Ndeupi musiyano uripo pakati peMedicare Kubatsira PPO uye HMO Zvirongwa?

Zvemukati

• Chii chinonzi Medicare Kubatsira PPO?
• Inoshanda sei
• Zvazvinofukidza
• Avhareji mari
• Dzimwe fizi
• Chii chinonzi Medicare Kubatsira HMO?
• Inoshanda sei
• Zvazvinofukidza
• Avhareji mari
• Dzimwe fizi
• PPO uye HMO kuenzanisa chati
• Maitiro ekusarudza izvo zviri nani kwauri
• Vanopa
• Kuvhara
• Mariro
• Kuwanika
• Kutora

Medicare Advantage (Chikamu C) inozivikanwa yeMedare sarudzo kune vanobatsirwa avo vanoda zvese zvavo zveMedicare zvekuvhara pasi pechirongwa chimwe. Kune akawanda marudzi ehurongwa hweMedicare Advantage, kusanganisira Hutano Hwekuchengetedza Masangano (HMOs) neMasangano Anopa Vanopa (PPOs).

Ose maviri HMO uye PPO zvirongwa zvinovimba nekushandisa mune-network vanopa. Nekudaro, zvirongwa zvePPO zvinopa mukana wekuchinja nekuvhara vekunze-ve-network vanopa nemutengo wakakwira. Ikoko zvakare kunogona kuve nemimwe misiyano mukuwanika, kufukidzwa, uye mutengo pakati pemhando mbiri idzi dzezvirongwa.

Muchikamu chino, tichaongorora mutsauko uripo pakati peMedicare Advantage PPO nehurongwa hweHMO uye maitiro ekuona kuti nderupi rudzi rwechirongwa chingangonyanya pane zvaunoda.

Chii chinonzi Medicare Kubatsira PPO?

Medicare Kubatsira PPO zvirongwa zvinopa mumwe mupi kushandurika kune avo vanozvida, asi pamutengo wakakwira.

Inoshanda sei

PPO zvirongwa zvinofukidza zvese mu-network uye kunze-kwe-network vanopa, vanachiremba, uye zvipatara. Iwe uchabhadhara zvishoma yemasevhisi kubva mu-network vanopa uye zvimwe yemasevhisi kubva kunze-kwe-network vanopa. Pasi pechirongwa chePPO, kusarudza chiremba wekutanga (PCP) hakudiwe uye hakuna kutumirwa kwekushanya kwenyanzvi.

Zvazvinofukidza

PPO zvirongwa zvinowanzo bata ese masevhisi ayo Medicare Advantage akaronga kufukidza, kusanganisira:

• inishuwarenzi yechipatara
• inishuwarenzi yezvokurapa
• kunyorerwa zvinodhaka

Kana iwe uchinge wagamuchira chipatara kana zvekurapa pasi pechirongwa chePPO, kushandisa mu-network vanopa vanogona kukubatsira kuti usabhadhara mari yepamusoro. Sezvo yega Medicare Inobatsira PPO chirongwa chakasiyana, iwe uchafanirwa kutsvagisa chaiwo marongero anopiwa munharaunda mako kuti uwane chaizvo zvimwe zvakafukidzwa mune yega yega chirongwa.

Avhareji mari

Medicare Kubatsira PPO zvirongwa zvine zvinotevera mutengo:

• Ronga-yakatarwa premium. Aya maprimiyamu anogona kubva kubva pa $ 0 kusvika paavhareji ye $ 21 pamwedzi muna 2021.
• Chikamu B chekutanga. Muna 2021, chikamu chako chePrim B chiri $ 148.50 pamwedzi kana kupfuura, zvichienderana nemari yaunowana.
• In-network inobviswa. Mari iyi inowanzoita $ 0 asi inogona kunge yakakwira kunge $ 500 kana kupfuura, zvinoenderana nechirongwa chaunonyoresa.
• Zvinodhaka zvinobviswa. Izvi zvinobviswa zvinogona kutanga pa $ 0 uye zvinowedzera zvichienderana nehurongwa hwako hwePPO.
• Copayments. Iyi miripo inogona kusiyana zvichienderana nekuti uri kuona chiremba wekutanga wekurapa here kana nyanzvi uye kana iwo masevhisi ari mu-network kana kunze-kwenetiweki.
• Coinsurance. Iyi mubhadharo inowanzova makumi maviri muzana yemari yako inobvumidzwa neMedare-mushure mekubvisirwa kwako kwakabviswa.

Kusiyana neyekutanga Medicare, Medicare Inobatsira PPO zvirongwa zvakare zvine yekunze-kwehomwe yakakwira. Mari iyi inosiyana asi kazhinji iri pakati pezviuru.

