Ukukhetha umshwalense wezempilo akulula njengokukhetha uhlelo oluneprimiyamu ephansi kakhulu yanyanga zonke. Kwabaningi abahlala eMaryland, inselele yangempela ukuthola umshwalense ofanelana nendlela abaphila ngayo ngempela. Uchwepheshe osemusha eBaltimore angase afune isivikelo esingabizi kakhulu ngokufinyelela ekunakekelweni okuphuthumayo. Umndeni eFrederick ungadinga umshwalense osekela ukuvakasha okuvamile kodokotela, imithi kadokotela, ukunakekelwa kwamazinyo, kanye nezidingo zokubona. Umeluleki ozisebenzelayo e-Annapolis angadinga izinketho eziguquguqukayo ezingaxhomekile kumqashi.
Yingakho izinqumo zomshuwalense wezempilo zidinga okungaphezu kokuqhathanisa amanani ngokushesha. Uhlelo olufanele kufanele luhambisane nesabelomali somuntu, izidingo zezempilo, odokotela abakhethwayo, ukubekezelela izingozi, kanye nemigomo yesikhathi eside. Kufanele futhi kunikeze ukuthula kwengqondo lapho kuvela izinkinga zezokwelapha ezingalindelekile.
Izakhamuzi zaseMaryland zinokufinyelela ezinhlotsheni ezahlukene zomshwalense wezempilo, okuhlanganisa izinhlelo ezixhaswe ngumqashi, izinhlelo zemakethe, i-Medicaid, izinketho zesikhathi esifushane, umshwalense owengeziwe, izinhlelo zamazinyo, izinzuzo zokubona, kanye nezixazululo zomshwalense wezempilo wangasese. Ukukhetha okungcono kuncike ezimweni zomuntu ngamunye. Akukho uhlelo olulodwa olusebenza kahle kuwo wonke umuntu.
Kubantu abaqhathanisayo izinhlelo zomshuwalense wezempilo eMaryland, kuyasiza ukubheka ngale kobuso bese ugxila endleleni ukumbozwa okuzosebenza ngayo empilweni yansuku zonke. Uhlelo lungase lubonakale lungabizi ekuqaleni, kodwa imininingwane ephathelene nezimali ezidonswayo, amanethiwekhi abahlinzeki, imithi kadokotela, kanye nezindleko eziphuma ephaketheni kungenza umehluko omkhulu.
Nazi izinto ezibalulekile izakhamuzi zaseMaryland okufanele zizicabangele ngaphambi kokukhetha umshwalense wezempilo.
Qala Ngezidingo Zakho Zangempela Zokunakekelwa Kwempilo
Ngaphambi kokuqhathanisa izinhlelo, kubalulekile ukuqonda ukuthi hlobo luni lokunakekelwa okulindeleke ukuthi ulusebenzise. Abanye abantu bavakashela udokotela kanye noma kabili ngonyaka. Abanye badinga imithi kadokotela ejwayelekile, ukuvakashelwa ochwepheshe, ama-aphoyintimenti okwelashwa, umsebenzi webhu, noma ukunakekelwa kwesimo esingamahlalakhona.
Umuntu omdala onempilo onezidingo ezimbalwa zezokwelapha angase abeke phambili amaphrimiyamu aphansi anyanga zonke kanye nokuvikelwa okuyisisekelo ezindlekweni ezinkulu ezingalindelekile. Umndeni onezingane ungadinga ukumbozwa okuqinile kokuvakashelwa kwezingane, ukunakekelwa okuphuthumayo, imithi kadokotela, kanye nezinsizakalo zokuvimbela. Umuntu ophethe isifo sikashukela, i-asthma, isifo senhliziyo, noma esinye isimo esiqhubekayo angadinga ukufinyelela okubonakalayo kodokotela kanye nemithi.
Lesi sinyathelo sokuqala sisiza ukunciphisa usesho. Esikhundleni sokubuza ukuthi, “Yiluphi uhlelo olushibhile?” kungcono ukubuza ukuthi, “Yiluphi uhlelo oluhambisana nendlela engisebenzisa ngayo ukunakekelwa kwezempilo?”
Isibonelo, uhlelo olusezingeni eliphansi lungase lukhange, kodwa uma luhambisana nokuvakasha kochwepheshe okubiza kakhulu nokuncishisiwe, lungase lungafaneleki kahle kumuntu odinga ukunakekelwa njalo. Ngakolunye uhlangothi, uhlelo olusezingeni eliphezulu lungase lufaneleke kumuntu olindele izindleko zezokwelapha ezivamile unyaka wonke.
