Indlela Yokufaneleka Nge-Medicaid Ngo-2026: Imikhawulo Yemali Engenayo & Umhlahlandlela Wokusetshenziswa

Indlela ofaneleka ngayo nge- Medicaid incike kakhulu esifundazweni sakho. Emazweni angu-40 kanye ne-Washington D.C. andwe asekela i-Medicaid ngaphansi kwe-Affordable Care Act, abantu abadala abangaphansi kweminyaka 65 bafaneleka uma imali engenayo yasekhaya ingaphansi noma ilingana no-138% weFederal Poverty Level. Ngo-2026, lokho cishe kungu-$22,025 ngonyaka kumuntu oyedwa noma u-$45,540 emndenini wabane. Emazweni angu-10 angakasekeli (i-Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming), ukufaneleka kunzima kakhulu. Umthetho webhajethi wezwe yango-2025 uphinde wengeze izidingo zokusebenza ziqala ngoMeyi 2026 kwezinye izifundazwe, ne-Congressional Budget Office ilinganisa ukuthi abantu abangafika ezigidini ezingu-5.3 bangalahlekelwa ukumbozwa ngo-2034. Ngokwe- Medicaid.gov, abantu baseMelika ababalelwa ezigidini ezingu-80 manje sebebhaliswe ku-Medicaid noma ku-CHIP.

Lo mhlahlandlela uchaza indlela yokufaneleka nge-Medicaid ngo-2026, okubandakanya imikhawulo yemali engenayo ngesigaba, imithetho yempahla, umehluko phakathi kwezifundazwe ezisekela kanye nalezo ezingasekeli, nendlela yokufaka isicelo. Ulwazi luvela ku- Medicaid.gov, i-CMS, kanye nezinhlelo zikahulumeni wezifundazwe ze-Medicaid.

Imikhawulo yemali engenayo ye-Medicaid yango-2026

I-Medicaid isebenzisa izinhlaka ezimbili ezihlukene zokufaneleka ngemali engenayo kuye ngokuthi yisiphi isigaba esisebenza kuwe:

I-MAGI Medicaid (Modified Adjusted Gross Income). Isetshenziswa kubantu abadala, izingane, abesifazane abakhulelwe, abazali, kanye nabantu abadala abasekelwe yi-ACA. Akukho ukuhlolwa kwempahla okusebenzayo ku-MAGI Medicaid. Imali engenayo ibalwa njengephesenti le- Federal Poverty Level.

Emazweni asekelwe yi-Medicaid (imizwe engu-40 + i-DC), umkhawulo wabantu abadala ngu-138% FPL:

• Umuntu omunye omdala: $22,025/ngonyaka ($1,835/ngenyanga)

• Isibhangani: $29,720/ngonyaka ($2,477/ngenyanga)

• Umndeni wabathathu: $37,440/ngonyaka ($3,120/ngenyanga)

• Umndeni wabane: $45,540/ngonyaka ($3,795/ngenyanga)

I-Non-MAGI Medicaid. Isetshenziswa kubantu asebekhulile (abangu-65+), abantu abakhubazekile, nabafake izicelo zokunakekelwa isikhathi eside. Kubandakanya imikhawulo yemali engenayo KANYE nokuhlolwa kwempahla:

• Umkhawulo wemali engenayo ye-Medicaid yokunakekelwa isikhathi eside (2026): $2,982/ngenyanga kumuntu oyedwa, $5,964/ngenyanga eshadile

• I-Federal Benefit Rate (FBR) yango-2026: $994 kumuntu oyedwa, $1,491 eshadile

• Umkhawulo wempahla (ezifundazweni eziningi): $2,000 kumuntu oyedwa

• Imvume yempahla yomyeni/umkaommashiyane: kufika ku-$162,660

Umehluko ezifundazweni. Ezinye izifundazwe zivumela i-MAGI Medicaid ngaphezu kuka-138% (i-Connecticut, i-DC, i-Maine, i-Maryland, i-Massachusetts), kanti ezinye zikhawulela emaphesentini aphansi. Imikhawulo yempahla ku-non-MAGI Medicaid iyahlukahluka: i-Connecticut, i-Delaware, i-Louisiana, i-Maine, i-Mississippi, i-Vermont, nezinye azinayo imikhawulo yempahla. E-California kukhona imikhawulo yempahla ephakeme ($130,000 kumuntu oyedwa / $195,000 eshadile ngo-2026).

Ukuze uthole ulwazi oluqondene nesifundazwe lwe-Medicaid, buka umhlahlandlela wethu we- Medicaid Illinois kanye nezihloko ezizayo ezizolandelwa ezifundazweni ezithile zeCalifornia, Pennsylvania, Michigan, kanye neNorth Carolina.

