What Does Health Insurance Cover?

Kodi inshuwaransi yazaumoyo imapereka chiyani? Mlangizi wa Forbes

Zolemba mkonzi: Timalandira ndalama kuchokera ku maulalo a anzathu pa Forbes Advisor. Magulu sasintha malingaliro a akonzi kapena mavoti.

Inshuwaransi yaumoyo ndi chinthu chomwe aliyense amafunikira. Dongosolo labwino la inshuwaransi yazaumoyo ndilofunika kwambiri kuti mupeze chithandizo chamankhwala chomwe mukufuna pamtengo womwe mungakwanitse.

Mukamvetsetsa momwe inshuwaransi yaumoyo imagwirira ntchito, mudzakhala okonzeka bwino kuti mupeze inshuwaransi yabwino kwambiri pazosowa zanu. Pansipa pali kufotokozedwa kwazinthu zofunika kwambiri za dongosolo la inshuwaransi yazaumoyo.

Kodi inshuwaransi yazaumoyo imapereka chiyani?

Inshuwaransi yazaumoyo imakhudza ntchito zambiri, njira, ndi chithandizo. Nazi zitsanzo za zomwe inshuwaransi yazaumoyo nthawi zambiri imaphimba.

Kuyendera chipatala ndi madokotala

Inshuwaransi yazaumoyo imalipira mtengo woyendera kuti mukawone dokotala wanu wamkulu, akatswiri ndi ena azachipatala. Zimakhudzanso nthawi yomwe muli ndi mwayi wopeza chithandizo chamankhwala kuchipatala, kaya ndi chithandizo chadzidzidzi, maopaleshoni, chisamaliro chakunja, njira kapena kugona usiku wonse.

Mutha kukhala ndi udindo wochotsera mapulani, malipiro a co-pay, ndi ndalama za coinsurance. Koma bola mutakhala pa intaneti ndipo chisamaliro chanu chikuwoneka kuti ndi chofunikira pamankhwala, dongosolo lanu la inshuwaransi yazaumoyo liyenera kutenga gawo la mkango wa mtengowo mukagunda deductible yanu.

Phindu la thanzi labwino

Pamene Affordable Care Act idaperekedwa, idawonetsetsa kuti mapulani omwe amaperekedwa pamsika wa inshuwaransi yazaumoyo akwaniritsa zosachepera 10 zabwino izi:

  • Ma Ambulatory Patient Services
  • Ntchito zadzidzidzi
  • Chithandizo chachipatala
  • Chithandizo cha matenda amisala komanso kugwiritsa ntchito mankhwala osokoneza bongo, kuphatikiza chithandizo chamakhalidwe
  • Ntchito za ana, kuphatikiza chisamaliro chapakamwa ndi masomphenya (mano akulu akulu ndi masomphenya osafunikira)
  • Mimba, uchembere ndi chisamaliro chakhanda
  • Mankhwala olembedwa
  • Ntchito zodzitetezera komanso zaumoyo (kuphatikiza ma jakisoni ndi ntchito zowunikira) komanso kasamalidwe ka matenda osatha
  • Ntchito za Laboratory
  • Ntchito zokonzanso ndi kukonzanso ndi zida

Mapulani a inshuwaransi yazaumoyo ayeneranso kutsata njira zolerera komanso zoyamwitsa.

Ntchito Zoteteza

Mapulani a inshuwaransi yazaumoyo akuyenera kukupatsirani ntchito zina zodzitetezera popanda mtengo kwa inu. Izi zikutanthauza kuti sizingatheke kulipira co-pay kapena co-inshuwaransi.

Ntchitozi zikhoza kugawidwa m’magulu atatu: akuluakulu onse, amayi ndi ana.

Ntchito zodzitetezera ndizofunikira kwa akulu onse

Ntchito zodzitetezera zofunika kwa amayi

Ntchito zodzitetezera zofunika kwa ana

malangizo azachipatala

Mapulani ambiri a inshuwaransi yazaumoyo amafunikira kuti apereke chithandizo chamankhwala operekedwa ndi dokotala, koma mankhwala omwe amaperekedwa amasiyanasiyana ndi inshuwaransi.

