Did you know that you can apply for Medicare online even if you are not ready to retire? And it takes less than 10 minutes! There are no forms to sign and usually no required documentation. We’ll process your application and contact you if we need more information. To apply for Medicare and find other important information, visit www.ssa.gov/benefits/medicare.
If you want to start receiving Medicare at age 65, you must apply for Medicare no earlier than three months before your 65th birthday and no later than three months after that birthday. We refer to this window of opportunity to apply for Medicare as your initial enrollment period.
Some Medicare beneficiaries may qualify for Extra Help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug program. You must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia to qualify for the Extra Help. For more information on Extra Help, visit www.ssa.gov/benefits/medicare/prescriptionhelp
La red dirigida por médicos de Conviva, dedicada a brindar atención primaria a las personas mayores, se está expandiendo con un nuevo centro de salud y bienestar de 8,000 pies cuadrados en Dania Pointe, uno de los destinos de estilo de vida más atractivos del sur de Florida.
Conviva continúa reinventando la excelencia en la atención médica al brindar relaciones significativas con los pacientes enfocadas en producir resultados de salud óptimos. Conviva tiene más de 110 ubicaciones convenientes en Florida (Condado de Broward, Daytona Beach, Jacksonville, Condado de Miami-Dade, Condado de Palm Beach y Tampa/Costa del Golfo) y Texas (Corpus Christi, El Paso y San Antonio). La amplia comunidad de Conviva Care Centers incluye un equipo multidisciplinario de más de 300 médicos de atención primaria y más de 800 especialistas afiliados que brindan una amplia gama de servicios de atención médica vitales que los pacientes requieren diariamente, incluidas las ventajas de los centros de actividades de atención para personas mayores y 24/ 7 proveedores de guardia. Conviva mide su éxito por los resultados clínicos de sus pacientes y los beneficios para la salud a largo plazo
Conviva Dania Pointe cuenta con capacidades de ultrasonido cardíaco y ecocardiograma en el lugar, además de tener servicios internos de nefrología, cardiología y manejo del dolor. Adoptando la comodidad y el estilo, el centro cuenta con mesas de examen ergonómicas para pacientes y escritorios ergonómicos en todas las áreas médicas. La instalación incluye una gran área designada para realizar servicios de telepsicología personalizados y confidenciales. Para los pacientes que experimentan problemas médicos urgentes que no ponen en peligro la vida y desean abordar sus inquietudes de inmediato, el nuevo centro de Conviva ofrece médicos de guardia dedicados, las 24 horas del día, los 7 días de la semana. Las opciones de atención “a pedido” incluyen programar citas de telesalud para el mismo día o visitas en persona.
La nueva instalación también incluye uno de los centros de bienestar in situ más grandes de la red. El Centro de Bienestar Conviva Dania Pointe ofrece varios talleres y clases, desde yoga, tai-chi y Zumba hasta proyectos de manualidades y celebraciones navideñas. Conviva también se ha alineado con especialistas para presentaciones sobre EPOC, diabetes, Alzheimer, Parkinson y otros temas relevantes para las personas mayores. Y el transporte gratuito al centro está disponible para los pacientes que lo necesiten.
Conviva, a physician-led network dedicated to providing primary care to seniors, is expanding with a new 8,000-square-foot health and wellness center at Dania Pointe, one of South Florida’s most attractive lifestyle destinations.
Conviva Dania Pointe features on-site cardiac ultrasound and echocardiogram capabilities in addition to having nephrology, cardiology, and pain management services in-house. Embracing comfort and style, the center has ergonomic exam room tables for patients and ergonomic desks in all physician areas. The facility includes a large designated area for conducting personalized and confidential tele-psych services. For patients who are experiencing non-life-threatening, but urgent medical issues and would like to address their concerns right away, Conviva’s new center offers dedicated on-call doctors, 24 hours a day, 7 days a week. “On-demand” care options include, scheduling same day telehealth appointments or in-person visits.