Izakhamuzi zaseMaryland kufanele zenze uhlu olulula ngaphambi kokuqhathanisa ukumbozwa. Faka odokotela bamanje, imithi ejwayelekile, ama-aphoyintimenti alindelekile, izinqubo ezizayo, kanye nanoma yiziphi izidingo zempilo yomndeni. Lokhu kwenza kube lula ukwahlulela ukuthi uhlelo lunikeza yini inani langempela.
Qhathanisa Okungaphezu Kwe-Premium Yanyanga Zonke
Amaphrimiyamu enyanga ngokuvamile ayinombolo yokuqala abantu abayiqaphelayo. Lokho kunengqondo ngoba amaphrimiyamu athinta isabelomali somndeni njalo ngenyanga. Kodwa-ke, iphrimiyamu iyingxenye eyodwa kuphela yezindleko eziphelele zokumbozwa kwezempilo.
Uhlelo oluneprimiyamu ephansi lungase lube ne-deductible ephezulu. Lokhu kusho ukuthi ilungu kungadingeka likhokhe imali eningi ephuma ephaketheni ngaphambi kokuba uhlelo luqale ukumboza izinsizakalo ezithile. Ezinye izindleko zingase zihlanganise ama-copay, i-coinsurance, izindleko zikadokotela, kanye ne-out-of-pocket maximum.
Isamba esiphezulu semali engenayo ephaketheni sibaluleke kakhulu. Simelela imali eningi umuntu okufanele ayikhokhele izinsizakalo ezimboziwe ngonyaka wohlelo. Kubantu abakhathazekile ngemicimbi emikhulu yezokwelapha, leli nani lingabaluleka njengeprimiyamu yanyanga zonke.
Ukuqhathanisa okuhlakaniphile kubheka isithombe esiphelele sezezimali. Izakhamuzi zaseMaryland kufanele zicabangele ukuthi yini ezizoyikhokha ngonyaka ojwayelekile nokuthi yini ezingayikhokha ngonyaka onzima. Uhlelo olubonakala lungabizi kakhulu phakathi nezinyanga ezinempilo lungase lubize kakhulu ngemva kokuvakashelwa ekamelweni eliphuthumayo, ukuhlinzwa, noma ukwelashwa okukhethekile.
Kuyasiza futhi ukucabanga ngokugeleza kwemali. Abanye abantu bakhetha iphrimiyamu ephansi futhi bakhululekile ukuthatha ingozi enkulu yokuphuma ephaketheni. Abanye bakhetha izinkokhelo eziphezulu zanyanga zonke ukuze bathole izindleko ezingalindeleka kalula lapho bethola ukunakekelwa. Ayikho indlela elungile noma engalungile ngokuzenzakalelayo. Ukukhetha okungcono kuncike ezimalini zomuntu siqu kanye nezinga lokunethezeka.
Hlola Amanethiwekhi Abahlinzeki Ngokucophelela
Ukufinyelela komhlinzeki kungenza noma kuphule uhlelo lomshuwalense wezempilo. Uhlelo lunganikeza izinzuzo ezinamandla ephepheni, kodwa uma udokotela, umtholampilo, isibhedlela, noma uchwepheshe okhethwayo engekho kunethiwekhi, izindleko zingakhuphuka ngokushesha.
Izakhamuzi zaseMaryland kufanele zihlole ukuthi abahlinzeki bazo bamanje bayahlanganyela yini kunethiwekhi yohlelo. Lokhu kubaluleke kakhulu kubantu asebevele benodokotela abathembekile noma ubudlelwano bokunakekelwa obuqhubekayo. Imindeni kufanele futhi ihlole odokotela bezingane, izikhungo zokunakekelwa okuphuthumayo, izibhedlela, amakhemisi, kanye nochwepheshe.
Usayizi wenethiwekhi kanye nokuguquguquka kubalulekile. Amanye amapulani anikeza ukufinyelela okubanzi kubahlinzeki abaningi, kanti amanye alinganiselwe kakhulu. Inethiwekhi encane ingase ibe nezindleko eziphansi, kodwa futhi inganciphisa ukukhetha. Kubantu abahamba njalo noma abahlukanisa isikhathi phakathi kwezindawo ezahlukene, ukufinyelela okubanzi kungaba wusizo kakhulu.
