Ma'anar Daban Daban Daban Dabaru guda biyu
A cikin shekaru tun lokacin da aka kafa Dokar Kulawa ta Hankali (ACA), an yi amfani da kalmar nan "tsarin alamar shafi". Amma ana amfani da shi don bayyana bangarorin biyu daban-daban na dokoki, wanda zai iya rikicewa ga masu amfani. Yawanci, mahallin zai bari ka ƙayyade wane ma'anar bayanin da aka rubuta, muddun kuna fahimtar nau'ikan alamomin alamomin.
Alamar mahimmanci yana nufin:
- Shirye-shiryen kayan azurfa na biyu mafi ƙasƙanci cikin musanya a kowane yanki, a cikin kasuwa inshora ɗaya, OR
- Shirye-shiryen da kowace jihohi ke amfani da ita don ƙayyade muhimmancin amfanin kiwon lafiya a cikin wannan jiha don shirin mutum da kananan kungiyoyi.
Wadannan ra'ayi ne daban daban, amma suna da suna daya, wanda zai iya haifar da rikicewa. Bari mu dubi yadda kowane nau'ikan alamar alamar aiki ke aiki.
Shirin Ƙari na Ƙari na Biyu-Mafi Girma a cikin Exchange
Ga mutanen da suka cancanci tallafin kuɗi na ACA (yawan kuɗin kuɗin harajin ku] a] e , asusun tallafin ku] a] en ya dogara ne da bin bayanan ku] a] e na biyan ku] a] en na biyu na ku] a] en ku] a] e . Wannan shiri na biyu mafi ƙasƙanci shine ake kira tsarin alamar.
Alamar alamar ta bambanta daga wannan yanki zuwa wani, kuma daga shekara guda zuwa na gaba tun lokacin da yake matsayin matsayin alamomin da aka ƙayyade gaba ɗaya ta wurin farashin da aka danganta da sauran tsare-tsaren kudi da aka samo a wannan yanki.
Saboda haka a cikin jihohi, akwai alamun daban-daban na alamar kasuwanci idan jihar yana da kasuwar inshora mai ƙarfi wanda ya bambanta daga wannan yanki zuwa wani, ko kuma akwai wata manufa daya da ke riƙe da wurin zama a cikin jihar, idan jihar tana da aure insurer ko masu insurers masu yawa tare da farashi mai kyau a fadin jihar.
A lokacin bude rajista don kasuwar kasuwa daya (Nuwamba 1 zuwa Disamba 15), masu amfani zasu iya ganin yadda farashin shirin zai kasance don shekara mai zuwa. Za su kuma ga irin adadin da aka samu-idan duk wani yaron zai karbi tallafin bashi, bisa la'akari da yadda shirin zai ba da kudin ga wannan lamarin, farashin ainihin shirin da suke son saya, da kuma samun kudin shiga na samun kudin shiga da za a sa ran za su biya bashin da aka tsara, an kwatanta math don haka a nan).
Za'a iya ba da alamar benci ta hanyar wani kamfanin inshora daban-daban daga shekara guda zuwa na gaba, tun lokacin da masu sayarwa suka canza farashin su a kowace shekara. Ana sanya farashin a shekara, saboda haka shirin da aka ba da shi a cikin wani yanki ba zai canza ba har sai shekara ta gaba sai dai idan mai insurer ya fita kasuwannin kasuwancin shekaru (wannan ba shi da wuya, amma ya faru-wasu daga cikin AC-OPs an tilasta su rufe tsakiyar shekaru a 2015 da 2016). Amma saboda shekara ta gaba, marubutan insurers a kan farashin farashin za su iya shuɗewa, kamar yadda wasu masu sayarwa suke tada yawan su fiye da wasu, wasu kuma suna rage yawan su daga shekara guda zuwa gaba.
Amma hanyar da za a fahimta shine fahimtar kuɗin bashi ne bisa adadin kuɗin da zai biya ku saya tsarin kula.
