Chii chinonzi HMO?

Kambani Healthcare Yakatsanangurwa

Kuziva iyo inishuwarenzi yehutano kuronga kusarudza inogona kuve inonyengera sarudzo. Kwete chete kuti iwe unofanirwa kuyera mitengo nezvako zvehutano zvido, asi dzimwe nguva mazwi nezvipiriso zvinongovhiringidza. Mune yedu Hutano hwakatsanangurwa hwakateedzana , tinoedza kuputsa uyu mutauro wakaomarara. Pano, tinokurukura chirongwa chehutano chinozivikanwa seHMO.

Chii chinomirira HMO? Zvinorevei?

HMO inotsanangurwa nesangano rekuchengetedza hutano. Iyo mhando yehurongwa hweinishuwarenzi yehutano inoda kuti iwe ushandise chete mu-network vatapi vezvehutano. Ava ndivanachiremba (pamwe nemamwe masevhisi akaita semarabhabu nezvipatara) zvine chibvumirano nehurongwa hweinishuwarenzi. Iwe unokwanisa enda kune vanopa kunze kwenetiweki yako kune ekurapwa masevhisi, asi chirongwa cheHMO kazhinji hachibhadhare mari kunze kwekunge kuri kwekuchengetedzwa kwekukurumidza.

Izvo zvakakosha kuti uzive kuti kana iwe uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchiita zvekuchirapa. Maererano ne zvehutano.gov , zvese zvirongwa zvinofanirwa kukubatsira iwe kubhadhara rubatsiro rwechimbichimbi, zvisinei nekuti unoenda kuna chiremba kana chipatara mukati meiyo HMO network yevanopa kana kwete.

HMOs inoshanda senge echinyakare ehutano inishuwarenzi zvirongwa mune izvo iwe:

• kubhadhara pamwedzi shoma (mari inodzokororwa kuve neinishuwarenzi yehutano), uye
• ndinofanira kubhadhara copays (seta fizi iwe yaunobhadhariswa masevhisi sekushanya kwachiremba kana X-ray), zvinokamurwa (iyo mari yaunofanirwa kubhadhara gore rega usati inshuwarisi yako yehutano yatanga kuvhara mari), uye coinsurance (iyo muzana yemutengo wakazara wekutarisira iwe unobhadhara mushure mekunge iwe wasangana neyako deductible).

Maererano ne neworleansurance.org, HMO dzave kuve dzakakurumbira kupfuura mamwe akawanda marongero ezvehutano muUnited States kubvira hurumende yemubatanidzwa Affordable Care Act (ACA) yakatanga kushanda muna 2014. California Hofisi yeMurwere Gweta inotaura kuti vangangoita 50% yevagari veCalifornia vakafukidzwa neHMOs.

HMOs inoshanda sei?

Kana iwe ukasarudza HMO yehurongwa hweinishuwarenzi yehutano, unofanirwa kusarudza chiremba wekutanga (PCP) mukati mechirongwa chehurongwa uyo anozobatanidza kurapa kwako kwese. (Kana chiremba wawanga uchishandisa hausi mumutambo weHMO, ungatofanira kusarudza imwe nyowani.) Chiremba uyu anozotarisira zvekuchengetedzwa kwehutano hwako, sekuongororwa kwegore, majekiseni, uye zvimwe zvekurapa. hanya.

Kana iwe uine Medicare, unogona kusarudza kuwana HMO-dhizaini chirongwa cheinishuwarenzi kuburikidza nechirongwa cheMedicare Advantage (chinozivikanwawo seMedicare Chikamu C) - zvinopesana neiyo Original Medicare, iyo isingashandise netiweki yechiremba.

Kana iwe uchida kuona nyanzvi kune dambudziko rekurapa-semuenzaniso, iwe uri mumhanyi uyo akabvarura ACL-iwe uchafanirwa kuwana kutumira kubva kune yako PCP kune iye-mu-network mupi. Kana iwe ukaenda usina kuendesa, kana sarudza kuona mumwe munhu kunze kwenetiweki kana iri isiri yechimbichimbi, unogona kuve nemhosva yemubhadharo wese wekuchengetwa kwaunopihwa nachiremba. Pamusoro pezvo, vakadzi vanowanzo enda kune-mu-network chiremba wekubereka / gynecologist yekutarisirwa kwepamuviri uye mukadzi-mushe vasina kuendeswa uye vane masevhisi akafukidzwa. Asi zvakadaro, kuti usabatwe nechengetedzo iwe yawaifunga kuti yakafukidzwa nehurongwa hweinishuwarenzi yehutano, zvakakosha kuti iwe uverenge yako hurongwa hweHMO uye unzwisise chaizvo masevhisi auchabatwa nawo kana iwe ukabuda kunze kwenetiweki.

Nei mumwe munhu achizosarudza HMO?

Iyo HMO ndiyo inodzvinyirira fomu yeinishuwarenzi yehutano sezvo ichiganhurira iyo vanachiremba iyo yavanobhadhara kuburikidza neinishuwarenzi. Kana iwe ukasarudza kubuda kunze kwenetiweki, iwe unogona kunamatira kubhadhara iyo yese mutengo weiyo hanya. Asi, padivi rekuwedzera, nekuti iwe unonyanya kushomeka, iwe kazhinji unobhadhara zvishoma mune einishuwarenzi ehutano maprimiyamu eHMOs maringe nemamwe marongero ehutano. Izvo zvinogona kuve rombo rakanaka kune mudiki, munhu ane hutano uyo anongowana chete kurapwa kwehutano hwekuchengetedza, sekutarisirwa kwegore. Pamusoro pekudzikisa mitengo yekuvhara hutano, Kaiser Permanente inocherekedza kuti zvimwe zvezvakanaka zveHMOs ndeizvi:

• Yakaderera-mutengo wemishonga yekunyorera, uye
• Kuve nachiremba mumwe chete anosvika pakuziva zvako zvekurapa uye kuronga kwese kutarisira kwako.

Kana mutengo uchinge wakakomba pane kuchinjika, HMO inogona kunge iri iyo chaiyo inishuwarenzi yehutano sarudzo kwauri.

Ndeupi musiyano uripo pakati peHMO nePPO?

PPO chimwe chirevo — ichi chinomirira sangano rinopa mubatsiri Zvirongwa zvePPO zvakasiyana neHMO mune izvo zvekuti zvinokutendera kuti ubve kunze kwenetiweki yekuchengetwa pasina kutumirwa uye pasina kubhadhara mari izere kana uchidaro. Iwe hautombofaniri kusarudza chiremba wekutanga wekutarisira. Kunyangwe iwe uchizosevha mari yekugara nevatapi venetiweki, iyo PPO inowanzo bhadharira zvimwe zvekunze-kwe-network chengetedzo iwe yaunogashira. Semuenzaniso, yako PPO inogona kubhadhara 80% yemari yako yekurapa paunoshanyira in-network Provider (uye iwe unobhadhara 20%). Asi kana iwe uchienda kunze kwenetiweki, inogona kungotora 60% yemutengo - ichikusiya iwe forogo pamusoro pemutengo we40%. PPO isarudzo inokwezva kune vanhu vanofarira timu yavo yechiremba uye vasinganetse kubhadharira yakawedzera rusununguko rwekugona kuvawana pazvinenge zvichidikanwa. Kana iwe uine Medicare, PPOs dzinowanikwawo pasi pechirongwa cheMedicare Advantage.

Kuti uwane rumwe ruzivo, verenga chinyorwa chedu pa HMO vs. PPO .