Ukuqonda izicwangciso zeCandelo leMedare

Inkampani

Ukuyalelwa kunokuba kubiza, kwaye oko kuyabangela uxinzelelo ukuba unengxaki ekuzinikezeleni. Isicwangciso seinshurensi yezempilo egubungela ezinye zeendleko zakho zamayeza zinokukunceda ukuhlala usempilweni lula. Icandelo le-Medicare Icandelo D linokunceda.

I-Medicare Part D isebenza njani?

I-Medicare Icandelo D yinxalenye yokuzikhethela yeMedicare egubungela uninzi lwamayeza amiselweyo. Icandelo D linikezelwa ngeenkampani ze-inshurensi zabucala ukuba abantu abaninzi kwi-Medicare bakhethe ukunceda ukuhlawula iindleko zamachiza.

I-Medicare inamacandelo amane: A, B, C, kunye no-D. Icandelo le-Medicare A ligubungela ukhathalelo lwezibhedlele ezingalaliswayo, ukhathalelo lweziko lononophelo, ukhathalelo lwempilo ekhaya emva kokukhutshwa esibhedlele.

Uninzi lwabantu abakulungeleyo ukufumana amayeza bafumana icandelo A ngokuzenzekelayo.

Icandelo leMedicare B ligubungela ukutyelelwa kweofisi kagqirha, iX-reyi, uvavanyo lweelebhu, iinkonzo zekhaya, iinkonzo zothintelo, izixhobo zonyango ezizinzileyo, iinkonzo zempilo yengqondo, iinkonzo zeenqwelo zezigulana, kunye nonyango lomzimba, phakathi kwezinye iinkonzo. Uninzi lwabantu abaneMedicare bakhetha ukufumana iSahlulo A kunye neCandelo B izibonelelo phantsi kwemirhumo yenkonzo yemveli ye-Medicare, okanye i-Original Medicare.

I-Medicare Icandelo C yinxalenye ye-Medicare phantsi kwayo apho izicwangciso ze-inshurensi zempilo zabucala-endaweni ye-Original Medicare- zilawula i-Part A kunye ne-B izibonelelo kwaye zihlala zinikezela ngoncedo lweziyobisi. Izicwangciso zeCandelo C zihlala zibizwa ngokuba ziiPlani zeNzuzo zeMedare.

Ukufumana ukugubungela amayeza amayeza, abaxhamli be-Medicare banokubhalisa kwi-Medicare Part D yesiCwangciso seDrug (PDP) okanye kwi-Medicare Advantage Prescription Drug plan (MAPD). Abaxhamli banokuhlawula ipremiyamu yenyanga kumphathi wabo weinshurensi, kwaye ke amayeza enkampani yeinshurensi ayigubungelayo anokuthengwa. I-deductible kunye ne-copay okanye i-coinsurance inokuhlawulwa ngumxhamli, kwaye inkampani ye-inshurensi igubungela iindleko eziseleyo.

Kukho amanqanaba amane Icandelo le-Medicare Icandelo D unyaka wonke apho iindleko zamachiza zinokutshintsha:

1. Ukutsalwa: Isixa seendleko zokuphuma epokothweni umboleki weMedicare kufuneka ahlawule ngaphambi kokugubungela iMedicare.
2. Ukufakwa okokuqala: Izicwangciso zeMedare kunye nomthengi babelana ngendleko zamayeza amiselweyo. Le copay okanye i-coinsurance isetyenziswe sisicwangciso ngokuxhomekeke kwinqanaba leyeza ngalinye, kunye nezinye izinto.
3. Umva wokuvala: Emva kokuba umboleki kunye nesicwangciso behlawule isixa esithile esidibeneyo kwiziyobisi ezigqunyiweyo, umboleki uye kwisithuba sokugubungela, esikwabizwa ngokuba ngumngxunya we-Medicare donut. Ngo-2019, uhlawula iipesenti ezingama-25 okanye ezingama-37% kwigama lophawu kunye neziyobisi eziqhelekileyo. Nangona kunjalo, kwi-2020, iyakuba ngama-25% kwibhodi yonke, utshilo uDanielle K. Roberts, ingcali ye-Medicare kunye nomseki-mbumbano Izibonelelo zeBoomer .
4. Ukufakwa kwintlekele: Inqanaba lokugqibela le-Medicare Icandelo D lokugubungela apho umboleki ahlawula malunga neepesenti ezintlanu zeendleko zamachiza ngokuphela konyaka. Ngo-2019, ukugubungela intlekele kufikelelwe emva kokuba umthengi eyedwa ehlawule i-5, 100 yeedola kwiindleko ezingaphandle kwepokotho.