Zaka iya amfani da wannan tallafi don saya kowane matakin matakin ƙarfe a cikin musayar. Ba dole ba ne ku saya tsarin benci, amma yawan kuɗin kuɗin din zai zama daidai, ko da wane shirin da kuka zaɓa (bayanan kuɗin bayanan kuɗi zai bambanta da yawa, dangane da abin da kuka zaɓi).
Ka'idodin Sharuɗɗa na Jihar don Amfanin Sanarwar Kiwon Lafiya
Sauran nau'ikan alamomin alamar shine tsarin kulawa a cikin kowace jiha don ƙayyade amfanin da mutum da ƙananan ƙungiyoyi suka tsara a jihar. Kowane sabon shiri na mutum da ƙananan yara dole ne ya rufe ACA goma sha biyu na amfanin lafiyar lafiyar (akwai wasu hanyoyi na likitancin yara / hangen nesa, amma sauran sauran muhimman sha'anin kiwon lafiyar guda tara dole ne a hada su a cikin duk wanda ya dace da ACA da kuma kananan kungiyoyi).
Kuma yayin da manyan kungiyoyi ba su da kariya ga amfanin lafiyarsu, ba za su iya ba da iyakar yawan amfanin kuɗi na shekara-shekara ko na rayuwa a kan duk wani amfanin kiwon lafiyar da suke rufewa ba.
Don haka yana da mahimmanci don bayyana abin da ya ƙidaya a matsayin muhimmin amfanin lafiyar jiki. Ƙungiyar ta ACA ta ƙayyade su da ƙwaƙwalwar ƙwaƙwalwar ƙwararraɗi, suna riƙe da jerin sharuɗɗun lafiyar lafiyar goma da ake amfani da ita ga faɗakarwar da za ta dace da rabin shafi. Dokar ta kuma lura cewa, Sashen Harkokin Kiwon Lafiyar Jama'a da Hodima (HHS) za a yi tasiri tare da tabbatar da cewa ɗaukar hoto zai kasance "daidai da yawan amfanin da aka bayar a ƙarƙashin tsarin aikin ma'aikata.
Daga can, gwamnatin tarayya ta bar shi har zuwa HHS don rarraba bayanan. HHS, bi da bi, ya tashe kowane jihohi tare da zayyana tsarin alamar da za a yi amfani dashi a matsayin tsari na tunani don sabon mutum da ƙananan ƙungiyoyi a cikin wannan jiha. A 2012, HHS ta wallafa jerin tambayoyin tambayoyin game da tsare-tsare na benci , don taimakawa jihohin su bi tsarin, kuma an shirya karin jagora a shekarar 2015 . An yarda da Amurka su karbi shirin su na benci daga ɗaya daga cikin zaɓuɓɓuka guda huɗu masu zuwa ("mafi girma" aka ƙaddara bisa la'akari):
- Ɗaya daga cikin manyan ƙananan ƙananan kananan yara uku a cikin jihar
- Ɗaya daga cikin uku mafi girma na tsarin kiwon lafiyar ma'aikata na jihar (ɗaukar hoto da aka ba ma'aikata)
- Ɗaya daga cikin manyan tsare-tsare uku na ma'aikatan lafiyar ma'aikatan tarayya (Hukumar FEHBP da aka ba wa ma'aikatan tarayya)
- Mafi yawan shirin HMO marasa magani ya miƙa a kasuwar kasuwancin jihar.
Manufar ita ce, duk wani zaɓin zai ba da tabbaci, kuma ba zai yiwu ba a samar da "ƙasusuwan da ba a kasuwa ba" tun lokacin da ake ba da su ga ma'aikatan gwamnati ko kuma an zabi su ta hanyar manyan kamfanoni don tabbatar da ma'aikata.
