Muxuu qofku rabi lahaa in ka badan hal qorshe caymis? Waxay kuxirantahay qofka aad waydiisato. Waxaa laga yaabaa inaad rabto caymis dheeraad ah si aad u hubiso inaad hesho dhammaan daryeelka caafimaad ee aad u baahan tahay. Medicare iyo caymisyada kale, dhinaca kale, waxay leeyihiin dulsaar kale. Haddii aad leedahay wax ka badan hal qorshe caafimaad, waxay awoodi karaan inay beddelaan culeyska lacag bixinta dhinaca kale.
Ha welwelin. Qof ayaa raacaya biilka, iyo inta uu qof waliba u socdo sida qorshaha, waa inuusan noqonin. Waxaad u baahan tahay inaad fahamto cidda bixinaysa marka hore iyo cida, haddii qofna, uu bixinayo kharashka ka baxsan. Tani waa halka uu qofku bixiyo Medicare Secondary Payer.
Maxaad u Baahan Tahay Maxay Tahay Medicare?
Medicare waxay bixisaa daryeel caafimaad in ka badan 56.8 milyan oo Maraykan ah, laakiin taasi macnaheedu maaha inay daboolayso wax kasta oo ay u baahan yihiin. Ka fikir waxyaabahan caadiga ah ee Medicare kaa baxayo inaad bixiso jeebka:
- Acupuncture
- Daryeelka xilliga safarka ajnabiga ah oo aad u yar
- Adeegyada lafdhabarka marka laga reebo saxda ah ee sumbux-ka ee dhabarka
- Muraayadaha indhaha ee saxda ah (muraayadaha indhaha ama muraayadaha indhaha)
- Daryeelka xanaanaynta (qubayska, dhar xidhashada, musqusha)
- Ilkaha
- Daryeelka cagta
- Qalabka maqalka
- Daryeelka guriga daryeelka muddada dheer
- Gaadiidka aan deg-deg ahayn oo leh waxyaabo naadir ah
- Daawooyinka miisaanka laga iibsado, fiitamiinada, iyo waxyaalo dheeraad ah
- Daawooyinka dhakhtarku qoray qaybaha qaarkood
- Kuwa indhoolayaasha ah ee indhoolaha ah
Tani ma aha liis dhamaystiran, dabcan, laakiin ma aha wax la yaab leh in dadka qaar ay raadsadaan caymis caafimaad oo kale si ay u buuxiyaan farqiga. Inkasta oo ay jirto ikhtiyaarka Qorshaha Lacagta Medicare ee Medicare, oo loo yaqaan Qorshaha Medigap , si looga caawiyo daboolidda qarashka Medicare ee ka baxsan qarashka jeebka ( copayments, coasurance, iyo deductibles ), qorshooyinkani dhab ahaan kuma dheehanayaan faa'iidooyinka caafimaadka ee caymiskaaga.
Taa baddalkeeda, dad badan ayaa u jeestay caymis kale sida qorshooyinka caafimaadka ee loo-shaqeeyaha, kaalmooyinka milatariga, iyo manfacyada hawlgabka si loo helo caynsanaanta ay u baahan yihiin.
Qorsheyaasha Caafimaadka ee Medicare iyo Loo-Shaqeeyaha
Da'da hawlgabka ee macaashka Lambarka Bulshada ayaa loo isticmaalaa in ay ahaato 65 jir, da'da isku mid ah ee aad xaq u leedahay Medicare . Dhammaantii isbeddelay 1983 markii shirwaynaha loo ansixiyey sharci si loo kordhiyo da'da hawlgabka iyada oo ku saleysan dhalashadaada dhalashadaada. Dadka da'doodu u dhaxayso 1943 ilaa 1954, da'da hawlgabka waa 66 jir. Da'da hawlgabka ayaa si tartiib ah u kordha ilaa ugu badnaan 67 sano oo loogu talagalay dadka dhashay 1960-kii. Ciridii hore ee ka dhalatay da'daas loo qoondeeyey waxay ku dambeyn doontaa inaad lacag yar ka qaadato Lambarka Bulshada.
Natiijada ugu dambeysa waxay tahay in dad badan ay shaqeynayaan muddo dheer si ay u kordhiyaan dhaqaalahooda hawlgabka. Shaqada waxay siinaysaa helitaanka daryeelka caafimaadka iyada oo loo marayo loo-shaqeeyayaashooda si ay u doortaan inay sii wadaan kaligood, sii wadaan inta ay sidoo kale saxiixaan Medicare, ama joojiyaan oo ay ku bedelaan Medicare.