Dongosolo lanu lili ndi kabuku kake ka maphikidwe kapena mndandanda wamankhwala ovomerezeka. Mutha kupeza mndandandawu patsamba la kampani ya inshuwaransi yazaumoyo. Mndandandawu uyeneranso kukhala mbali ya zolemba zomwe kampani ya inshuwaransi imakupatsirani. Mutha kulumikizananso ndi kampani yanu ya inshuwaransi kuti mudziwe mankhwala omwe ali pamndandanda.

Nthawi zina, zitha kukhala zotheka kupeza zina kuchokera kukampani yanu ya inshuwaransi kuti mulipire mankhwala omwe mulibe m’mapangidwe ake. Izi ndizotheka makamaka ngati palibe mankhwala omwe ali mu formulary omwe angathe kuchiza matenda anu. Lumikizanani ndi kampani yanu ya inshuwaransi kuti mudziwe zambiri.

Zomwe zidalipo kale

Ma inshuwaransi azaumoyo omwe amagulitsa inshuwaransi yazaumoyo m’mbuyomu sankafuna kubweza chithandizo chokhudzana ndi zomwe zidalipo kale, vuto lomwe adakumana nalo kale asanafune kapena kugula inshuwaransi yaumoyo. Makampani a inshuwaransi akhoza kukana kuperekedwa kapena kulipiritsa ndalama zambiri.

Izi zidasintha ndi gawo la Affordable Care Act. Ma inshuwaransi azaumoyo sangathenso kukana kuperekedwa kapena kulipiritsa chindapusa chochulukirapo chifukwa chozindikira kuti analipo kale.

Kodi inshuwaransi yazaumoyo imapereka chiyani?

Inshuwaransi yazaumoyo silipira chilichonse. Zotsatirazi ndi zitsanzo za chithandizo chamankhwala chomwe sichingaganizidwe.

njira zodzikongoletsera

Njira zodzikongoletsera zimaphatikizapo zinthu zomwe zimapanganso mbali zina za thupi, makamaka ndi cholinga chowongolera maonekedwe.

Inshuwaransi yazaumoyo nthawi zambiri sipereka chithandizo chamtunduwu, ngakhale kuti mapulani ena atha kuphimba njira zodzikongoletsera ngati zili zofunika kuchipatala.

Chithandizo cha chonde

Chithandizo cha chonde sichiri m’gulu lazinthu zofunikira zaumoyo zomwe boma la feduro limatsimikizira, ndipo makampani ambiri a inshuwaransi samapereka chithandizo chamankhwala otere.

Koma maiko ena amafuna makampani a inshuwaransi kuti apereke zina mwazinthu izi.

Zaukadaulo zatsopano pazogulitsa kapena ntchito

Zikuoneka kuti makampani ambiri a inshuwaransi angakane kupereka chithandizo chamankhwala choyesera kapena chosavomerezeka chomwe chimaphatikizapo ukadaulo watsopano.

Musanagwiritse ntchito mankhwala atsopanowa, onetsetsani kuti kampani yanu ya inshuwaransi ndiyokonzeka kubweza njira yatsopanoyi.

Zolemba zopanda label

Dongosolo lopanda chizindikiro limatanthauza kuti mankhwalawa akugwiritsidwa ntchito m’njira yomwe sinavomerezedwe ndi U.S. Food and Drug Administration.

Kampani yanu ya inshuwaransi ikhoza kubisa kapena kusapereka mankhwala omwe amagwiritsidwa ntchito mwanjira imeneyi, chifukwa chake ndikofunikira kulankhula ndi kampani yanu ya inshuwaransi kuti muwonetsetse kuti mankhwalawa aperekedwa.

Zoyenera kuchita ngati inshuwaransi yanu yaumoyo siyikulipira malonda kapena ntchito

Mapulani ena a inshuwaransi yazaumoyo sangakwaniritse zomwe mukufuna. Kumvetsetsa kufalikira kwanu momwe mungathere kudzakuthandizani kupewa zodabwitsa.

