Kumvetsetsa mapulani a inshuwaransi yazaumoyo

Makampani ambiri a inshuwaransi amapereka mitundu yosiyanasiyana yamaphunziro azaumoyo. Ndipo mukamayerekezera mapulani, nthawi zina zimawoneka ngati msuzi wa alifabeti. Kodi pali kusiyana kotani pakati pa HMO, PPO, POS, ndi EPO? Kodi amapereka chithunzi chofanana?

Kuwongolera kwa mapulani azaumoyo kungakuthandizeni kumvetsetsa mtundu uliwonse wamapulani. Ndiye mutha kusankha mosavuta pulani yoyenera kwa inu ndi banja lanu.

Kutengera ndi momwe mumapezera inshuwaransi yazaumoyo, mutha kukhala ndi mwayi wosankha mapulani osiyanasiyana.

Mabungwe Okonza Zaumoyo (HMOs). Mapulaniwa amapereka netiweki ya othandizira azaumoyo komanso ndalama zochepa pamwezi. Othandizirawo ali ndi mgwirizano ndi dongosolo laumoyo. Izi zikutanthauza kuti amalipiritsa ndalama zomwe amapeza. Mudzasankha amene adzakusamalirani. Munthuyu azisamalira chisamaliro chanu ndikukutumizirani kwa akatswiri. Ngati mumagwiritsa ntchito othandizira, zipatala, ndi othandizira ena kuchokera pa netiweki, mumalipira zochepa mthumba. Ngati mugwiritsa ntchito omwe amapereka kunja kwa netiweki, muyenera kulipira zochulukirapo.

Mabungwe Opereka Opatula (EPOs). Awa ndi mapulani omwe amapereka ma network a operekera ndalama komanso ndalama zochepa pamwezi. Muyenera kugwiritsa ntchito omwe akukupatsani ndi zipatala kuchokera pamndandanda wa netiweki kuti musawononge ndalama zambiri. Mukawona opereka kunja kwa netiweki, mitengo yanu idzakhala yokwera kwambiri. Ndi ma EPO, simukusowa woyang'anira wamkulu kuti azisamalira chisamaliro chanu ndikupatseni chiyembekezo.

Mabungwe Omwe Amapereka (PPOs). Ma PPO amapereka netiweki ya omwe amapereka komanso kusankha kuwona omwe amapereka kunja kwa netiweki kuti apeze ndalama zochulukirapo. Simukusowa wothandizira wamkulu kuti muzisamalira chisamaliro chanu. Mulipira ndalama zambiri pamalipiro poyerekeza ndi HMO, koma muli ndi ufulu wowonera omwe amapereka mkati ndi kunja kwa netiweki osafunikira kutumizidwa.

Ndondomeko za Point-of-Service (POS). Zolinga za POS zili ngati PPO. Amapereka maubwino onse mu intaneti komanso kunja kwa netiweki. Mutha kuwona omwe amapereka ma intaneti popanda kutumizidwa. Koma mukufunika kutumizidwa kuti muwone omwe akutuluka pa netiweki. Mutha kusunga ndalama pamalipiro apamwezi ndi mapulani amtunduwu poyerekeza ndi PPO.

Ndondomeko Zapamwamba Zathanzi (HDHPs). Dongosolo lamtunduwu limapereka ndalama zochepa pamwezi komanso kuchotsera kwapachaka. HDHP ikhoza kukhala imodzi mwanjira zomwe zili pamwambapa ndi deductible yayikulu. Deductible ndi ndalama zomwe mumayenera kulipira inshuwaransi yanu isanapereke. Kwa 2020, ma HDHP amachotsera $ 1,400 pa munthu aliyense komanso $ 2,800 pa banja pachaka kapena kupitilira apo. Anthu omwe ali ndi malingalirowa nthawi zambiri amalandila ndalama kuchipatala kapena akaunti yobweza. Izi zimakuthandizani kuti muzisungira ndalama zochotsera ndi zina zotuluka mthumba. Ikhozanso kukuthandizani kuti musunge ndalama pamisonkho.

Ndalama zolipirira (FFS) mapulani siofala masiku ano. Mapulaniwa amapereka ufulu wowona aliyense amene akukuthandizani kapena chipatala chomwe mungasankhe. Dongosololi limalipira ndalama zoikika pa ntchito iliyonse, ndipo zina mumalipira zina zonse. Simukusowa kutumizidwa. Nthawi zina, mumalipira ntchitoyo kutsogolo, ndikupereka zomwe mukufuna, ndipo dongosololi limakubwezerani. Ili ndi dongosolo la inshuwaransi yotsika mtengo pomwe siliphatikiza netiweki kapena PPO.

Zolinga zowopsa amapereka zabwino pazithandizo zoyambira ndi matenda akulu kapena kuvulala. Amakutetezani ku mtengo wangozi yayikulu kapena matenda. Mapulaniwa alibe chithunzithunzi chabwino kwa anthu omwe ali ndi mavuto azaumoyo omwe amafunikira chisamaliro kapena mayeso nthawi zonse. Mutha kungogula dongosolo lowopsa ngati muli ndi zaka zosakwana 30 kapena mutha kutsimikizira kuti simungakwanitse kupereka chithandizo chazachipatala. Malipiro apamwezi amakhala otsika, koma zochotseredwa pamalingaliro awa ndizokwera kwambiri. Monga munthu, ndalama zanu zimatha kukhala pafupifupi $ 6,000. Muyenera kulipira ndalama zochulukirapo asanalandire inshuwaransi.

Posankha pulani, ganizirani zosowa zanu zamankhwala ndi zomwe mumakonda. Kuphatikiza pa mtundu wamakonzedwewo, onetsetsani kuti mukufanizira zabwinozo, zolipirira mthumba, ndi netiweki yothandizira bwino.

Maziko AHIP. Kuwongolera ogula kuti mumvetsetse magawo amathandizidwe azaumoyo. www.ahip.org/wp-content/uploads/2018/08/ConsumerGuide_PRINT.20.pdf. Idapezeka pa Disembala 18, 2020.

Healthcare.gov tsamba. Momwe mungasankhire dongosolo la inshuwaransi yazaumoyo. Ndondomeko ya inshuwaransi yazaumoyo & mitundu yama network: HMOs, PPOs, ndi zina zambiri. Healthcarecare.gov/choose-a-plan/plan-types. Idapezeka pa Disembala 18, 2020.

Zaumoyo.gov.website. Ndondomeko yathanzi yodula (HDHP). www.healthcare.gov/glossary/high-deductible-health-plan/. Inapezeka pa February 22, 2021.

Healthcare.gov tsamba. Momwe mungasankhire dongosolo la inshuwaransi yazaumoyo: 3 zinthu zoti mudziwe musanapange dongosolo la inshuwaransi yazaumoyo. Zaumoyo.de.gov/choose-a-plan. Idapezeka pa Disembala 18, 2020.

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