Health and Insurance Law

Healthcare and associated insurance are critical to American livelihood. Protecting your rights and ensuring coverage via healthcare insurance can help ease the financial strain of expensive medical costs.

Understanding your rights as a patient, healthcare privacy, and medical programs such as Medicaid and Medicare are all part of healthcare law. Navigating private, government, and employer-sponsored medical providers can be confusing. A healthcare attorney can ensure your rights are protected.

Learn more about healthcare laws and healthcare-related programs and insurance available to U.S. citizens below. You will also find online resources for several of the programs listed below.

Government Agencies and Programs

Both state and federal governments offer a variety of healthcare and insurance benefits. Below are several major insurance and healthcare agencies and programs.

COBRA

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), employers must provide an employee continued group health coverage for a limited time after the employee is terminated from his/her position.

COBRA applies to private, state, or local government employers with 20 or more employees that offer group health plans. COBRA coverage will last for up to 18 or 36 months after the date of the qualifying event (i.e. termination of employment).

Medicare vs. Medicaid

Medicare is a set of federal medical assistance programs available to retirement-age people, people with disabilities, and people with other qualifying conditions. Medicaid provides federal health coverage to low-income individuals who cannot afford health insurance or medical care.

There are several differences that set Medicare apart from Medicaid, though you may be able to receive benefits from both. The differences include:

· Medicare is federally-administered, so eligibility requirements and benefits are more standard than Medicaid's. Medicaid is state-administered, so there is variation in its offerings and requirement.

· Medicare is available to every eligible person who has paid into the program over time through payroll taxes. Medicaid doesn't require beneficiaries to pay for its services but is only available for low-income individuals.

· Medicaid can be flexible in its benefits while Medicare has a definitive structure of plans which cover only certain benefits.

Medical Insurance

Medical insurance is a type of contract with a private or government provider that promises to administer benefits in exchange for financial compensation (premiums).

An insurance attorney can help ensure a contract is not breached. An attorney can also protect a consumer in the event of contractual discrepancies in payments, qualifications, or receipt of benefits.

Insurance law encompasses insurance regulations, claims, rates, and policies and typically breaks down into three regulation categories:

  • The regulation of the insurance business, including company policies and ethics.
  • The regulation of policy content, including the language of the policy and what can/cannot be written into insurance policies.
  • The regulation of how companies handle insurance claims, including rules and protocol for who handles what and how.

These are the four most common types of insurance:

  • Health insurance covers most everything you may need for medical purposes, including hospital services, prescription drugs, therapy, and even optical and dental services and products. You can purchase health insurance through private providers, enroll in federal or state programs, or receive health insurance from employer group health plans. Most health insurance programs require beneficiaries to pay premiums and/or co-pays before the insurance pays for medical supplies and services.
  • Life insurance allows individuals to secure their family's financial future in the event of the insured's death. The insured pays monthly or annual premiums over a period of time. If and when they die, a specific amount will be paid out to the beneficiaries listed in the insurance contract.
  • Auto insurance covers damages and injuries for both the insured and the other party involved in an automotive accident. Auto insurance is meant to supplement healthcare costs before health insurance starts paying. Individuals with auto insurance are both aided by the insurance and can be protected from the expenses of the other party's personal injuries and medical costs.
  • Homeowners insurance can help pay for non-resident medical costs resulting from personal injuries sustained on a homeowner's property. Homeowners are liable for any injuries a visitor (non-resident) sustains on their property, so homeowners insurance helps to pay for part or all of the medical expenses the visitor may demand repayment for. Residents or homeowners who are injured on the homeowner's property are not covered by homeowners insurance.

Social Security Disability Insurance

Social Security Disability Insurance (SSDI) is a federal program that provides financial benefits to disabled people. Like Medicare, eligible individuals have paid into Social Security through payroll deductions, which are then withdrawn to fund SSDI benefits.

In order to qualify to receive SSDI benefits, the insured must (1) have worked and paid Social Security taxes and (2) possess a medical condition that is defined as a disability by Social Security.

Applying for SSDI can be complicated and requires a lot of documentation. If your application is denied, you can appeal for Social Security to reexamine your application with a notice explaining why you or your loved one qualifies for SSDI benefits. SSDI attorneys are specialized in the application process and fighting for the benefits of their clients.

Get Legal Help

Healthcare and insurance laws and rules are inherently complex. It can be frustrating and time-consuming when your application for insurance or healthcare is denied and you don't know why you didn't qualify. Consult with a qualified healthcare and insurance attorney to make plan/program shopping and application stress-free and to protect your rights to benefits.

The information on this page is meant to provide a general overview of the law. The laws in your state and/or city may deviate significantly from those described here. If you have specific questions related to your situation you should speak with a local attorney.

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