Menene Medicare? Duk abin da kuke buƙatar sani game da kayan aikin likita

Wadatacce

• Menene Medicare?
• Sashin Kiwon Lafiya A
• Sashin Kiwon Lafiya na B
• Medicare Kashi na C
• Sashin Kiwon Lafiya na D
• Madigap
• Menene Medicare ke rufewa?
• Sashe na A ɗaukar hoto
• Sashe na B ɗaukar hoto
• Sashe na C ɗaukar hoto
• Sashe na D ɗaukar hoto
• Mitar Medigap
• Cancanta don Medicare
• Shiga cikin Medicare
• Menene farashin?
• Sashi na A farashin
• Kudin B na kudi
• Sashi na C farashin
• Sashi na D farashin
• Kudaden Medigap
• Menene bambanci tsakanin Medicare da Medicaid?
• Takeaway

• Medicare zaɓi ne na inshorar lafiya ga samari masu shekaru 65 da haihuwa da waɗanda ke da wasu larura ko nakasa.
• Na asaliMedicare (sassan A da B) sun rufe mafi yawan asibitocinku da bukatun likita.
• Sauran sassanMedicare (Sashe na C, Sashe na D, da Medigap) shirye-shiryen inshora ne mai zaman kansa wanda ke ba da ƙarin fa'idodi da sabis.
• Kudaden Medicare na wata-shekara da na shekara-shekara sun hada da na zamani, rarar kudi, biyan kudi, da kuma biyan kudi.

Medicare zaɓi ne na inshorar kiwon lafiya na gwamnati wanda ke samarwa ga Amurkawa waɗanda ke da shekaru 65 da tsufa da waɗanda ke da wasu mawuyacin yanayin lafiya da nakasa. Akwai zaɓuɓɓuka daban-daban don ɗaukar hoto na Medicare, saboda haka yana da mahimmanci a fahimci wane nau'in ɗaukar hoto kowane shiri zai iya ba ku.

A cikin wannan labarin, zamu bincika duk abin da zamu sani game da kayan aikin Medicare, daga ɗaukar hoto, zuwa farashi, zuwa rajista, da ƙari.

Menene Medicare?

Medicare shiri ne na gwamnati wanda ke ba da inshorar lafiya ga Amurkawan da ke da shekaru 65 da sama. Wasu mutanen da shekarunsu suka gaza 65 kuma suna da yanayin rashin lafiya na yau da kullun ko naƙasa suma na iya cancanta don ɗaukar nauyin Medicare.

Medicare ya ƙunshi "sassa" da yawa waɗanda zaku iya shiga don nau'ikan ɗaukar hoto na kiwon lafiya daban-daban.

Sashin Kiwon Lafiya A

Sashin Kiwon Lafiya na A, wanda kuma aka fi sani da inshorar asibiti, yana ɗaukar sabis ɗin da kuka karɓa lokacin da aka shigar da ku asibiti ko wasu wuraren kula da lafiya. Akwai ragi don biyan kuɗi da kuɗin tsabar kuɗi. Hakanan ƙila ku biya farashi don sashin A, dangane da matakin kuɗin ku.

Sashin Kiwon Lafiya na B

Sashin Kiwon Lafiya na B, wanda aka fi sani da inshorar likita, yana rufe rigakafin marasa lafiya, bincike, da sabis na jiyya da suka shafi yanayin lafiyar ku. Akwai rangwame na shekara-shekara da kuma darajar wata-wata don rufewa, gami da wasu ƙididdigar kuɗin tsabar kuɗi.

Tare, sassan Medicare A da B an san su da “Asalin Medicare.”

Medicare Kashi na C

Sashin Medicare Sashe na C, wanda aka fi sani da Medicare Advantage, zaɓi ne na inshora mai zaman kansa wanda ke ɗauke da duka ayyukan Medicare Sashe na A da Sashin B. Yawancin tsare-tsaren Amfani da Medicare suna ba da ƙarin ɗaukar hoto don magungunan ƙwayoyi, hangen nesa, haƙori, ji, da ƙari. Kuna iya biyan kuɗin kowane wata da biyan kuɗi tare da waɗannan tsare-tsaren, kodayake kowannensu yana da farashi daban-daban.

Sashin Kiwon Lafiya na D

Sashin Kiwon Lafiya na D, wanda aka fi sani da ɗaukar magungunan ƙwaya, ana iya ƙara shi akan Medicare na asali kuma yana taimakawa rufe wasu kuɗin kuɗin maganin ku. Za ku biya keɓaɓɓen ragi da kuma kyauta don wannan shirin.

