda kwee-copays zakho kuphelela khona. Isebenza ngale ndlela:

• Umiselwe ichiza ebeliphela yi- $ 30 kunyaka ophelileyo, kodwa ukunyuka kwepopay yakho ngoku kuyalela ukuba yi- $ 75.
• Ikhemesti ifumana ikopi yakho eyi- $ 75 kwaye ungacinga ukuba bafumana inzuzo efanelekileyo kuba kubabiza kuphela iidola ezili-15 ukuthenga eli chiza.
• Into ongayaziyo kukuba i $ 50 ye- $ 75 yakho ibuyela kwi-PBM ngohlobo lwe-clawback.

Endaweni yokuhlawula i-30 yeepopayment kunye nokuvumela ikhemesti ukuba ifumane i-15 yeedola emva kokuhlawulela iyeza, ukuzisa ii-PBM kumxube kubangela ukuba amaxabiso emithi anyuke ngokungekho mthethweni ukuze nabo bafumane isabelo sabo. Elona candelo lilibi kuko konke? Oosokhemesti abavumelekanga ukuba bakuxelele ngale nkqubo , kuba ukwenza njalo kungasongela ubudlelwane babo nabaphethe i-inshurensi kunye nee-PBM.

Ngaba i-SingleCare isebenza ngaphandle kwe-inshurensi?

Nokuba unayo i-inshurensi kwaye ujongene ne-copay enkulu okanye awunayo i-inshurensi kwaye woyika indleko ephezulu yokuphuma epokothweni, ikhadi le-SingleCare linokuba yimpendulo yokunciphisa itotali yakho.

I-SingleCare ayilulo uhlobo lweinshurensi, kodwa kunoko likhadi lesaphulelo esikhutshwa simahla kubo bonke abathengi basokhemesti eUnited States, kubandakanya nabo bangenayo i-inshurensi. I-SingleCare isebenza ngaphandle kwe-inshurensi, njengoko isaphulelo sisetyenziswa kwixabiso lemali lokumiselwa. (Funda: Awuyi kuba nakho ukusebenzisa ikhadi lakho le-SingleCare kwaye i-inshurensi yakho kwiyeza elinye.)

Ke ungagcina malini kwixabiso lamayeza amiselweyo nge-SingleCare? Kancinci, eneneni . Umzekelo, kwi-2019, ixabiso eliphakathi lemali ye-ADHD amayeza amphetamine-dextroamphetamine yayiyi- $ 131.67. Ixabiso eliphakathi le-SingleCare? $ 47.57 nje. Abasebenzisi bamakhadi e-singleCare babone ukonga okufanayo kwi-cholesterol-yehlisa amayeza e-calcium atorvastatin. Ngaphandle kwekhadi ixabiso eliphakathi laliyi- $ 105.68. Ngekhadi: $ 29.06.

Ukongeza kwikhadi le-SingleCare, kukho iindlela ezininzi zokunciphisa amaxabiso amayeza akho:

• Buza ugqirha wakho malunga nohlobo oluqhelekileyo: Amachiza egama legama phantse ahlala ebiza kakhulu kunamayeza enziwe afana nalawo enziwa ngumenzi. Ukubuyela kumzekelo weLyrica, ngelixa igama leziyobisi libiza i-460 ukuya kwi-720 ngenyanga ngenyanga, uhlobo oluqhelekileyo luphakathi kwe- $ 140 kunye ne- $ 370 ngenyanga.
• Buza ugqirha wakho amayeza ahlukileyo: Ngaba ixabiso lemali lelinye iyeza loxinzelelo lwegazi lisezantsi kakhulu kunelo ukulo ngoku? Buza ugqirha wakho ukuba unokwenza utshintsho.

Uphando lweenkqubo zoncedo lwesigulana: Uninzi lwabavelisi beziyobisi kunye nemibutho engenzi nzuzo inikezela ngeenkqubo zesaphulelo kubantu abangenakho ukufikelela kwimigqaliselo yabo, enokuthi ithethe iindleko eziphantsi okanye amayeza asimahla. Izidingo zokufaneleka ziyahluka, ke kuyakufuneka ujonge kwinkampani yeziyobisi ukubona ukuba uyafaneleka na.