Vanachiremba veMedicaid Vepedyo Newe: Maitiro Ekuwana Vanopa Mubazi Renyu

Kuwanikwa Kwevachiremba veMedicaid Vepedyo Newe: Maitiro Ekuwana Vanopa Mubazi Renyu

Kuwana vanachiremba veMedicaid vave pedyo newe kunoda kuedza kwakawanda pane kuwana vanachiremba vanogamuchira inishuwarisi yakavandika nekuti havasi vose vanopa vanobatanidzwa muMedicaid. Sekureva kwekuongorora kweSHADAC kwe data rehutano hwehurumende, kunyangwe kupfuura 95% yevachiremba vanogamuchira varwere vatsva vane inishuwarisi yakavandika munyika yose, ingangoita 74% chete vanogamuchira varwere vatsva vane Medicaid coverage. Musiyano uyu weinodarika 20% unoratidza mwero wakaderera wekubhadhara kweMedicaid uye mabasa anovhiringidza anodzora vamwe vanopa kuti vasabatane. Musiyano uyu unosiyana zvakanyanya nechikamu. MuNew Jersey, Florida, Louisiana, neCalifornia, vanachiremba vanoda kupfuura 30% kuti vatore varwere vatsva veMedicaid pane varwere vakavandika. New Jersey ine mwero wakaderera wekutora nekungosvika 42.2%. Wisconsin, Minnesota, neNorth Dakota hadzina musiyano pakati peMedicaid neinishuwarisi yakavandika. Idaho ine mwero wepamusoro wekutora weMedicaid munyika yose.

Bhuku iri rinotsanangura maitiro ekuwana vanachiremba veMedicaid vave pedyo newe muna 2026, zvekuita kana usingakwanise kuwana anopa aripo, uye maitiro ekufamba munzira dzezvikamu.

Maitiro Ekuwana Vanachiremba veMedicaid Mubazi Renyu

Nzira huru yekuwana vanachiremba veMedicaid ndiyo kuburikidza nechirongwa chekugadzirira kweMedicaid chechikamu chako. Ingangoita 75% yevakanyoresa veMedicaid munyika yose vari mumamiriro ekugadzirira uko vanowana masevhisi eMedicaid kuburikidza nechirongwa chehutano chakasarudzika chine network yaro yavanopa. Sangano rega rega rekugadzirira (MCO) rine dhairekitori repamhepo revanopa vari mukati me network, kusanganisira vanachiremba vekutanga, vanachiremba vehunyanzvi, vanachiremba vemazino, uye vanopa hutano hwepfungwa.

Kana usingazivi kuti ndeupi chirongwa chekugadzirira chaunonyoresa maari, kadhi rako reMedicaid ID rinoratidza zita rechirongwa chako. Unogonawo kufonera sangano reMedicaid renyu kana kutarisa ku account yako yepuratifomu yeMedicaid. Kubva ipapo, pinda portal yemwanga wechirongwa chako kuti uwane dhairekitori revanopa, tsvaga ne ZIP code, hunyanzvi, zvaunoda zviri pamutauro, uye sarudzo dzekugamuchira varwere vatsva.

Kune vanonzi Medicaid vanobatana nefee-for-service (FFS) Medicaid (ingangoita 25% yevakanyoresa, kunyanya muzvikamu zvimwe chete kune zvimwe zvikamu sezvakasanganiswa kana kuchengetwa kwenguva refu), sangano reMedicaid rechikamu rine dhairekitori revanopa. Unogona kutsvaga pawebhusaiti yeMedicaid yenyu kana kufonera rubatsiro rweMedicaid rwenzvimbo.

Zvinhu zvakakosha zvezvikamu zvinosanganisira North Carolina Medicaid Provider and Health Plan Lookup Tool yevagari veNC, Florida's Choice Counselor service pa 1-877-711-3662, nezvimwe zvinhu zvakafanana kune zvimwe zvikamu. Medicaid.gov state contacts page inobatanidza kune sangano reMedicaid rechikamu chega chega.

Kune vanopa hunyanzvi veMedicaid, ona magwara edu e vanachiremba veziso vanogamuchira Medicaid, vanachiremba veganda vanogamuchira Medicaid, uye vanachiremba vemazino vanogamuchira Medicaid.