“The goal is to eliminate as much wait time as possible—and help avoid unnecessary visits to the emergency room,” explained Dr. Souffront. “We are working to change that culture and mindset. We are calling patients who routinely go to ERs but may not have to, and ensuring they are able to receive the proper care they really need without having to call or visit an ER.”
Thousands of UnitedHealthcare members this morning lost in-network access to Broward Health hospitals and ambulatory care facilities after the two entities failed by Thursday to reach agreement on a new contract.
UnitedHealthcare plans affected are employer-sponsored, individual, Medicare Advantage and Medicaid plans branded under UnitedHealthcare’s name or affiliates Preferred Care Network, WellMed, Medica and Neighborhood Health Partnership. AARP Medicare Supplement members are not affected.
This means UnitedHealthcare members will no longer be covered at in-network rates if they use Broward Health facilities. The health insurer will compensate the hospital company at larger out-of-network rates, forcing members to pay much higher costs for services.
About 13,000 UnitedHealthcare members used one of Broward Health’s facilities over the past year, but the contract expiration also affects tens of thousands of non-users who have lost Broward Health as an in-network option.
Loss of in-network access for UnitedHealthcare members is not necessarily permanent. The two entities said they were willing to continue negotiations.
UnitedHealthcare previously claimed that Broward Health sought a more than 40% increase over it charged under the previous contract. The higher cost would increase members’ health care costs by nearly $26 million in the first year of a multiyear contract, the insurer said.
On Friday, UnitedHealthcare said that the cost-increases sought by Broward Health amounted to “an egregious 88% price hike over four years.”
Broward Health disputed those numbers and claimed it was seeking to bring prices charged to UnitedHealthcare in line with those paid by other health insurers. Currently, those prices are lowest among all major health insurers, said Alex Fernandez, Broward Health’s chief financial officer.
Ukrainian Parliament member: ‘You cannot just invade countries without consequences’
Broward Health offered to bring in a third-party analyst to make sure that new contract rates would not exceed the average of what all other major health insurers are contracted to pay Broward Health, but UnitedHealthcare declined the offer, Fernandez said.
As the contract expiration date drew closer, UnitedHealthcare offered to pay an average of 6% more than they were paying under the old contract, Fernandez said.
“I said, ‘You’ve had no [price] increase for the last two years and inflation is running higher than 6%.” Broward Health’s costs, he said, have increased 17.5% since the pandemic began.
The hospital system released a statement on Thursday saying that the organization was “greatly disappointed that UnitedHealthcare has been unwilling to negotiate a reasonable new agreement.”
A UnitedHealthcare spokesman contended it was already reimbursing Broward Health at rates similar to other insurers and offered “significant increases” to those amounts.
“Unfortunately, they refused to move off the 88% ask,” the spokesman said, “which is not affordable for employers in Broward County or consumers. Some of our self-funded employer group customers would see their health care costs increase by more than $1 million if we agreed to Broward Health’s demands.”
The insurer pledged to help its members transition to one of the other Broward County hospital systems that remain in its network. Those include Cleveland Clinic, Holy Cross, and Memorial Healthcare.
About 13,000 UnitedHealthcare members who used Broward Health facilities over the past year received letters from both entities in recent months warning that they would lose in-network access if the impasse was not resolved by March 31. UnitedHealthcare members make up 19% of Broward Health’s market share, Fernandez said, behind Blue Cross Blue Shield (33%) and Humana (19%).
Also, UnitedHealthcare members will still be able to see physicians employed by Broward Health at in-network rates through Aug. 31. Those physicians typically see patients at outside facilities. But patients who need services that require hospitalization could be forced to switch to physicians allowed to use other hospitals in UnitedHealthcare’s network, Fernandez said.
The statement by Broward Health said it is willing to continue negotiating with UnitedHealthcare “to reach a new contract agreement as quickly as possible.”