Ndizothekanso kuti kampani yanu ya inshuwaransi yazaumoyo ikukana kupatsidwa chiwongola dzanja mutatha kugwiritsa ntchito chinthu kapena ntchito. Izi zikachitika, ndipo mukukhulupirira kuti muli ndi chidziwitso chomwe chikugwira ntchito, muli ndi ufulu wopempha apilo wamkati, pomwe kampani ya inshuwaransi imayang’anitsitsa chigamulo chake.

Ngati zonena zanu sizikuvomerezedwa, mutha kupempha kuwunikanso kwakunja, komwe munthu wina adzakhala ndi chigamulo chomaliza pakudandaula.

Kodi pali kufunikira kwachipatala?

Makampani a inshuwaransi yazaumoyo amagwiritsa ntchito mawu oti “zofunikira zamankhwala” pofotokoza ntchito zomwe amapereka. Monga lamulo, makampani a inshuwaransi adzalipira osachepera gawo la mtengo wa mautumiki omwe amakwaniritsa tanthauzo ili. Nthawi zambiri ntchitoyo iyenera kukhala “yofunikira pazachipatala” isanaphimbidwe.

Kufunitsitsa kwa dokotala kunena kuti ntchitoyo ndi “yofunikira pazachipatala” ingathandize kutsimikizira kampani ya inshuwaransi kuti ntchitoyo ndiyofunikira.

Zinthu zina zofunika kuziganizira za inshuwaransi yazaumoyo

Kumvetsetsa momwe inshuwaransi yanu yaumoyo imagwirira ntchito ndikofunikira kuti mupewe zolakwika zomwe zingawononge ndalama zambiri. Nawa mawu ena oti mumvetsetse:

zilolezo zisanachitike

Ma inshuwaransi azaumoyo amagwiritsa ntchito njira yovomerezera kale kuti asankhe ngati mankhwala, njira, kapena ntchito ndizofunikira pachipatala.

Izi zikutanthauza kuti muyenera kupeza chilolezo chodziwitsidwa musanachite izi zachipatala. Ngati simutero, mutha kukhala ndi udindo pa bilu yonse.

Mu-network vs. off-grid

Madokotala, zipatala, ndi othandizira ena azachipatala omwe amavomereza kuvomereza inshuwaransi yanu yaumoyo amadziwika kuti “in-network” opereka chithandizo. Magulu ena onse ndi ‘opanda grid’.

Mapulani ena a inshuwaransi, monga Health Maintenance Organisation (HMO) ndi Exclusive Provider Organisation (EPO) mapulani, nthawi zambiri samalipira omwe amapereka kunja kwa intaneti. Izi zikutanthauza kuti mudzakhala m’mavuto pazowononga zonse zomwe zawonongeka.

Nthawi zina, dongosololi lidzalipira ndalama zina, koma nthawi zambiri pamtengo wotsika kwambiri kuposa mabungwe a “in-network”. Izi ndizomwe zimachitika pa mapulani a Preferred Provider Organisation (PPO) ndi Points of Service (POS).

Mtengo wa mankhwala

Mapulani a inshuwaransi yazaumoyo nthawi zambiri amalipira mtengo wamankhwala omwe amaperekedwa ndi dokotala. Izi sizikutanthauza kuti adzaphimba mankhwala onse, choncho onetsetsani kuti mukumvetsa zomwe mankhwala amaphimbidwa komanso mlingo wake.

malipiro ogwirizana

Kulipiritsa limodzi ndi ndalama zokhazikika zomwe mungakhale nazo ngongole kuti mukakumane ndi wosamalira, kukayezetsa labu, kapena kulandira mankhwala olembedwa. Kawirikawiri, kulipira limodzi kukawonana ndi katswiri kapena kupita kuchipinda chodzidzimutsa ndi okwera mtengo kuposa kupita kwa wothandizira wamkulu kapena kupita kumalo osamalira anthu mwamsanga.

kuchotsera (kuchotsera

Inshuwaransi yazaumoyo ndiyo ndalama zomwe muyenera kulipira m’thumba chaka chilichonse pazachipatala inshuwaransi yanu isanayambe. Ma deductibles amatha kukhala okwera, nthawi zambiri masauzande a madola.

