Kodi Ndondomeko Yabwino Kwambiri ya Medicare kwa Inu Ndi Iti?

Zamkati

• Njira zosankhira dongosolo labwino pazosowa zanu
• Fufuzani mavoti a nyenyezi a CMS
• Dziwani zinthu zofunika kwambiri pamoyo wanu
• Sankhani zosowa zanu monga chithandizo chamankhwala
• Kambiranani za kuchuluka komwe mungakwanitse kulipira
• Onaninso zabwino zomwe mungakhale nazo kale
• Ganizirani kusaina ku Medicare Part D koyambirira
• Kutenga

Ngati mukusaka pafupi ndi dongosolo la Medicare Advantage chaka chino, mwina mungakhale mukuganiza kuti mapulani ake ndi abwino bwanji kwa inu. Izi zimatengera momwe zinthu zilili paumoyo wanu, zosowa zamankhwala, kuchuluka komwe mungakwanitse, ndi zina.

Pali zida zomwe zingakuthandizeni kupeza mapulani a Medicare Advantage mdera lanu omwe angakwaniritse zosowa zanu zonse.

Nkhaniyi ifufuza momwe mungapezere dongosolo labwino la Medicare Advantage pazomwe muli, komanso malangizo amomwe mungalembetsere ku Medicare.

Njira zosankhira dongosolo labwino pazosowa zanu

Ndi kusintha konse komwe kukupangidwira mapulani a Medicare pamsika, zingakhale zovuta kuti muchepetse dongosolo labwino kwambiri kwa inu. Nazi zinthu zingapo zofunika kuziyang'ana mu dongosolo la Medicare Advantage:

• ndalama zomwe zimagwirizana ndi bajeti yanu ndi zosowa zanu
• mndandanda wama intaneti omwe akuphatikizira (kapena) adotolo omwe mungafune kusunga
• Kuphunzira za ntchito ndi mankhwala omwe mukudziwa kuti mufunika
• CMS nyenyezi mlingo

Pemphani kuti muphunzire zina zomwe mungaganizire mukamagula mapulani a Medicare Advantage mdera lanu.

Fufuzani mavoti a nyenyezi a CMS

Centers for Medicare & Medicaid Services (CMS) yakhazikitsa njira ya Five-Star Rating System kuti athe kuyerekeza zaumoyo ndi mankhwala omwe amaperekedwa ndi Medicare Part C (Advantage) ndi Part D (mankhwala osokoneza bongo). Chaka chilichonse, CMS imatulutsa ziwonetserozi ndi zina zowonjezera kwa anthu.

Mapulani a Medicare Advantage ndi Gawo D amayesedwa ndi zinthu zosiyanasiyana, kuphatikiza:

• kupezeka kwa kuyezetsa zaumoyo, mayeso, ndi katemera
• kasamalidwe ka matenda aakulu
• Zomwe membala akuchita ndi dongosolo laumoyo
• kukonza mapulani ndi madandaulo amembala
• kupezeka kwa makasitomala ndi zokumana nazo
• mitengo ya mankhwala, chitetezo, ndi kulondola

Dongosolo lililonse la Medicare Part C ndi D limapatsidwa gawo lililonse mwamagawo awiriwa, gawo limodzi la nyenyezi ya Gawo C ndi D, komanso dongosolo lonse.

Malingaliro a CMS atha kukhala malo abwino kuyamba mukamagula za Medicare Advantage plan yabwino mdziko lanu. Ganizirani kufufuza mapulaniwa kuti mumve zambiri pazomwe zimaphatikizidwazo komanso mtengo wake.

Kuti muwone mavoti onse omwe alipo a Medicare Part C ndi D 2019, pitani ku CMS.gov ndikutsitsa 2019 Part C ndi D Medicare Star Ratings Data.

Dziwani zinthu zofunika kwambiri pamoyo wanu

Zolinga zonse za Medicare Advantage zimafotokoza zomwe Medicare imakhudza koyambirira - izi zimaphatikizapo kufalitsa kuchipatala (Gawo A) ndi kufotokozera zamankhwala (Gawo B).

Mukasankha dongosolo la Medicare Advantage, choyamba muyenera kuganizira za mtundu wanji wazomwe mungafune kuwonjezera pazolemba pamwambapa.

