政策解答 | 居民医保参保缴费的必要性
<section data-mpa-powered-by="yiban.io" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; visibility: visible;"><section style="margin: 0px; padding: 0px 5px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; letter-spacing: 4px; visibility: visible;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; text-align: justify; text-indent: 2em; line-height: 1.75em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); letter-spacing: 0.544px; text-indent: 32px; font-family: 仿宋, 仿宋_GB2312, SimFang; visibility: visible;">2023年各省市的城乡居民医保缴费参保时间及标准陆续发布，关于居民医保参保缴费的重要性，可以从以下六个方面洞悉。</span></p></section></section></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"><section style="margin: 0px 20px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: flex; justify-content: center; align-items: flex-start; visibility: visible;"><section data-support="96编辑器" data-style-id="28909" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center; visibility: visible;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: flex; justify-content: center; align-items: center; visibility: visible;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; width: 2.2em; height: 2.2em; border-width: 2px; border-style: solid; border-color: rgb(255, 175, 4); border-radius: 50%; background-color: rgb(255, 244, 216); color: rgb(255, 174, 0); visibility: visible;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 20px; visibility: visible;">问</span></strong></p></section><section style="margin: 0px 0px 0px -1px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; height: 0px; border-top: 6px solid transparent; border-right-color: rgb(255, 175, 4); border-bottom: 6px solid transparent; border-left: 6px solid rgb(255, 175, 4); display: inline-block; visibility: visible;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"/></section><section data-width="90%" style="margin: 0px; padding: 5px 20px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 175, 4); border-radius: 20px; width: 483.75px; visibility: visible;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; text-align: left; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang; visibility: visible;">居民医保个人缴费为什么涨？</span></p></section></section><section style="margin: 0px 0px 0px 12px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; border-color: transparent transparent rgb(255, 244, 216); border-style: solid; border-width: 10px; float: none; height: 0px; width: 0px; visibility: visible;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"/></section><section style="margin: 0px; padding: 15px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 244, 216); border-radius: 10px; visibility: visible;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(86, 78, 60); visibility: visible;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; text-align: left; visibility: visible; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); visibility: visible; font-family: 仿宋, 仿宋_GB2312, SimFang;">2003年只需要缴纳10元钱的医保，现在为什么就要350元了。</span></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 2em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang; visibility: visible;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); visibility: visible;">首先，</span><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(83, 165, 220); visibility: visible;">居民医保基金的筹资来源，主要依靠是个人缴费及国家补助，</span></strong><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); visibility: visible;">以前10元钱的医保，虽然国家也投入20元，但因筹资水平较低，医保基金池较小，主要用于保障参保人住院待遇，一年最高报几千元，门诊大多不能报销。可以说这种保障水平是非常低下、保障力度也是非常不充分的，难以满足人民群众的就医需求。</span></span></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 2em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); visibility: visible; font-family: 仿宋, 仿宋_GB2312, SimFang;">20年间，随着经济发展、新药和新医疗技术的使用、群众健康意识的增强、交通条件的改善等原因，导致医疗成本、医疗价格、医保基金支出的不断上涨。为适应这种变化，并不断提高参保居民的保障水平和扩大医保报销范围，国家做出了个人参保缴费和财政补助标准逐年适当上调的规定。</span></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 2em; visibility: visible; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang; visibility: visible;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); visibility: visible;">到2022年，</span><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; visibility: visible;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(83, 165, 220); visibility: visible;">个人缴费标准的提升及国家财政补助加大投入，使得我们居民医保基金池愈加充裕。