UnitedHealthcare’s spokesman said the insurer would “stay at the negotiating table as long as it takes to reach an agreement” but called on Broward Health to make “a realistic proposal that is affordable for employers and consumers.”
Dear Amiro: I just turned 64 and now get stuff about Medicare and Medigap and so on. I really don’t know how to retire when it’s time. What should I do? What am I looking for? Am I eligible for anything as of now? I’m so confused about all this that I don’t even know if I can retire when it’s time. Maybe I should just continue working so I don’t have to try to figure this out. Signed: Confused and lost
Dear Confused: Deciding when to retire from work is usually a difficult decision for everyone, so don’t feel alone as you struggle with deciding what’s best for you personally. I’ll try to provide some insight into what you should be looking at now, at age 64:
The reason you’re now getting all that unsolicited information about Medicare and “Medigap” is because you’re approaching the magic age of 65, when you first become eligible for those senior healthcare services. But if you are still working and now have “creditable” healthcare coverage from your employer, you don’t need to enroll in any Medicare plan until your employer coverage ends (If your employer healthcare coverage is a group plan with at least 20 participants, that coverage is “creditable”). So, if you plan to continue working and have creditable healthcare coverage, you can simply ignore all those healthcare solicitations. You don’t need to worry about enrolling in Medicare until your creditable employer coverage ends, at which point you will be able to enroll in a Medicare program without incurring a late enrollment penalty.
Choosing when to collect your Social Security benefits can have a large impact on your standard of living in retirement, especially if you didn’t save enough on your own. According to the Social Security Administration, Social Security benefits represent 30% of retirement income for the elderly. Deciding when to collect is a complicated task — you’ll have to consider factors like your spouse, your other sources of retirement income, your health status and the cost of Medicare deductions.
“Because SSA maintains a neutral stance on the claiming decision, many other government, academic, nonprofit, and private groups have developed Social Security benefit calculators and tools for analyzing retirement finances to provide clarity on individuals’ retirement decisions,” states a 2016 report by the Social Security Administration. “The calculators may be very informative for older workers who have an established earnings record, but less so for younger workers whose future earnings may be unpredictable.”
While these tools vary in how much information they collect and how accurate the earnings estimates are, online calculators and tools can still provide individuals with an estimate of how much they’ll earn in benefits. The choice of when to collect could mean earning thousands or hundreds of thousands of dollars more.
Below, Select highlights four online Social Security free and fee-based tools that people can use to figure out when to collect benefits.
The social security Administration webdite
This one is a no-brainer, but the Social Security Administration website provides a number of different calculator tool— there’s a tool to help you figure out when your full retirement age is and another that calculates how your earnings (before full retirement age) could impact your benefit amount.
The most useful tool that the Social Security administration has is the retirement estimator which calculates your monthly benefits from the administration’s own data on your earnings history. The closer you are to retirement, the more accurate the calculator will be because you’ll have fewer earnings years ahead of you.
However, most of the calculators on the Social Security Administration website don’t account for many factors in the calculation of your monthly benefit. If you have a spouse or other sources of retirement income that could affect the percentage of your benefits that are taxable, you may have to use multiple tools.
Open Social Security
Open Social Security is a free calculator developed by Mike Piper, a CPA. This calculator, unlike the Social Security Administration calculators, is more complex, accounting for multiple factors like whether an individual has a spouse, the average lifespan of men versus women and the potential for benefits to be cut in the future.
The tool also provides individuals with a rundown of their yearly Social Security benefits and their cumulative earnings with a spouse over the course of retirement.
The AARP Social Security calculator is a basic calculator that provides a graphical depiction of how much your monthly benefit is depending on when you choose to collect. The calculator also provides information on how much of your living expenses (based on an average retiree’s monthly living expenses) your Social Security benefits will cover.
The major drawback of this calculator is that it determines your monthly benefit with your average annual salary, so it might not be entirely accurate if your estimate of your average annual salary is not correct. The calculator also determines cumulative benefits based on if an individual collected at age 70, a goal that may not be realistic for many.