Domin shekarar 2014 zuwa 2016, shirin da aka ba da alama shine shirin da aka bayar a shekara ta 2012 (tun lokacin da jihohi ke ƙayyade shirin su). Wajibi ne a kara haɓaka wasu daga cikinsu don tabbatar da cewa sun rufe dukan EHBs, tun da ba a daina yin amfani da shirye-shiryen ACA a shekarar 2012 ba. A shekara ta 2017 kuma, shirin na benci shine shirin da aka bayar a shekarar 2014. Kusan dukkanin jihohin sun yi ƙoƙari don ƙananan ƙungiyoyi su zama alamomin su. Bayanai na cikakkun bayanai game da kowane shirin da aka samu game da alamar shafi na samuwa a nan.
Kasuwancen kasuwa da ƙananan ƙungiyoyi da aka ba su a cikin jihar dole ne su haɗa da ɗaukar hoto wanda "daidai yake" ga amfanin da aka ba da shi ta hanyar tsarin alamar da aka zaɓa na jihar. Akwai ci gaba daga wannan jihar zuwa wani, kamar yadda ACA ta ƙayyade ainihin sigogi na EHBs. Amma bambance-bambance a cikin tsarin tsare-tsare na jihar shi ne dalilin da ya sa za ka ga wasu ayyuka-irin su maganin rashin haihuwa-an gano su daban-daban daga jihohi zuwa jiha, bisa ga umarnin da aka yi amfani da shi a jihar, ko kuma bambanci daga tsari ɗaya na jihar zuwa wani.
A cikin watan Oktoba 2017, HHS ta wallafa wallafe-wallafen da aka ba da kyauta da kuma biyan kuɗi don 2019, wanda ya haɗa da wasu canje-canje da aka kwatanta da shirin EHB. Idan ya kammala kamar yadda aka samar, jihohin zasu sami karin sauƙi tun daga farkon shekara ta 2019, ciki har da zaɓin da za a yi amfani da shi a matsayin tsarin kansa, ko kuma ya ƙunshi sassa daban-daban na tsarin jihohi don ƙirƙirar shirin kansu. Bugu da ƙari, jihohin za su iya zaɓar ko tsara sabon tsarin tsari a kowace shekara, maimakon ci gaba da amfani da tsarin alamar da aka kammala don 2017.
Kalma Daga
Lokacin da ka ji wani yayi magana game da tsari na benci dangane da ACA, mahallin zai bari ka ƙayyade wane nau'i na shirin da aka zana.
Shin suna magana ne game da tsarin azurfa na biyu wanda aka ba da shi a kasuwa ɗaya a kan musayar, ko kuma game da shirin da aka ba da wata ƙasa wadda ta zaɓa don zama nauyin amfani mai mahimmanci wanda duk wanda ya dace da ACA da ƙananan ƙungiyoyi suke shirin Jihar na da tushe? Da zarar ka san cewa, bayanan da ke sama zasu taimake ka ka fahimci tattaunawa.
> Sources:
> Cibiyar Kula da Magungunan Magunguna da Magungunan Medicaid. Cibiyar Bayar da Bayani da Bayani da Assurance. Amfanin Amfani da Kiwon Lafiyar Mahimmanci: Tabbatar da Gaskiya, Kyau mai Kyau.
> Cibiyar Kula da Magungunan Magunguna da Magungunan Medicaid. Cibiyar Bayar da Bayani da Bayani da Assurance. Bayani game da Amfanin Amfani da Kiyaye Masu Mahimmanci (EHB) Taswirar Ƙira.
> Cibiyar Kula da Magungunan Magunguna da Magungunan Medicaid. Amfanin Lafiya na Musamman: Lissafi na Ƙananan Ƙananan Rukunin Kasuwancin by State . Afrilu 8, 2015.
> House.gov. Rubutun Ma'aikatar Tsaro da Taimako .
> Sabis na Gida na cikin gida. Hanyar samun kudin 2017-36 .
> Kayan Gida na Kaiser. Amfanin lafiya mai muhimmanci (EHB) Taswirar Manyan Lambobi, 2017.