Shirye-shiryen Magungunan California a 2021

Wadatacce

• Menene Medicare?
• Sashe na A (inpatient da asibiti)
• Sashe na B (marasa lafiya da asibiti)
• Sashe na D (ɗaukar maganin magani)
• Amfanin Medicare
• Waɗanne tsare-tsaren Amfani da Medicare suke da shi a cikin California?
• HMO
• PPO
• SNP
• Masu bayarwa a California
• Wanene ya cancanci Medicare a California?
• Yaushe zan iya yin rajista a Medicare a California?
• Lokacin yin rajista na farko
• Lokacin zaben shekara-shekara
• Amfani da Medicare Amfani a buɗe rajista
• Janar lokacin yin rajista
• Lokaci na yin rajista na musamman
• Nasihu don yin rajista a Medicare a California
• Albarkatun Medicare na California
• Shirin Inshorar Kula da Lafiya da Ba da Tallafi (HICAP)
• Medicare
• Ɗaukar hoto da ke ɗaukar ma'aikata
• Me zan yi a gaba?

Menene Medicare?

Medicare ita ce inshorar lafiya ga mutanen da shekarunsu suka wuce 65 zuwa sama. Hakanan zaka iya cancanci Medicare idan ka kasance kasa da shekaru 65 kuma kana rayuwa tare da wasu nakasa ko yanayin kiwon lafiya.

Shirye-shiryen likita a California sun hada da:

• asali Medicare: shirin inshorar lafiya na tarayya wanda Cibiyoyin Kula da Medicare & Medicaid Services ke gudanarwa (CMS)
• Amfani da Medicare: tsare-tsaren da aka bayar ta hanyar kamfanonin inshora masu zaman kansu waɗanda suka yi kwangila da CMS
• Shirye-shiryen maganin likita: inshorar tsare-tsaren da ke biyan kuɗin magani

Sashe na A (inpatient da asibiti)

Sashe na A ya shafi kulawar da kuka samu yayin kasancewa a asibitoci, asibitocin samun damar mahimmanci, da iyakantaccen lokaci a cikin ƙwararrun wuraren jinya. Yawancin mutane ba sa biyan kuɗin kowane wata don shirye-shiryen Sashe na A, amma akwai abin cire kuɗi idan an shigar da ku a asibiti.

Sashe na B (marasa lafiya da asibiti)

Sashi na B ya shafi kulawa a bayan asibiti don abubuwa kamar:

• ziyarar likitoci
• binciken bincike
• dakin gwaje-gwaje
• kayan aikin likita masu dorewa

Za ku biya ƙarin kuɗi don shirye-shiryen Sashe na B. CMS an saita farashi kuma suna canza kowace shekara bisa la'akari da ƙimar kuɗin kiwon lafiya.

Sashe na D (ɗaukar maganin magani)

Kowane mutum a kan Medicare ya cancanci (Sashe na D), amma dole ne ku sami shi ta hanyar inshorar mai zaman kansa. Yana da mahimmanci a kwatanta waɗannan tsare-tsaren saboda farashin da ɗaukar hoto sun bambanta.

Amfanin Medicare

Shirye-shiryen Amfanin Medicare (Sashe na C) ana bayar dasu ta hanyar masu inshora masu zaman kansu waɗanda ke haɗa duk ɗaukarku don sassan A da B, da kuma wani lokacin ɗaukar magungunan ƙwayoyi, zuwa tsari guda. Tare da tsare-tsaren Amfani da Medicare, har yanzu kuna biyan kuɗin Medicare Sashe na B.

Shirye-shiryen Amfanin Medicare dole ne su rufe abubuwa iri ɗaya kamar sassan Medicare A da B, amma wasu suna da ƙarin ɗaukar hoto (da ƙarin kari) don abubuwa kamar:

• hakori ko ayyukan gani
• gidajan kayan kwalliya
• isar da abinci
• sufuri zuwa da dawowa daga alƙawarin likita

Waɗanne tsare-tsaren Amfani da Medicare suke da shi a cikin California?

A cikin California, Shirye-shiryen Amfanin Medicare sun kasu kashi uku: Maungiyoyin Kula da Kiwon Lafiya (HMOs), Providungiyoyin Masu Ba da Mafifici (PPOs), da Shirye-shiryen Buƙatu na Musamman (SNPs).

HMO

Tare da HMO, ka zaɓi likita na farko wanda zai tsara kulawarka kuma ya tura ka zuwa ƙwararru kamar yadda ake buƙata. Yawancin tsare-tsaren suna buƙatar ka sami kulawa daga masu samarwa a cikin hanyar sadarwar HMO.