</span></strong><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); visibility: visible;">正是有了这样的底气，2003年-2022年间，医保为解决大家“看病难、看病贵”的问题，做了大量的改革工作，不仅将普通门诊、慢（特）病门诊、重特大疾病纳入医疗保障范围，还将住院政策范围内基金最高支付限额从最初的几千元提高到了现在的几十万元，报销比例也从40%左右提高到70%左右。</span></span></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; text-align: left; text-indent: 2em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97);">所以2023年的350元，是为了不断提高居民医保保障水平，减轻参保群众看病就医费用负担而科学设定的缴费标准，让大家实实在在地享受改革释放的红利。况且，医保从启动之初，国家就一直按个人缴费标准的2倍左右，来弥补因个人筹资不足，医保基金支付产生的缺口风险。据悉，2023年您个人缴350元,国家</span>也将按不低于610元/年/人的标准进行补助。</span></p><section data-support="96编辑器" data-style-id="41587" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 15px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(250, 249, 245);"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section></section></section></section><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section></section></section><p></p><section style="margin: 0px 10px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-support="96编辑器" data-style-id="28909" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: flex; justify-content: center; align-items: center;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; width: 2.2em; height: 2.2em; border-width: 2px; border-style: solid; border-color: rgb(255, 175, 4); border-radius: 50%; background-color: rgb(255, 244, 216); color: rgb(255, 174, 0);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 20px;">问</span></strong></p></section><section style="margin: 0px 0px 0px -1px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; height: 0px; border-top: 6px solid transparent; border-right-color: rgb(255, 175, 4); border-bottom: 6px solid transparent; border-left: 6px solid rgb(255, 175, 4); display: inline-block;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section><section data-width="90%" style="margin: 0px; padding: 5px 20px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 175, 4); border-radius: 20px; width: 501.738px;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; text-align: left; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang; color: rgb(0, 0, 0);">居民医保个人缴的钱去哪里了？</span></p></section></section><section style="margin: 0px 0px 0px 12px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; border-color: transparent transparent rgb(255, 244, 216); border-style: solid; border-width: 10px; float: none; height: 0px; width: 0px;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section><section style="margin: 0px; padding: 15px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 244, 216); border-radius: 10px;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(86, 78, 60);"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang;">其实刚才也讲了，居民医保参保人看病就医产生的医疗费用，主要就是靠我们医保基金来保障，而<strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(83, 165, 220);">医保基金主要由个人缴费加国家财政补助构成。</span></strong>咱们帮大家收集起来后，把它统一放到一个叫医保基金池的地方，按照国家《医疗保障基金使用监督管理条例》第二十一条规定“医疗保障基金专款专用，任何组织和个人不得侵占或挪用”。所以，大家不用担心，一旦进入了医保基金池的基金，唯一的用途就是保障居民医保参保人的门诊、住院医药费用。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang;">如果参保当年，参保人没有使用到这份保障，那么首先恭喜您，健健康康地度过了一年。就算在缴费当年没有享受居民医保待遇，但其他（她）参保人一旦发生了符合医保报销条件的看病就医费用，医保基金将及时为他（她）启动支付保障机制，这笔支付费用有可能大大超过个人缴费及国家财政补助的总和，这就是医保互助共济功能的体现。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang;">通俗点讲，就是参保人所缴的参保费用，将用于保障和您同样参保的患者身上了。所以，<strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(83, 165, 220);">一个参保年度内，参保人谁符合享受居民医保报销的待遇，医保都会通过调动基金池的基金来进行保障。</span></strong>比如，某甲，新生儿，2021年患呼吸衰竭入院，住院花费425，769.37元，居民医保报销326,521.67元。某乙，老人，2022年患冠状动脉粥样硬化性心脏病入院，住院花费284，169.89元，居民医保报销217,428.11元。一句话，就是“我为人人，人人为我”</span>。</section><section data-support="96编辑器" data-style-id="41587" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 15px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(250, 249, 245);"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section></section></section></section></section></section></section></section><section style="margin: 0px 10px; padding: 0px; outline: 0px; max-width: 100%; color: rgb(34, 34, 34); font-family: system-ui, -apple-system, BlinkMacSystemFont, Helvetica Neue, PingFang SC, Hiragino Sans GB, Microsoft YaHei UI, Microsoft YaHei, Arial, sans-serif; font-size: 17px; letter-spacing: 0.544px; text-align: justify; white-space: normal; background-color: rgb(255, 255, 255); box-sizing: border-box !important; overflow-wrap: break-word !important;"><section data-support="96编辑器" data-style-id="28909" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: