Buyintoni ubuninzi obuphuma epokothweni?

Inkampani yezeMpilo ichaziwe

I-inshurensi yezempilo inzima, ngeendlela ezahlukeneyo zokudideka ekunokuba nzima ukuziqonda. Kodwa ukwazi nokuqonda iinkcukacha zesicwangciso sakho seinshurensi yezempilo kungahamba indlela ende, ngakumbi xa kusiziwa ekongeni imali. Enye yezi nkcukacha zibalulekileyo ziphezulu epokothweni.

Ubuninzi bepokothweni yesicwangciso sakho seinshurensi yezempilo ngumda wonyaka oya kuthi, njengomthengi, ufune ukuhlawulela iinkonzo zempilo ezigqunyiweyo. Isixa sobungakanani bepokotho yakho engaphandle epokothweni sigqitywa zizinto ezahlukeneyo, kubandakanya indleko zesicwangciso kunye nokuba bangaphi abantu kusapho lwakho abagutyungelwe phantsi kwesicwangciso sakho.

Umxholo wokuphuma epokothweni ubuninzi unokubonakala unokudideka ngokufana namanye amagama athi iinkampani zeinshurensi zikuphose, ezinje nge Uqinisekiso , ikopi , i-premium, kunye kutsalwa . Kodwa umahluko phakathi kwabo ubalulekile kwaye unokuchaphazela zombini ukhuseleko lwezempilo kunye nesipaji sakho.

Esi sikhokelo sinayo yonke into oyifunayo malunga nokungena nokuphuma kwee-maximum ezingaphandle kweepokotho.

Yintoni ebala ubungakanani obuphezulu bepokotho?

Nje ukuba uchithe imali eyoneleyo kwiinkonzo zonyango ukufikelela kwinqanaba eliphezulu langaphandle epokothweni, inkampani yakho yeinshurensi yezempilo iya kuthi gxalathelana ukugquma konke zihlawulwe iindleko zonyaka wonke. Kodwa zithini iindleko zonyango ezibalelwa kumda wokuphuma epokothweni? Kwizicwangciso ezininzi, ngaphandle kwe-pocket-maximums kubandakanya imali echithwe kwezinye izicwangciso zesicwangciso sakho sezempilo, njenge:

• Ukutsalwa
• UQinisekiso
• Iikopi

Iindleko ezinkulu ezingabhekiseli kwimali ephuma epokothweni yipremiyamu yakho yenyanga. Oku kuthetha ukuba nokuba iphrimiyamu yakho ingakanani, ukuze ugcine i-inshurensi yakho yezempilo isebenza, kuyakufuneka uqhubeke nokuyihlawula qho ngenyanga, kwanasemva kokuba ubethe ubuninzi bepokotho yakho.

Olunye udidi olungabalulekanga kubuninzi beepokotho zakho ziinkonzo zononophelo lwempilo ezingagutyungelwanga sisicwangciso sakho seinshurensi, njengabanye ababoneleli bangaphandle kwenethiwekhi kunye nezinye iindlela zonyango ezingagutyungelwanga okanye amayeza. Iindleko eziphuma epokothweni zamayeza kagqirha owahlawulelayo Ukhathalelo amatikiti nawo awabalali kubungakanani obuphuma epokothweni, nangona unganakho ukubuyiselwa ngumnikezeli wakho weinshurensi ekupheleni konyaka wesicwangciso sakho.

Inokutsalwa xa ithelekiswa nephuma epokothweni ubuninzi

Ukuba ucinga ukuba ii-maximums ezingaphandle kweepokotho zivakala ngokufana nokutsalwa, awuphosisi. Kodwa zahluke kancinane, kwaye lo mahluko ubalulekile ekuqondeni apho iindleko zonyango lwakho zivela khona.

Sele simisele ukuba ukuphuma epokothweni ubuninzi apho umgaqo-nkqubo weinshurensi yakho uthimba inkcitho yakho yezempilo yonyaka. Emva kokufikelela kwesi sixa simiselweyo, i-inshurensi yakho iyakungena kwaye inoxanduva lokuhlawula ezinye iindleko zonyaka ophelileyo.

Ukutsalwa kwakho, kwelinye icala, linani leenkonzo zakho zononophelo lwempilo ekufuneka uzihlawule ngokupheleleyo Phambi kokuba uthathe amanyathelo akho okwabelana ngendleko, njengesiqinisekiso semali, Ngena ngamanye amagama, nje ukuba ubethe imali yakho ekhutshiweyo i-inshurensi yakho iya kuqala ukukunceda ukuhlawulela iinkonzo, kodwa uya kuhlala usekhonkxweni ezinye zeendleko uqinisekiso lwemali okanye iikopa. Oko kukuthi, ude ubethe ubuninzi bepokotho yakho. Ke uya kuba noxanduva lokuhlawula kuphela i-premium yakho yenyanga, yeenkonzo ezingagutyungelwanga, okanye ezithile kwizibonelelo zenethiwekhi.

Ezinxulumene: Iinkonzo zempilo ezi-5 ekufuneka uzenzile emva kokuba udibene nokutsalwa kwakho

Kwenzeka ntoni emva kokuphuma epokothweni ubuninzi?