Madigap

Medigap, wanda aka fi sani da ƙarin inshora na Medicare, ana kuma iya sanya shi akan Medicare na asali kuma yana taimakawa ɗaukar nauyin wasu kuɗaɗen kuɗin Medicare na aljihu. Za ku biya kuɗin daban don wannan shirin.

Menene Medicare ke rufewa?

Maimakon aikinka na Medicare ya dogara da wane ɓangare na Medicare da ka shiga.

Sashe na A ɗaukar hoto

Sashe na A na A ya rufe yawancin ayyukan asibiti, gami da:

• kulawar asibiti
• inpatient gyarawa kula
• inpatient hauka kula
• iyakance ƙwararrun ma’aikatan kulawa da jinya
• iyakance lafiyar gida
• hospice kula

Sashi na A bai rufe ayyukan asibiti ba, kamar ziyartar dakin gaggawa wanda ba ya haifar da zaman asibitin. Madadin haka, an rufe ayyukan asibiti a ƙarƙashin Partungiyar Kula da Lafiya ta Sashe na B.

Sashe na A baya ɗaukar mafi yawan kayan aikin ɗakin asibiti, na sirri da na kulawa, ko na dogon lokaci.

Sashe na B ɗaukar hoto

Sashe na B na Medicare yana dauke da kariya mai mahimmanci, bincike, da sabis na magani, gami da:

• ayyukan rigakafi
• gaggawa motar asibiti
• ayyukan bincike, kamar gwaje-gwajen jini ko haskoki
• jiyya da magunguna waɗanda ƙwararrun masu kula da lafiya ke gudanarwa
• kayan aikin likita masu dorewa
• ayyukan bincike na asibiti
• ayyukan kula da lafiyar kwakwalwa

Sashe na B na Medicare ya ƙunshi yawancin ayyukan rigakafin, daga binciken cuta zuwa binciken lafiyar hankali. Har ila yau, ya shafi wasu maganin rigakafi, ciki har da na mura, hepatitis B, da ciwon huhu.

Sashe na B baya rufe yawancin magungunan ƙwayoyi kuma yana ba da iyakantaccen ɗaukar magani kawai.

Sashe na C ɗaukar hoto

Sashe na Medicare Sashe na C ya rufe duk abin da ke ƙarƙashin asalin Medicare Sashe na A da Sashe na B. Mafi yawan shirye-shiryen Sashe na C sun haɗa da:

• magungunan ƙwayoyi
• hakori sabis
• ayyukan hangen nesa
• ayyukan ji
• shirye-shiryen motsa jiki da mambobin motsa jiki
• ƙarin ribar lafiya

Ba duk shirye-shiryen Amfani da Medicare suke rufe ayyukan da ke sama ba, saboda haka yana da mahimmanci a kwatanta zaɓin ɗaukar ka lokacin siyayya don mafi kyawun shirin Amfani da Medicare a gare ku.

Sashe na D ɗaukar hoto

Sashin Kiwon Lafiya na D ya shafi magungunan magani. Kowane shirin likitancin likita yana da tsari, ko jerin magungunan da aka yarda da su waɗanda aka rufe. Dole ne tsari ya ƙunshi aƙalla magunguna biyu don kowane ɗayan rukunin magungunan da aka saba ba, kazalika da:

• magungunan daji
• masu cin amanan
• maganin damuwa
• maganin tabin hankali
• Kwayar HIV / AIDS
• immunosuppressant kwayoyi

Akwai wasu magungunan likitanci waɗanda ba a rufe su a ƙarƙashin Sashe na D, kamar waɗanda aka yi amfani da su don magance matsalar rashin ƙarfi ko magungunan ƙwayoyi.

Kowane shirin likitancin magani yana da dokokinsa, don haka yana da mahimmanci a yi la'akari da wannan lokacin kwatanta tsare-tsaren.

