Hlav mus rau cov ntsiab lus tseem ceeb
Rau Cov Tswv Cuab (Qhib hauv phab tshiab)
Cov ntsiab lus tseem ceeb

Ib daim ntawv teev npe tshuaj yog dab tsi (formulary) thiab nws ua hauj lwm li cas

Tshaj tawm: Lub Kaum Hli 13, 2021

Hnub hloov tshiab zaum kawg los no: Lub Kaum Hli 13, 2021

Dab tsi yog Daim Ntawv Teev Npe Tshuaj (Formulary) thiab Nws Ua Hauj Lwm Li Cas?

Yog muab hais kom yooj yim, lo lus formularly tsuas yog lub npe siv rau ib daim ntawv teev npe tshuaj xwb. Ib daim ntawv teev npe tshuaj yog cov tshuaj tsis muaj npe (generic) thiab cov muaj npe (brand) uas them rau tus nqi los ntawm ib daim phiaj tuav pov hwm kho mob tshwj xeeb. Qee zaum, daim phiaj kho mob cov tshuaj teev npe formularies kuj tseem muab hu ua preferred drug lists (PDLs).

Tau txais koj daim ntawv qhia txog daim phiaj muaj ob yam kev pab pub dawb

 Txhua yam koj xav paub txog Dual Special Needs Plans hauv ib qho, phau ntawv qhia yooj yim.

Lub hom phiaj ntawm daim ntawv teev npe tshuaj (formulaly) yog dab tsi?

Lub hom phiaj ntawm daim ntawv teev npe tshuaj yog los pab tswj seb cov tshuaj twg cov kws kho mob tuaj yeem sau ntawv tau rau koj mus yuav thiab them rau los ntawm koj daim phiaj npaj kho mob hauv xyoo 2022. Lub hom phiaj ntawm daim ntawv teev npe tshuaj yog kom paub tseeb tias cov tshuaj them los ntawm daim phiaj kho mob muaj kev nyab xeeb, ua tau hauj lwm thiab muaj nyob ntawm tus nqi tsim nyog them taus. 

Leej twg tsim daim ntawv teev npe tshuaj?

Daim phiaj kho mob cov ntawv teev npe tshuaj kheev yog tsim los ntawm ib pawg neeg uas tsa muaj los ntawm daim phiaj lub tuam txhab kev tuav pov hwm kev noj qab haus huv. Pawg neeg tsim daim ntawv teev npe tshuaj yuav muaj xws li cov kws muag tshuaj thiab kws kho mob los ntawm ntau qhov chaw kho mob. Pawg neeg no kheev yuav xaiv seb cov tshuaj twg uas yuav tau muaj rau hauv daim phiaj kho mob daim ntawv teev npe tshuaj. Ib daim phiaj kho mob tuaj yeem hloov paus nws daim ntawv teev npe tshuaj ib lub sij hawm rau ib lub sij hawm. Qhov ntawd yuav yog vim muaj cov tshuaj tshiab, cov kev hloov kho mob los sis raws li cov ntaub ntawv kho mob tshiab.

Yog tias muaj ib qho tshuaj uas kws kho mob sau ntawv yuav tsis nyob hauv koj daim phiaj kho mob daim ntawv teev npe tshuaj, tej zaum koj yuav tau rho nyiaj hauv hnab tshos los them rau.

Medicare daim phiaj kho mob cov ntawv teev npe tshuaj (formularies)

Qee cov tshuaj tej zaum yuav them rau los ntawm Medicare Part B (kev pov hwm kho mob). Tab sis feem ntau, cov tshuaj Medicare Part B tsis yog cov tshuaj uas koj yuav muab rau koj tus kheej. Feem ntau, Medicare Part B cov tshuaj yog cov uas yuav tau muab rau koj hauv tus kws kho mob lub chaw ua hauj lwm los sis tsev kho mob sab nraud.

Medicare Part D cov phiaj xwm tshuaj thiab Medicare Advantage (Part C) cov phiaj xwm yuav muaj cov ntaub ntawv kho mob teev cov tshuaj uas txhua daim phiaj them tus nqi. Feem ntau, cov ntawv teev npe tshuaj yuav muaj xws li ib qho kev xaiv yam tsawg kawg nkaus 2 tshuaj nyob rau hauv feem ntau ntawm cov tshuaj uas kws kho mob sau ntawv yuav thiab nyob ua chav lawm. Qhov no yuav pab kom cov neeg muaj mob sib txawv tuaj yeem tau txais cov tshuaj uas lawv xav tau. Kawm kom paub ntxiv txog 4 txhua feem sib txawv ntawm Medicare.