Other options that you can apply for retirement
Since Social Security is only meant to supplement people’s retirement income, it’s vital for people to save for retirement on their own. Pensions, 401(k)s, traditional IRAs and Roth IRAs are other popular sources of retirement income. If your employer offers matching 401K contributions,your first priority shoukd be maxing out the match
If your employer doesn’t offer matching contributions or you have extra money leftover to save for retirement, you might consider opening a Roth IRA or a traditional IRA.
A Roth IRA has an income limit so not everyone is eligible. Individuals who make less than $144,000 and married couples filing jointly who make less than $204,000 are eligible to contribute to a RothIRA. These accounts offer a unique tax advantage You pay taxes on your upfront contributions so your investments grow tax-free over time. And when you do withdraw, you won’t pay taxes on any of your distributions (as long as you withdraw after age 59 and a half).
For those who don’t qualify for a Roth IRA, a traditional IRA is a good option because there are no income requirements. A traditional IRA offers a different type of tax advantage. With a traditional IRA individuals pay taxes on their investments when they withdraw that money in retirement. However, depending on your income and whether your employer offers a retirement plan, your traditional IRA contributions may be tax deductible. This means your contributions reduce your taxable income now and therefore how much you owe in taxes.
Exclusive benefits now available to support a happier, healthier you. Ethos cares about the well-being of our customers and now offers most policyowners access to a variety of health and lifestyle benefits.
Get coverage todayOnce approved, you can elect to begin coverage as soon as today! Simply select your coverage and term, then activate your policy.
Activate perksEthos now offers exclusive perks to most policyowners! Enjoy the choice of a benefit from various lifestyle and wellbeing products to help you live a happy and protected life. Upon completion of the free look period (first 30 days), you’ll receive access to your choice of benefit.*Choose from the following perks:PHYSICAL FITNESSAaptiv
Aaptiv lets you workout when you want, where you want, the way you want. Get unlimited access to audio-based fitness classes led by certified personal trainers.
Normal value: $180 per year
Through science-backed meditation and mindfulness tools, Headspace helps you create life-changing habits to support your mental health and find a healthier, happier you.
Value: $70 per year
HEALTH & FITNESSSHRED
SHRED lets you experience the fun of working out with your friends from the comfort of your home (or at the gym) and join the millions of people around the world that wake up excited to get fit.
Today Florida Blue, the Blue Cross and Blue Shield Plan for Florida, announced the introduction of new health insurance plans and services for expatriates and business travelers through its GeoBlue program, an international health insurance business.
Through a partnership with Worldwide Insurance Service, an independent licensee of the Blue Cross Blue Shield Association, GeoBlue is a new line of group health insurance products made available to companies in Florida. Branded GeoBlue Expat and GeoBlue Traveler, these two new plans provide an array of health-related insurance services that traditional domestic health insurance plans do not offer business travelers outside of the U.S.
“GeoBlue provides businesses and employees peace of mind as they pursue their international business goals,” said Deanna McDonald, group vice president, strategy and diversification. “Given the global arc of business today, the need is clear – timely access to an international network of carefully selected doctors and hospitals to meet whatever health needs while traveling aboard is apparent and GeoBlue delivers on those needs.”
The U.S. Department of Commerce tallied more than six million outbound overseas business trips last year, and the U.S. Department estimates there are more than four million Americans living abroad as expatriates in all countries of the world.
GeoBlue group health plans combine unsurpassed service and mobile technology to help expatriates and travelers access trusted doctors and hospitals in 180 countries around the globe as well as the full resources of Blue Cross and Blue Shield’s doctor and hospital network in the U.S.
Key GeoBlue services include: appointment scheduling with contracted international doctors and facilities with no out-of-pocket-costs; outpatient care coordination, especially for chronic conditions and special needs; inpatient case management and emergency evacuation; online and mobile global tools to find carefully selected providers, find brand name medications equivalents, translate key medical terms and phrases and confirm eligibility for benefits; and just recently GeoBlue released the first downloadable application that serves as a hand-held global concierge for medical services.