Mapulogalamu ambiri a Medicare Advantage amapereka imodzi, ngati si yonse, ya mitundu iyi yowonjezera:

• Kuphunzira mankhwala osokoneza bongo
• Kuphimba mano, kuphatikizapo mayeso a pachaka ndi njira zake
• kufotokozera masomphenya, kuphatikiza mayeso a pachaka ndi zida zowonera
• kumva nkhani, kuphatikizapo mayeso ndi zida zomvera
• mamembala olimba
• mayendedwe azachipatala
• zina zowonjezera zaumoyo

Kupeza dongosolo labwino kwambiri la Medicare Advantage kumatanthauza kupanga mndandanda wazantchito zomwe mukufuna kulandira. Mutha kutenga mndandanda wazomwe mungapeze pa Chida cha Medicare 2020 Plan ndikuyerekeza mapulani omwe amakwaniritsa zomwe mukufuna.

Ngati mupeza dongosolo lomwe likuwoneka bwino kwa inu, musawope kuyimbira kampani kuti akufunseni ngati akupatsanso zowonjezera kapena zofunikira.

Sankhani zosowa zanu monga chithandizo chamankhwala

Kuphatikiza pa kuzindikira zomwe mukufuna mu dongosolo lazachipatala, ndikofunikanso kudziwa zomwe mukufuna pazosowa zanu zanthawi yayitali.

Ngati muli ndi matenda osachiritsika kapena kuyenda pafupipafupi, zinthu izi zitha kutengera mtundu wamalingaliro omwe mungafune. Mapulani osiyanasiyana amapereka maubwino osiyanasiyana kutengera momwe mukukhalira.

Mukadongosolo ka CMS, mutha kupeza mapulani omwe amawerengedwa kwambiri pamatenda osiyanasiyana. Mapulani amawerengedwa pamtundu wa chisamaliro cha kufooka kwa mafupa, matenda ashuga, shuga wambiri, kuthamanga kwa magazi, matenda a impso, nyamakazi ya nyamakazi, matenda a chikhodzodzo, ndi chisamaliro cha achikulire (kugwa, mankhwala, kupweteka kosatha).

Mtundu wa Medicare Advantage plan womwe muli nawo ndiwofunikanso. Pali mitundu isanu yamapulani omwe muyenera kuganizira mukamafuna dongosolo:

• Mapulani a Health Maintenance Organisation (HMO). Zolingazi zimayang'ana makamaka pantchito yazaumoyo yapaintaneti.
• Mapulani a Preferred Provider Organisation (PPO). Mapulaniwa amalipira mitengo yosiyanasiyana kutengera ngati mautumikiwa ali netiweki kapena kunja kwa netiweki. ("Netiweki" ndi gulu la omwe amapereka mgwirizano wopereka chithandizo ku kampani ya inshuwaransi ndi mapulani.) Izi zitha kupereka njira zina zakulandirira kunja kwa netiweki.
• Ndalama Zoyang'anira payekha (PFFS)mapulani. Mapulaniwa amakulandirani chisamaliro kuchokera kwa omwe adzavomerezedwe ndi Medicare omwe angalandire ndalama zomwe mwalandira kuchokera ku pulani yanu.
• Ndondomeko Zofunikira Zazikulu (SNP). Izi zimapereka chithandizo chowonjezera pamankhwala omwe amathandizidwa ndi matenda ena okhalitsa.
• Akaunti ya Medicare Medical Savings (MSA)mapulani. Mapulaniwa amaphatikiza dongosolo laumoyo lomwe limachotsedwa kwambiri ndi akaunti yosungira zamankhwala.

Ndondomeko iliyonse imapereka njira zomwe mungakwaniritsire zosowa zanu zathanzi. Ngati muli ndi matenda osachiritsika, ma SNP apangidwa kuti athandizire kuchepetsa ndalama zazitali. Kumbali inayi, dongosolo la PFFS kapena MSA litha kukhala lothandiza ngati mungayende ndipo muyenera kuwona omwe akutuluka pa netiweki.

Kambiranani za kuchuluka komwe mungakwanitse kulipira

Chimodzi mwazinthu zofunika kuziganizira posankha njira yabwino kwambiri ya Medicare Advantage ndi momwe zingakulipirireni. Chida cha Pezani Chithandizo cha Medicare chikulemba mndandanda wazidziwitso zotsatirazi ndi mapulani:

• kulipira pamwezi
• Gawo B loyamba
• mu-network pachaka deductible
• mankhwala osokoneza bongo
• mkati ndi kunja kwa maukonde mthumba mthumba
• copays ndi coinsurance

Izi zimatha kuyambira $ 0 mpaka $ 1,500 ndi pamwambapa, kutengera mtundu wakunyumba, mtundu wa mapulani, ndi mapulani ake.

