HMO vs. EPO vs. PPO: Kodi pali kusiyana kotani?

Kampani

Lingaliro la inshuwaransi yazaumoyo ndi losavuta: Zimathandiza kulipirira ndalama zomwe mumalandira mukadwala kapena mukudwala. Koma zenizeni za inshuwaransi yazaumoyo ku America ndizovuta kwambiri. Pali zilembo zambiri zomwe zimakhudzidwa-HMO vs. EPO vs. PPO vs. POS vs. HSA vs. PCP. Kuzindikira kuti ndi inshuwaransi iti yomwe ingakhale yabwino kwa inu kungakhale kosokoneza.

Mitundu itatu yodziwika bwino ya mapulani a inshuwaransi yaumoyo ndi mapulani a HMO, EPO, ndi PPO. Kusankha kwanu kutengera zomwe mumapeza, moyo wanu, ntchito yanu, komanso thanzi lanu lonse, zachuma, komanso zosowa zamankhwala.

Chofunikira kwambiri ndikuwunika zonse musanasankhe pulani, m'malo mongoganizira kuti gulu la zilembozi ndilabwino kuposa gulu lina la makalata, atero a Vincent Plymell, wothandizira Commissioner wa Colorado Division of Insurance. Pankhani yosankha pakati pa ma HMO, ma EPO, ndi ma PPO, mzaka zaposachedwa mitundu yamalingaliro iyi yakhala ikufanana kwambiri, chifukwa chake zimachepa kutchula dzina la dongosololi komanso za ntchito zomwe zili mgululi.

HMO motsutsana. EPO motsutsana PPO

Bungwe lokonza zaumoyo, kapena HMO , ndi mtundu wa mapulani azaumoyo omwe amakupatsani mwayi wolumikizana ndi othandizira, zipatala, ndi othandizira azaumoyo m'dera lanu. Nthawi zambiri, mapulani a HMO amafuna kuti musankhe dokotala woyang'anira chisamaliro choyambirira (PCP). Uyu ndi dokotala wanu, yemwe mumamufunsira koyamba pazokhudzana ndiumoyo. Ngati mukufuna zina zowonjezera zaumoyo, PCP yanu idzakutumizirani kwa katswiri wapa netiweki ya HMO. Mukapita kuchipatala kapena kuchipatala, mutha kulipira mthumba pazandalama zosavomerezeka.

Bungwe lokhalo, kapena EPO, ili ngati HMO chifukwa onsewa amakhala ndi gulu la othandizira pazachipatala. Ngakhale muyenera kusankha dokotala woyang'anira chisamaliro choyambirira yemwe ali ndi ma EPO ambiri, simukufunika kutumizidwa kuti mukhale ndi mwayi wodziwa katswiri-mosiyana ndi HMO. Ma netiweki a EPO amathanso kukhala ochulukirapo kuposa netiweki ya HMO. Pokhapokha zitakhala zadzidzidzi, ma HMO ndi ma EPO nthawi zambiri amafuna kuti mulipire zonse zofunika kusamalira anthu ena kunja kwa netiweki.

Ndi bungwe lomwe amakonda, kapena PPO , ndondomeko yanu ya inshuwaransi yazaumoyo ili ndi netiweki ya othandizira azaumoyo ndi malo m'dera lanu komanso kuzungulira dziko lomwe imagwira nawo ntchito ndipo angakonde mutafufuza. Mukapita kwa operekawa, gawo lanu lalikulu limalipiridwa ndi ndondomekoyi. Mosiyana ndi ma EPO ndi ma HMO, ma PPO amalipira ndalama zina zapaintaneti bola ngati zili zantchito. Netiweki ya PPO nthawi zambiri imakhala ndi omwe amapereka m'malo osiyanasiyana, ndipo, monga EPO, simudzafunika kutumizidwa kuchokera kwa dokotala woyang'anira wamkulu kuti akawone katswiri.

Ma HMO amapereka zosintha zochepa koma nthawi zambiri amakhala ndi mtengo wotsika kwambiri pamwezi. EPOs imasinthasintha koma nthawi zambiri imawononga kuposa ma HMO. Ma PPO, omwe amasinthasintha kwambiri, nthawi zambiri amakhala okwera mtengo kwambiri.

Zomwe zili bwino: PPO, EPO, kapena HMO?

Zosowa zaumoyo wa aliyense ndizosiyana. Anthu ena amafunikira chithandizo chamankhwala nthawi zonse. Ena ali ndi mankhwala omwe amafunika kudzazidwa. Ndipo anthu ambiri ali ndi thanzi labwino ndipo sangakhale ndi zosowa zaumoyo konse. Ichi ndichifukwa chake ndizosatheka kunena kuti ndi mapulani ati omwe ali abwino kwambiri. Yankho limasiyanasiyana malinga ndi munthu, dera, boma, komanso wolemba anzawo ntchito.

Pa kulembetsa kutseguka , muyenera kudzifunsa mafunso musanapange mfundo:

• Kodi zosowa zanga zaumoyo ndi ziti za banja langa?
• Ndimatenga malangizo ati?
• Kodi ndili ndi zikhalidwe zotani?
• Ndi matenda ati omwe ine kapena wachibale timayembekezera chaka chamawa? Ganizirani: opaleshoni yayikulu, kuthana ndi mpikisano, mimba, kufikira tsiku lokumbukira kubadwa, ndi zina zambiri.
• Kodi ndikufuna kapena ndikufuna kuwona wopita kunja kwa netiweki?