Ukusekelwa kwe-Medicaid kuqhathaniswa nezifundazwe ezingasekeli

Lapho uhlala khona kunquma ukuthi ngabe uyafaneleka yini ngokwemali engenayo kuphela noma ubhekana nemithetho eqinile:

Izifundazwe ezisekela (imizwe engu-40 + i-DC): Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, DC, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina (kusukela ngoDisemba 2023), North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, Washington, West Virginia.

Ezifundazweni ezisekela:

• Abantu abadala bafaneleka ngokusekelwe kuphela emalini engenayo (138% FPL)

• Akukho ukuhlolwa kwempahla kwe-MAGI Medicaid

• Abantu abadala abangenazo izingane bafaneleka kungakhathalekile isimo somndeni

• Inqubo yesicelo esisodwa ngokusebenzisa umphathi wezempilo wesifundazwe

Izifundazwe ezingasekeli (ingu-10): Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming.

Ezifundazweni ezingasekeli:

• Abantu abadala ngokuvamile kudingeka babe ngabazali, asebekhulile, noma abakhubazekile ukuze bafaneleke

• I-Texas ikhawulela abazali ku-17% we-FPL cishe (~$273/ngenyanga emndenini wabathathu)

• I-Alabama ikhawulela abazali ku-18% we-FPL cishe

• Abantu abadala abangenazo izingane ngokuvamile abafaneleki kungakhathalekile imali engenayo

Uweziko lokumbozwa. Abantu abangaboshiwe ababalelwa ezigidini ezingu-1.4 ezifundazweni ezingasekeli benza imali eningi kakhulu kune-Medicaid esifundazweni sabo kodwa bambalwa kakhulu (ngaphansi kwe-100% FPL) ngezinxephezelo zentela ye-ACA Marketplace. Cishe u-97% walaba bahlali abathintekayo bahlala emazweni aseNingizimu, kanti i-Texas yodwa inikeza u-42% wezwe lonke lolweziko lokumbozwa.

Ngemininingwane nge- ukusekelwa kwe-Medicaid nendlela izinhlelo ze- Medicare vs Medicaid ezihlobene ngayo, bona imihlahlandlela yethu.

Okumbozwa yi-Medicaid

I-Medicaid imboza izinhlobonhlobo zezinsizakalo zezempilo. Izinzuzo ezithile ziyahlukahluka ngesifundazwe kodwa izinsizakalo ezidingeka nguhulumeni zihlanganisa:

• Ukulaliswa esibhedlela kanye nokwelashwa esibhedlela

• Izinsizakalo zikadokotela

• Izinsizakalo zezulu kanye ne-X-ray

• Izinsizakalo ze-Federally Qualified Health Center

• Izinsizakalo zokuhlela umndeni

• Izinsizakalo zikamfelwa kadokotela

• Izinsizakalo zezingane

• Ukunakekelwa kwabantu ababesifazane abakhulelwe

• Izinsizakalo zesikhungo sokunakekela izindlu zabantu abadala

• Izinsizakalo zasekhaya

• Izinsizakalo zokunakekelwa isikhathi eside

• Ezokuthutha zezimo eziphuthumayo zezokwelapha

Izinzuzo ezikhethwayo ezihlukahlukene ngesifundazwe zihlanganisa ukumbozwa kwamazinyo, imithi kadokotela, izibuko, izinsizakalo zempilo yengqondo, ukwelashwa ngokomzimba, ukunakekelwa kwe-hospice, ama-dentures, kanye nezinsizakalo ezahlukahlukene zokubuyiselwa emalungelweni.

Ukuze uthole imininingwane yokumbozwa okukhethekile, bona imihlahlandlela yethu ku- Medicaid dental yabantu abadala, odokotela bamazinyo abamukela i-Medicaid, kanye odokotela bamehlo abamukela i-Medicaid.

Indlela Yokufaka Isicelo se-Medicaid

Ungafaka isicelo se-Medicaid nganoma yisiphi isikhathi sonyaka. Asikho isikhathi sokubhalisa ovulekile. Inqubo yesicelo enezinyathelo ezinhlanu:

Isinyathelo 1: Qinisekisa ukuthi ukwesinye sezicelo zokufaneleka. Abantu abadala abaningi ezifundazweni ezisekela bafaneleka ngokusekelwe kuphela emalini engenayo. Abahlali bezifundazwe ezingasekeli kudingeka babe ngabazali bezingane ezincikene, abakhulelwe, asebekhulile, noma abakhubazekile.

