I-Medicare ne-Medicaid: Umhlahlandlela Ophelele Womehluko, Ukufaneleka Nokuhlanganiswa

Umehluko phakathi kwe-Medicare ne-Medicaid udida izigidi zabantu baseMelika minyaka yonke futhi amagama akusizekelanga. Zombili yizinhlelo zempilo zikahulumeni. Zombili ziqala ngo-"Medi." Zombili zaqala ukusebenza ngosuku olufanayo ngo-1965. Nokho, zisebenza nabantu abahlukene ngokuphelele, azisebenzi ngendlela efanayo, futhi zinemithetho ehlukene. I-Medicare ingumshwalense wezempilo osuselwa eminyakeni, okungukuthi ikakhulukazi kubantu abaneminyaka engu-65 nangaphezulu. Ukuhlanganiswa kwezempilo okususelwa emholweni kwabantu abanemali engenayo ephansi, kungakhathalekile iminyaka yabo, kuyichaza i-Medicaid. Kukhona labo bantu abafanelekile kokubili.

Lo mhlahlandlela uzokukhombisa ukuthi yini eyenziwa yizo zonke izinhlelo, ubani ofanelekayo, kubiza malini, kuyahlanganiswa ini, nokuthi ukufaneleka kokubili kusebenza kanjani. Umthombo wolwazi yi-CMS, i-Medicare.gov, i-Medicaid.gov, kanye ne-KFF. 

Iyini i-Medicare futhi iyini i-Medicaid?

I-Medicare uhlelo lomshwalense wezempilo lukahulumeni phakathi kwabantu abaneminyaka engu-65 nangaphezulu, kanye nalabo abaneminyaka engaphansi kwengu-65 abanezifo ezithile noma isifo sezinso esiphelayo. Kuxhaswa ngokushibila komholo ikakhulukazi ngokushibila komholo obukwenza kusukela ebuncaneni bakho besebenza. Ayikho imali engenayo, noma ezinye izidingo ezidingekayo ukuze uthole ukufaneleka, futhi izinzuzo zivame ukufana kuzo zonke izifundazwe.

I-Medicaid isinyathelo sikahulumeni nesifundazwe, esinikeza ukuhlanganiswa kwezokunakekelwa kwezempilo kubantu abahola imali ephansi. Isifundazwe ngasinye sinenguqulo yayo, futhi uhulumeni omkhulu uwaxhasa ngendlela efanayo neyezifundazwe. Imithetho, ukufaneleka kanye nezinsizakalo ezihlanganisiwe zihluka kakhulu kuye ngesifundazwe. Ngokwezibalo ze-CMS, cishe abantu abayizigidi ezingu-80 bahlanganiswa uhlelo olukhulu lomshwalense wezempilo e-U.S., okuyi-Medicaid.

Isifinyezo esisetshenziswa abashushumbisi bomshwalense abaningi: I-Medicare iyabantu abadala, i-Medicaid yimali engenayo ephansi. 

I-Medicare ne-Medicaid: ukuqhathanisa ohlangothini

Umehluko we-medicare ne-medicaid uveza kucace lapho ubheka ohlangothini. Zombili izinhlelo zihlanganisa ukuvakashelwa odokotela, ukulaliswa esibhedlela, nemiyalelo, kodwa ukufaneleka kanye nesakhiwo sezindleko kuhluke kakhulu.

I-Medicare inezingxenye ezine (A, B, C, D), ngayinye ihlanganisa izinsizakalo ezahlukene. I-Medicaid inohlelo olulodwa oluyinhloko esifundazweni ngasinye, nezingeziwe ezikhethekayo. Izakhiwo zezinhlelo zihlukene ngokwanele ukuthi "I-Medicare ne-Medicaid" akulona nhlobo uhlaka olulungile lwabantu abaningi. Umbuzo wangempela uthi ngumuphi ongakufanelekayo, nokuthi ungakufanelekela kokubili.

Umehluko phakathi kokufaneleka kwe-Medicare ne-Medicaid?

I-Medicare ne-Medicaid zihlukana kanjani enanini yabantu abafanelekayo? Konke kuya ngeminyaka nemali engenayo. 

Ukufaneleka kwe-Medicare kufuna iminyaka (engama-65 nangaphezulu) noma ukukhubazeka. I-Medicare.gov ithi iningi labantu lifanelekele ngokuzenzakalelayo uma nje bona noma omunye wabo besebenze iminyaka okungenani eyi-10 (ama-40 ama-quarter) bekhokha izintela ze-Medicare. Abantu abangaphansi kweminyaka engu-65 bafaneleka uma beathole i-Social Security Disability Insurance (SSDI) izinyanga ezingama-24, noma banayo i-ALS noma isifo sezinso esiphelayo. 