Nei Vamwe Vanachiremba Vasingagamuchiri Medicaid

Kunzwisisa kuti nei kubatana kwevanopa muMedicaid kwakaderera pane inishuwarisi yakavandika kunokubatsira kugadzirisa nzira yako yekutsvaga. Chinhu chikuru ndechekubhadhara. Medicaid inowanzobhadhara vanachiremba 60-70% yezvavanobhadhara Medicare nemasevhisi akafanana, uye Medicare pachayo inowanzobhadhara zvishoma pane inishuwarisi yakavandika. Muchiremba anorapa murwere weMedicaid anogona kugashira $60 nekushanya kunopa $150 kubva kumurwere weinishuwarisi yakavandika.

Kuoma kwemabasa kunowedzera chimwe chikamu. Medicaid inowanzoda authorization yekutanga, mapepa akawanda, uye zvinyorwa zvakawanda pane inishuwarisi yakavandika. Zvipatara zvakavandika zvishoma zvisina vashandi vekubhadhara vanozvitsaurira vanowana dambudziko iri rakanyanya kuoma.

Kugara kwevanopa kunokosha munzvimbo. Nzvimbo dzeguta dzinowanzova nevanopa vanobatana neMedicaid vakawanda nekuti masisitimu makuru ezvipatara anogona kubhadhara mari dzemabasa uye kubhadhara kushoma kuburikidza nehuwandu. Nzvimbo dzemaruwa dzinowanzova nevanopa vanobatana neMedicaid vashoma, dzimwe nguva vachida kufamba makwara 50+ kuti vawane vanopa hunyanzvi.

Musiyano wevanopa wakanyanya kune vanopa hunyanzvi muzvikamu zvimwe chete. Vanachiremba vezvemoyo, vanachiremba veganda, vanachiremba wefupa, nevanachiremba vepfungwa vanogamuchira varwere vatsva veMedicaid vashoma kune vanachiremba vekutanga. Ndicho chikonzero nei tele-health yakawedzera kune varwere veMedicaid muna 2026, zvakawanda zvezvikamu zvinozadzwa nekushanya kwe tele-health pamwero wakafanana nekugara pachiso.

Zvekuita Kana Usingakwanise Kuwana Anopa Aripo

Kana kutsvaga kwako kwekutanga kusingawani anopa aripo, nzira dzakawanda dzinogona kubatsira. Chekutanga, wedzera nzvimbo yako yekutsvaga. Tsvaga vanopa mukati me 25-50 maero pane kungosvika pamba pako. Zvirongwa zveMedicaid zvakagadzirirwa zvinofanira kusangana nezvinodiwa zve network, asi izvi zvinogona kubvumira kureba kwekufamba kunyanya munzvimbo dzemaruwa.

Federally Qualified Health Centers (FQHCs) nezvipatara zvevanhu zvakagadzirirwa kushandira vanhu veMedicaid. Zvipatara izvi zvinofanira kugamuchira Medicaid nemutemo uye zvinowanzova ne nguva yekumirira pfupi yekugadzwa kwevarwere vatsva pane zvipatara zvakavandika. HRSA Find a Health Center tool inowana FQHCs munyika yose.

Zvipatara zvine hukama nezvipatara zvinowanzogamuchira Medicaid zviri nyore pane zvipatara zvakavandika. Masisitimu makuru ezvipatara ane infrastructure yekubhadhara kuti iite Medicaid zvinobudirira uye inogamuchira Medicaid senzvimbo yebasa renharaunda yavo.

Kune kuchengetwa kwehunyanzvi kwakaoma kuwana, taura nechirongwa chako cheMedicaid chakagadzirirwa zvakananga. Zvirongwa zvinodiwa nemirau yehurumende kupa mukana wakakodzera kune vanopa hunyanzvi. Kana usingakwanise kuwana muvapi wekunyanzvi mukati me network mukati me chinhambwe chakakodzera, chirongwa chako chinogona kubvumidza kuchengetwa kwe kunze kwe network kana kuronga nezvekufambisa kune vanopa kure.

Kufona 211 kunokubatanidza nezvinhu zvesevhisi zvevanhu, kusanganisira zvipatara zvevanhu, zvipatara zvemahara, nevanoipa Medicaid mune nzvimbo yako. 211 service inoshanda muzvikamu zvese uye inobatanidza vanofona nezviuru zvezvinhu zvenharaunda.

Zvekutarisa Usati Wagadzirira Kugadzirira Kwako Kwokutanga

Usati wagadzirira kugadzirira kwako kwekutanga nemuchiremba weMedicaid, tarisa zvinhu zvakawanda kudzivirira zvinoshamisa. Sanyanzvi kuti nzvimbo iri kugamuchira varwere vatsva veMedicaid nechirongwa chako chakatarwa. MaDhairekitori evanopa haanyatso kugadziridzwa nekukurumidza, uye anopa akanyorwa seari kubatana anogona kunge akarega kugamuchira varwere vatsva veMedicaid. Fona hofisi zvakananga uye bvunza.