Zeziphi iziyobisi ezogqunywe licandelo leMedicare D?

Amachiza amayeza agqunywe zizicwangciso ze-Medicare Part D ziya kwahluka ngokuxhomekeke kwinto nganye egqubuthelwa ngumntu ophethe i-inshurensi.

Isicwangciso se-Medicare Part D siya kuthi sigubungele ubuncinci ubuncinci iziyobisi ezivela kuwo onke amayeza. Izicwangciso ziyafuneka ukugubungela phantse lonke ichiza kwezi klasi zilandelayo:

• Antipsychotic: La machiza amiselwe ukunceda ukulawula isifo sengqondo. Imizekelo ye-antipsychotic eqhelekileyo ibandakanya iHaldol (haloperidol) kunye neRisperdal (risperidone).
• Uxinzelelo: La machiza anceda ukunyanga uxinzelelo kunye noxinzelelo kubantu abaninzi. I-Effexor XR (venlafaxine) kunye neProzac (i-fluoxetine) zizinto ezimbini ezichaziweyo ezichasene nokuxinezeleka.
• IiAnticonvulsants: Eli qela iziyobisi equka arhente amayeza kunceda abo baxhuzule. Imizekelo yee-anticonvulsants ezinokuthi zigutyungelwe sisicwangciso se-Medicare Part D kubandakanya iKeppra (levetiracetam) kunye neLamictal (lamotrigine).
• Amajoni omzimba: La machiza anciphisa ukomelela kwamajoni omzimba, ngamanye amaxesha afunekayo ukufakelwa kwamalungu okanye ukunyanga izifo ezenzekelayo. Amayeza ePrednisone, njengeDeltasone kunye ne-Orasone, yimizekelo ye-immunosuppressants eqhelekileyo.
• Iziyobisi zomhlaza: Izicwangciso zeMedicare zeCandelo D ziya kubandakanya amachiza omhlaza. Kubalulekile ukuba uthethe nomboneleli wakho wezempilo kunye nomphathi weinshurensi ukuze uqiniseke ukuba ichiza olifunayo lifunekile ngaphambi kokuba ubhalise kwisibonelelo seyeza. Imizekelo yeziyobisi zomhlaza eziqhelekileyo zibandakanya iAvastin (bevacizumab) kunye neRevlimid (lenalidomide).
• Intsholongwane kaGawulayo / uGawulayo: Isicwangciso se-Medicare seCandelo D siya kubandakanya amayeza amiselweyo e-HIV / AIDS. Eminye imizekelo yezi ntlobo zamachiza zibandakanya iTruvada (emtricitabine-tenofovir), iNorvir (ritonavir), kunye ne-Isentress (raltegravir).

Omabini la machiza enziwe afana nalawo enziwe afana nalawo enziwe afana nalawo enziwe afana nalawo enziwe afana nalawo enziwe afana nalawo enziwe afana nalawo enziwe afana nalawo enziwe afana nalawo aveliswe ngumenzi nalawo abizwa ngegama ligutyungelwe yiCandelo leMedicare D, kodwa amayeza egama elibizwa ngegama anokuxabisa ngaphezulu kubaxhamli. Iziyobisi zibekwa kumacandelo ngamacebo e-Medicare Part D, kunye iziyobisi kumanqanaba ahlukeneyo ziya kuba neendleko ezahlukeneyo. Amachiza anegama lebrand anokufakwa kumanqanaba aphezulu aneendleko eziphezulu ze-copay okanye ze-coinsurance.

Inye into oyaziyo malunga neMedicare Icandelo D kukuba ayigubungeli amayeza e-counter, iivithamini kagqirha, kunye namanye amayeza. Ukuthetha nomboneleli wezempilo okanye ugqirha, kunye nokuphononongwa kwesicwangciso sakho rhoqo ngonyaka yeyona ndlela ifanelekileyo yokufumanisa ukuba isicwangciso sakho se-Medicare Part D sisicwangciso esifanelekileyo kuwe ngokusekwe kwiimfuno zakho zonyango. Unethuba lokutshintsha izicwangciso ziye kolunye uhlobo olulungele iimfuno zakho ngexesha lokuBhalisa ngokuVulekileyo. Abantu abanezicwangciso ze-Medicare Advantage banokukwazi ukutshintsha izicwangciso ngexesha le-Medicare Advantage Open.

Zithini iindleko zeCandelo leMedicare D?