Ngoku ukuba uyazi ukuba yintoni, zisebenza njani ii-maximums ezingaphandle kweepokotho? Iimali ezingaphandle kweepokotho zikunceda ukukhusela ekufuneni ukubhatalela unyango olubizayo okanye olungalindelekanga (njengohambo oluya kwigumbi likaxakeka) ngokubeka ikepusi yokuba kulindeleke ukuba uhlawule malini ngonyaka. Xa inkcitho yakho yokhathalelo lwempilo isicwangciso sonyaka omnye sinqumla isixa semali esichongiweyo sokufumana okuphezulu epokothweni, isicwangciso sakho sezempilo sihlawula zonke iindleko zokhathalelo lwempilo — ukuba nje ezo ndleko ziinkonzo ezihlawulwa sisicwangciso sakho.

Nje ukuba udibane nomda wakho ophuma epokothweni, awusayi kuphinda uhlawule ikopi okanye isiqinisekiso semali ngenkathalo yenethiwekhi. Imizekelo yokhathalelo olugqityiweyo inokubandakanya ukutyelela ugqirha wakho okhathalelayo oyintloko okanye iindleko zomyalelo ogqunyiweyo. Kodwa kuya kufuneka uhlawule ngeenkonzo zangaphandle kwenethiwekhi ezingagqitywanga ngokwesicwangciso sakho.

Ezinye izicwangciso ze-inshurensi zibonelela ngokhuseleko olulinganiselweyo lwenkcitho yezempilo engaphandle kwenethiwekhi, kwaye inokuthi ikhuphe imali ekufuneka uyihlawule ngononophelo lwangaphandle kwenethiwekhi unyaka nonyaka. Le cap iya kuhlala ngokwahlukeneyo, kwaye iphezulu, kunomyinge we-in-network ophuma epokothweni. Kodwa ezinye izicwangciso ezininzi azinakho ukuphuma ngaphandle kweepokotho kwiinkonzo ezingaphandle kwenethiwekhi, oko kuthetha ukuba i-inshurensi yakho ayinakungena ekuncedeni ukuhlawulela iinkonzo ezingaphandle kwenethiwekhi, nokuba zibiza malini iindleko zonyango. Nika ingqalelo isicwangciso sakho sokuphuma ngaphandle kwenethiwekhi, kwaye uzame ukuhlala kwinethiwekhi xa kunokwenzeka ukuba usebenzise ithuba lakho lokuphuma epokothweni.

Ngaba zonke izicwangciso zeinshurensi yezempilo zinokuphuma epokothweni ubuninzi?

Zonke izicwangciso zeinshurensi ezihlangabezana noMgangatho woKhathalelo olufikelelekayo (ACA) zinemigangatho ephezulu yokuphuma epokothweni. Kwi-2020, ezona ziphuma ngaphandle ezipokothweni zezicwangciso zokuthobela i-ACA azinakuba ngaphezulu Iiplani ezizodwa ze-8,150 kunye ne-16,300 yeedola kwizicwangciso zosapho . Kwizicwangciso ezininzi, umda wokuphuma epokothweni uya kuba mbalwa kakhulu, nangona ezinye izicwangciso zenziwe ngaphambi kokuba i-ACA izalele kwimida yayo. Unokufumana ulwazi oluthe kratya malunga nezicwangciso onelungelo kuzo kwezempilo.gov .

Ubungakanani obuphuma epokothweni Unyango ziyahluka kancinci. Kwintlawulo yemveli yenkonzo ye-Medicare (i-Original Medicare), akukho mda kwimali oyibhatalayo yeendleko zonyango unyaka nonyaka. Ukuba unayo iMedical Medicare, unokukwazi ukunciphisa iindleko zakho ezingaphandle kweepokotho ngokuthenga isicwangciso seMedigap, okanye ngokubhalisa kwizibonelelo zikarhulumente ezinengeniso ephantsi njengeNkqubo yoLondolozo lweMedare okanye uNcedo olongezelelekileyo kwiCandelo leMedare D Kodwa izicwangciso ze-Medicare Advantage, ezinikezelwa ngabanini-inshurensi babucala kwaye zamkelwe yi-Medicare, kufuneka zilandele izikhokelo ezifanayo njengezinye izicwangciso zokuthobela i-ACA kwaye zinokuba nezona zinto zingaphantsi ezipokothweni kunezicwangciso ze-ACA.

Iindleko ezingaphandle kweepokotho zezicwangciso zeMedicaid ziyahluka zikarhulumente, kodwa azivunyelwa ukuba zidlule I-5% yengeniso yosapho .

Ukufumana ukhathalelo lwempilo

Nangona isicwangciso sakho seinshurensi yezempilo sinokuthi singaphenduli kuzo zonke iindleko zonyango, zikho ezinye iindlela zokonga . I-singleCare inceda ekupheliseni ukudideka malunga nokuqokelela iindleko ngokunikezela ngesaphulelo kumaxabiso amiselweyo. Kwaye nangona amayeza amaninzi engaxhomekeki kubuninzi be-out-of-pocket okanye unciphise, amakhuphoni e-SingleCare anokuwenza amayeza owafunayo afikeleleke ngakumbi.