Mitar Medigap

A halin yanzu akwai shirye-shiryen Medigap guda 10 daban waɗanda zaku iya siyan su ta hanyar kamfanonin inshora masu zaman kansu. Shirye-shiryen Medigap suna taimakawa wajen biyan kuɗaɗen aljihu waɗanda suka haɗa da sabis ɗin ku na Medicare, wanda zai haɗa da:

• Sashe Na cirewa
• Sashe na Asusun ajiyar kuɗi da kuɗin asibiti
• Sashe na Asusun ajiyar kuɗi ko biyan kuɗi
• Sashe na B mai karɓar bashi da na kowane wata
• Asusun B tsabar kudi na B ko kuma biyan kuɗi
• Chargesarin cajin excessangare B
• karin jini (pints 3 na farko)
• ƙwarewar aikin kulawa da ƙwararrun masu kula da jinya
• farashin likita yayin tafiya a wajen Amurka

Yana da mahimmanci a san cewa shirye-shiryen Medigap ba su ba da ƙarin aikin Medicare ba. Madadin haka, suna taimakawa kawai tare da farashin da ke tattare da tsare-tsaren likitancin da kuka shiga.

Cancanta don Medicare

Yawancin mutane sun cancanci fara rajista a cikin Medicare na asali watanni 3 kafin ranar haihuwarsu ta 65. Koyaya, akwai wasu yanayi lokacin da zaku cancanci ɗaukar aikin Medicare a kowane zamani. Wadannan banda sun hada da:

• Wasu nakasa. Idan ka karɓi fa'idodin nakasa kowane wata ta hanyar Social Security Administration ko Railroad Retirement Board (RRB), kun cancanci Medicare bayan watanni 24.
• Amyotrophic na gefe sclerosis (ALS). Idan kana da ALS kuma ka sami tallafin Social Security ko amfanin RRB, ka cancanci Medicare daga watan farko.
• Stagearshen cutar koda (ESRD). Idan kana da ESRD, kai tsaye ka cancanci shiga cikin Medicare.

Da zarar sun shiga cikin sassan Medicare A da B, Amurkawa masu cancanta na iya yin rajista a cikin shirin Amfani da Medicare.

Shiga cikin Medicare

Yawancin mutanen da suka cancanci ɗaukar aikin likita dole ne su yi rajista yayin lokutan yin rajista. Lokaci da kwanakin ƙarshe don rajistar Medicare sun haɗa da:

• Rijista na farko Wannan ya hada da watanni 3 kafin, watan, da watanni 3 bayan kun cika shekaru 65.
• Janar yin rajista. Wannan daga 1 ga Janairu zuwa 31 ga Maris idan kun rasa lokacin yin rajista na farko. Koyaya, ana iya amfani da kuɗin rajista na ƙarshen.
• Rijista na musamman. Wannan zaɓi ne don takamaiman adadin watanni dangane da dalilinku na cancantar.
• Rijistar Medigap Wannan ya hada da watanni 6 bayan kun cika shekaru 65 da haihuwa.
• Rijistar Medicare Part D Wannan daga 1 ga Afrilu zuwa 30 ga Yuni idan kun rasa lokacin yin rajista na asali.
• Bude rajista. Kuna iya canza ɗaukarku daga Oktoba 15 zuwa 7 ga Disamba kowace shekara idan kuna son yin rajista, sauke, ko canza shirin Medicare.

Za a sanya ku ta atomatik cikin sassan Medicare A da B idan:

• kuna cika shekaru 65 a tsakanin watanni 4 kuma kuna karɓar fa'idodin nakasa
• baku cika shekaru 65 ba amma kuna karɓar fa'idodin nakasa tsawon watanni 24
• baku cika shekaru 65 ba amma an gano ku tare da ALS ko ESRD

Ga mutanen da ba a shigar da su ta atomatik cikin Medicare ba, za ku buƙaci shiga ta hanyar gidan yanar gizon Tsaro na Tsaro. Idan bakayi rajista ba yayin lokutan yin rijistar, akwai hukunce-hukuncen jinkirta yin rajista.

Menene farashin?

Kudin ku na Medicare zai dogara ne da wane irin tsari kuke dashi.