Zonke izicwangciso zeCandelo D zifumana ukuseta ezitsalwayo, iipremiyamu, amanqanaba emigangatho, kunye neefomula. Iipremiyamu yenyanga yabo banenxalenye ye-Medicare Icandelo D iya kwahluka ngokuxhomekeke kwisicwangciso. I-avareji yenyanga kazwelonke ye-2019 yi- $ 33.19, nangona kunokwenzeka ukuba oku kutshintshe kwi-2020.

Ukuba inkampani yeinshurensi ifuna ukutsalwa, eya kuthi ihlawulwe kuqala, ilandelwe yicopay okanye i-coinsurance kuwo onke amayeza amiselweyo. Kukho imida kwimalini enokutsalwa; Umda we-2019 awunakuba ngaphezulu kwe- $ 415.

Emva kokuba kuhlawulwe i-deductible, izicwangciso ze-Medicare Icandelo D ziya kufuna ukuba abaxhamli bahlawule ikopi okanye isiqinisekiso semali kwimimiselo. Ukuba ukuqinisekiswa kwemali kufuneka, ke umntu oza kuhlawula uya kuhlawula ipesenti yeziyobisi zithengwayo.

Enye yeengxaki ezichaphazela abantu abane-Medicare yinto ebizwa ngokuba yi-gap gap, okanye umngxuma wedonathi . Isithuba sokufikelela siyafikelelwa xa iindleko zizonke zamachiza ezihlawulwe ngumthengi kunye nesicwangciso sifikelela kumda othile. Wakuba umda ufikelelwe, umntu unokuhlawula iindleko ezingaphezulu epokothweni ngamayeza abo.

Ezinxulumene: Ndingayisebenzisa i-SingleCare ngelixa ndikwiMedicare?

Abantu abanemivuzo ephezulu banokuhlawula iindleko eziphezulu kwiCandelo D lokugubungela. Kwelinye icala, abantu abakwiMedicaid okanye abakulungeleyo ukufumana uNcedo olongezelelweyo banokuhlawula iindleko eziphantsi kakhulu phantsi kweCandelo D.

Umseki we Amayeza ngokukhawuleza , Kathe Kline, ucebisa ukuba ufumane ukuqonda ngokupheleleyo malunga nendlela i-Medicare Part D esebenza ngayo ukuze uqikelele iindleko ezinokubakho.

Isicwangciso ngasinye sineendleko zepremiyamu, iimali ezixhuzulwayo, iimali zeepopay, iimali zemali, kunye neefomula, utshilo uKline. I-formulary ikuxelela ukuba zeziphi iziyobisi ezigutyungelweyo sisicwangciso, kwaye ziya kuba yintoni iindleko zakho. Uninzi lwabantu ngempazamo lujonga kuphela ipremiyamu kunye nokutsalwa. Yimpazamo leyo. Ndincoma ukuba abantu abakwiMedicare bajonge iindleko zabo minyaka le besebenzisa isixhobo esibizwa ngokuba yi-MyMedicare.gov. Ngale ndlela uya kujonga zonke iindleko, kubandakanya amayeza akho, anokuba sisininzi seendleko.

Ndilufumana njani i-Medicare Part D?

Kulula ukujonga kwaye uthelekise iindlela onokukhetha kuzo Unyango.gov ukuba unomdla wokubhalisela isicwangciso seyeza sonyango seMedicare njengeMedicare Part D. Ukubiza u-1-800-Medicare kunye nokuthetha nomcebisi lukhetho olufanelekileyo ukuba ufuna uncedo.

Qiniseka ukuba uqwalasela i-premium, ukukhutshwa kwentlawulo, ukuqinisekiswa kwemali, kunye nokuncitshiswa, kwaye ujonge amayeza agutyungelweyo kunye nezithintelo ezinokubakho kweziyobisi ukuze uqiniseke ukuba ukhetha isicwangciso esifanelekileyo seCandelo leMedare.

Amaxesha okuqala obhaliso lwabo batsha kwiMedicare kwaye abaguquka iminyaka engama-65 ubudala kubandakanya iinyanga ezintathu ngaphambili, inyanga, kunye neenyanga ezintathu ezilandela usuku lwabo lokuzalwa. Yonyaka Ixesha lokuBhalisa eliVulekileyo iqala ngo-Okthobha u-15 ukuya ku-Disemba 7. Ukuba awubhalisi kula maxesha, ungahlawula isohlwayo sokubhalisa kade. Ngumbono olungileyo ukujonga i-Medicare.gov ukuqinisekisa ukuba uyayazi imihla ebekiweyo kwaye ubone ukuba ufanelekile na kwiXesha elithile loBhaliso.