Dzimwe fizi

Uine chirongwa chePPO, iwe unozokwereta mari yekuwedzera yekuona vekunze-ve-network vanopa. Izvi zvinoreva kuti kana ukasarudza PCP, shanyira chipatara, kana kutsvaga masevhisi kubva kune mupi asiri muPOO network, unogona kubhadhara zvinopfuura mari yepakati yakanyorwa pamusoro.

Chii chinonzi Medicare Kubatsira HMO?

Medicare Kubatsira HMO zvirongwa hazvipe mupi anochinjika, kunze kwekukurumidza mamiriro ekurapa.

Inoshanda sei

HMO inoronga kufukidza mu-network vanopa, vanachiremba, uye zvipatara chete, kunze kwechiitiko chekurapwa kwekukurumidza kana kunze-kwenzvimbo kutarisirwa nekukurumidza uye dialysis. Mune zvimwe zviitiko, iwe unogona zvakare kukwanisa kushandisa vekunze-ve-network vanopa, asi iwe unobhadhara zana muzana yemasevhisi iwe pachako.

Pasi pechirongwa cheHMO, iwe unofanirwa kusarudza in-network PCP uye zvakare unodikanwa kuti uve nekutumira kune-mu-network nyanzvi kushanya.

Zvazvinofukidza

Kufanana nePPO zvirongwa, HMO inoronga kufukidza ese masevhisi ayo Medicare Advantage zvirongwa zvinowanzovhara, kusanganisira:

• inishuwarenzi yechipatara
• inishuwarenzi yezvokurapa
• kunyorerwa zvinodhaka

Kana iwe uchitsvaga chipatara kana zvekurapa masevhisi, iwe uchafanirwa kusarudza kubva pane irwo rwe-mu-network vanopa iyo yako HMO inoronga inovhara. Kana iwe uchitsvaga masevhisi kunze kwehurongwa hwako mune-network vanopa rondedzero, iwe ungatofanira kubhadhara mari izere yeavo masevhisi.

Nekudaro, mumamiriro ekurumidziro, senge kana uchifamba, unogona kuvharwa zvichienderana nematemu akasarudzika ehurongwa hwako.

Avhareji mari

Medicare Advantage HMO zvirongwa zvine zviyero zvepakutanga zvakafanana nePSO zvirongwa, kusanganisira chirongwa chepamwedzi uye chikamu chePrim B, madhiri, uye macopayment uye coinsurance. Sezvinodiwa nemutemo, chirongwa chako cheHMO chichavawo neagore-kunze-kwehomwe yakakwira pamitengo iwe yaunokwereta.

Dzimwe fizi

Sezvo HMO zvirongwa zvinoda kuti iwe utsvage masevhisi mu network, kazhinji haufanire kubata nemari yekuwedzera kunze kwekunge iwe wafunga kushandisa vekunze-ve-network vanopa. Mumamiriro ekukurumidzira, unogona kunge uine chikwereti chekuwedzera, asi iwe uchafanirwa kutarisa nehurongwa hwako kuti uone kuti idzi mari ndedzipi.

PPO uye HMO kuenzanisa chati

Pane zvakawanda zvakafanana pakati peMedicare Advantage PPO nehurongwa hweHMO, senge mutengo wemaprimiyamu, zvakabviswa, uye zvimwe zvirongwa zvehurongwa. Mazhinji misiyano pakati pemhando mbiri idzi dzehurongwa dzinonyanya kubva mukuvhara uye mutengo we-mu-network uye kunze-kwe-network masevhisi.

Pazasi pane chirafu chekuenzanisa cheicho chirongwa chega chega chinopa maererano nekuvhara uye mutengo.

Hazvina mhosva kuti rudzii rweMedical Advantage chirongwa chaunosarudza, gara uchinyatsoteerera kune akasarudzika maficha sarudzo uye mutengo unobatana nechirongwa chaunosarudza. Nekuti zvirongwa zveAdvantage zvinopihwa nemakambani einishuwarenzi akazvimirira, vanogona kusiyana mune zvavanogona kupa uye nezvavanofunga kubhadharisa.

Maitiro ekusarudza izvo zviri nani kwauri

Kusarudza rakanakisa Medicare Kubatsira chirongwa kunoenderana zvachose neako wega mamiriro ekurapa uye emari mamiriro. Izvo zvinoshandira mumwe munhu zvinogona kusashandira iwe, saka zvakakosha kuti uite tsvagiridzo yako pazvirongwa zviri munharaunda mako.

Hezvino zvinhu zvishoma zvekutarisa kana uchisarudza kana kunyoresa muPPO kana HMO Advantage chirongwa.

