HMO vs. EPO vs. PPO: Ndeupi mutsauko?

Kambani

Pfungwa iri shure kweinishuwarenzi yehutano iri nyore: Inobatsira kuvhara mari dzako dzekurapa kana ukakuvara kana kurwara. Asi chokwadi cheinishuwarenzi yehutano muAmerica chakanyanya kuomarara. Kune akawanda madimikira anobatanidzwa-HMO vs. EPO vs. PPO vs. POS vs. HSA vs. PCP. Kufungidzira kuti ndeipi inishuwarenzi chirongwa chakanakira iwe unogona kuvhiringidza.

Matatu matatu akajairwa ehurongwa hweinishuwarenzi ehutano zvirongwa zveHMO, EPO, uye PPO. Sarudzo yako inozoenderana nemari yaunowana, mararamiro, uye basa, pamwe nehutano hwemhuri yako, mari, uye zvekurapa.

Chinhu chakakosha ndechekuongorora zvinhu zvese usati wasarudza chirongwa, pane kufunga kuti boka iri rematsamba riri nani pane rimwe boka retsamba, anodaro Vincent Plymell, mutevedzeri wemukuru weColorado Division of Insurance. Panyaya yekusarudza pakati peHMOs, EPOs, uye maPPO, mumakore achangopfuura idzi mhando dzehurongwa dzave kunyanya kufanana, saka zvinova zvishoma nezve zita rehurongwa uyezve nezve masevhisi ari mukati mechirongwa ichocho.

HMO Vs. EPO vs. PPO

Sangano rekuchengetedza hutano, kana HMO , rudzi rwehurongwa hwekuchengetedza hutano hunokupa mukana wekupinda netiweki yevanopa, zvipatara, uye vanopa hutano munzvimbo yako. Kazhinji, zvirongwa zveHMO zvinoda kuti iwe usarudze chiremba wekutanga (PCP). Uyu ndiye chiremba wako, iye waunotanga wabvunza naye nezve chero nyaya dzehutano. Kana iwe uchida mamwe masevhisi ezvehutano, PCP yako inokuendesa kune nyanzvi mukati meiyo HMO network. Kana iwe ukaenda kune wekunze-kwe-network chiremba kana chipatara, iwe ungangodaro uchafanirwa kubhadhara kubva muhomwe kune asiri-ekukurumidzira ekurapa kwehutano.

Sangano rinopa wega, kana EPO, yakafanana neHMO mune izvo zvese zviri zviviri zvine network yevanopa zvehutano uye zvivakwa. Kunyangwe iwe uchifanira kusarudza chiremba wekutanga wekuchengeta ane mazhinji maEPO, haudi kutumirwa kuti uwane mukana kune nyanzvi-kusiyana neHMO. Inetiweki ye EPO inogona zvakare kuve yakanyanya kuwanda kupfuura network yeHMO. Kunze kwekunge iri mamiriro ekukurumidzira, maHMO nema EPOs zvinowanzoda kuti iwe ubhadhare mari dzese dzekuchengetwa kwe-network.

Nesangano rinodiwa remupi, kana PPO , chirongwa chako cheinishuwarenzi chehutano chine hunyanzvi hwevanoona nezvehutano nenzvimbo munzvimbo yako nemunyika yese iyo yaanoshanda nayo uye yaungade iwe utsvage. Kana iwe ukaenda kune vanopa izvi, chikamu chakakura chemitengo yako chinobhadharwa nechirongwa. Kusiyana neEPOs neHMOs, PPOs inovhara zvimwe zvekunze-zve-network mari sekureba sezvavanenge vakavharirwa masevhisi. Network yePPO inowanzo sanganisira vanopa rubatsiro kumatunhu akasiyana, uye, sekune EPO, haufanire kutumirwa kubva kuna chiremba wekutanga kuti uone nyanzvi.

HMOs dzinopa kushomeka kushoma asi kazhinji dzinowana yakaderera pamwedzi mari. EPOs dzinonyanya kuchinjika asi kazhinji dzinodhura kupfuura HMOs. PPOs, iyo inopa inonyanya kuchinjika, ndiyo inowanzo dhura.

Ndezvipi zvakanakisa: PPO, EPO, kana HMO?

Zvese zvemunhu zvinodiwa nezvehutano zvakasiyana. Vamwe vanhu vanoda zvechiremba zvekurapa. Vamwe vane zvirevo zvinoda kuzadzwa. Uye vanhu vazhinji vane hutano sezvazvinogona kuva uye vanenge vasina kana hutano hwekuda zvachose. Ndosaka zvisingaite kutaura kuti nderupi rudzi rwehurongwa hwakanakisa. Mhinduro yacho inosiyana pamunhu nemunhu, nyika nenyika, uye mushandirwi kumushandirwi.

Panguva kuvhura kunyoresa , iwe uchafanirwa kuzvibvunza mimwe mibvunzo usati wasarudza mutemo:

• Ndezvipi zvinodiwa zvangu zvehutano uye zvinodiwa zvehutano zvemhuri yangu?
• Ndeapi matsamba andinotora?
• Ndeapi mamiriro andinawo?
• Ndeapi matanho ehutano ini kana nhengo yemhuri inotarisira mugore rinouya? Funga: kuvhiyiwa kukuru, kugadzirisa marathon, kubata, kusvika kune yakakosha zuva rekuzvarwa, nezvimwe.
• Ini ndinoda here kana kuti ndoda kuona wekunze-kwe-network mupi?

