Daim ntawv kho mob: Daim ntawv them nqi kho mob Health Insurance yog kev cog lus ntawm koj thiab lub tuam txhab muag daim ntawv kho mob es qhia tias lub tuam txhab yuav them cov nqi thiab koj ho yuav tau them ntau npaum cas thaum koj mus kho mob. Cov nqi lus teev meej nov hu ua daim ntawv kho mob Health Insurance “plan,” “policy,” los yog “coverage.”
Deductible: Koj qhov deductible yog qhov nyiaj koj yuav tau them rau cov kev kho mob hu ua non-preventive health care ntawm ib xyoos twg ua ntej koj daim ntawv kho mob mam li pib them. Piv txwv, yog koj qhov deductible yog $1,000, koj yuav them $1,000 ua ntej koj daim ntawv kho mob pib them ib co nqi. Tom qab koj them tag nrho qhov deductible rau xyoo ntawd lawm los yog “meet your deductible,” koj yuav muab cov nqi kho mob ntawd rau koj daim ntawv kho mob pab koj them es yog them yam li paying co-insurance.
Co-pay: Ib qho nqi es teev rau them yam tsis hloov, feem ntau yog them thaum koj tau txais kev kho mob. Qhov ntau thiab tsawg nyob ntawm hom kev kho mob twg. Piv txwv, tej zaum koj kuj them $25 thaum koj mus ntsib kws kho mob, $50 yog mus ntsib tus kws specialist thiab $10 rau ib zaug twg es mus nqa tshuaj noj.
Co-insurance: Co-insurance yog qhov nqi es koj pab them thaum muaj kev kho mob. Koj tsuas pib them qhov Co-insurance tom qab koj them tag koj qhov deductible lawm. Co-insurance yog muab laij ua percent ntawm koj daim ntawv kho mob es pub rau koj siv los kho mob.
Piv txwv, yog tias koj daim ntawv kho mob es muaj qhov Co-insurance yog 20%, thaum koj them tag koj daim ntawv kho mob qhov deductible lawm, koj yuav them 20% ntawm qhov kev pub pab kho koj txog thaum koj them puv qhov out-of-pocket lawm.
Out-of-pocket costs: Out-of-pocket cost yog cov nqi koj them rau kev kho mob es koj yog tus lav phib xaub los them; yuav tsis yog koj daim ntawv kho mob yog tus them. Out-of-pocket cost suav nrog cov deductibles, co-insurance, thiab co-payments rau cov kev kho mob rau koj, thiab tag nrho cov nqi kho mob es koj daim ntawv kho mob tsis them.
Out-of-pocket maximum: Qhov nyiaj koj them out-of-pocket ntau tshaj plaws es koj yuav tau them ib xyoos twg rau cov kev kho mob. Thaum koj them txog tus nqi ntawd lawm ces koj daim ntawv kho mob yuav pib them 100% ntawm qhov nqi pub them.
Nco ntsoov tias tsis yog tag nrho cov nqi kho mob koj them yuav muab suav rau qhov them tsis pub them tshaj nov. Piv txwv, qhov koj them tsis pub them tshaj ntawm qhov out-of-pocket tsis suav nrog cov nqi koj them rau koj daim ntawv kho mob txhua lub hli (premium) los yog tej yam nqi koj them rau cov kev kho mob es koj daim ntawv kho mob tsis them rau.
Premium: Koj qhov premium yog qhov nyiaj koj them ib hlis ib zaug mus rau lub tuam txhab muab daim ntawv kho mob rau koj. Koj yuav tsum them tus nqi premium ib hlis ib zaug txawm tias koj tsis siv daim ntawv musk ho mob lub hlis ntawd.
Qhov nqi premium them ib hlis ib zaug them ntau thiab tsawg nyob ntawm lub hnub nyoog, qhov chaw, haus luam yeeb, seb koj yuav rau koj tus kheej los yog yuav rau koj tsev neeg, thiab seb koj xav kom daim ntawv kho mob them nqi rau theem twg (lwm lub npe hu ua theem metal level). Koj qhov nyiaj them txhua hli (premium) tsis muab suav rau koj qhov nyiaj deductible ntawm ib xyoos twg.