Ukufaneleka kwe-Medicaid kuyahlukahluka ngokwemali engenayo, usayizi womndeni kanye nemithetho yesifundazwe sakho. Kukhona izindinganiso eziphansi zikahulumeni omkhulu, kodwa izifundazwe zibeka imingcele yazo yemali engenayo. Ezifundazweni ezinwebele i-Medicaid ngaphansi kwe-ACA, abantu abadala bayafaneleka ngemali engenayo efika ku-138% we-Federal Poverty Level (cishe $20,800 ngonyaka we-2026). Ezifundazweni ezinganwelanga, imingcele yemali engenayo iphansi kakhulu noma izigaba ezithile kuphela ezifanelekayo (abakhulelwe, abazali, izingane, abantu abakhubazekile). 

Usebenzisa i-Social Security Administration ukufaka isicelo se-Medicare. Ubhalisela i-Medicaid kwi-ejensi yakho ye-Medicaid yesifundazwe noma ku-healthcare.gov. Ukuze uthole izeluleko zesifundazwe esithile, isibonelo sendlela imithetho yesifundazwe esebenza ngayo yile i-Medicaid Illinois guide yethu.

Yini eyihlanganiswa yizo zonke izinhlelo?

Zombili izinhlelo zihlanganisa izinsiza eziningi ezinkulu zezokwelapha, kodwa imininingwane yehlukile.

Ukuhlanganiswa kwe-Medicare:

• Ingxenye A (ibhedlela): Ukulaliswa ezibhedlela, ukunakekelwa ezikhungweni zezisebenzi eziqeqeshiwe, i-hospice

• Ingxenye B (yokwelapha): Ukuvakashelwa odokotela, ukunakekelwa okungaboshwe esibhedlela, izinsizakalo zokuvimbela, okokusebenza okudala okunamandla. Bona okwethu okugcwele umhlahlandlela we-Medicare Part B ukuze uthole imininingwane.

• Ingxenye C (I-Medicare Advantage): I-Part A + B ehlanganisiwe (futhi ngokuvamile i-D) ngabashicileli abayimfihlo

• Ingxenye D (imiyalelo): Imishanguzo yomlomo. Bona okwethu i-Medicare Part D explainer

I-Medicare ayihlanganisi iningi lamazinyo, umbono, ukuzwa, noma ukunakekelwa kwesikhathi eside. Leli yis surprise ejwayelekile kubazuzi abasha. Ngemininingwane eyengeziwe ngama-gaps amazinyo, bona okwethu ingabe i-medicare ihlanganisa amazinyo umhlahlandlela.

Ukuhlanganiswa kwe-Medicaid: Umthetho wezwe udinga ukuthi uhlelo ngalunye lwe-Medicaid lwesifundazwe luhlanganise izinsizakalo zezibhedlela nezezibhedlela, izivivinyo nokuhlolwa ngama-X-ray, ukuhlelwa komndeni, ukunakekelwa ezindlini zabalulekile, impilo yasekhaya yabantu abafanelekayo ezindlini zabalulekile, ezokuthutha ukuya emihlangano yezokwelapha, kanye ne-EPSDT (ukuvimbela ukunakekelwa) kwezingane ezingaphansi kweminyaka engu-21. Izifundazwe zingangeza imiyalelo, amazinyo, umbono, ukwelashwa ngokomzimba, nezinye izinsizakalo njengezinsizakalo ezikhethekayo. Bona okwethu ukuhlanganiswa kwamahlabathi kwe-Medicaid kubadala umhlahlandlela wesifundazwe ngesifundazwe njengesibonelo sendlela lokhu okuhlukile ngayo.

I-Medicaid inamandla kakhulu kunama-Medicare ekunakekeleni isikhathi eside. Izindlu eziningi zabalulekile e-U.S. zikhokhwa yi-Medicaid, hhayi i-Medicare.

Ungaba ne-Medicare ne-Medicaid kokubili?

Yebo. Abantu abafanelekayo kokubili babizwa ngokuthi "abafanelekayo kaningi," futhi cishe abantu baseMelika abayizigidi ezingama-12.5 bangaphansi kwalesi sigaba, ngokusho kwe-ucwaningo lwe-KFF. Iningi labo ngabantu abangama-65+ abanenqola ephansi.

Ukuhlanganiswa kwe-Medicare ne-Medicaid kungasebenzi kanje: I-Medicare iyona ekhokha eyinhloko ezinsizakalweni zezokwelapha ezi-covering, futhi i-Medicaid iyazikhuza ukukhokha izinkokhelo ze-Medicare, ama-copay, nama-deductibles, kanye nezinsizakalo i-Medicare engazihlanganisi (ukunakekelwa kwesikhathi eside, ngokuvamile amazinyo nombono).

Ukuhlanganiswa okuhlanganisiwe kungenye yezinto zokuhlanganiswa zezempilo ezingcono kakhulu ezitholakala e-U.S. Abantu abafanelekayo ngokuvamile bakhokha $0 ephaketheni labo cishe kuyo yonke imithi, okuhlanganisa nemiyalelo nge-uhlelo lwe-Medicare Savings Program ne-Extra Help.

