Malingaliro Ofunika Kukuthandizani Kuyenda pa Medicare

Zamkati

• Amyotrophic lateral sclerosis (ALS)
• Kuwunikira koopsa
• Malo a Medicare & Medicaid Services (CMS)
• Funsani
• Coinsurance
• Copay
• Kuphunzira kusiyana
• Kuchotsa
• Dzenje la donut
• Zida zachipatala zokhazikika (DME)
• Mapeto a matenda a impso (ESRD)
• Thandizo Lina
• Zolemba
• Nthawi yolembetsa
• Mapulani a Health Maintenance Organisation (HMO)
• Ndalama zosinthira pamwezi (IRMAA)
• Nthawi yoyamba kulembetsa
• Chilango chakumapeto kwa olembetsa
• Mankhwala
• Phindu la Medicare (Gawo C)
• Mtengo wovomerezeka ndi Medicare
• Medicare Gawo A
• Medicare Gawo B
• Medicare Gawo C
• Gawo la Medicare D.
• Maakaunti osunga a Medicare
• Mapulani a Medigap
• Tsegulani nthawi yolembetsa
• Kulembetsa koyambirira
• Mankhwala Oyambirira
• Ndalama zotuluka m'thumba
• Kutuluka mthumba
• Wopereka nawo mbali
• Mapulani a Preferred Provider Organisation (PPO)
• Choyamba
• Wopereka chisamaliro choyambirira (PCP)
• Ndondomeko Zachinsinsi Zoyang'anira Ntchito (PFFS)
• Mapulani Apadera (SNP)
• Nthawi yolembetsa yapadera (SEP)
• Bungwe la Social Security Administration (SSA)
• Kudikirira zaka ziwiri
• Kuyamikira ntchito

Kumvetsetsa malamulo ndi mtengo wa Medicare kungakuthandizeni kukonzekera zosowa zanu zaumoyo. Koma kuti mumvetsetse Medicare, choyamba muyenera kudziwa zina zofunika - {textend} komabe nthawi zambiri zimasokoneza - mawu a {textend}.

Ngakhale mutakhala ndi inshuwaransi m'mbuyomu, Medicare ili ndi chilankhulo chake ndipo imagwiritsa ntchito mawu ndi mawu apadera omwe amangokhudza mapulani ake komanso kufotokozera kwake. Kudziwa tanthauzo la mawuwa ndi momwe amagwiritsidwira ntchito ku Medicare kungakuthandizeni kudziwa zambiri, kugwiritsa ntchito njirayi, ndikupanga chisankho chazomwe mungachite.

Nawa mawu omwe mungawone mukamafufuza zomwe mungasankhe pa Medicare:

Amyotrophic lateral sclerosis (ALS)

ALS ndimavuto omwe amachititsa kuti minofu iwonongeke ndipo pamapeto pake imapha. Amatchulidwanso kuti matenda a Lou Gehrig, otchulidwa ndi wosewera wamkulu wa baseball Lou Gehrig, yemwe adamwalira ndi ALS mu 1941.

Ngati muli ndi ALS, ndinu woyenera Medicare ngakhale simunakwanitse zaka 65. Ndipo mukuyenera kulandira thandizo nthawi yomweyo - {textend} osadikirira zaka ziwiri zomwe zimafunikira kuti muyenerere kukhala ndi Medicare mukadakwanitsa zaka 65 ndipo muli ndi chilema.

Kuwunikira koopsa

Mumayamba kulandira zomwe zimadziwika kuti zowopsa mukangopeza ndalama zochulukirapo m'thumba la mankhwala omwe mumalandira chaka chilichonse.

Mu 2020, kubisa koopsa kumayamba pa $ 6,350. Mukakwaniritsa ndalamayi, mudzangolipira ndalama zochepa zokha kapena zolipira ndalama chaka chonse chazopindulitsa.

Malo a Medicare & Medicaid Services (CMS)

CMS ndi bungwe la fedulo lomwe limayang'anira Medicare ndi Medicaid, komanso malo omwe amagwirizana nawo. Malamulo omwe amafalitsidwa ndi CMS amatsimikizira kuti malo onse omwe amalandira Medicare ndi Medicaid kuti alipire amakwaniritsa miyezo ina.

Funsani

Chopempha ndi pempho lolipira lomwe limatumizidwa ku inshuwaransi ngati Medicare. Kenako, a Medicare kapena kampani ya inshuwaransi yomwe ikuthandizira imawunikiranso ndikulipira woperekayo (wothandizira zaumoyo kapena malo). Medicare kapena kampani ya inshuwaransi itha kukana pempholo ngati ntchitoyi siyikuphimbidwa kapena ngati zinthu sizinachitike.

