Health Insurance Coverage
Coverage types and public programs
Disability income replaces part of earned income, usually 50–70%, and defines disability by own occupation or any occupation. Benefit periods, elimination periods, residual or partial disability, and occupation class drive cost. Medical expense coverage includes indemnity plans, HMOs, PPOs, and POS plans; network rules determine cost sharing. Group health uses eligibility, open enrollment, and a master policy; COBRA continuation generally lasts 18 months for termination or reduced hours and up to 36 months for certain dependents, with conversion rights. Medicare has Part A hospital, Part B medical, Part C Medicare Advantage, and Part D drugs; eligibility generally begins at 65, with disability or ESRD exceptions, and Medigap supplements original Medicare. Medicaid is income-tested. Long-term care covers ADL or cognitive impairment, with elimination periods, daily benefits, inflation protection, and tax-qualified rules; Medicare does not pay custodial LTC. Workers' compensation is no-fault workplace coverage.
Traps: assuming Medicare covers nursing-home custodial care; confusing group conversion with COBRA; and ignoring that disability benefits are usually a percentage, not full salary. Worked rule: match the product to the risk-income loss to disability income, medical bills to medical expense, custodial care to LTC. Example: a worker with a 60% own-occupation policy may receive benefits while unable to perform their specific job.