Kodi pali kusiyana kotani pakati pa Medicare Advantage PPO ndi HMO Plans?

Zamkati

• Kodi Medicare Advantage PPO ndi chiyani?
• Momwe imagwirira ntchito
• Zomwe zimaphimba
• Avereji ya ndalama
• Ndalama zina
• Kodi Medicare Advantage HMO ndi chiyani?
• Momwe imagwirira ntchito
• Zomwe zimaphimba
• Avereji ya ndalama
• Ndalama zina
• Tchati chofanizira cha PPO ndi HMO
• Momwe mungasankhire zomwe zili zabwino kwa inu
• Othandizira
• Kuphunzira
• Mtengo
• Kupezeka
• Kutenga

Medicare Advantage (Gawo C) ndi njira yotchuka ya Medicare kwa opindula omwe akufuna njira zawo zonse zothandizirana ndi Medicare pansi pa pulani imodzi. Pali mitundu yambiri yamalingaliro a Medicare Advantage, kuphatikiza Health Maintenance Organisations (HMOs) ndi mabungwe omwe amapereka kwa Preferred Provider Organisations (PPOs).

Mapulani onse a HMO ndi PPO amadalira kugwiritsa ntchito ma intaneti. Komabe, mapulani a PPO amapereka kusinthasintha pobisalira omwe amapereka ma network pamtengo wokwera. Pakhoza kukhalanso kusiyana pakupezeka, kufalitsa, ndi mtengo pakati pamitundu iwiri yamapulani.

Munkhaniyi, tiona zakusiyana pakati pa Medicare Advantage PPO ndi mapulani a HMO ndi momwe mungadziwire mtundu wamalingaliro omwe angakhale oyenera pazosowa zanu.

Kodi Medicare Advantage PPO ndi chiyani?

Madongosolo a Medicare Advantage PPO amapatsa wothandizirayo kusinthasintha kwa iwo omwe amawafuna, ngakhale atakhala okwera mtengo.

Momwe imagwirira ntchito

Zolinga za PPO zimakhudza onse omwe ali ma netiweki komanso kunja kwa ma netiweki, madokotala, ndi zipatala. Mulipira Zochepa mautumiki ochokera kwa omwe ali pa intaneti komanso Zambiri mautumiki ochokera kwa omwe akutuluka kunja kwa netiweki. Pansi pa pulani ya PPO, kusankha sing'anga woyang'anira (PCP) sikofunikira ndipo palibe kutumizidwa kukayendera akatswiri.

Zomwe zimaphimba

Mapulani a PPO nthawi zambiri amakhala ndi ntchito zonse zomwe Medicare Advantage amakonzera, kuphatikizapo:

• inshuwaransi ya chipatala
• inshuwaransi ya zamankhwala
• Kuphunzira mankhwala osokoneza bongo

Ngati mulandila zipatala kapena chithandizo chamankhwala pansi pa pulani ya PPO, kugwiritsa ntchito ma intaneti kungakuthandizeni kupewa kulipira ndalama zambiri. Popeza dongosolo lililonse la Medicare Advantage PPO ndi losiyana, muyenera kufufuza mapulani omwe aperekedwa mdera lanu kuti mupeze zomwe zikupezeka mu dongosolo lililonse.

Avereji ya ndalama

Mapulani a Medicare Advantage PPO ali ndi zotsatirazi:

• Ndondomeko yapadera. Ndalamazi zimatha kuyambira $ 0 mpaka avareji ya $ 21 pamwezi mu 2021.
• Gawo B loyamba. Mu 2021, gawo lanu loyambirira la B ndi $ 148.50 pamwezi kapena kupitilira apo, kutengera zomwe mumapeza.
• Maukonde odulidwa. Malipirowa nthawi zambiri amakhala $ 0 koma atha kukhala okwera mpaka $ 500 kapena kupitilira apo, kutengera mtundu womwe mukulembetsa.
• Mankhwala osokoneza bongo. Izi zimatha kuyamba $ 0 ndikuwonjezeka kutengera dongosolo lanu la PPO.
• Zokopa. Ndalama izi zimatha kusiyanasiyana kutengera ngati mukuwona dokotala woyang'anira kapena katswiri ndipo ngati mautumikiwa ali mu netiweki kapena kunja kwa netiweki.
• Coinsurance. Ndalamayi nthawi zambiri imakhala 20 peresenti ya ndalama zomwe Medicare imavomereza mukalandira deductible.