Daim phiaj muaj ob yam kev pab muaj feem tau txais cov ntawv teev npe tshuaj

Cov phiaj kho mob muaj ob yam kev pab muaj feem tau txais, los yog hu ua Dual Special Needs Plans (D-SNPs), yog ib hom ntawm Medicare Advantage daim phiaj rau cov neeg uas muaj cai tsim nyog tau txais Medicaid thiab Medicare ob qho tib si. Cov phiaj kho mob muaj ob yam kev pab tej zaum kuj yog kho lawv cov ntawv teev npe tshuaj, cov kev pab thiab cov kev xaiv kws kho mob kom tau raws li cov kev xav tau tshwj xeeb ntawm cov tswv cuab uas lawv pab.

Cov neeg ntawm Medicaid thiab Medicare yuav muaj cov teeb meem kev noj qab haus huv loj dua, mus sij hawm ntev. Thiab tej zaum lawv kuj yuav tau siv ntau yam tshuaj. Qee cov tshuaj yuav tsis muaj nyob hauv cov npe tshuaj uas tau pom zoo los ntawm Medicaid, cov tshuaj pom zoo los ntawm Medicare los sis koj daim phiaj kho mob. Cov tshuaj no yog muab los xam tias yog cov tshuaj tsis nyob hauv daim ntawv teev npe tshuaj.

Yog tias muaj ib qho tshuaj kws kho mob sau ntawv yuav tsis nyob ntawm koj daim phiaj kho mob daim ntawv teev npe tshuaj, tej zaum koj yuav tau rho nyiaj hauv hnab tshos them rau. Thiab kev them nyiaj rau cov tshuaj kuj yuav kim heev. Yog li ntawd nws yog ib qho tseem ceeb kom paub tseeb tias cov tshuaj uas koj xav tau muaj nyob rau hauv daim phiaj kho mob daim ntawv teev npe tshuaj ua ntej koj rau npe los sis hloov mus rau lwm daim phiaj kho mob.

Yuav kuaj xyuas seb puas muaj cov tshuaj uas koj xav tau nyob ntawm daim ntawv teev npe tshuaj li cas

Yog tias koj tab tom nrhiav daim phiaj muaj ob yam kev pab los yog Medicaid daim phiaj uas muab los ntawm UnitedHealthcare, nws yooj yim los saib seb puas muaj qhov tshuaj uas koj xav tau teev nyob rau hauv daim phiaj daim ntawv teev npe tshuaj. Nov yog yuav ua li cas saib cov npe tshuaj hauv Lus Askiv los yog Spanish:

  1. Ntaus koj tus lej ZIP code rau hauv lub box nyob nram qab kawg ntawm nplooj ntawv no txhawm rau los nrhiav daim phiaj hauv koj cheeb chav
  2. Nias rau ntawm lub pob "Saib daim phiaj qhia meej” (View plan details) hauv daim phiaj uas koj siab nyiam.
  3. Xaiv qhov "Teev npe Tshuaj" (Drug list) nyob rau hauv lub box xiav los mus saib cov tshuaj uas them rau los ntawm koj daim phiaj.

Feem ntau, koj yuav xav paub cov ntsiab lus ntawm cov tshuaj koj tab tom noj tam sim no. Qhov ntawd yooj yim ua, vim tias koj tuaj yeem saib cov npe ntawm cov tsiaj ntawv ntawm txhua yam tshuaj uas koj nyiam.

Mus saib UnitedHealthcare cov phiaj tuav pov hwm nyob hauv koj thaj tsam.

Muaj feem tau txais ob qho los yog Medicaid cov phiaj muab kev pab yuav hloov nyob ntawm seb koj nyob qhov twg. Tshawb xyuas los ntawm kev siv koj tus lej ZIP code txhawm rau los nrhiav daim phiaj uas ua tau raws li koj cov kev xav tau kev kho mob zoo tshaj plaws.

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