Kulawa ba a cikin hanyar sadarwar HMO galibi ba a rufe ta sai dai idan ta gaggawa ne, kulawa ta gaggawa daga waje, ko kuma wankan diyya.

Wasu shirye-shiryen HMO suna buƙatar ka sayi keɓaɓɓiyar magungunan ƙwaya (Sashe na D).

Samuwar shirye-shiryen HMO a cikin California ya bambanta da ƙananan hukumomi, kuma ba'a samesu ko'ina.

PPO

Tare da PPO, zaka iya samun kulawa daga cibiyoyin sadarwar likitoci da kayan aiki waɗanda ke ba da sabis waɗanda aka rufe a ƙarƙashin shirinka.

Hakanan zaka iya samun kulawa daga likita a wajen cibiyar sadarwarka, amma yawan kuɗin kashewa daga aljihu zai zama mafi girma.

Yawancin PPOs basa buƙatar gabatarwa don ganin ƙwararren masani.

California ba ta da tsarin shirin PPO na Jiha duka, amma ƙananan hukumomi 21 suna da shirye-shiryen PPO na gida.

SNP

Ana samun SNPs ga mutanen da suke buƙatar mafi girman matakin haɗin kai tare da kulawa da kulawa. Kuna iya samun SNP idan kun:

• samun rashin lafiya mai nakasa ko nakasa, kamar ciwon sukari ko ciwan zuciya mai ɗaci
• sun "cancanta biyu" don duka Medicare da Medicaid
• zama a gidan kula da tsofaffi ko makamancin haka ko kuma zama a gida amma samun kulawa daidai da wanda ke gidan kula da tsofaffi

Masu bayarwa a California

Waɗannan kamfanoni suna ba da shirye-shiryen Amfani da Medicare a California:

• Aetna Medicare
• Tsarin Lafiya jeri
• Waƙar Blue Cross
• Blue Cross na Kalifoniya
• Sabon Sabuwar Ranar
• Tsarin Kula da Kiwon Lafiya na tsakiya
• Tsarin Kiwon Lafiyar Kula da wayo
• Jihar Golden
• Health Net Community Solutions, Inc.
• Lafiya na California
• Humana
• Tsarin Lafiya na Imperial na California, Inc.
• Kaiser Dindindin
• Tsarin Kiwan Lafiya
• UnitedHealthcare
• WellCare

Ba kowane mai ɗaukar kaya ke ba da shirye-shirye a ko'ina cikin jihar ba, don haka zaɓin da kuke da shi zai bambanta dangane da yankin ku.

Wanene ya cancanci Medicare a California?

Mazaunan Kalifoniya sun cancanci shirin Medicare da Medicare Advantage idan:

• kai ɗan ƙasa ne na Amurka ko mazaunin doka a cikin shekaru 5 da suka gabata ko fiye
• shekarunka sun wuce 65 ko sama da haka, kuma kai ko abokin aure ya cika ƙa'idodi don aiki a cikin aikin tallafawa na Medicare

Mutanen da shekarunsu ba su kai 65 ba na iya cancanta idan:

• kuna da nakasa kuma karɓar inshorar nakasa na Social Security (SSDI) ko biyan kuɗin nakasa na Hukumar Railroad
• kana da amyotrophic lateral sclerosis (ALS) ko ƙarshen ƙwayar koda (ESRD)

Idan har yanzu kuna da tambayoyi game da ko kun cancanta, zaku iya amfani da kayan aikin cancanta akan layi na Medicare.

Yaushe zan iya yin rajista a Medicare a California?

Lokacin yin rajista na farko

Lokacin yin rajistar ɗaukar hoto na farko (EIP) shine watanni 7 wanda zai fara watanni uku kafin ranar haihuwar ku ta 65 kuma ya ƙare watanni 3 bayan kun cika shekaru 65. Idan kayi rajista, ɗaukar hoto zai fara a farkon watan da ka cika shekaru 65.

Idan kun jinkirta yin rajista har zuwa watan ko bayan ranar haihuwar ku, kuna iya samun gibi a cikin inshorar lafiyar ku.

Lokacin zaben shekara-shekara

Kuna iya yin rajista a cikin shirin Amfani da Medicare tsakanin Oktoba 15 da 7 ga Disamba kowace shekara. Verageaukar hoto yana farawa Janairu 1.