Mosiyana ndi Medicare yoyambirira, mapulani a Medicare Advantage PPO amakhalanso ndi mthumba. Ndalamayi imasiyanasiyana koma nthawi zambiri imakhala pakati pa masauzande.

Ndalama zina

Ndi pulani ya PPO, mudzakhala ndi ngongole zowonjezera pakuwona omwe ali kunja kwa netiweki. Izi zikutanthauza kuti ngati mungasankhe PCP, pitani kuchipatala, kapena mukalandire chithandizo kuchokera kwa omwe sakupezeka pa netiweki yanu ya PPO, mutha kulipira ndalama zowerengera zoposa zomwe zalembedwa pamwambapa.

Kodi Medicare Advantage HMO ndi chiyani?

Madongosolo a Medicare Advantage HMO samapereka mwayi kwa othandizira, kupatula zovuta zamankhwala zadzidzidzi.

Momwe imagwirira ntchito

Zolinga za HMO zimakhudza opereka ma netiweki, madotolo, ndi zipatala zokha, kupatula za chithandizo chamankhwala chadzidzidzi kapena chisamaliro chapadera chapafupi ndi dialysis. Nthawi zina, mutha kugwiritsanso ntchito othandizira omwe ali kunja kwa netiweki, koma mumalipira 100% ya ntchito zanu.

Pansi pa dongosolo la HMO, mukuyenera kusankha PCP yapaintaneti ndipo mudzafunikanso kutumizidwa kukayendera akatswiri pa intaneti.

Zomwe zimaphimba

Monga mapulani a PPO, mapulani a HMO amakwaniritsa ntchito zonse zomwe Medicare Advantage amakonza, kuphatikiza:

• inshuwaransi ya chipatala
• inshuwaransi ya zamankhwala
• Kuphunzira mankhwala osokoneza bongo

Mukapita kuchipatala kapena kuchipatala, muyenera kusankha pamndandanda wa omwe ali mu intaneti omwe HMO yanu ikukonzekera. Ngati mungafune ntchito kunja kwa mindandanda ya omwe amakupatsani ma netiweki, mungafunike kulipira ndalama zonse pazantchitozo.

Komabe, munthawi zadzidzidzi, monga poyenda, mutha kuphimbidwa kutengera ndi dongosolo lanu.

Avereji ya ndalama

Mapulani a Medicare Advantage HMO ali ndi mtengo wofanana ndendende monga mapulani a PPO, kuphatikiza dongosolo la mwezi ndi ndalama za Part B, zochotseredwa, ndi zolipiritsa komanso ndalama zandalama. Monga momwe lamulo likufunira, dongosolo lanu la HMO lidzakhalanso ndi ndalama zokwanira kutuluka chaka ndi chaka pazomwe mumalipira.

Ndalama zina

Popeza mapulani a HMO amafunikira kuti mupeze ntchito mu netiweki, simukuyenera kuthana ndi ndalama zowonjezera pokhapokha mutasankha kugwiritsa ntchito omwe amapereka ma network. Zikachitika mwadzidzidzi, mungakhale ndi ngongole zowonjezera, koma muyenera kuyang'anitsitsa dongosolo lanu kuti muwone ndalama zake.

Tchati chofanizira cha PPO ndi HMO

Pali zofanana zambiri pakati pa Medicare Advantage PPO ndi mapulani a HMO, monga mtengo wama premiums, zochotseredwa, ndi zolipira zina. Kusiyana kwakukulu pakati pa mitundu iwiri yamapulani makamaka kumangotengera kufalitsa ndi mtengo wa maukonde ndi ma network.

Pansipa pali tchati chofananizira zomwe dongosolo lililonse limapereka malinga ndi kufotokozera ndi mtengo wake.

Ngakhale mutasankha mtundu wanji wamankhwala a Medicare Advantage, nthawi zonse muziyang'anitsitsa zomwe mungasankhe ndi mtengo wogwirizana ndi pulani yomwe mwasankha. Chifukwa mapulani a Advantage amaperekedwa ndi makampani azinsinsi za inshuwaransi, amatha kusiyanasiyana pazomwe angapereke komanso zomwe angafune kulipiritsa.