“Our business sales team is thrilled to play a role in providing the GeoBlue Expat and GeoBlue Traveler health plans,” said Jon Urbanek, senior vice president, sales and marketing. These two products provide the international travelers and expats great peace of mind this elite community and Florida Blue is eager to be a part of it.”
About Florida Blue
Florida Blue is a leader in Florida’s health industry. Since 1944, the company has been dedicated to meeting the diverse needs of members by offering an array of choices. As Florida Blue transitions from a health insurance company to a health solutions company, “In the Pursuit of Health” reflects the Florida Blue commitment to ensuring affordable plans, providing personal support for health and wellness and building strong communities that enable health and wellness for all Floridians. Florida Blue is a not-for-profit, policyholder-owned, tax-paying mutual company. Headquartered in Jacksonville, Fla., Florida Blue is
Wellcare proudly serves over 1 million people with affordable Medicare Advantage plans.1
A healthier future starts with your Medicare Advantage plan.
Wellcare believes in high-quality healthcare that looks after your health and your budget.
Get money back
You could get some, or all, of your Medicare part B premium added back to your Social Security check each month.
Access large networks
Find plans with large networks that cover your preferred doctor and specialists.
Enjoy more benefits
Get $200-$2,500 in extra dental, vision or hearing care every year with our Visa Flex card.2
Save money every month
Wellcare Medicare Advantage plans offer all-in-one coverage for the benefits you want and need.
You deserve more than what Medicare Parts A and B provide. Shop for a Wellcare Medicare Advantage plan with valuable extra benefits.
for services like exams, extractions and dentures
for services like exams, eyeglasses or contact lenses
for services like exams, fittings and hearing aids
for items like vitamins, toothpaste and incontinence supplies
Get even more dental, vision and hearing care this year
Our exclusive Flex Card provides between $200-$2,500 in extra dental, vision or hearing care every year.2 Just swipe your pre-loaded Visa debit card after any dental, vision or hearing care appointment.
Do you earn too much money to get government help for an Obamacare health insurance plan, but you can’t get on an employer-funded plan?
If so, you’re probably self-employed, a contract worker, a bartender or restaurant server, or you retired early and live off dividends.
If you make at least $50,000 a year, you’re in a tight spot: Comprehensive plans being sold on the individual marketplace through the Open Enrollment period that ends Dec. 15 are likely priced out of your reach because you don’t qualify for government subsidies. That makes you a target for a growing number of companies promoting alternative discount plans.
They come up on web searches for “short term plans,” “Obamacare plans” “low-cost health insurance” or any number of terms used by consumers hoping to avoid Affordable Care Act plans that next year will cost a 40-year-old nonsmoking Broward County man between $313 and $1,131 a month
Some alternative plans have been accused of being outright wrong using agents to mislead consumers into believing they are buying comprehensive health insurance. Others are upfront about how they differ from ACA-compliant plans.
Patients who buy alternative plans could be left with crippling medical bills if they develop serious illnesses or must undergo expensive procedures because, unlike plans that comply with the minimum requirements of the Affordable Care Act, most alternative plans stop reimbursing once a patient hits the plan’s benefit cap.
Typically, these products are medically underwritten — meaning their premiums are based on consumers’ medical histories. This type of pricing was eliminated for major medical health insurance when the ACA was enacted, because one of the primary reasons the law was created was that people with preexisting conditions could be considered.
Consumers who don’t qualify for an employer-funded plan but make too much money for government subsidies comprise a small but significant portion of the country’s insured population, estimated by the U.S. Census Bureau as 295 million in 2017.
Of those, 1.1 million plans did not include services and benefits guaranteed by the Affordable Care Act. Nationwide, 9.3 million consumers were enrolled in subsidized ACA plans. About 1.7 million Floridians were enrolled (including about 660,000 in Broward, Miami-Dade and Palm Beach counties), and of them, about 91% subsidies.