Ukuhlola ukuthi ungakufanelekela yini kokubili, thintana ne-State Health Insurance Assistance Program (SHIP) yesifundazwe sakho noma faka isicelo nge-ejensi yakho ye-Medicaid yesifundazwe.

Imibuzo Evame Ukubuzwa

I-Medicare noma i-Medicaid ingcono?

Akekho "ongcono." Zisebenzela abantu abahlukene. I-Medicare uhlelo olufanele uma uneminyaka engu-65+ noma unokukhubazeka okufanelekayo. I-Medicaid uhlelo olufanele uma unemali engenayo ephansi, kungakhathalekile iminyaka. Cishe u-1 kwabangu-8 abathola i-Medicare bafanelekelwa yi-Medicaid, ebanikeza ukuhlanganiswa okuningiliziwe kunanoma iyiphi indlela yokuhlanganiswa yase-U.S.

Ngidinga i-Medicare ne-Medicaid kokubili? 

Awukhethi ukuba nezozimbili. Ufanelekelwa zombili ngokweminyaka nemali engenayo. Uma uneminyaka engu-65+ unemali engenayo ephansi, ukufaka isicelo sezombili kufanele kucatshangelwe. Izinhlelo ezimbili ndawonye zikhokha izindleko eziningi zezempilo, okuhlanganisa izinkokhelo, ama-copay, nezinsizakalo i-Medicare engazihlanganisi. Khuluma nomeluleki we-SHIP usizo olukhululekile.

Ngingalahlekelwa yi-Medicaid uma ngithola i-Medicare? 

Cha. Uma ufanelekelwa zombili, uba ngumfaneleki kaningi. I-Medicare iba umshwalense wakho oyinhloko, futhi i-Medicaid iqhubeka nokukhokha izinkokhelo, ama-copay, nezinzuzo ezengeziwe. Awulahlekelwa ukuhlanganiswa kwe-Medicaid ngoba nje ube neminyaka engu-65 noma ufanelwe yi-Medicare. Iminqamulajuqu yemali engenayo isasebenza ku-Medicaid, nokho, ngakho hlola izidingo zokuvuselela.

Yikuphi okuhlanganisa izindleko zezindlu zabalulekile? 

I-Medicaid ihlanganisa izindleko eziningi zokunakekelwa kwezindlu zabalulekile e-U.S. I-Medicare ihlanganisa kuphela izinsuku ezingama-100 zokunakekelwa ezikhungweni zezisebenzi eziqeqeshiwe, futhi kuphela ngemuva kokulaliswa esibhedlela okufanelekayo. Ngemuva kokuphela komkhawulo we-Medicare, imindeni ngokuvamile iyakhokha ngokuzenzakalela noma ifake isicelo se-Medicaid. Cishe u-60% wabahlali bezindlu zabalulekile ezweni lonke banakekelwa nge-Medicaid.

Ngabe i-Medicare noma i-Medicaid ihlanganisa amazinyo? 

I-Medicare yasekuqaleni (Izingxenye A ne-B) ayihlanganisi iningi lezokwelapha zamazinyo. Izinhlelo ze-Medicare Advantage ngokuvamile zihlanganisa ukuhlanganiswa kwamahlabathi. Ukuhlanganiswa kwamahlabathi kwe-Medicaid kuyahlukahluka kakhulu ngesifundazwe. Abanye bahlanganisa amazinyo agcwele abantu abadala, abanye bahlanganisa ukukhipha okungaphuthukisiwe kuphela. Izingane ezine-Medicaid zithola ukuhlanganiswa kwamahlabathi okugcwele kulo lonke izifundazwe ngaphansi kwemithetho ye-EPSDT yezwe.

Isiphetho

I-Medicare ne-Medicaid ayilona ukuqhathanisa kodwa kunalokho kuyimibuzo yokuthi yini ekusebenzela. I-Medicare ingumshwalense wezempilo wezwe osuselwa eminyakeni wabantu abangama-65+ kanye nabantu abathile abakhubazekile. I-Medicaid ingukuhlanganiswa kwezempilo okususelwa emalini engenayo okuyahlukahluka ngesifundazwe. Cishe abantu abayizigidi ezingama-12.5 bafanelekelwa zombili futhi bazuzwe ukuhlanganiswa okuningiliziwe kakhulu. Uma usulapha lapho usuzoba ngama-65, ukufaka isicelo se-Medicare nge-SSA kuzenzakalela kwabaningi. Uma unemali engenayo ephansi, ukufaka isicelo se-Medicaid nge-ejensi yesifundazwe sakho kuyindlela. Uma ungacacelwa ukuthi yini ekusebenzayo, umeluleki we-SHIP wesifundazwe sakho unikeza umhlahlandlela okhululekile noyize.