Momwe mungasankhire zomwe zili zabwino kwa inu

Kusankha dongosolo labwino kwambiri la Medicare Advantage kumadalira kwathunthu momwe muliri azachipatala komanso azachuma. Zomwe zimagwirira ntchito munthu wina sizingagwire ntchito kwa inu, chifukwa chake ndikofunikira kuti mufufuze za mapulani am'dera lanu.

Nazi zinthu zingapo zofunika kuziganizira mukamasankha kulowa mu PPO kapena HMO Advantage.

Othandizira

Ngati mumayang'ana kusinthasintha kwa omwe amapereka, pulogalamu ya PPO ikhoza kukhala yothandiza kwa inu, chifukwa imapereka mwayi wopezeka pa intaneti komanso kunja kwa netiweki. Komabe, izi zitha kukhala mwayi kwa inu ngati muli ndi ndalama zokayendera omwe amakupatsani ma netiweki, chifukwa ngongole zamankhwala izi zimatha kuwonjezera msanga.

Ngati muli bwino pogwiritsa ntchito okhawo omwe ali ndi ma netiweki, dongosolo la HMO limakupatsani mwayi wokhala mumanetiweki popanda ndalama zina zowonjezera.

Kuphunzira

Mwalamulo, mapulani onse a Medicare Advantage akuyenera kukhudzanso Medicare Part A ndi Part B. Kuphatikiza apo, pafupifupi mapulani onse a Advantage amakhalanso ndi mankhwala, masomphenya, ndi ntchito zamano. Zosankhazi ndizofotokozera dongosolo lililonse, koma nthawi zambiri pamakhala kusiyana kwakukulu pakati pazosankha za PPO ndi mapulani a HMO Advantage.

China choyenera kuganizira ndikuti ngati kufalitsa komwe kumaperekedwa ndi mapulani a PPO ndi HMO kungakhudzidwe ndi matenda anu. Mwachitsanzo, akuwonetsa kuti anthu omwe ali ndi matenda osachiritsika amatha kusiya mapulani a HMO ndikulembetsa mitundu ina yamaphunziro azaumoyo, monga.

Mtengo

Mapulani a Medicare Advantage PPO ndi HMO atha kukhala amasiyana pamitengo yawo kutengera momwe mukukhalira komanso mtundu wanji wazolemba zomwe mukufuna. Ziribe kanthu mtundu womwe mungasankhe, zopereka zonse zimatha kulipiritsa ndalama zolipirira, zochotseredwa, zolipiritsa, komanso ndalama zandalama. Kuchuluka kwa malipirowa kumatengera dongosolo lomwe mwasankha.

Komanso, ganizirani kuti pakhoza kukhala ndalama zowonjezera zogwirizana ndi pulani yanu kutengera ndi omwe akukupatsani mwayi. Mwachitsanzo, ngati mungayendere wopita kunja kwa netiweki pa pulani ya PPO, mudzalipira zambiri mthumba pazantchitozo.

Kupezeka

Ndondomeko za Medicare Advantage ndizokhazikika, kutanthauza kuti muyenera kulembetsa boma lomwe mukukhala ndikulandila chithandizo chamankhwala. Izi zikutanthauza kuti mapulani a PPO ndi HMO atha kukhala osiyana kutengera komwe mumakhala.

Makampani ena abizinesi amangopereka mtundu umodzi wamapulani, pomwe ena amakhala ndi nyumba zingapo zoti asankhe. Komwe mukukhala ndikuwonetsetsa kuti mapulani, kupezeka, ndi mtengo wamtundu uliwonse wamapulani a Medicare Advantage omwe mungasankhe.

Kutenga

Mapulani a Medicare Advantage PPO ndi HMO ndi njira yabwino kwambiri ya inshuwaransi kwa anthu omwe akufuna kulandira chithandizo cha Medicare pansi pa dongosolo limodzi la ambulera.

Ngakhale pali kufanana pakati pa mitundu iwiri yamapulani, palinso kusiyana pakupezeka, kufalitsa, ndi mtengo. Mukamasankha dongosolo labwino kwambiri la Medicare Advantage kwa inu, onetsetsani kuti mukuganizira zomwe amakupatsani, momwe ndalama ziliri, ndi zosowa zamankhwala.

Nthawi zonse mukakonzekera dongosolo la Medicare Advantage, pitani ku chida chopeza mapulani a Medicare kuti mumve zambiri zamapulani mdera lanu.

Nkhaniyi idasinthidwa pa Novembala 17, 2020, kuti iwonetse zambiri za 2021 Medicare.

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.