Makampani ena a inshuwaransi amalipira ntchito zina musanakumane ndi deductible yanu. Fufuzani ndi kampani yanu ya inshuwaransi kuti muwone ngati ikupereka izi.

Kuphatikiza apo, mapulani onse omwe amagulitsidwa pamsika amayenera kulipira mtengo wonse wazinthu zina zodzitetezera musanakwaniritse kuchotsera kwanu.

Ndalama zanu zochotsedwa zikakwaniritsidwa, kampani ya inshuwaransi yazaumoyo idzakulipirani zina mwa ndalamazo ndipo mudzatolera zotsalazo. Izi zimatchedwa inshuwaransi yolumikizana.

inshuwaransi ya ndalama

Co-inshuwalansi ndi kuchuluka kwa ndalama zothandizira zaumoyo zomwe muli ndi udindo wolipira mukangopeza ndalama zanu.

Mwachitsanzo, ngati coinsurance yanu ndi 20% ndipo mumalipira $ 100 pa chithandizo chamankhwala, muli ndi ngongole $20.

Inshuwaransi yaumoyo imabwera ndi ndalama zambiri zomwe zimatha kutulutsidwa chaka chilichonse. Ndalamazi nthawi zambiri zimakhala madola masauzande angapo. Mukangotuluka m’thumba lanu, simudzakhala ndi udindo pa ndalama zothandizira zaumoyo kwa chaka chonse. HMO imalipira ndalama zonse mukalandira chisamaliro.

Pezani makampani abwino kwambiri a inshuwaransi yazaumoyo mu 2022

Mafunso Omwe Amafunsidwa Kawirikawiri Okhudza Inshuwaransi Yaumoyo

Kodi inshuwaransi yazaumoyo ndiyofunikadi?

Ntchito zothandizira zaumoyo zitha kukhala zodula, kotero pafupifupi aliyense angapindule ndi inshuwaransi yazaumoyo.

Kugula inshuwaransi yazaumoyo pamsika wa Affordable Care Act (ACA) ndikotsika mtengo kuposa momwe mukuganizira, chifukwa cha thandizo lochepetsera ndalama la boma kwa mamiliyoni aku America. Mapindu amenewa amadalira ndalama za banja lanu.

Kodi choyipa kwambiri ndi chiyani chomwe chingachitike ngati ndilibe inshuwaransi yazaumoyo?

Popanda inshuwaransi yazaumoyo, mutha kukhala ndi udindo pazolipira zanu zonse zaumoyo. Nthawi zina, izi zingakhale zowononga ndalama.

Boma la federal linanena kuti kungochiritsa mwendo wothyoka kumawononga ndalama zokwana madola 7,500. Masiku atatu mchipatala angakuwonongereni $30,000.

Izi ndi zotsika mtengo poyerekeza ndi mazana masauzande a madola zomwe zikanafunika kuti muchiritse matenda owopsa kwambiri ngati mulibe inshuwaransi yazaumoyo.

Kodi chipatala chingandikane chisamaliro ngati sindilipidwa ndi inshuwaransi yazaumoyo?

Chipinda chodzidzimutsa sichingakane kuchiza munthu chifukwa chakuti wodwalayo alibe inshuwaransi yaumoyo, malinga ngati chisamaliro chomwe munthuyo akufunikira chikukwaniritsa zofunikira zadzidzidzi.

Munthu angalipitsidwebe pazintchito zoterezi. Kuonjezera apo, pamene mwadzidzidzi kutha, chipatala chikhoza kutulutsa kapena kusamutsa wodwalayo.

Kodi inshuwaransi yazaumoyo ndi ndalama zingati?

Malipiro a mwezi uliwonse a inshuwaransi yazaumoyo pa pulani ya Bronze pamsika ndi $928, $1,217 ya pulani ya Siliva, ndi $1,336 ya pulani ya Golide.

Mtengo weniweni wa inshuwaransi yaumoyo umasiyanasiyana kutengera zinthu zingapo, kuphatikiza zaka zanu, malo, kampani ya inshuwaransi, ndi mtundu wa mapulani. Ma inshuwaransi azaumoyo sangagwiritse ntchito jenda kapena thanzi lanu komanso zomwe zidalipo kale pokhazikitsa mitengo.


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