flex; justify-content: center; align-items: center;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; width: 2.2em; height: 2.2em; border-width: 2px; border-style: solid; border-color: rgb(255, 175, 4); border-radius: 50%; background-color: rgb(255, 244, 216); color: rgb(255, 174, 0);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 20px;">问</span></strong></p></section><section style="margin: 0px 0px 0px -1px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; height: 0px; border-top: 6px solid transparent; border-right-color: rgb(255, 175, 4); border-bottom: 6px solid transparent; border-left: 6px solid rgb(255, 175, 4); display: inline-block;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section><section data-width="90%" style="margin: 0px; padding: 5px 20px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 175, 4); border-radius: 20px; width: 501.738px;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; text-align: left; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(0, 0, 0); font-family: 仿宋, 仿宋_GB2312, SimFang;">为什么每次就医，医保支付都有门槛费？</span></p></section></section><section style="margin: 0px 0px 0px 12px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; border-color: transparent transparent rgb(255, 244, 216); border-style: solid; border-width: 10px; float: none; height: 0px; width: 0px;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section><section style="margin: 0px; padding: 15px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 244, 216); border-radius: 10px;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(86, 78, 60);"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang;">门槛费，准确来说就是医保起付线。它不是医保或医院额外向参保患者收取的费用，而是医保支付参保人员医疗费时，所划定的报销底线。低于“起付线”的这部分费用，由患者自己承担。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang;">起付线是根据医疗机构的级别进行设置，医院等级越高，起付线越高，这样设置的目的，主要有两个，一是增强费用节约意识，有了个人需承担的部分，可避免随意看病、开药，浪费有限的医疗资源和医保基金，也可防止门诊转住院，小病大治等情况。二是保障更多参保患者高额费用负担，通常情况下，在医保的支付限额（封顶线）内，就医发生的费用越多，医保报销的费用就越高。起付线以下的费用，基本上是个人完全能承担的部分，故医保不予支付，但这部分费用可用于保障更多发生高额医疗费用的参保患者。</span></section><section data-support="96编辑器" data-style-id="41587" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 0px; padding: 15px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(250, 249, 245);"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"></section></section><section style="margin: -30px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; width: 60px;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section></section></section><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; box-sizing: border-box !important; overflow-wrap: break-word !important;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></p></section></section></section></section><section data-support="96编辑器" data-style-id="28909" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: flex; justify-content: center; align-items: center;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; width: 2.2em; height: 2.2em; border-width: 2px; border-style: solid; border-color: rgb(255, 175, 4); border-radius: 50%; background-color: rgb(255, 244, 216); color: rgb(255, 174, 0);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 20px;">问</span></strong></p></section><section style="margin: 0px 0px 0px -1px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; height: 0px; border-top: 6px solid transparent; border-right-color: rgb(255, 175, 4); border-bottom: 6px solid transparent; border-left: 6px solid rgb(255, 175, 4); display: inline-block;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section><section data-width="90%" style="margin: 0px; padding: 5px 20px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 175, 4); border-radius: 20px; width: 501.738px;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; text-align: left; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang; color: rgb(0, 0, 0);">为什么缴费参保了，有些费用还是没能报销？</span></p></section></section><section style="margin: 0px 0px 0px 12px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; border-color: transparent transparent rgb(255, 244, 216); border-style: solid; border-width: 10px; float: none; height: 0px; width: 0px;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section><section style="margin: 0px; padding: 15px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 244, 216); border-radius: 10px;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(86, 78, 60);"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); font-family: 仿宋, 仿宋_GB2312, SimFang;">不论是职工医保还是居民医保，筹集的基金都是有限的，不可能覆盖所有的医疗需求，有限的基金只能用在刀刃上“保重点”，而不是撒胡椒面儿式的“平均主义”。