Coinsurance

Mtengo wa chitsimikizo cha ntchito ndi gawo la mtengo wonse womwe mumayang'anira. Medicare Part B ili ndi chitsimikizo cha ndalama zokwana 20 peresenti ya zovomerezeka zomwe Medicare imalandira. Izi zikutanthauza kuti Medicare imalipira 80 peresenti ya mtengo wake ndipo mudzalipira 20% yotsalayo.

Copay

Copay, kapena copayment, ndi ndalama zomwe mumalipira pantchito inayake. Dongosolo lanu limakhudza mtengo wotsalira. Mwachitsanzo, ndondomeko yanu ya Medicare Advantage ikhoza kukhala ndi $ 25 copay paulendo uliwonse wa dokotala.

Kuphunzira kusiyana

Kusiyana komwe kumatchulidwa, komwe kumatchedwanso kuti donut hole, kumatanthauza nthawi yomwe mungalipire ndalama zambiri pazakumwa zanu. Mu 2020, inu ndi dongosolo lanu la Medicare Part D mutalipira ndalama zokwana $ 4,020 pazomwe mukulembera, ndiye kuti mwakhala mukugwirizana. Nthawi imeneyi imatha mukafika $ 6,350 yofunikira kuti mulandire zoopsa.

M'mbuyomu, kusiyana kumeneku kunasiya omwe amapindula ndi Medicare akulipira m'thumba chifukwa cha mankhwala awo onse. Koma kusintha kwaposachedwa kwamalamulo a inshuwaransi ndi Affordable Care Act kwapangitsa kuti mpatawu ukhale wosavuta kuwongolera.

Kuyambira pa Januware 1, 2020, m'malo mongolipira 100% mthumba, mudzalipira 25% ya mtengo wamankhwala opangidwa ndi generic komanso dzina lanu mukadali pagawo lofikira.

Kuchotsa

Chodulidwa ndi ndalama zomwe muyenera kulipira m'thumba kuti muchite ntchito yanu ya Medicare isanalipire chilichonse. Mu 2020, Medicare Part B yochotsedwa ndi $ 198.

Chifukwa chake, mudzalipira $ 198 yoyamba mthumba kuti mupeze chithandizo chazaumoyo. Pambuyo pake, dongosolo lanu la Medicare liyamba kulipira.

Dzenje la donut

Phando lazopereka ndi liwu lina lomwe limagwiritsidwa ntchito pofotokoza kusiyana komwe kulipo pakati pa gawo lolipira la Part D ndi kulipira kwakukulu pachaka.

Zida zachipatala zokhazikika (DME)

DME imaphatikizapo mankhwala omwe mungafunike mnyumba mwanu kuti athane ndi vuto. DME imaphatikizapo zinthu monga akasinja a oxygen kunyumba ndi zinthu zina zothandizira kapena kuyenda ngati oyenda. Dongosolo lanu la Medicare Part B limakhudza DME yomwe dokotala wovomerezeka ndi Medicare adakulamulirani.

Mapeto a matenda a impso (ESRD)

ESRD ndiye gawo lomaliza la matenda a impso, otchedwanso matenda a impso. Impso za anthu omwe ali ndi ESRD sakugwiranso ntchito. Amafuna chithandizo cha dialysis kapena kumuika impso.

Ngati muli ndi ESRD, mutha kulandira Medicare popanda nthawi yazodikirira zaka ziwiri, ngakhale mutakwanitsa zaka 65.

Thandizo Lina

Thandizo lowonjezera ndi pulogalamu ya Medicare yomwe imathandizira omwe akutenga nawo mbali kubweza mtengo wa Medicare Part D. Mapulogalamu ena othandizira amachokera ku ndalama zomwe mumapeza ndipo amatha kukuthandizani ndi ndalama za ndalama kapena ndalama zoyambira.

Zolemba

Formulary ndi mndandanda wa mankhwala omwe gawo lina la D D limafotokoza. Ngati mumamwa mankhwala omwe sali pamakonzedwe anu, muyenera kulipira mthumba kapena kufunsa dokotala kuti akupatseni mankhwala omwewo omwe mukukonzekera.

Nthawi yolembetsa

Mutha kulembetsa ku Medicare yoyambirira (magawo A ndi B) chaka chilichonse pakati pa Januware 1 ndi Marichi 31. Iyi imadziwika kuti nthawi yolembetsa. Kuti mugwiritse ntchito zenera, muyenera kukhala woyenera ku Medicare koma simulandiridwa kale.