Sanyanzvi kuti vanobatana nechirongwa chako cheMedicaid chakatarwa. Muchiremba anogona kugamuchira Medicaid kubva kune chimwe chirongwa asi kwete chimwe. New Jersey, semuenzaniso, ine zvirongwa zvakawanda zvekugadzirira, uye vanopa vanogona kunge vari mukati me network nezvimwe asi kwete zvese.

Bvunza nezvekumirira nguva dzekugadzirira kwevarwere vatsva. Vamwe vanopa vanobatana neMedicaid vane marudzi ekumirira kwe mavhiki kana mwedzi kune varwere vatsva. Kuziva izvi pachine nguva kunokubatsira kuronga kana kutsvaga kumwe kana zvaunoda zvichida nguva.

Nzwisisa zvinhu zvekutanga zvekubvumidzwa zvemamiriro ako. Medicaid inowanzoda authorization yekutanga kwezviito, kutumirwa kwehunyanzvi, mushonga unodhura, uye michina yekurapa inogara. Hofisi yemuchiremba wako inofanira kubata izvi, asi kuziva maitiro kunokubatsira kutaura kana chimwe chinhu chakadzimwa.

Kufamba neMedicaid Mazino NeChiono

Zvakanaka zvemazino nechekuona hazviwanzoita sezvakafanana nekuchengetedzwa kwekurapa. Mazhinji zvirongwa zveMedicaid zvechikamu zvinoparadzanisa kuchengetedzwa kwemazino kubva kune masevhisi ekurapa. Iwe unowanzoda kuwana chiremba wemazino anogamuchira Medicaid kuburikidza nechirongwa chemazino chechikamu chako pane kuburikidza nechirongwa chako chekugadzirira kwekurapa. Medicaid dental coverage state-by-state inosiyana zvakanyanya. Zvikamu zvine kuchengetedzwa kwakawanda zvinosanganisira California, Colorado, Connecticut, DC, Hawaii, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Virginia, Vermont, Washington, uye Wisconsin. Zvikamu zvine kuchengetedzwa kushoma zvinosanganisira Arkansas, Delaware, Florida, Georgia, Maine, Mississippi, North Carolina, North Dakota, South Dakota, Utah, neWyoming. Zvikamu zvine emergency-only zvinosanganisira Alabama, South Carolina, neTennessee.

Kuchengetedzwa kwechiono kunosiyanawo. Mazhinji zvirongwa zveMedicaid zvechikamu zvinobhadhara kuongororwa kweziso kwevana asi zvinogona kushandisa kuchengetedzwa kwechiono kwevakuru kune kuchengetwa kweziso kwekurapa (kurapa zvirwere) pane kuongororwa kwenguva dzose nemagirazi. Ona bhuku redu re vanachiremba veziso vanogamuchira Medicaid kuti uwane zvakadzama.

Mibvunzo Inowanzobvunzwa

Ndinowana sei vanachiremba vanogamuchira Medicaid pedyo neni?

Nzira yakanaka yekuwana vanachiremba veMedicaid pedyo newe ndiyo kuburikidza nedhairekitori revanopa rechirongwa chako cheMedicaid chakagadzirirwa, chinowanikwa pa portal yemwanga wechirongwa chako. Kana uri mu fee-for-service Medicaid, shandisa chishandiso chekutsvaga chevanopa chesangano reMedicaid renyu. Kuti uwane zvimwe zvingasarudzwa, tsvaga Federally Qualified Health Centers (FQHCs) kuburikidza HRSA's Find a Health Center tool kana fonera 211 kuti uwane zvinhu zvevanhu.

Ndeipi chikamu chezviremba chinogamuchira Medicaid?

Munzvimbo dzose, ingangoita 74% yevachiremba vanogamuchira varwere vatsva vane Medicaid coverage, zvichienzaniswa ne95% kune inishuwarisi yakavandika. Kugamuchirwa kunosiyana zvakanyanya nechikamu, kubva pa42.2% muNew Jersey (yakaderera) kusvika padyo ne100% muIdaho (yakakwira). Vanopa hunyanzvi sevanoita zvepfungwa, vanachiremba veganda, uye vanachiremba vefupa vanogamuchira Medicaid pamwero wakaderera kune vanachiremba vekutanga. Nzvimbo dzeguta dzinowanzova nevanopa vanobatana neMedicaid vakawanda kune nzvimbo dzemaruwa.

