Health coverages

The health product families. Know what each does and the key cost-sharing terms. All concepts STABLE; dollar amounts and program rules are VERIFY (CMS / current law).

Medical expense plans (and managed care)

How you get and pay for care:

Plan	How it works
HMO	Health Maintenance Org: prepaid care through a network; needs a primary care physician (PCP) and referrals; little/no out-of-network coverage. Emphasis on prevention.
PPO	Preferred Provider Org: a network with discounted in-network rates, but no referral needed and out-of-network allowed at higher cost.
POS	Point of Service: HMO-style with a PCP gatekeeper, but allows out-of-network like a PPO at higher cost.
HDHP + HSA	High-Deductible Health Plan paired with a tax-advantaged Health Savings Account to pay qualified expenses.

Cost-sharing terms: premium (what you pay to have it), deductible (you pay first), copay (flat fee per service), coinsurance (you pay a %), out-of- pocket maximum (cap on your annual share).

Disability income (DI)

Replaces income when you can’t work:

• Short-term vs long-term disability.
• Own-occupation (“can’t do your job”) vs any-occupation (“can’t do any job you’re suited for”) — own-occ is broader/more favorable to the insured.
• Elimination period — a waiting period (a “time deductible”) before benefits start.
• Benefit period — how long benefits last.
• Benefits are usually a percentage of income (so you keep an incentive to return to work).

Long-term care (LTC)

Covers extended custodial/nursing care (help with activities of daily living), typically triggered by inability to perform a set number of ADLs or cognitive impairment. Often sold with an elimination period and a daily/benefit-pool limit.

Government programs

• Medicare (primarily 65+ / certain disabilities):
  • Part A — hospital/inpatient.
  • Part B — physician/outpatient.
  • Part C (Medicare Advantage) — private plans bundling A/B (often D).
  • Part D — prescription drugs.
  • Medicare Supplement (Medigap) — private policies that fill Medicare’s gaps (deductibles/coinsurance), sold in standardized lettered plans.
• Medicaid — joint federal/state program for low-income individuals (means-tested).

Supplemental / other

• Group health + COBRA continuation.
• Dental / vision.
• AD&D (accidental death & dismemberment).
• Critical illness / specified disease — lump sum on diagnosis of a covered condition.

VERIFY — confirm before you rely on it

Medicare/Medicaid eligibility, Medigap plan letters, and all dollar figures (deductibles, premiums, limits) · source: CMS (cms.gov) and current-year guidance.

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