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97);">目前，</span><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(83, 165, 220);">医保报销范围主要依据国家明确的“三目录”，即“医保药品目录、诊疗项目目录和医疗服务设施范围目录”。</span></strong><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97);">超过三目录规定的费用，比如养生保健消费、应从工伤保险基金支付等项目，医保都不予支付。这就是为什么有一部分费用需要患者自己承担的原因。</span></span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); font-family: 仿宋, 仿宋_GB2312, SimFang;">近年来，很多常见病、多发病的主要治疗用药、诊疗项目等都已纳入医保支付。所以医保基金支付内容并不是一成不变，而是随着筹资标准的不断增加，不断适应人民群众的现实就医需求。并且，国家加快了医保药品目录调整频率，把更多救命救急的抗癌药纳入医保支付。</span></section><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: justify; text-indent: 2em;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); font-family: 仿宋, 仿宋_GB2312, SimFang;">2021年，国家医保局的灵魂砍价依然让人记忆犹新！那句“人民健康至上，每一个小群体都不应该被放弃”，多少人为之动容。当治疗罕见病脊髓性肌萎缩症的药物诺西那生钠注射液，从最初的70万元一针，到报价53680元最终被砍到了33000元，价格得到大幅下降，且还纳入了医保支付，又有多少患者家庭为之欢呼雀跃，这对参保患者来说就是实实在在的实惠。</span></section></section></section></section></section><section data-support="96编辑器" data-style-id="28909" style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><section style="margin: 10px 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; text-align: center;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; display: flex; justify-content: center; align-items: center;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; width: 2.2em; height: 2.2em; border-width: 2px; border-style: solid; border-color: rgb(255, 175, 4); border-radius: 50%; background-color: rgb(255, 244, 216); color: rgb(255, 174, 0);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; box-sizing: border-box !important; overflow-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-size: 20px;">问</span></strong></p></section><section style="margin: 0px 0px 0px -1px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; height: 0px; border-top: 6px solid transparent; border-right-color: rgb(255, 175, 4); border-bottom: 6px solid transparent; border-left: 6px solid rgb(255, 175, 4); display: inline-block;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section><section data-width="90%" style="margin: 0px; padding: 5px 20px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 175, 4); border-radius: 20px; width: 501.738px;"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; letter-spacing: 2px; text-align: left; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; font-family: 仿宋, 仿宋_GB2312, SimFang; color: rgb(0, 0, 0);">缴了多年的医保，从来没用过是不是有点亏？</span></p></section></section><section style="margin: 0px 0px 0px 12px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; border-color: transparent transparent rgb(255, 244, 216); border-style: solid; border-width: 10px; float: none; height: 0px; width: 0px;"><br style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;"/></section><section style="margin: 0px; padding: 15px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; background-color: rgb(255, 244, 216); border-radius: 10px;"><section style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(86, 78, 60);"><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; text-align: justify; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); font-family: 仿宋, 仿宋_GB2312, SimFang;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(83, 165, 220);"><strong style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important;">医保是“保险”而非“存钱”，医保就是通过把大家缴的钱和国家财政补助的钱放到一起，做大医保基金池来帮助有需要的参保患者，</strong></span>使其能抵抗不可预知的疾病和经济风险。医保基金今天有人需要那他（她）就先用，明天您有需要您也能再用。</span></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; outline: 0px; max-width: 100%; clear: both; min-height: 1em; text-align: justify; box-sizing: border-box !important; overflow-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box !important; overflow-wrap: break-word !important; color: rgb(64, 59, 97); font-family: 仿宋, 仿宋_GB2312, SimFang;">俗话说，人吃五谷杂粮，谁人保证不生病。疾病风险的不确定性和偶发性，是谁也无法掌控的。当然作为医保部门，根本宗旨还是希望保障参保人权益，缴了参保费却一直用不上，因为这种风险是谁都不愿降临到自己身上的。因为怕“吃亏”，突发疾病导致家底一夜掏空的案例，也在我们身边真实发生过。其实，进行居民医保参保缴费就是买一份安心、买一份放心，当真正风险来临时，能互助共济。</span></p></section></section></section></section></section><p></p><p>来源：渭南医保</p><link rel="stylesheet" href="//www.dafuping.cn/source/plugin/wcn_editor/public/wcn_editor_fit.css?v134_Dvx" id="wcn_editor_css"/>
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