Pamusoro peiyi mibvunzo yehutano, Plymell anoti iwe unofanirwa kubvunza inotevera mibvunzo yemari:

• Ndezvipi zvandinoda zvemari?
• Ini ndinogona kutenga yakakwira inobvisirwa mukutsinhana kwepasi yeprimiyamu?
• Ini ndinosarudza kufanofungidzira mune zvehutano zvinodhura kana ini ndingatoda ini kuva nemadhora emwedzi mashoma?

Ongorora: Kana iwe ukawana inishuwarenzi yehutano kuburikidza nebasa rako, unogona kunge uine sarudzo shoma dzekuti ndeipi inishuwarenzi yaunowana. Chero zvazvingaitika, iwe unowanzo kupedzisira uine mutemo unodhura kupfuura uyo unotengwa wega.

HMO inogona kunge iri nani kana…

Vaya vachiri vadiki, vane hutano hwakanaka, uye vasingatarisirwe kurapwa mugore rinouya vanowanzofarira zvirongwa zveHMO nemari yepasi shoma (iyo mari yaunobhadhara mwedzi wega wega) uye yakaderedzwa yakakwenenzverwa (iyo mari yaunofanira kubhadhara pamberi peinishuwarenzi inobatsira kuvhara vamwe vese). Izvi zvinochengetedza mari kunze kwekunge iwe uine kukuvara kana chirwere, zvinova zvakanaka kune mhando dzine njodzi shoma, asi hazvisi zvakanakira munhu wese.

EPO inogona kunge iri nani kana…

Kune avo vane nyaya dzisingaperi dzehutano uye vanoziva vachazoda kuona nyanzvi, chirongwa che EPO chinogona kuita pfungwa yemari zvakanyanya. Iyo inodimura iyo kudikanwa kwekumisikidza sarudzo yehutano sarudzo kuburikidza nachiremba wekutanga wekuchengeta uye kazhinji ine yakawanda mu-network vanachiremba uye zvivakwa kupfuura HMO.

PPO inogona kunge iri nani kana…

Kana iwe ukafamba zvakanyanya, kunyanya kana uine nyaya dzisingaperi dzekurapa, iwe ungangoda kutarisa kune chirongwa chePPO. PPOs dzine yakafararira yenyika network yevanopa zvehutano uye inovhara zvimwe zvinodhura kana ukasarudza wekunze-kwe-network mupi.

RELATED: HMO vs. PPO

Ndeupi hurongwa hwakachipa pane hutano?

Iyo yakachipa pashoma hutano hurongwa, pamwedzi, ichave iyo ine yakaderera mari. Asi izvo zvinowanzoreva kubvisirwa kwakakwirira, saka chirongwa ichi chinogona kudhura zvakanyanya nekukurumidza kana iwe ukarwara kana kukuvara. Ndosaka zvakachipa ishoko risiri iro rekushandisa kana zvasvika kune inishuwarenzi yehutano. Panzvimbo pekutarisa chete kune-kunze-kwehomwe mutengo, zvakakosha kuti utarise kukosha kwaunenge uchiwana yako mari.

Sekureva kweKaiser Family Foundation , avhareji yehutano inishuwarenzi premium kune mumwe munhu muU.S. yaive $ 7,188 pagore. Kune mhuri, avhareji yaifungidzirwa kuve $ 20,576.Mari yeinishuwarenzi yehutano inogona kusiyana zvichienderana nekwaunogara, asi kana uri mudiki uye uine hutano, ndizvo Chivabvu kuve nekukwanisa kuwana maprimiyamu emwedzi pasi pe $ 100 Nekudaro, idzi dzinogona kunge dzisiri huru marongero. Iwe unogona kunge uri pachirauro cheyakakura inobviswa kana iwe ukarwara kana kukuvara. Kazhinji, zvakadaro, mari yeinishuwarenzi yehutano ichave yakakwira zvakanyanya.

Imwe yekufungisisa ndeye copays. Mamwe marongero, kunyanya maHMO, anogona kutanga kubhadhara chikamu chemitengo yezvinhu zvakaita sekushanya kwachiremba usati wasangana neyako yaunobvisa. Vamwe havazodi, kunyanya maPPO. Izvi zvinoreva kuti mutengo wekuona chiremba unogona kunge uri kubva pamadhora gumi kusvika pamadhora mazana maviri zvichikwira, zvinoenderana nachiremba uye nekuvharwa kwemutemo wako.

Imwe nzira yekugona kuchengetedza mari ndeyekusarudza mutemo unoratidzira kudhara. Aya marudzi emitemo anogona kuve nemari yepasi shoma. Zvisinei, iwe uchazofanira kubhadhara chikamu chemari yako yekurapa kunyangwe mushure mekunge iwe wasangana neyako deductible. Iyo inishuwarenzi kambani ichabhadhara muzana (kazhinji iri pakati pe75% uye 90%) - uye uchafanirwa kubhadhara iyo yasara. Iyo Affordable Care Act inoganhurira iyo mari yaunogona kushandisa kunze-kwehomwe mune rakapihwa gore nemitemo yakadaro. Ye 2020, iyo kunze-kwehomwe kunonyanyisa yezvirongwa zveMusika unoita $ 8,150 kuvanhu uye $ 16,30 yemhuri. Iwe unogona zvakare kuve unokodzera ACA rubatsiro izvo zvinoderedza mari yeinishuwarenzi yehutano zvichienderana nemari yako

Zvisinei nebumbiro raunosarudza, iwe unogona kugara uchichengeta pane zvako zvakatemwa uine Kamwe kadhi rekunyorera kadhi rekudzora.