Health Insurance Coverages: Disability, Medical, Group, and Government Programs
Disability, medical, group, and government coverage
Disability income replaces earned income, not medical bills. Key terms: elimination period (waiting time before benefits), benefit period, own-occupation vs any-occupation definition, residual disability, and recurrent disability. Own-occupation is more favorable and usually more expensive. Noncancelable policies guarantee premiums and renewability; guaranteed renewable guarantees renewal but not premiums. Medical expense coverage pays providers and includes individual, group, Medicare, Medicaid, and CHIP. Group health is employer-sponsored, often without individual evidence of insurability, and includes open enrollment and special enrollment rights. COBRA continuation generally lasts 18 months, with longer periods for disability or certain events. HIPAA provides portability and privacy protections.
Medicare: Part A hospital, Part B outpatient/medical, Part C Medicare Advantage, Part D prescription drugs. Medigap supplements Original Medicare but generally does not cover drugs. Medicaid is income-based; CHIP covers children in eligible families. Social Security disability requires total disability expected to last at least 12 months or result in death. Workers’ compensation covers work-related injury.
Traps: elimination period is not benefit period; Medicare does not pay custodial long-term care; group conversion is not the same as COBRA; own-occupation does not mean any job.
Rule: for a 90-day elimination period and 2-year benefit period, no benefit is paid in the first 90 days; after that, benefits can run up to 24 months if disability continues.