Kaiser warns consumers that they’re flying without a net once they stray from the official government-run Obamacare site healthcare.gov . All available plans on that site comply with minimum coverage requirements of the Affordable Care Act. That means applicants can’t be denied coverage if they have preexisting conditions, including cancer, HIV/AIDS, hepatitis C or diabetes.
ACA-compliant plans must cover preventative services for no additional cost, including immunizations, screenings and birth control. Even though deductibles and out-of-pocket payment maximums can be ridiculously high, consumers pay for nothing — no matter how expensive the procedure — once they reach those maximums.
While criticism of the ACA focuses on high premiums and deductibles requiring patients without subsidies to spend thousands of dollars before reimbursements kick in, all ACA plans cap the amount of medical costs they would have to pay for out-of-pocket at $8,150. (That’s in addition to monthly premiums).
That can matter quickly. According to Kaiser’s website, an average three-day hospital stay costs $30,000.
Huge debt is big risk outside the ACA
The risk of incurring huge debt for unexpected medical problems should be considered by anyone shopping outside the ACA, argues Karen Pollitz, senior policy fellow at Kaiser.
“It’s tempting to look for cheaper coverage, but they’re not going to pay your medical bills,” she said.
Pollitz says that patients put themselves at such risk even with newly formed companies that are introducing new coverage and reimbursement models, such as Sidecar Health, which just began selling plans in Florida last week after debuting in Alabama, Georgia, Texas, Arkansas and Kentucky earlier in the year.
Sidecar Health offers customized plans priced according to how much coverage a consumer wants. A 50-year-old Broward County male with no preexisting conditions can buy as little as $5,000 in annual coverage with no deductible for $169 a month or $2 million in annual coverage for $375 a month.
Consumers pay for services using a special debit card, and then the company reimburses for those services based on fixed rates that the company’s CEO Patrick Quigley says are based on average cash prices for those services. That eliminates administrative fees, he said. The reimbursement model is known as an indemnity plan.
Providers tend to charge less to patients that pay in cash rather than directing the provider to bill their insurer, and if the provider charges less than Sidecar’s fixed reimbursement amount, the patient actually gets money back, he said.
But patients would still be liable for any amount over the fixed reimbursement rate for major procedures, said Amiro Gnecco a health insurance broker based Boca Raton.
And Sidecar Health doesn’t want patients over 300 pounds or who have had any major medical issues over the last five years, including cancer, lung disease, lupus, muscular dystrophy, and organ transplant, HIV/AIDS, rheumatoid arthritis, heart disease, among others. Checking yes to any of those conditions during an online signup session and then asking for a quote brings up a box declaring “our prices are no longer competitive” and directing the patient to Healthcare.gov.
According to Kaiser, alternative policies are generally unavailable to consumers with such preexisting conditions.
Risks of short-term plans
Short-term plans are being sold more aggressively by some insurers and web brokers as a result of the Trump administration’s expansion of their allowable terms from three months to a full year and overall duration to three years.
Like Sidecar Health’s products, however, short-term plans are priced according to a patient’s current health status. If a patient develops a serious condition during their term, insurers will increase their renewal rate or, more likely, refuse to renew them, Kaiser warns.
And if a consumer with a policy lasting shorter than a year gets sick and then gets non-renewed, they won’t qualify for a special ACA enrollment period and will have to go without coverage until the following Jan. 1.
Allan Baumgarten, an independent health market analyst who publishes Florida Health Market Research every two years, said short term plans might be suitable in specific situations. An example was “when my daughter finished graduate school at 26 and went off our group plan and needed coverage for the summer until she started a job with benefits that fall.
“We encouraged her to look for plans that provided protection against large unexpected bills, even if they didn’t cover routine exams and tests.”