Mapulani a Health Maintenance Organisation (HMO)

Mapulani a Medicare Advantage (Gawo C) atha kuperekedwa m'njira zosiyanasiyana, kutengera komwe muli. HMO ndi mtundu wa mapulani othandiza. Ndi HMO, mukuyenera kugwiritsa ntchito njira zopezera othandizira azaumoyo ngati mukufuna kuti Medicare yanu ikwaniritse ndalamazo. Mwinanso mungafunike kusankha dokotala woyambirira ndikumutumiza kuchipatala ngati mukufuna kuwona akatswiri.

Ndalama zosinthira pamwezi (IRMAA)

Othandizira a Medicare omwe amapanga ndalama zoposa $ 87,000 amalipira ndalama zoposa $ 144.60 Part B mwezi uliwonse. Kuwonjezeka kumeneku kumatchedwa IRMAA. Mukakweza ndalama zambiri, IRMAA yanu ikhala yochuluka, mpaka $ 491.60.

Nthawi yoyamba kulembetsa

Nthawi yanu yoyamba kulembetsa ndi zenera la miyezi 7 lomwe limayambira miyezi 3 mwezi wanu usanakwanitse 65. Apa ndipamene mutha kulembetsa ku Medicare. Nthawi yolembetsa imatha miyezi itatu kuchokera mwezi wanu wobadwa.

Mwachitsanzo, ngati mutakwanitsa zaka 65 mu Ogasiti 2020, nthawi yanu yoyamba kulembetsa imatha kuyambira Meyi 2020 mpaka Novembala 2020.

Chilango chakumapeto kwa olembetsa

Ngati simulembetsa mu Gawo B mukayamba kulandira Medicare, mungafunikire kulipira ngongole yolembetsa mukamalembetsa.

Nthawi zambiri mumalipira 10% pachaka chilichonse chomwe simunalembetse. Ndalamazo zimawonjezeredwa pamalipiro anu apamwezi pamwezi.

Simulipira chindapusa cholembetsa ngati mukuyenera kulembetsa.

Mankhwala

Medicaid ndi pulogalamu ya inshuwaransi yazaumoyo yopangidwira anthu omwe alibe ndalama zochepa.Mapulogalamu a Medicaid amayendetsedwa ndi boma lililonse, chifukwa chake malamulo ndi ndondomeko ya pulogalamuyo zimatha kusiyanasiyana.

Ngati mukuyenerera Medicaid, mutha kuyigwiritsa ntchito limodzi ndi Medicare ndikuchepetsa kapena kuchotsera zomwe mumagwiritsa ntchito m'thumba.

Phindu la Medicare (Gawo C)

Mapulani a Medicare Advantage amatchedwanso mapulani a Medicare Part C. Amaperekedwa ndi makampani wamba omwe amachita mgwirizano ndi Medicare.

Zolinga zamalonda zimatenga malo a Medicare yoyambirira (Gawo A ndi Gawo B). Mapulani onse a Medicare Advantage akuyenera kuphimba chilichonse chomwe chimakwirira A ndi B. Kuphatikiza apo, mapulani ambiri amawonjezera zowonjezera pazinthu monga chisamaliro cha mano, ntchito zowonera, kapena mankhwala.

Mapulani a Medicare Advantage amakhala ndi zolipira zawo, zochotseredwa, ndi ndalama zina zotuluka m'thumba.

Mtengo wovomerezeka ndi Medicare

Medicare yakhazikitsa mitengo yomwe izilipira chithandizo chazaumoyo. Mtengo womwe wakhazikitsidwa umatchedwa kuchuluka kovomerezeka ndi Medicare. Malo onse azaumoyo omwe amalandira Medicare agwirizana kuti alipire ndalama zovomerezedwazo.

Medicare Gawo A

Medicare Part A ndi inshuwaransi ya chipatala. Zimakhudza komwe mumakhala mchipatala, komanso kumakhala m'malo osamalira anthu kwanthawi yayitali. Muthanso kulandila chithandizo chamankhwala anyumba kapena chisamaliro cha odwala.

Medicare Gawo B

Medicare Part B ndi inshuwaransi yamankhwala. Ikufotokoza zinthu monga kuyendera kwa adotolo, maulendo a akatswiri, thanzi lam'mutu, komanso zida zolimbitsa thupi. Gawo B limakhudzanso chisamaliro mwachangu komanso kuchezera kuchipinda chadzidzidzi.

