医保报销是怎么报销的?

9个月前 (05-08) 0 点赞 0 收藏 0 评论 343 已阅读

住院的医疗医保是怎么报销的,是大部分报销吗?那事实真的是这样的吗?

那我们今天就一起来了解一下医保到底是怎么报销的,到底能报销多少。也许你会有新的发现,有新的认识。首先我们来了解一下我国医保的构成。在我们国家,医保分为职工医保和居民医保。职工医保的费用由单位和个人共同缴纳,分为单位缴纳的部分、个人缴纳的部分。当然,灵活就业的人自己缴纳医保。职工医保要求女性至少要交满二十年,男性至少要交满二十五年才能在退休后终身享受医疗保险。居民医保是完全由个人来交费,而且是每年都要交的,活到老,交到老,只要交就能享受医疗报销,不交就不能享受医疗报销。职工医保又分为省医保和市医保。居民医保又分为城镇居民医保和新农村合作医疗。

目前,医疗机构从一级二级三级(从低到高),报销比例不同,越往上起付线越高,报销比例越低,以部分市二级医院为例,很多人认为省医保能报销住院费用的百分之九十以上,甚至达到百分之九十五。市医保呢,也能够报销住院费用的百分之八十到百分之八十五。城镇居民医保能够报销住院费用的百分之七十到八十。新农合在城市里也能够报销百分之六十左右的住院医疗费用。我们的医保真的能如大家所愿报销那么多吗?今天我们就一起来了解一下医保到底是怎么来报销的,能报销多少。

医保报销比例

如果我用这个v 型图来表示住院的医疗花费,那么在医保报销时,首先我们会看到医保的报销起付线。这个起付线也就是我们所说的医保的报销门槛,起付线以下的部分是不报销的。根据医院不同,起付线标准也不同,起付标准一般在四百元到两千元。从县级医院到区级、市级和省级医院起步标准是不一样的,医院的级别越高,起伏标准越高,起伏线以下的部分不报销,那是不是起伏线以上的部分都报销呢?其实也不是,我们的医保是有封顶线的,不同地区不同封顶线的标准也不同。比如北京职工医保的封顶线是五十万,陕西和河南都是四十万,封顶线以上的部分也是无法报销的。

那是不是起付线和封顶线中间的部分全部都能报销呢?我们接着往下看,事实上起步线和封顶线中间的部分也不是全都报销的。

首先自费的费用是无法报销的。自费的费用主要包括哪些呢?丙类药品,比如进口药、特效药等,非医保目录里的药品,还有一些特殊的诊疗项目及服务项目的费用。这块费用医保一分钱都不报。在我们的住院费用里,自付费用会占一定的比例。因为这一块费用几乎都是一些治疗效果比较好的药品和诊疗项目的费用。同时医生的提成也比较高,所以每次住院都会产生自费费用。除了自费的费用不报销,还有一部分的费用也是不报销的,那就是医保报销目录里的乙类药品的按比例(3-6%)自付费用部分以及丙类项目。但这些自付项目在住院期间院方会以书面形式告知患者及家属。

医保

其实在我们的医保目录里面百分之百能报销的甲类药只有一千八百多种部分,报销的乙类药品也只有八百多种,加起来才两千六百多种。而医保不报销的丙类药却超过了十九万种。可想而知,在住院的时候,医生不可能给你用的都是医保可报销的甲类药。为了达到很好的治疗效果,医生一定会使用很多的乙类药品和部分的丙类药。所以当一个人住院时,他的医疗费、医保不会百分之百全报销的。

如果你有医保报销相关问题请给我留言。

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