Kuti mupeze kuyerekezera koyambira kwa mtengo wanu wapachaka, lingalirani za premium, deductible, ndi kunja kwa thumba max.Deductible iliyonse yomwe ili pamndandanda ndi ndalama zomwe mudzakhale nazo muthumba lanu inshuwaransi yanu isanayambe. Ma max omwe ali kunja kwa thumba omwe adatchulidwa ndiye kuchuluka komwe mumalipira pantchitoyo chaka chonse.

Mukamawerengera mtengo wanu wa Advantage, ganizirani ndalamazi komanso kuchuluka kwa nthawi yomwe mufunika kudzazitsanso mankhwala omwe mumalandira kapena kuyendera ofesi.

Ngati mukufuna akatswiri kapena ochezera maukonde, onaninso ndalama zomwe zingathenso kuwerengetsa. Musaiwale kuganizira kuti ndalama zanu zitha kukhala zochepa ngati mungalandire thandizo lililonse lazandalama kuchokera kuboma.

Onaninso zabwino zomwe mungakhale nazo kale

Ngati mwalandira kale mitundu ina yazithandizo zamankhwala, izi zitha kukhala mtundu wamapulani a Medicare Advantage omwe mungafune.

Mwachitsanzo, ngati mwalandira kale Medicare yoyambirira ndipo mwasankha kuwonjezera Gawo D kapena Medigap, zosowa zanu zambiri zitha kulipidwa kale.

Komabe, nthawi zonse mumatha kuyerekezera kuti muone ngati njira ya Medicare Advantage ingagwire ntchito bwino kapena kuti ikhale yotsika mtengo kwa inu.

Ntchito yolembetsa ku Medicare imatha kuyamba miyezi itatu musanakhale ndi zaka 65. Ino ndi nthawi yabwino kuyika, chifukwa zidzaonetsetsa kuti mulandiridwa ndi 65 yanu^th tsiku lobadwa.

Mutha kudikirira kuti mulembetse ku Medicare mpaka mwezi wazaka 65 zanu^th tsiku lobadwa kapena miyezi itatu kutsatira tsiku lanu lobadwa. Komabe, kufalitsa kumatha kuchedwa mukadikirira, chifukwa chake yesetsani kuyitanitsa koyambirira.

Nayi chidziwitso chofunikira cha ofunsira chomwe muyenera kukhala nacho kuti mulembetse ku Medicare:

• malo ndi tsiku lobadwa
• Nambala ya Medicaid
• inshuwaransi yazaumoyo

Mukakhala ndi chidziwitso chofunikira pamwambapa, pitani patsamba la Social Security kuti mulembetse. Mukamaliza kugwiritsa ntchito Medicare ya wokondedwa wanu ndikuvomerezedwa, mutha kuyamba kugula pafupi ndi dongosolo la Medicare Advantage kuti likwaniritse zosowa zanu.

Ganizirani kusaina ku Medicare Part D koyambirira

Chinthu chimodzi chofunikira kudziwa ndi chakuti ngati mwalembetsa kale mu gawo la Medicare A ndi B koma simunalembetsedwe mu Gawo C, Gawo D, kapena mankhwala ena operekedwa ndi mankhwala, mutha kukumana ndi chilango chakumapeto.

Chilango ichi chimayamba ngati simunalembetse m'masiku 63 kuyambira nthawi yoyamba kulembetsa. Kulembetsa kumeneku nthawi zambiri kumakhala tsiku lanu lobadwa la 65, koma mwina kungakhale koyambirira ngati muli olumala kapena mukukumana ndi zofunikira zina.

Ngati mulandila chilango chakuchedwa, chidzagwiritsidwa ntchito ku gawo D mwezi uliwonse pamwezi.

Ngati mukuvutika kuti mupeze dongosolo la Gawo C, musayembekezere kuti mugule kufalitsa kwa Gawo D, kapena mungakhale pachiwopsezo chokhala ndi chindapusa cha Plan D.

Kutenga

Pali zinthu zambiri zomwe zingakhudze dongosolo lomwe mungasankhe la Medicare Advantage. Ganizirani kuchuluka kwa nyenyezi za CMS, zomwe mumayika patsogolo komanso zosowa zaumoyo, kuchuluka kwa zomwe mungakwanitse, ndi mtundu wanji wa inshuwaransi yomwe muli nayo pakadali pano.

Ndikofunika kulembetsa ku Medicare musanakwanitse zaka 65 kuti muwonetsetse kuti simupita popanda chithandizo chamankhwala. Musaiwale kuti muli ndi mphamvu zogulira pafupi ndi dongosolo labwino kwambiri la Medicare Advantage lomwe likugwirizana ndi zosowa zanu zonse.

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.