Qorshahaaga caafimaadka ee loo-shaqeeyahaagu wuxuu dabooli karaa xaaskaaga iyo dadka kugu tiirsan , halka Medicare ay adiga keligaa ku daboosho. Qorshahani wuxuu kaloo bixin karaa adeegyada aysan Medicare bixin karin. Haddii aad xaq u leedahay Muddada Diiwaangelinta Gaarka ah , waxaa laga yaabaa inaad dib u dhigto isqorista Medicare adiga oo aan la kulmin ganaaxyo goor dambe ah marka aad ugu dambeyn saxiixdo.
Tani waxay kaa badbaadin kartaa qiimo aad u badan tan iyo markii aanad bixin laheyn lacagta caymiska laba qorshe oo kala duwan.
Markaad leedahay labadaba Medicare iyo qorshaha caafimaadka ee loo-shaqeeyaha, Medicare wuxuu bixin doonaa marka hore xaaladaha qaarkood. Go'aanka wuxuu ku salaysan yahay da'daada, haddii aad qabto cudurka dhamaadka kalyaha (ESRD) ama curyaan kale, iyo inta qof ee ka shaqeynaya loo-shaqeeyahaaga.
Haddii aadan buuxin shuruudaha Medicare si aad u bixiso marka hore, qorshahaaga caymiskaaga ee loo-shaqeeyahaagu waa la soo diri doonaa. Maxay iyagu lacag bixiyaan kadib ayaa loo xisaabin doonaa Medicare. Medicare wuxuu bixin doonaa adeegyada daryeelka caafimaadka ee sida caadiga ah u dabooli doono hadba sida ay u aragto caafimaad ahaan lagama maarmaan u yahay.
| Medicare ayaa marka hore bixin doonta | Medicare ayaa bixin doonta labaad |
|---|---|
|
|
Medicare iyo COBRA
Thanks to Sharciga Dib-u-heshiisiinta Miisaaniyadda ee 2007 (COBRA) 1985 waxaad sii wadi kartaa qorshahaaga caafimaad ee loo-shaqeeyahaaga ka dib markaad ka tagto shaqadaada. Sharcigu wuxuu u baahan yahay loo shaqeeyayaasha 20 ama kabadan shaqaale waqti buuxa ah si ay u sii wataan helitaanka qorsheha caafimaad muddo wakhti ah, inta badan 18 bilood, ka dib markaad shaqadaadu dhammaato ama joojiso. Muddada COBRA waxaa laga yaabaa in la kordhiyo illaa 36 bilood haddii shuruudaha qaarkood la buuxiyo.
Medicare iyo COBRA waxay leeyihiin xiriir adag. Haddii aad horey u leedahay COBRA markaad isqorto Medicare, ceymiskaaga COBRA wuxuu u egtahay inuu dhammaado taariikhda aad iska qorto Medicare. Haddii aad hore u haysato Medicare marka aad xaq u leedahay COBRA, waxaa laguu oggol yahay inaad iska diiwaangeliso COBRA.
Haddii aad qabtid COBRA oo aad Medicare u-qalantid mudadaas, waxaad leedahay go'aan muhiim ah oo aad ku sameyso. Diiwaangelinta Medicare macnaheedu waa inaad lumiso faa'iidooyinkaaga COBRA-ta, inkastoo laga yaabo in aad sii wadi karto caymiskaaga xaaskaaga iyo dadka kugu tiirsan. Haddii aad dooratid inaad dib u dhigto isqorista Medicare, waxaad ogaataa in aad la kulmi doonto ciqaabta goor dambe markaad ugu dambeyn saxiixdo. Macaashka COBRA ma kuu qalmin Muddada Diiwaangelinta Gaarka ah ee Medicare.
| Medicare ayaa marka hore bixin doonta | Medicare ayaa bixin doonta labaad |
|---|---|
|
|
Medicare iyo Magdhawga Shaqaalaha
Magdhawga Shaqaaluhu wuu ka shaqeeyaa si ka duwan sida qorshahaaga caymiskaaga ee loo-shaqeeyaha. Waa heshiis dawlad-goboleed oo u dhexeeya adiga iyo loo-shaqeeyahaaga oo sheegaya inaadan ku dacwoon doonin ilaa inta ay daboolayaan kharashyada caafimaadkaaga wixii ah dhaawacyada shaqada. Markaad aqbasho dheefaha magdhawga shaqaalaha, ma raadsan kartid ganaaxa dhaawacaas. Haddii aad hoos u dhigto manfacyadaas, waxaad ku dacwoon kartaa magdhow sida xanuunka iyo silica.