Premium tax credit: Ib qhov nyiaj se tax credit pub dawb tej zaum koj kuj qhuas lis fais rau uas txo tau koj tus nqi them txhua hli rau daim ntawv kho mob kom qis zog thaum koj cuv npe rau daim ntawv kho mob muaj tswv (private health plan) hauv MNsure mus.
Koj yeej siv tau tag nrho, ib co, los yog tsis siv koj qhov premium tax credit ua ntej kom txo tau tus nqi them txhua hli rau daim ntawv kho mob kom qis zog. Piv txwv: Koj yeej xaiv tau qhov es muab cov se tax credit ua ntej (advanced premium tax credit, or "APTC") kom txo tau tus nqi them txhua hli rau daim ntawv kho mob kom qis zog. Los yog, koj yeej tau qhov es tos kom txog thaum koj ua cov se federal tax es mam li muab cov se tax credit ntawd ntxiv rau cov nyiaj ua se es koj tau los.
Essential health benefits: Tag nrho MNsure cov ntawv kho mob muaj nrog kev them nqi rau cov kev kho mob hu ua essential health benefits (or “EHBs”) xws li kev pab thaum ti tes ti taw, pw hoo maum, muaj menyuam hauv plab thiab tu tus menyuam nyuam qhuav yug, cov tshuaj kws kho mob sau ntawv rau koj mus yuav noj, mus kuaj txog kev noj qab haus huv, kev muaj mob saum lub hlwb thiab kuaj qhov muag rau menyuam yaus.
Metal level: Feem ntau ntawm cov ntawv kho mob los ntawm MNsure yog muab faib ua ib pawg ntawm plaub them ntawm cov kib: kib txhuas, kib nyiaj, kib kub los yog kub dawb. Cov theem ntawm cov kib metal yog muab raws li qhov koj thiab koj lub tuam txhab muab daim ntawv kho mob rau koj neb sib faib them cov nqi kho mob. Nyob rau theem lub kib txhuas, koj lub tuam txhab muab daim ntawv kho mob rau koj them tsawg heev thiab koj yuav yog tus lav phib xaub them qhov ntau ntawm qhov nqi kho mob; nyob rau theem kub los yog kub dawb, koj lub tuam txhab muab daim ntawv kho mob rau koj them qhov ntau thiab koj yuav yog tus lav phib xaub them qhov tsawg ntawm koj qhov nqi kho mob
Ib daim ntawv kho mob es muab rau koj thaum muaj kev kub ntxhov ceev hu ua Catastrophic plans yeej muaj rau ib co tib neeg. Daim ntawv kho mob es muab rau koj thaum muaj kev kub ntxhov ceev hu ua Catastrophic plans muaj muaj qhov nyiaj deductible siab thiab qhov nqi them txhua hli yuav qis zog tshaj li qhov es nyob rau theem kib txhuas tabsis them nqi kho mob tsawg heev thaum koj xav tau kev kho mob. Koj yuav tsum muaj hnub nyoog qis tshaj 30 xyoo los yog raug kev txom nyem mas thiaj zam rau koj es pub koj yuav daim ntawv kho mob es muab rau koj thaum muaj kev kub ntxhov ceev hu ua Catastrophic plans
Preventive services: Kev kuaj mob xws li kuaj lub cev ntaj ntsug, kuaj ib ce thiab sab laj nrog tus neeg mob kom tiv thaiv tsis txhob muaj mob, txhob muaj kab mob los yog lwm yam teem meem rau kev noj qab haus huv.
Provider: Ib tug neeg los yog ib lub chaw kho mob los yog muab tshuaj rau noj. Piv txwv xws li cov kws kho mob, cov kws kuaj hlwb, cov kws pab kom tes taw muaj zog, hoo maum, cov chaw kuaj ntsav, cov tsev kuaj mob me, thiab cov chaw mus nqa tshuaj noj.
In-network provider: Ib qhov chaw kuaj mob es lub tuam txhab muab daim ntawv kho mob cog lus nrog koj pab muab kev kho mob rau nws cov tswv cuab.
Out-of-network provider: Ib qhov chaw kuaj mob es lub tuam txhab muab daim ntawv kho mob tsis muaj kev cog rau.