Sashi na A farashin

Kudin Medicare Part A sun hada da:

• Sashe na A kyauta: a matsayin ƙasa kamar $ 0 (Sashin A kyauta ba kyauta) ko sama da $ 471 kowace wata, ya danganta da tsawon lokacin da ku da abokiyar zamanku suka yi aiki a tsawon rayuwarku
• Sashe na A cirewa: $ 1,484 a kowane lokacin fa'ida
• Sashe na A coinsurance: jere daga $ 0 zuwa cikakken farashin sabis dangane da tsawon zaman ku

Kudin B na kudi

Kudin Medicare Part B sun hada da:

• Sashe na B kyauta: farawa daga $ 148.50 kowace wata ko mafi girma, gwargwadon kuɗin ku
• Sashe na B wanda aka cire: $ 203 a kowace shekara
• Asusun tsabar kudi na B: Kashi 20 na adadin da aka amince da Medicare don ayyukan Sashe na B da aka rufe

Sashi na C farashin

Har yanzu zaku biya ainihin kuɗin Medicare lokacin da kuka yi rajista a cikin Medicare Sashe na C. Shirye-shiryen Amfani da Medicare na iya biyan kuɗin shirin, wanda zai haɗa da:

• farashin kowane wata
• shekara-shekara cire
• sayen magani ya rage
• biyan kuɗi da kuma tsabar kudi

Wadannan tsaran shirin shirin na Masarufi na iya bambanta dangane da inda kake zaune da kuma kamfanin inshorar da ka zaba.

Sashi na D farashin

Za ku biya keɓaɓɓen kyauta don shirin Sashe na D na Medicare, da kuma biyan kuɗi don magungunan likitanku. Wadannan adadi na biyan kudi sun banbanta dangane da irin tsarin "tier" din da magungunan da kake rubutawa suka fada. Kowane shirin yana da tsada da magunguna daban-daban waɗanda aka haɗa a cikin matakansu.

Kudaden Medigap

Za ku biya wani keɓaɓɓen daraja don manufofin Medigap. Koyaya, ka tuna cewa shirye-shiryen Medigap an shirya su ne don taimakawa sake biyan wasu ƙididdigar kuɗin Medicare na asali.

Wasu daga cikin hanyoyin biyan kuɗin aikin likita a kowane wata sun haɗa da:

• Yanar gizon Medicare, tare da zare kudi ko katin kuɗi
• ta hanyar wasiku, ta amfani da ceki, umarnin kudi, ko fom na biya

Wata hanyar biyan kuɗin aikin ku na Medicare ana kiran sa Medicare Easy Pay. Medicare Easy Pay sabis ne na kyauta wanda zai baka damar biyan kudin duk wata na bangaren Medicare Sashi na A da Sashi na B ta hanyar cire kudi ta banki.

Idan kun shiga cikin sassan Medicare A da B, zaku iya samun ƙarin bayani game da yadda zaku shiga cikin Medicare Easy Pay ta danna nan.

Menene bambanci tsakanin Medicare da Medicaid?

Medicare shine shirin inshorar lafiya na gwamnati wanda aka samarwa Amurkawa masu shekaru 65 zuwa sama da waɗanda ke da wasu yanayi ko nakasa.

Medicaid shine shirin inshorar lafiya na gwamnati wanda ke samun wadatar Amurkawa masu ƙarancin kuɗi.

Kuna iya cancanta ga duka aikin Medicare da na Medicaid. Idan wannan ya faru, Medicare zai zama shine inshorar inshorar ku na farko kuma Medicaid zai zama inshorar inshorar ku ta biyu don taimakawa kan farashi da sauran ayyukan da Medicare bata rufe su.

Cancantar Medicaid kowane yanki ne ke yanke shawara kuma ya dogara da ƙa'idodi masu zuwa:

• babban kudin shiga shekara-shekara
• girman gida
• matsayin iyali
• halin nakasa
• matsayin ɗan ƙasa

Kuna iya ganin idan kun cancanci ɗaukar Medicaid ta hanyar tuntuɓar ko ziyarci ofishin sabis na zamantakewar ku don ƙarin bayani.

Takeaway

Medicare sanannen zaɓi ne na inshorar lafiya ga Amurkawan da ke da shekara 65 da haihuwa ko kuma suke da wasu nakasa. Kashi na A ya shafi ayyukan asibiti, yayin da Medicare Part B ke dauke da ayyukan likita.

Sashin Kiwon Lafiya na D yana taimakawa wajen biyan kuɗin magungunan ƙwaya, kuma shirin Medigap yana taimakawa wajen biyan kuɗin Medicare da kuɗin tsabar kuɗi. Shirye-shiryen Amfani da Medicare suna ba da dacewa ga duk zaɓukan ɗaukar hoto a wuri guda.

Don nemowa da yin rajista a cikin shirin Medicare a yankinku, ziyarci Medicare.gov kuma yi amfani da kayan aikin mai nemo shirin kan layi.

An sabunta wannan labarin a Nuwamba 18, 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.