Halkaad bixiso lacagta caymiska ee qorshahaaga caafimaadka ee loo-shaqeeyaha, caymiska mushaharka shaqaalaha waxaa bixinaya loo-shaqeeyahaaga. Wax kharash ah ma laha. Dhibaatada ka dib, waxaad dalbataa sheegasho qiimeynna u dhacdaa si loo go'aamiyo iyo haddii dhaawacu yahay mid ka dhalatay jawiga goobta shaqada.
Waxay noqon kartaa kiiska magdhawga shaqaalaha uu diidayo sheegashadaada ama qayb ahaan waxay dabooleysaa iyadoo ku saleysan xaalad horey u jirtay . Tusaale ahaan, haddii aad qabtid xannuun dhab ah , laakiin xanuunka dhabarkaaga wuu ka sii darayaa ka dib dhaawac, way adkaan kartaa in la go'aamiyo sida masuuliyaadka loo-shaqeeyahaagu u yahay calaamadahaaga. Tallaabooyinka Medicare ee marxaladdan si ay u sameeyaan lacagaha ugu horeeya.
Magdhawga Shaqaalahu wuxuu soo celin karaa kharashyadaada caafimaadka wakhtiga ay dhaceen ama waxay bixin karaan heshiis hal-mar ah. Qaar ka mid ah maaliyaddan waxaa lagu dhejin karaa Magdhowga Shaqaalaha Magdhawga Medicare Set Medium Adjustment (WCMSAA), qorshe loogu talagalay in lagu keydsado dhaqaalaha mustaqbalka ee dhaawacyada keena dhibaatooyinka muddada dheer. Medicare ma bixin doono ilaa lacagaha WCMSAA ay daalan yihiin.
| Medicare ayaa marka hore bixin doonta | Medicare ayaa bixin doonta labaad |
|---|---|
|
|
Lacagta Medicare iyo Milatariga Milatariga
Haddii aad tahay askari, qof xubin ka ah adeegga hawlgabka ah, ama xubin hawlgab ah oo ka mid ah adeegga lebiska ah waxaad xaq u yeelan kartaa faa'iidooyinka caafimaadka ee Maamulka Veteran (VA) ama barnaamij loogu yeero TRICARE. Faa'idooyinkaasi waxay isku-duwanyihiin Medicare qaab gaar ah.
Marka ugu horeysa, faa'idooyinka VA waxay kaliya ku dabooli doonaan daryeelka lagu helo xarun la aqoonsan yahay VA.
Tan labaad, Medicare ma bixin doonto kharashka daryeelka ee ay bixiso macaashka VA iyo kan kale. Ma jiraan arrin ku saabsan mushaharka hoose ee caadiga ah halkan.
Saddexaad, shaqada TRICARE iyo Medicare ee xafladaha. Medicare wuxuu u dhaqmaa sida bixiyaha aasaasiga ah ee adeegyada Medicare ee daboosha iyo TRICARE waxa ay dabooshaa wixii Medicare ka jaray ama caymiska caymiska ee la xiriira adeegyadaas. Marka adeeggu uusan daboolin Medicare, TRICARE waxay u dhaqmi doontaa sida lacagta aasaasiga ah.
Iyadoo ku xiran daryeelka aad hesho, waxaa suurtogal ah in labadaba Medicare iyo TRICARE u dhaqmaan sida mushaar bixiyaha isla waqtigaas!
> Ilo:
> Medicare iyo Faa'iidooyinka Kale ee Caafimaadka: Tilmaamahaaga Qofka Kale Ugu Bixiya. Xarumaha adeegyada Medicare iyo Medicaid. https://www.medicare.gov/Pubs/pdf/02179-Medicare-Sawiro -Benefits-Payer.pdf.
> Dareemaha Diiwaangelinta Medicare-ka. Xarumaha bogga Adeegyada Medicare iyo Medicaid. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/Medicare-Enrollment/Enrollment%20Dashboard.html. La sii daayay July 2016.
> Bixiyaha Medicare Secondary Medicare. Xarumaha bogga Adeegyada Medicare iyo Medicaid. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Medicare-Secondary-Payer.html. La daabacay Janaayo 30, 2014.
> Magdhawga Shaqaalaha 'Medicare Set of Adide Standards. Xarumaha bogga Adeegyada Medicare iyo Medicaid. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/WCMSA-Overview.html. La daabacay Abriil 18, 2016.