Kaiser recommends that short-term policy shoppers check to see what limits might apply, such as limiting doctor visits to no more than three, or covering hospital stays for no more than $1,000 a day. Kaiser also recommends checking policy exclusions. Most short-term policies exclude maternity care, substance abuse treatment or mental health services. Some don’t cover prescription drugs.
Pollitz recommends consumers avoid non-ACA plans altogether, saying “why buy a roller skate when you actually need a car?”
Consider yourself lucky you’ve probably never had to use critical illness insurance (sometimes called catastrophic illness insurance). Perhaps you’ve never even heard of it. But in the event of a big health emergency, such as cancer, a heart attack, or a stroke, critical illness insurance could be the only thing standing between you and financial ruin. Many people assume they’re fully protected with a standard health insurance plan, but the exorbitant costs of treating life-threatening illnesses are usually more than any plan will cover. Read on to learn more about critical illness insurance and whether it’s something you and your family should consider.null
Critical illness insurance provides additional coverage for medical emergencies like heart attacks, strokes, or cancer.
Because these emergencies or illnesses often incur greater-than-average medical costs, these policies pay out cash to help cover those overruns when traditional health insurance may fall short.
These policies come at a relatively low cost. However, the instances that they will cover are generally limited to a few illnesses or emergencies.
Critical Illness Insurance 101
As the average life expectancy in the United States continues to increase, insurance brokers are finding ways to make sure Americans can afford the privilege of getting older. Critical illness insurance was developed in 1996, as people realized that surviving a heart attack or stroke could leave a patient with insurmountable medical bills.
“Even with excellent medical insurance, just one critical illness can be a tremendous financial burden,” says certified financial planner Jeff Rossi, director of talent development at Santander Bank in New York. Critical illness insurance provides a benefit if you experience one or more of the following medical emergencies:null
Because these illnesses require extensive medical care and treatment, their costs can outstrip a family’s medical insurance policy quickly. If you don’t have an emergency fund or health savings account (HSA), you’ll have an even harder time paying those bills out of pocket.
Many people are now choosing high-deductible health plans, which can be something of a double-edged sword: Consumers benefit from relatively affordable monthly premiums but can find themselves in a real pinch if a serious illness strikes.
Critical illness insurance can pay for costs not covered by traditional insurance. The money can also be used for nonmedical costs related to the illness, including transportation, child care, and so on. Typically, the insured will receive a lump sum to cover those costs. Coverage limits vary—you could be eligible for a few thousand dollars all the way up to $100,000, depending on your policy. Policy pricing is impacted by a number of factors, including the amount and extent of coverage, the sex, age, and health of the insured, and family medical history.2
There are exceptions to critical illness insurance coverage. Some types of cancer may not be covered, while chronic illnesses are also frequently exempted. You may not be able to receive a payout if a disease comes back or if you suffer a second stroke or heart attack. Some coverage might end when the insured reaches a certain age. So, like any form of insurance, make sure to read the policy carefully. The last thing you want to worry about is your emergency plan.3
Why It May Be Important
You can purchase critical illness insurance on your own or through your employer (many offer it as a voluntary benefit). You can also add it to your current life insurance plan as a rider, which may be a more affordable option with the same benefit.4
One of the reasons companies have been keen to add these plans is that they recognize employees are worried about steep out-of-pocket expenses with a high-deductible plan. Unlike other healthcare benefits, workers generally bear the entire cost of critical illness plans. That makes it a money saver for companies and workers alike.
A big draw of critical illness insurance is that the money can be spent on a variety of things, such as:
To pay for critical medical services that might otherwise be unavailable
To pay for treatments not covered by a traditional policy
To pay for daily living expenses, enabling the critically ill to focus their time and energy on getting well instead of working to pay their bills
Transportation expenses, such as getting to and from treatment centers, retrofitting vehicles to carry scooters or wheelchairs, and installing lifts in homes for critically ill patients who can no longer navigate staircases
Terminally ill patients, or those simply in need of a restful place to recuperate, can use the funds to take a vacation with friends or family
Low Cost, Limited Coverage
Part of what makes these policies appealing is that they generally don’t cost much, especially when you get them through an employer. Some smaller plans run as little as $25 a month, which looks like a bargain compared to the cost of a typical, low-deductible health insurance policy. null
Some healthcare experts are skeptical as to whether they really are a good deal for consumers. One overarching concern is that they’ll only reimburse you for a somewhat narrow range of illnesses. If the illness you’re diagnosed with doesn’t fit the definition of a covered illness, you’re out of luck.