Kuphatikiza pa mafunso azaumoyo awa, Plymell akuti muyenera kufunsa mafunso otsatirawa azachuma:

• Kodi zosowa zanga ndizotani?
• Kodi ndingakwanitse kuchotsera ndalama zocheperako mtengo wotsika?
• Kodi ndimakonda kudziwiratu zamankhwala kapena ndingakhale ndi ndalama zochepa pamwezi?

Chidziwitso: Ngati mungapeze inshuwaransi yazaumoyo pantchito yanu, mutha kukhala ndi zosankha zochepa za mtundu wa inshuwaransi yomwe mumalandira. Mulimonsemo, nthawi zambiri mumakhala ndi mfundo zotsika mtengo kuposa zomwe mumagula payokha.

HMO itha kukhala yabwino ngati…

Omwe ali achichepere, athanzi labwino, ndipo sangafune thandizo lachipatala chaka chamawa nthawi zambiri amakonda mapulani a HMO ndi ndalama zochepa (ndalama zomwe mumalipira mwezi uliwonse) ndi deductible yayikulu (ndalama zomwe mumayenera kulipira inshuwaransi isanachitike zina zonse). Izi zimapulumutsa ndalama pokhapokha mutavulala kapena kudwala, zomwe zili zabwino pamitundu yoopsa, koma sizabwino kwa aliyense.

EPO itha kukhala yabwino ngati…

Kwa iwo omwe ali ndi matenda azaumoyo ndipo akudziwa kuti adzafunika kukawona akatswiri, dongosolo la EPO lingakhale lanzeru kwambiri pazachuma. Zimathetsa kufunika kogwiritsa ntchito zisankho kudzera mwa dokotala woyang'anira chisamaliro chachikulu ndipo nthawi zambiri amakhala ndi madotolo ndi ma intaneti ambiri kuposa HMO.

PPO itha kukhala yabwino ngati…

Ngati mumayenda kwambiri, makamaka ngati muli ndi zovuta zamankhwala, mwina mungafune kuyang'ana dongosolo la PPO. Ma PPO ali ndi netiweki yotsogola kwambiri yazaumoyo ndipo amalipira zina ngati mungasankhe wopezera netiweki.

ZOKHUDZA: HMO vs. PPO

Kodi njira yotsika mtengo kwambiri yathanzi ndi iti?

Ndondomeko yotsika mtengo yathanzi, pamwezi, izikhala yomwe imalandira ndalama zochepa kwambiri. Koma izi nthawi zambiri zimatanthauza kuchotsedwa kwakukulu, chifukwa chake mapulaniwa akhoza kukhala okwera mtengo kwambiri ngati mutadwala kapena kuvulala. Ndicho chifukwa chake mtengo wotsika mtengo ndi mawu olakwika oti mugwiritse ntchito pankhani ya inshuwaransi yazaumoyo. M'malo mongoyang'ana pa mtengo wakuthumba, ndikofunikira kulingalira mtengo womwe mudzalandire ndalama zanu.

Malinga ndi Kaiser Family Foundation , avareji ya inshuwaransi yazaumoyo kwa munthu aliyense ku US inali $ 7,188 pachaka. Kwa mabanja, pafupifupi akuti anali $ 20,576.Ndalama za inshuwaransi yaumoyo zimatha kusiyanasiyana kutengera komwe mumakhala, koma ngati ndinu achichepere komanso athanzi, ndizo mwina khalani kotheka kupeza ndalama zapamwezi zosakwana $ 100. Komabe, awa sangakhale malingaliro abwino. Mutha kukhala pachikopa cha deductible yayikulu mukadwala kapena kuvulala. Nthawi zambiri, ndalama za inshuwaransi yaumoyo zimakhala zazikulu kwambiri.

Kuganizira kwina ndikopopera. Ndondomeko zina, makamaka ma HMO, zitha kuyamba kulipira gawo la mtengo wa zinthu monga maulendo a dokotala musanakumane ndi ndalama zanu. Ena sangatero, makamaka ma PPO. Izi zikutanthauza kuti mtengo wowonera dokotala ukhoza kukhala paliponse kuyambira $ 10 mpaka $ 200 kupitilira apo, kutengera ndi zomwe adokotala akufotokoza.

Njira ina yosungira ndalama ndikusankha mfundo zomwe zimakhala ndi chitsimikizo. Ndondomeko zamtunduwu zimatha kukhala ndi ndalama zochepa. Komabe, mudzayenera kulipira gawo lina lazamalipiro anu azachipatala ngakhale mutakumana ndi deductible yanu. Kampani ya inshuwaransi ilipira peresenti (makamaka pakati pa 75% ndi 90%) - ndipo mudzayenera kulipira zotsalazo. The Affordable Care Act imachepetsa kuchuluka kwa ndalama zomwe mungagwiritse ntchito mthumba mchaka chimodzi ndi ndondomekoyi. Za 2020, the Kutuluka mthumba Zolinga pamsika ndi $ 8,150 za anthu komanso $ 16,30 yamabanja. Muthanso kukhala woyenera Zothandizira ACA izi zithandizira kuchepa kwa inshuwaransi yaumoyo kutengera ndalama zomwe mumapeza.

Mosasamala kanthu za mfundo zomwe mungasankhe, mutha kupulumutsa pamankhwala anu ndi khadi yotsitsa ya SingleCare.