Ndinogona here kuona chiremba chero neMedicaid?

Kwete. Kusiyana neMedicare iyo inogamuchirwa ne90%+ yevachiremba munyika yose, Medicaid ine mwero wekugamuchirwa unosiyana. Ingangoita 74% yevachiremba vanogamuchira varwere vatsva veMedicaid, asi unofanira kusanyanzvi kuti mupe anogamuchira chirongwa chako cheMedicaid chakatarwa (nekuti zvikamu zvinoshandisa nzira dzakasiyana dzekugadzirira). Muchiremba "akakodzera" anoenderana nechirongwa chako cheMedicaid chakagadzirirwa, nzvimbo, uye hunyanzvi hwekuchengetwa kunodiwa.

Nei vamwe vanachiremba vasingagamuchiri Medicaid?

Zvikonzero zvakakosha zvevanachiremba vasingagamuchiri Medicaid zvinosanganisira mwero wakaderera wekubhadhara (Medicaid inowanzobhadhara 60-70% yezvavanobhadhara Medicare, iyo pachayo inobhadhara zvishoma pane inishuwarisi yakavandika), mabasa anovhiringidza senge zvinyorwa zvakawanda nezvinodiwa zvekutanga zvekubvumidzwa, uye nguva dzekubhadhara dzishoma. Zvipatara zvimwe zvakavhara mapanel avo eMedicaid nekuti vawana kugona kwavo kwevarwere veMedicaid vachiramba vachigamuchira varwere vatsva veinishuwarisi yakavandika.

Ndinogona here kuwana kuchengetwa kwehunyanzvi neMedicaid?

Hongu, asi kuwana vanopa hunyanzvi neMedicaid kunoda kuedza kukuru kune inishuwarisi yakavandika. Muchiremba wako wekutanga anowanzokutumira kune muvapi wekunyanzvi mukati me network yechirongwa chako chakagadzirirwa. Kana muvapi wekunyanzvi asingawanikwe mukati me network, chirongwa chako chakagadzirirwa chinofanira kuronga mukana kuburikidza nekuchengetwa kwe kunze kwe network, kufambiswa kune vanopa kure, kana tele-health. Vanoipa hunyanzvi sevanoita zvepfungwa vanogamuchira Medicaid uye vanachiremba veziso vanogamuchira Medicaid vanogona kunge vakaoma kuwana.

Zvinoitika sei kana usingakwanise kuwana chiremba anogamuchira Medicaid?

Kana usingakwanise kuwana muvapi aripo muMedicaid munzvimbo yako, taura nechirongwa chako cheMedicaid chakagadzirirwa zvakananga. Zvinodiwa nehurumende zvenetwork zvinoda kuti zvirongwa zvipe mukana wakakodzera. Unogonawo kushanyira Federally Qualified Health Center, iyo inofanira kugamuchira Medicaid nemutemo, kana kufona 211 kuti uwane zvinhu zvevanhu. Kune zvinodiwa zvinokurumidza, dzimba dzekukurumidza dzezvipatara dzinofanira kukuporesa zvisinei nekukwanisa kubhadhara pasi peEMTALA.

Chikuru

Kuwana vanachiremba veMedicaid vave pedyo newe kunoda kushandisa dhairekitori revanopa rechirongwa chako chakagadzirirwa, wobva wasanyanzvi kubatana nekufonera hofisi zvakananga. Munzvimbo dzose, ingangoita 74% yevachiremba vanogamuchira varwere vatsva veMedicaid (zvichienzaniswa ne95% kune inishuwarisi yakavandika), ine musiyano wakakura pakati pezvikamu. New Jersey ine mwero wakaderera wekugamuchira pa42.2% uku Wisconsin, Minnesota, neNorth Dakota dzisina musiyano neinishuwarisi yakavandika. Nzira dzekuita nyaya dzakaoma dzinoda kuwedzera nzvimbo yako yekutsvaga, kushandisa Federally Qualified Health Centers, kufonera chirongwa chako chakagadzirirwa rubatsiro rwe network, uye kufona 211 kuti uwane zvinhu zvevanhu. Kune vanopa hunyanzvi, ona magwara edu pa vanachiremba vemazino vanogamuchira Medicaid, vanachiremba veziso vanogamuchira Medicaid, uye vanachiremba veganda vanogamuchira Medicaid. Kuti uwane mamwe mashoko eMedicaid, ona magwara edu Medicaid uye maitiro ekukwanira Medicaid.