Medicare Gawo C

Medicare Advantage nthawi zina amatchedwa Medicare Part C. Mawu awiriwa amatanthauza pulogalamu yomweyo. Chifukwa chake, dongosolo la Gawo C ndi mwayi wopindulitsa.

Gawo la Medicare D.

Medicare Part D ndikutulutsa kokhako kwa mankhwala operekedwa ndi mankhwala. Magawo a Medicare A ndi B amangopereka chithandizo chamankhwala chochepa chokha, kotero ena opindula amasankha kugula zowonjezera zowonjezera ndi gawo la D D. Dongosolo lanu la Gawo D lidzakhala ndi ndalama zoyambirira.

Maakaunti osunga a Medicare

Akaunti yosunga Medicare (MSA) ndi mtundu wamadongosolo a Medicare Advantage omwe amakhala ndi ndalama zochepetsedwa komanso zotetezedwa. MSA ikukonzekera kuyika ndalama muakaunti yosungira, yomwe itha kugwiritsidwa ntchito kulipirira ndalama zomwe mumawonongera musanalandire ndalama zanu.

Mapulani a Medigap

Mapulani a Medigap ndi mapulani owonjezera omwe amakuthandizani kulipira ndalama zotulutsira mthumba za Medicare yoyambirira. Pali mapulani 10 osiyanasiyana a Medigap.

Izi zimaperekedwa ndi makampani omwe amachita mgwirizano ndi Medicare. Ndalama zanu za Medigap zimatha kusiyanasiyana kutengera dera lanu.

Tsegulani nthawi yolembetsa

Nthawi zolembetsa zotseguka zimachitika nthawi yoikika chaka chilichonse, kuyambira Okutobala 15 mpaka Disembala 7. Pazenera lotseguka, mutha kulembetsa dongosolo la Advantage, kugula Medigap, ndi zina zambiri.

Kulembetsa koyambirira

Nthawi yanu yoyamba kulembetsa ndi nthawi yoyamba kulembetsa ku Medicare. Izi nthawi zambiri nthawi yoyamba kulembetsa, pazenera la miyezi 7 kuzungulira tsiku lanu lobadwa la 65. Ngati simunakwanitse zaka 65, zitha kukhalanso zaka ziwiri mutayamba kulandira maubwino olumala.

Mankhwala Oyambirira

Magawo a Medicare A ndi B limodzi nthawi zambiri amatchedwa Medicare yoyambirira, kapena a Medicare achikhalidwe. Medicare yapachiyambi sichiphatikizapo Gawo C (mapulani a Advantage), Gawo D, kapena mapulani a Medigap.

Ndalama zotuluka m'thumba

Ndalama zanu zakuthumba ndizomwe mumalipira paumoyo wanu. Zitha kuphatikizanso kuchotsedwa kwanu, ndalama zandalama, komanso ndalama zomwe mumalipiritsa.

Kutuluka mthumba

Kuchuluka kwa mthumba ndi kapu pamlingo wa ndalama zomwe mudzalipira pazithandizo zovomerezeka chaka chilichonse. Mukafika pa ndalamayi, Medicare idzapeza ndalama zonse pazantchito zovomerezeka izi.

Ma maximum akunja kwa thumba amaphatikizira kulipidwa ndi ndalama zandalama. Mapulani a Medicare Advantage okha (Gawo C) ndiwo ali nawo. Dongosolo lililonse la Medicare Advantage litha kukhazikitsa ndalamazi, chifukwa zimatha kusiyanasiyana. Mu 2020, kutuluka mthumba sikungadutse $ 6,700 pachaka.

Wopereka nawo mbali

Omwe akutenga nawo mbali ndiwothandizira zaumoyo omwe amagwirizana ndi Medicare kuti athandizire kapena omwe ali mgululi pa pulani ya HMO kapena PPO. Omwe akutenga nawo mbali avomereza kulandira ndalama zovomerezeka ndi Medicare ndikuchiritsa omwe adzapindule ndi Medicare.

Mapulani a Preferred Provider Organisation (PPO)

Ma PPO ndi mtundu wina wotchuka wa dongosolo la Medicare Advantage. Monga HMO, ma PPO amagwira ntchito ndi gulu la omwe amapereka. Ndi PPO, mutha kupita kunja kwa netiweki yanu ngati mukufuna kulipira ndalama zochulukirapo kapena zolipiritsa.

Choyamba

Umafunika ndi ndalama pamwezi zomwe mumalipira kuti mupeze inshuwaransi. Popeza anthu ambiri salipira mtengo wa Medicare Part A, mumalipira gawo la B pokhapokha mutakhala ndi Medicare yoyambirira. Gawo la B mu 2020 ndi $ 144.60.