Izakhamuzi zasezindaweni zasemaphandleni zaseMaryland zingase zidinge ukunaka kakhulu ukutholakala kwabahlinzeki. Uhlelo olusebenza kahle kwesinye isifunda lungase lungabi lula kakhulu kwesinye. Ukufinyelela ukunakekelwa okuseduze kungathinta ukuthi umuntu ufuna ukwelashwa ngokushesha kangakanani nokuthi kulula kangakanani ukuhambisana nezikhathi ezijwayelekile.
Ngaphambi kokubhalisa, kungumqondo omuhle ukuqinisekisa ukubamba iqhaza kwenethiwekhi ngqo ngethuluzi lokusesha umhlinzeki womshwalense noma ngokushayela ihhovisi lomhlinzeki. Amanethiwekhi angashintsha, futhi ulwazi oluphelelwe yisikhathi lungaholela ezimangazweni kamuva.
Cabanga Ngokumbozwa Kwemithi Kadokotela
Ukumbozwa kwemithi kadokotela kungenye into ebalulekile ekukhetheni uhlelo lwezempilo. Ngisho nomuthi owodwa ojwayelekile ungathinta izindleko zokunakekelwa kwempilo zanyanga zonke. Kubantu abathatha imithi kadokotela eminingana, umehluko phakathi kwezinhlelo ungaba mkhulu.
Lonke uhlelo lunefomula, okuwuhlu lwemithi ehlanganisiwe. Imithi ivame ukufakwa ezigabeni eziphansi. Imithi yesigaba esiphansi ingase ibize kancane, kuyilapho imithi yesigaba esiphezulu noma ekhethekile ingase ibize kakhulu. Eminye imithi ingadinga ukugunyazwa kusengaphambili noma ukwelashwa ngesinyathelo ngaphambi kokuba kusebenze ukumbozwa.
Izakhamuzi zaseMaryland kufanele zibukeze ukuthi imithi yazo iyambozwa yini nokuthi izobiza malini. Kuyasiza futhi ukuhlola ukuthi amakhemisi akhethwayo afakiwe yini kunethiwekhi yohlelo. Amanye amapulani anikeza amanani aphansi ngamakhemisi athile noma izinketho zoku-oda ngeposi.
Lesi sinyathelo kulula ukusikhohlwa, kodwa sibalulekile. Uhlelo oluneprimiyamu ephansi lungase lungabi yinani elihle uma lungambozi kahle imithi edingekayo. Kubantu abaphatha izifo ezingamahlalakhona, ukumbozwa ngodokotela kufanele kube yinto eza kuqala.
Ungazinaki Izidingo Zamazinyo Nokubona
Izingxoxo zokumbozwa kwezempilo zivame ukugxila ekunakekelweni kwezokwelapha, kodwa izidingo zamazinyo nezokubona nazo zingathinta isabelomali somndeni. Ukuhlanza amazinyo njalo, ukugcwalisa, imiqhele, ama-braces, ukuhlolwa kwamehlo, izibuko, kanye nama-contact lens kungabiza kakhulu ngaphandle kokumbozwa.
Ezinye izinhlelo zezempilo zingase zihlanganise izinzuzo zamazinyo noma zokubona ezilinganiselwe, kodwa abantu abaningi badinga ukumbozwa okuhlukile. Imindeni enezingane ingazuza kakhulu ekubukezeni izinketho zamazinyo nezokubuka zezingane. Abantu abadala kufanele futhi bacabangele ukuthi bazisebenzisa kangaki lezi zinsizakalo.
Ukumbozwa kwamazinyo kungasiza ngokunakekelwa kokuvimbela futhi kunganciphisa izindleko zezinqubo ezihilelekile kakhulu. Ukumbozwa kwamehlo kungenza ukuhlolwa kwamehlo, amalensi, oxhumana nabo, kanye namafreyimu kube lula. Kubantu asebevele bazi ukuthi badinga lezi zinsizakalo minyaka yonke, izinhlelo zamazinyo ezihlukene kanye nezinhlelo zokubona zingaba nenani eliqinile.
Izinketho zokumbozwa kwe-USHEALTH Group eMaryland zifaka phakathi izixazululo zezempilo, zamazinyo, kanye nezokubona, ezingaba wusizo kubahlali abafuna ukubheka ukumbozwa ngokuphelele kunokugxila ezinzuzweni zezokwelapha kuphela.