Vanopa

Kana iwe uchikoshesa mupi anochinjika, chirongwa chePPO chinogona kunge chiri chako chakanakira, sezvo ichipa kufukidza kune vese vari-network uye kunze-kwe-network masevhisi. Zvisinei, izvi zvinogona kungova sarudzo yako kana iwe uine mari yekushanyira kunze-kwe-network vanopa, sezvo izvi zvikwereti zvekurapa zvinogona kuwedzera nekukurumidza.

Kana iwe uri wakanaka nekushandisa chete mu-network vanopa, chirongwa cheHMO chinokutendera iwe kuti ugare mukati metiweki pasina imwe yekuwedzera mutoro wemari.

Kuvhara

Nemutemo, zvese zvirongwa zveMedicare Advantage zvinofanirwa kuvhara kanenge Medicare Chikamu A uye Chikamu B. Pamusoro pezvo, angangoita ese Advantage zvirongwa zvakare anonyorera mishonga yemishonga, chiratidzo, uye mazino masevhisi. Idzi sarudzo dzekuvhara dzakanangana nehurongwa hwese, asi kazhinji hapana mutsauko mukuru pakati pesarudzo dzekuvhara dzeazhinji PPO neHMO Advantage zvirongwa.

Chimwe chinhu chekufunga nezvacho ndechekuti kufukidzwa kunopihwa nePPO nehurongwa hweHMO kuchakanganiswa nemamiriro ako ehutano. Semuenzaniso, inoratidza kuti vanhu vane hutano husingaperi mamiriro vangangoita ekuzvinyoresa kubva kuhurongwa hweHMO uye kunyoresa mune mamwe marudzi ezvirongwa zvehutano, senge.

Mariro

Medicare Kubatsira PPO uye HMO zvirongwa zvinogona kusiyana mumitengo yavo zvinoenderana nedunhu raunogara uye rudzii rwekuvhara iwe kwauri kutsvaga. Hazvina mhosva kuti ndechipi chimiro chaunosarudza, zvese zvinopihwa zvehurongwa zvinogona kubhadharisa maprimiyamu, zvakabviswa, macopayments, uye coinsurance. Kuwanda kweimwe yeiyi fizi kunoenderana nechirongwa chaunosarudza.

Zvakare, funga kuti panogona kunge paine mari yekuwedzera inosangana nehurongwa hwako zvichienderana nekuti ndevapi vauri kuona. Semuenzaniso, kana iwe ukashanyira wekunze-kwe-network mupi pane chirongwa chePPO, iwe unobhadhara yakawanda kubva muhomwe kune iwo masevhisi.

Kuwanika

Medicare Advantage mapurani ari enzvimbo-based, zvichireva kuti iwe unofanirwa kunyoresa mudunhu rauri kugara parizvino uye kupihwa rubatsiro rwekurapa. Izvi zvinoreva kuti PPO neHMO zvirongwa zvinogona kunge zvakasiyana zvichienderana nekwaunogara.

Mamwe makambani akazvimiririra anongopa chete imwe mhando yehurongwa, nepo vamwe vachizove nezvakawanda zvivakwa zvekusarudza kubva. Kwamunogara ndiko kuchapa hurongwa hwekuwanikwa, kufukidzwa, uye mutengo wechero ipi mhando yeMedicare Advantage chirongwa chaunosarudza.

Kutora

Medicare Advantage PPO nehurongwa hweHMO inzira huru yeinishuwarenzi kune vanhu vanoda kuwana kufukidzwa kweMedare pasi peimwe chirongwa chemaambura.

Nepo paine fanano pakati pemhando mbiri dzezvirongwa, kune zvakare mutsauko mukuwanika, kufukidza, uye mutengo. Paunenge uchisarudza yakanakisa Medicare Kubatsira chirongwa chimiro chako, ita shuwa yekutarisa zvaunofarira mupi, mamiriro emari, uye zvekurapa zvinodiwa.

Chero pese paunenge wagadzirira kusarudza chirongwa cheMedicare Chakanakira, shanyira chirongwa cheMedicare chekutsvaga ruzivo rwezvirongwa pamusoro penzvimbo yako.

Ichi chinyorwa chakagadziridzwa munaNovember 17, 2020, kuratidza 2021 Medicare ruzivo.

Ruzivo ruri pane ino webhusaiti runogona kukubatsira mukuita sarudzo pachako nezve inishuwarenzi, asi haina kuitirwa kupa zano maererano nekutenga kana kushandiswa kweinishuwarenzi kana zvigadzirwa zveinishuwarenzi. Healthline Media haifambise bhizinesi reinishuwarenzi munzira ipi neipi uye haina kupihwa rezenisi sekambani yeinishuwarenzi kana mugadziri mune chero hutongi hweU.S. Healthline Media haina kukurudzira kana kutsigira chero mapato echitatu anogona kuita bhizinesi reinishuwarenzi.