Mapulani a Medicare Advantage, mapulani a Part D, ndi mapulani a Medigap amagulitsidwa ndi makampani abizinesi a inshuwaransi. Izi zitha kulipiritsa mtengo wosiyana kutengera kampani kapena pulani yomwe mungasankhe.

Wopereka chisamaliro choyambirira (PCP)

PCP wanu ndi dokotala yemwe amakuwonani kuti muzisamalidwa nthawi zonse komanso zodzitetezera, monga zolimbitsa thupi zapachaka. Pansi pa mapulani ena a Medicare Advantage HMO, muyenera kugwira ntchito ndi PCP yapaintaneti. Ndipo ngati mukufuna chisamaliro chapadera, PCP yanu iyenera kutumiza kwa njira yanu kuti mupeze izi.

Ndondomeko Zachinsinsi Zoyang'anira Ntchito (PFFS)

Dongosolo la PFFS ndi njira yodziwika bwino ya Medicare Advantage plan yomwe ilibe netiweki kapena ikufuna kuti mukhale ndi dokotala woyamba. M'malo mwake, mudzalipira kuchuluka kwa ntchito iliyonse yomwe mumalandira kuchokera kumalo aliwonse ovomerezeka ndi Medicare.

Mapulani Apadera (SNP)

Makampani ena amapereka mapulani a Medicare Advantage omwe amadziwika kuti SNPs. SNP yapangidwa kuti ipindule ndi omwe adzapindule ndi zosowa zapadera zandalama kapena zamankhwala.

Mwachitsanzo, mutha kuwona ma SNP makamaka a:

• anthu omwe amakhala m'malo osungira anthu okalamba
• anthu omwe amapeza ndalama zochepa
• anthu omwe ali ndi matenda aakulu ngati matenda ashuga

Nthawi yolembetsa yapadera (SEP)

SEP ndi zenera lomwe limakupatsani mwayi woti mulembetse ku Medicare kunja kwa nthawi yoyambira kulembetsa. SEP zimachitika mukamasintha kwambiri moyo, monga kusamukira kumalo atsopano kapena kuchoka pantchito yomwe yakhala ikukuthandizani kuti mukhale ndi inshuwaransi yazaumoyo.

Pambuyo pa kusintha kwanu kapena moyo wanu, mudzakhala ndi zenera la miyezi 8 kuti mulembetse Medicare. Ngati mungalembetse panthawiyi, simulipira chiwongola dzanja chochedwa.

Bungwe la Social Security Administration (SSA)

Social Security Administration (SSA) ndi bungwe loyang'anira mabungwe omwe amayang'anira ntchito zopuma pantchito ndi zopunduka. Mukalandira ma SSA, mutha kulandira Medicare Part A yaulere. Ngati mwakhala mukulandira zabwino za Social Security kwa zaka ziwiri, mudzangolembetsa ku Medicare, ngakhale mutakhala ndi zaka 65.

Kudikirira zaka ziwiri

Mutha kupeza Medicare ngati muli ndi zaka 65 ndipo muli ndi chilema chosatha. Muyenera kukhala ndi mwayi wolandila ndalama za Social Security ndikuzilandira kwa zaka 2 Medicare isanayambike. Imadziwika kuti nthawi yazodikirira zaka ziwiri.

Ndikofunika kuzindikira kuti nthawi yodikirira zaka ziwiri sizikugwira ntchito kwa anthu omwe ali ndi ESRD kapena ALS.

Kuyamikira ntchito

Kuyamika kwa pantchito kumatsimikizira kuyenerera kwanu phindu la Social Security komanso gawo lopanda premium. Mumalandira mbiri yakugwira ntchito pamlingo wa 4 pachaka - {textend} ndipo mudzafunika ngongole 40 kuti mulandire phindu la Part A kapena SSA . Ogwira ntchito achichepere omwe amakhala olumala amatha kukhala ndi mbiri yochepa.

Zomwe zili patsamba lino zimatha kukuthandizani posankha nokha za inshuwaransi, koma cholinga chake si kupereka upangiri wokhudzana ndi kugula kapena kugwiritsa ntchito inshuwaransi kapena zinthu zilizonse za inshuwaransi. Healthline Media siyigulitsa bizinesi ya inshuwaransi mwanjira iliyonse ndipo siyololedwa kukhala kampani ya inshuwaransi kapena opanga madera aliwonse aku U.S. Healthline Media sivomereza kapena kuvomereza aliyense wachitatu yemwe angachite bizinesi ya inshuwaransi.