Cabanga Ngesembozo Esengeziwe Ukuze Uvikeleke Okwengeziwe
Ngisho nangomshwalense wezempilo, izindleko zezokwelapha ezingalindelekile zisengadala ubunzima bezezimali. Imali edonswayo, umshwalense we-coin, izindleko zokuhamba, isikhathi sokungafiki emsebenzini, kanye nezindleko ezingamboziwe zingase zikhule ngokushesha. Ukumbozwa okwengeziwe kungasiza ekuhlinzekeni ngesivikelo esengeziwe ezimweni ezithile.
Izinhlelo ezengeziwe zingafaka phakathi ukumbozwa kwengozi, ukumbozwa kwesifo esithile, ukumbozwa kwesifo esibucayi, izinzuzo zesinxephezelo sasesibhedlela, noma ezinye izinketho zesamba. Lezi zinzuzo azithathi indawo yokumbozwa kwezokwelapha okukhulu, kodwa zingasiza ekugcwaliseni izikhala.
Isibonelo, umuntu onohlelo lwezempilo oluncishisiwe kakhulu angase afune umshwalense owengeziwe wengozi ukuze asize ngezindleko ngemva kokulimala. Umndeni onomlando wezimo ezithile zezokwelapha ungase ufune ukuvikelwa ngokwezimali okwengeziwe kokugula okungathi sína. Umuntu ozisebenzelayo angase afune umshwalense osiza ekunciphiseni umthelela wezezimali wezehlakalo zezempilo ezingalindelekile.
Inani lesembozo esengeziwe lincike ezingeni lengozi yomuntu, isabelomali, kanye nezinzuzo ezikhona. Akudingeki kuwo wonke umuntu, kodwa kungaba usizo kubantu abafuna olunye ungqimba lokuvikeleka kwezezimali.
Qondanisa Ukumbozwa Nesimo Sakho Somsebenzi
Isimo somsebenzi sidlala indima enkulu ezinqumweni zomshuwalense wezempilo. Izakhamuzi eziningi zaseMaryland zithola umshwalense ngomqashi. Abanye bangabantu abazisebenzayo, abasebenza isikhathi esithile, osonkontileka abazimele, abanikazi bamabhizinisi amancane, noma phakathi kwemisebenzi.
Abantu abanesembozo esixhaswe ngumqashi kufanele basabukeze izinketho zabo ngokucophelela ngesikhathi sokubhalisa okuvulekile. Izinhlelo zabaqashi zingashintsha unyaka nonyaka, kufaka phakathi amaphrimiyamu, ama-deductibles, amanethiwekhi abahlinzeki, kanye nesembozo sikadokotela.
Izisebenzi ezizisebenzelayo kanye nezinkontileka ezizimele zingadinga izinketho eziguquguqukayo kakhudlwana. Ngaphandle kokumbozwa ngumqashi, zingase ziqhathanise izinhlelo ezizimele, izinhlelo zemakethe, izinketho zesikhathi esifushane, noma imikhiqizo eyengeziwe. Izidingo zazo zingase zishintshe kuye ngenzuzo, usayizi womndeni, kanye nokuzinza kwebhizinisi.
Abanikazi bamabhizinisi amancane banezinye izinto okufanele bazicabangele. Ukunikeza umshwalense wezempilo kungasiza ekudonseni nasekugcineni abasebenzi, kodwa ukuphathwa kwezindleko kubalulekile. Abaqashi kungadingeka baqhathanise izinhlelo zeqembu, amasu okufaka isandla, kanye nezinketho zomshwalense ezisekela ibhizinisi kanye namalungu eqembu lalo.
Isihluthulelo ukukhetha ukumbozwa okubonisa umsebenzi wangempela kanye namaphethini emali engenayo. Uhlelo olusebenzela isisebenzi sesikhathi esigcwele lungase lungafanelani nomuntu onomholo oguquguqukayo noma oshintsha umsebenzi.
Naka Amafasitela Okubhalisa
Isikhathi sibalulekile lapho ukhetha umshwalense wezempilo. Izinhlelo eziningi zitholakala kuphela ngezikhathi ezithile zokubhalisa ngaphandle kokuthi umuntu ufanelekela isikhathi sokubhalisa esikhethekile. Ukuphuthelwa yisikhathi esibekiwe kungadala izikhala zokumbozwa noma kunciphise izinketho ezitholakalayo.
Izakhamuzi zaseMaryland kufanele zilandelele izinsuku zokubhalisa ezivulekile kanye nemithetho yokubhalisa ekhethekile. Imicimbi emikhulu yokuphila njengomshado, isehlukaniso, ukuzalwa kwengane, ukufuduka, ukulahlekelwa umsebenzi, noma ukulahlekelwa omunye umshwalense kungavumela othile ukuba abhalise ngaphandle kwefasitela elijwayelekile.