Isinyathelo 2: Qoqa amaphepha akho. Adingeka ezicela eziningi:

• Amakhadi e-Social Security kuwo wonke amalungu asekhaya

• Umazisi onesithombe noma ilayisense yomshayeli

• Ubufakazi bemali engenayo (amarisidi emvuzo akamuva, izitatimende zentela, isaziso se-Social Security)

• Ubufakazi bokuhlala (isikweletu samapayipi kagesi, isivumelwano sokuqashisa)

• Ubufakazi bobuzwe noma isimo sokufudukela kwelinye izwe

• Kubantu abesifazane abakhulelwe: isiqinisekiso sezokwelapha sokukhulelwa

• Kwezinhlobo ezingewona i-MAGI: izitatimende zasebhange, imininingwane yempahla

Isinyathelo 3: Khetha ukuthi uzofaka kanjani isicelo. Izinketho ziyahlukahluka ngesifundazwe kodwa ngokuvamile zihlanganisa:

• Ku-inthanethi nge-portal yakho ye-Medicaid yesifundazwe

• Ku-inthanethi nge- HealthCare.gov (kwezifundazwe ezisebenzisa i-marketplace yesifundazwe)

• Ngocingo kumphathi wezempilo wesifundazwe sakho

• Ngokuthumela iphepha lesicelo

• Ngoqobo ehhovisi le-Medicaid lendawo noma esikhungweni sezempilo somphakathi

Isinyathelo 4: Thumela isicelo sakho futhi uphendule izicelo. Izifundazwe eziningi zilungisa izicelo phakathi kwezinsuku ezingu-30-45. Izicelo ezisekelwe ekukhubazekeni zingathatha izinsuku ezingu-90. Phendula ngokushesha kunoma yimaphi amaphepha aceliwe ukugwema ukulibaziseka.

Isinyathelo 5: Thola isinqumo sakho sokufaneleka. Uma uvunyelwe, uzothola isaziso ngeposi ngosuku lokuqala kanye ne-ID ye-Medicaid. Ungase ubhaliswe ohlelweni lokunakekelwa oluhanjiswa ngokulawulwa ngokuzenzakalelayo uma isifundazwe sakho sisisebenzisa.

Uma wenqatshuziwe, unamalungelo okudlulisa isikhalo. Ngokuvamile, ungacela ukulalelwa ngaphakathi kwezinsuku ezingu-30-90 zenqatshelwe kuye ngesifundazwe sakho.

Izidingo zokusebenza ze-Medicaid ngo-2026

Umthetho wezwe wangaphambilini ka-2025 (osayinelwe ngoJulayi 4, 2025) wengeza izidingo zokusebenza ze-Medicaid kubantu abadala abasekela ezizosebenza ngo-2026:

• I-Nebraska: Kuqala ngoMeyi 2026, abantu abadala abasekela kudingeka baqinisekise amahora angu-80 ngenyanga emisebenzi efanelekile

• I-Montana: Kuqala ngoJulayi 2026, isidingo esifanayo samahora angu-80

Imisebenzi efanelekile ihlanganisa umsebenzi, ukuqeqeshwa komsebenzi, ukuzithandela, imfundo, noma ukunakekela. Izinhlobo ezikhululiwe ngokuvamile zisebenza kubakho:

• Abesifazane abakhulelwe

• Abantu abakhubazekile

• Abanakekeli bezingane ezincane

• Abafundi ababhalise okungenani isigamu sokuphila

• Abantu abaphathwa ukuhlukunyezwa kwezidakamizwa

Isiqondiso sokugcina sezwe kulindeleke ku-CMS ngoJuni 2026. I-Congressional Budget Office ilinganisa ukuthi abantu abafika ezigidini ezingu-5.3 bangalahlekelwa ukumbozwa yi-Medicaid kusuka ezidingweni zokusebenza kuphela ngo-2034.

Imibuzo Evame Ukubuzwa

Yisiphi isikhawulo semali engenayo sokufaneleka nge-Medicaid ngo-2026?

Kubantu abadala abaningi ezifundazweni ezisekela i- Medicaid, umkhawulo ungu-138% we-Federal Poverty Level: $22,025/ngonyaka kumuntu oyedwa noma u-$45,540 emndenini wabane ngo-2026. I-Medicaid yokunakekelwa isikhathi eside isebenzisa umkhawulo wemali engenayo owahlukile ongama-$2,982/ngenyanga kubafake izicelo abangashadile. Izifundazwe ezingasekeli zinomkhawulo oqinile kakhulu, ngokuvamile ama-17-50% e-FPL kubazali.

Ngingathola i-Medicaid uma ngisebenza?