The more illnesses your plan covers, the more you’ll pay in premiums. A 45-year-old female with an individual, cancer-only plan may pay $40 a month for $25,000 of coverage. That same woman may pay twice that a month if she expanded the coverage to include coronary illnesses, organ transplants, and certain other conditions.
Like all insurance policies, critical illness policies are also subject to a host of stipulations. Not only do they cover only the conditions listed in the policy, but they cover them only under the specific circumstances noted in the policy. A diagnosis of cancer, for example, may not be enough to trigger payment of the policy if the cancer has not spread beyond the initial point of discovery or is not life-threatening. A diagnosis of a stroke may not trigger a payment unless the neurological damage persists for more than 30 days. Other restrictions may include a specific number of days for which the policyholder must be ill or must survive after diagnosis.5
Seniors should be particularly careful about these policies. There may be limits for payout on some policies, with persons over a certain age (such as 75) ineligible for payment, or they may include so-called “age reduction schedules,” which means your potential insurance payout shrinks as you get older.
It is important to note that many of these policies do not provide a guaranteed payment. For example, a typical insurance company discloses that in its critical illness policy “the expected benefit ratio for this policy is 60%. This ratio is the portion of future premiums that the company expects to return as benefits when averaged over all people with this policy.” If 60% of the premiums are eventually paid out in claims, 40% of the premiums are never paid out at all.
Alternatives to Critical Illness Insurance
Insiders point out that there are alternative forms of coverage without all these restrictions. Disability insurance, for example, provides income when you can’t work for medical reasons, and financial protection isn’t limited to a narrow set of illnesses. This is an especially good option for anyone whose livelihood would take a significant hit from a prolonged work absence.6
Consumers with a high-deductible plan can also make contributions to either a health savings account or flexible spending account (FSA), both of which offer tax benefits when used for qualified expenses.7
You can also build a separate savings account to cover nonmedical outlays that could arise if you have cancer, for example, and have taken leave from your job.
How Do I Buy Critical Illness Insurance?
Critical illness insurance is a policy that pays a direct lump-sum benefit that you can spend to pay for expenses not covered by other insurance. You can purchase it yourself or through your employer, or add it to your personal life insurance plan.
What Does Critical Illness Insurance Provide for Assistance?
Critical illness insurance can help fund the bills that life-threatening illnesses like heart attack, stroke, or cancer can incur. At your discretion, the benefit from a critical illness policy can cover anything from medical expenses not covered by a healthcare policy to household bills for utilities, rent or mortgage payment, or grocery bills.8
Which Critical Illnesses Qualify for This Insurance?
Coverage is usually limited to medical crises involving heart attack, stroke, renal failure, cancer, paralysis, and a few others. Each plan has a specific list, which varies from plan to plan.
What Are the Pros of Critical Illness Insurance?
Critical illness insurance provides a lump sum of money when you are diagnosed with an illness covered under the policy. The payout can be spent on any needs, including nonmedical expenses such as mortgage payments, transportation or equipment, or even vacation while you recover. The premiums are low and affordable, compared with those of a typical health insurance policy.9
What Are the Cons of Critical Illness Insurance?
Some types of cancer may not be covered, and chronic illnesses are frequently exempted. Recurrences of a critical illness, such as a second stroke or heart attack, may not receive a payout. Coverage might end or be reduced when the insured reaches a specified age. It is important to note the particular circumstances under which a policy covers a condition, as some critical illness policies stipulate narrow restrictions.9