Kungcono ukuqala ukuqhathanisa ukumbozwa ngaphambi kokuba kufike isikhathi esibekiwe. Izinqumo ezisheshayo zingaholela emaphutheni. Abantu bangakhohlwa ukuhlola amanethiwekhi, banganaki izindleko zikadokotela, noma bakhethe uhlelo olusekelwe entengo ephezulu kuphela.
Ukulungiselela kusenesikhathi kwenza inqubo ibe lula. Qoqa ulwazi lwemali engenayo, imininingwane yomshuwalense wamanje, amagama abahlinzeki, uhlu lwemithi, kanye nezidingo zokunakekelwa kwempilo ezilindelekile ngaphambi kokubukeza izinhlelo.
Funa Isiqondiso Lapho Izinketho Zizwakala Zingaphezu Kwesiphetho
Umshwalense wezempilo ungadida, futhi abantu abaningi bazizwa bengaqiniseki ngalokho abakuthengayo. Lokho kuvamile. Amagama asetshenziswayo kuphela angakhungathekisa: amaphrimiyamu, ama-deductibles, umshwalense we-coinsurance, ama-copay, amanethiwekhi abahlinzeki, ama-formularies, okungafakwanga, kanye ne-out-of-pocket maximums.
Ukusebenza nomeluleki womshuwalense onelayisensi kungasiza izakhamuzi ziqonde izinketho zazo ngokucacile. Umeluleki angachaza umehluko ohlelweni, axoxe ngezinkinga zesabelomali, abukeze izidingo zomndeni, futhi asize ekutholeni ukumbozwa okuhambisana nesimo.
Lolu hlobo lokusekelwa lungaba usizo ikakhulukazi kubantu abazithengela umshwalense bebodwa, imindeni enezidingo eziningi zezempilo, izisebenzi ezizisebenzelayo, noma ubani ocabanga ngezinzuzo ezengeziwe.
Isiqondiso esihle akufanele sizizwe sicindezelwe. Kufanele sisize umuntu ukuthi enze isinqumo esinolwazi. Umgomo ukukhetha ikhava ngokuzethemba, hhayi ukudideka.
Kungani Ukumbozwa Kwezempilo Okufanele eMaryland Kubalulekile
Umshwalense wezempilo awugcini nje ngokuhlangabezana nesidingo noma ukuphatha ikhadi le-ID. Umayelana nokuvikela impilo, ezezimali, kanye nokuthula kwengqondo. Ukumbozwa okufanele kungenza kube lula ukuthola ukunakekelwa kokuvimbela, ukuphatha izimo eziqhubekayo, ukusabela ezimweni eziphuthumayo, nokugwema izikweletu zezokwelapha ezisindayo.
Kubahlali baseMaryland, uhlelo oluhle kakhulu luncike ezidingweni zomuntu siqu. Abanye abantu badinga ukufinyelela okubanzi kwabahlinzeki. Abanye badinga izindleko zanyanga zonke ezingabizi. Abanye babeka phambili imithi kadokotela, kanti abanye badinga ukuvikelwa kwamazinyo, ukubona, noma okwengeziwe. Imindeni ingadinga ukumbozwa okuhlukile kunabantu ngabanye. Izisebenzi ezizisebenzelayo zingadinga izinketho ezihlukile kunezisebenzi.
Yingakho ukuqhathanisa kubalulekile. Isinqumo esiqinile somshwalense wezempilo sibheka isithombe sonke: izindleko, ukufinyelela, izinzuzo, ukuguquguquka, kanye nokuvikelwa kwesikhathi eside.
Izakhamuzi zaseMaryland zinezinketho eziningi, kodwa ezifanele kufanele zizizwe ziwusizo empilweni yansuku zonke. Kungakhathaliseki ukuthi othile uzimboza, umlingani wakhe, izingane, noma abasebenzi, umgomo uyafana: isivikelo esithembekile esifanelana nezidingo zezempilo kanye nesabelomali.
Ukukhetha ikhava kungathatha isikhathi, kodwa kuwufanele umzamo. Uhlelo olucatshangelwe kahle lunganikeza ukwesekwa ngesikhathi sokunakekelwa okuvamile kanye nokuqinisekiswa ngezikhathi ezingalindelekile okungekho muntu ozihlelelayo.