Health Insurance Policy Provisions and Government Programs
Mandated provisions
Individual health policies typically include required provisions on the entire contract, time limit on certain defenses, grace period, reinstatement, claim forms, proof of loss, time of payment of claims, payment of claims, physical examination, legal actions, change of occupation, misstatement of age, other insurance, and cancellation or renewal. These provisions protect consumers and standardize claim handling. Riders may add dental, vision, prescription, or hospital benefits.
Government programs
Medicare is federal health coverage mainly for people 65 and older and some disabled individuals. Part A covers inpatient hospital and related care; Part B covers medical services and outpatient care; Part C is Medicare Advantage; Part D covers outpatient prescription drugs. Medicare Supplement (Medigap) policies help pay Medicare cost sharing. Medicaid is income-based state and federal coverage. CHIP covers eligible children. TRICARE covers military families. Social Security Disability Insurance may provide Medicare after a waiting period.
Traps
Do not say Medicare covers all long-term custodial care. Part A is not the same as Part B. Medicaid is not Medicare. Medigap does not replace Medicare Advantage in the same way; enrollment rules and plan availability vary.
Rule of thumb
For Medicare questions, match the letter to the benefit: A hospital, B medical, C advantage, D drugs.