Yebo. Abantu abadala abaningi abasebenzayo bafaneleka nge-Medicaid ezifundazweni ezisekela ngoba umkhawulo wemali engenayo (138% FPL) uphezulu kakhulu kune-federal minimum wage equivalent. Umuntu oyedwa owenza imali engaphezu kuka-$22,025 ngonyaka uyafaneleka. Ezinye izifundazwe zinomkhawulo ophakeme. Izidingo zokusebenza zango-2026 eNebraska naseMontana zithinta kuphela labo bantu abadala asebevele bafaneleka ngokwemali engenayo, hhayi abafake izicelo abasha.

Ngidinga ukuba yisakhamuzi sase-US ukuze ngifaneleke nge-Medicaid?

Udinga ukuba yisakhamuzi sase-U.S., isakhamuzi esihlala unomphela ngokomthetho, noma isimo sokufudukela kwelinye izwe esifanelekile. Abafuduki abaningi abasemthethweni kumele balinde iminyaka emi-5 ngemuva kokungena ngaphambi kokufaneleka nge-Medicaid, yize abesifazane abakhulelwe, izingane, kanye nababaleki bekhululiwe kulesi sikhathi sokulinda. Ezinye izifundazwe (i-NY, CA, IL, OR) zinikeza ukumbozwa okuxhaswe nguhulumeni kubantu abangebona izakhamuzi kungakhathalekile isimo sokufudukela kwelinye izwe.

Kungathatha isikhathi esingakanani ukuze ngivunyelwe yi-Medicaid?

Izifundazwe eziningi zilungisa izicelo ze-MAGI Medicaid phakathi kwezinsuku ezingu-30-45. Izicelo ezisekelwe ekukhubazekile zingathatha izinsuku ezingu-90. Abesifazane abakhulelwe bavame ukufaneleka ku- presumptive eligibility phakathi kwezinsuku ezimbalwa. Uma uvunyelwe, ukumbozwa kwakho kuvame ukuqala ngosuku lokuqala lwenyanga lapho wafaka isicelo khona (noma inyanga edlule, kuye ngemithetho yokumbozwa kwe-retroactive esifundazweni sakho).

Ingabe i-Medicaid inokuhlolwa kwempahla?

I-MAGI Medicaid (abantu abadala abaningi, izingane, nabesifazane abakhulelwe) ayinayo inhlolo yempahla. I-Non-MAGI Medicaid (abantu asebekhulile, abakhubazekile, abanakekelwa isikhathi eside) ihlanganisa izinhlobo zempahla, ngokuvamile u-$2,000 kubafake izicelo abangashadile. Indlu yakho eyinhloko (kufika ku-$1,071,000 yenzuzo ezifundazweni eziningi), imoto eyodwa, izinto zasekhaya, nezindleko zokungcwaba ngokuvamile azibandakanyi ekubalweni kwempahla.

Ngingaba ne-Medicaid ne-Medicare ngesikhathi esisodwa?

Yebo. Uma uyafaneleka kokubili, ubizwa nge-"dual eligible." I-Medicaid imboza lokho i-Medicare engakumbozi (izimpahla, izimfono, ama-copay, ukunakekelwa isikhathi eside). Abazuzayo ababili ngokuvamile bafaneleka ngokuzenzakalelayo ku- Medicare Extra Help kanye ne- Medicare Savings Programs. Ukuze uthole kabanzi ngalo mqeqeshi, bona umhlahlandlela wethu we- Medicare vs Medicaid.

Isiphetho

Indlela yokufaneleka nge- Medicaid ngo-2026 incike kakhulu lapho uhlala khona. Emazweni angu-40 asekelayo kanye ne-DC, abantu abadala bafaneleka ngemali engenayo elingana noma engaphansi kuka-138% we-FPL ($22,025/ngonyaka kumuntu oyedwa, u-$45,540 emndenini wabane). Emazweni angu-10 angasekeli (AL, FL, GA, KS, MS, SC, TN, TX, WI, WY), ukufaneleka kunzima kakhulu, ngokuvamile kufuna isimo sokuba umzali noma ukukhubazeka. Asikho isikhathi sokubhalisa ovulekile; ungafaka isicelo nganoma yisiphi isikhathi. Izifundazwe eziningi zilungisa izicelo ngezinsuku ezingu-30-45. Izidingo zokusebenza zomthetho wezwe ka-2025 ziqala ukusebenza ngo-2026 eNebraska naseMontana, kanti ezinye izifundazwe zizolandela. Ukuze uthole ulwazi olunzulu lwe-Medicaid, bona imihlahlandlela yethu eyinhloko ye- Medicaid, Medicaid Illinois, kanye ne- Medicare vs Medicaid.