Amfani da Medicare Amfani a buɗe rajista

Idan kun riga kun kasance akan shirin Amfani da Medicare kuma kuna son canzawa zuwa wani shirin Amfani da Medicare ko zuwa asalin Medicare, zaku iya yin hakan tsakanin 1 ga Janairu da 31 ga Maris kowace shekara.

Janar lokacin yin rajista

Gabaɗaya rajista yana tsakanin 1 ga Janairu da 31 ga Maris kowace shekara. Idan kuna da Medicare Part A kuma kuna son yin rijista a Sashi na B, shirin Amfani da Medicare, ko ɗaukar hoto na Part D zaku iya yin hakan a wannan lokacin. Verageaukar hoto yana da tasiri Yuli 1.

Lokaci na yin rajista na musamman

Lokaci na yin rajista na musamman yana ba ku damar yin rajista a waje da lokacin yin rajista na al'ada a ƙarƙashin yanayi na musamman. Misali, lokacin yin rajista na musamman yana baka damar yin rajista a cikin sabon tsari ba tare da wani hukunci ba idan ka rasa shirin inshorar da mai daukar aiki ya dauki nauyin sa kuma kana bukatar yin rajista a Kashi na B, ko kuma ka fita daga yankin sabis din shirin ka na yanzu.

Nasihu don yin rajista a Medicare a California

Shirye-shiryen Medicare da Medicare Advantage a cikin California na iya zama mai rikitarwa, don haka kafin ku yi rajista yana da mahimmanci a kimanta abubuwan da kuka zaba da kuma kwatanta abubuwa kamar:

• halin kaka
• ɗaukar hoto
• masu samarwa da kayan aiki a cikin hanyar sadarwar shirin
• Starididdigar tauraron CMS don Sashe na C da shirin D

Idan kuna buƙatar taimako don tantance waɗanne tsare-tsare ne mafi kyau don bukatunku ko kuna da tambayoyi game da wadatattun zaɓuɓɓuka, akwai wadatattun albarkatu don taimaka muku.

Albarkatun Medicare na California

Shirin Inshorar Kula da Lafiya da Ba da Tallafi (HICAP)

Ma'aikatar tsufa ta California tana ba da shawarwari game da Medicare ta hanyar HICAP. Suna bayar da:

• bayani game da rajistar Medicare
• bayani game da sassan A, B, da C, da kuma yadda za'a tantance wane ɗaukar hoto kake buƙata
• amsoshi ga tambayoyi game da sashin maganin likita na Sashi na D, farashi, da cancanta

HICAP amintacce ne kuma kyauta ga duk wanda ya cancanci Medicare ko kuma ya kusan cancanta. Kuna iya bincika ayyukan HICAP na gida ta hanyar gunduma ko kira 800-434-0222.

Medicare

Tuntuɓi Medicare kai tsaye don taimako tare da yin rajista ko shirya tambayoyi ta hanyar kiran 800-MEDICARE (800-633-4227) ko ziyarci medicare.gov. Hakanan zaka iya kiran ofishin CMS na yanki a San Francisco a 415-744-3501.

Ɗaukar hoto da ke ɗaukar ma'aikata

Idan kuna da damuwa ko kuna buƙatar taimako game da ɗaukar lafiyar Medicare California da aka siya ta hannun mai aiki, tuntuɓi Ma'aikatar Kula da Kiwon Lafiya ta California a 888-466-2219 ko imel [email protected].

Me zan yi a gaba?

Lokacin da kake shirye don yin rajista don Medicare a California:

• ƙayyade wane ɗaukar hoto kake buƙata da bincika tsare-tsaren da ake da su, zaɓuɓɓukan ɗaukar hoto, da tsada
• tuntuɓi HICAP ko Medicare idan kuna da tambayoyi game da cancanta ko ɗaukar hoto
• gano lokacin da lokacin yin rajista na gaba zai fara

An sabunta wannan labarin a watan Oktoba 5, 2020 don yin tunani game da 2021 bayanin Medicare.

Bayanin da ke wannan gidan yanar gizon na iya taimaka muku wajen yanke shawara na kanku game da inshora, amma ba a nufin ba da shawara game da sayan ko amfani da kowane inshora ko samfuran inshora. Media na Lafiya ba ya canza kasuwancin inshora ta kowace hanya kuma ba shi da lasisi a matsayin kamfanin inshora ko mai samarwa a cikin kowane ikon Amurka. Media na Lafiya ba ya ba da shawara ko amincewa da wani ɓangare na uku da zai iya ma'amala da kasuwancin inshora.