Individual and Family

Critical-Illness Insurance: Is It Worth the Cost?

Published on August 01, 2014


Critical-illness insurance works differently from major medical plans. Major medical plans may require copayments, deductibles, and coinsurance before paying any benefits. Major medical plans may also impose a limited doctor network and/or limited prescription drug coverage.
Critical-illness plans, on the other hand, are a form of catastrophic insurance that is meant to supplement, but not replace, your major medical insurance (which you are required to have under the Affordable Care Act). Critical-illness plans generally pay a lump-sum benefit directly to you if you are diagnosed with certain covered illnesses. You aren’t required to seek treatment within any particular network of doctors or other health-care providers. Premiums are based on your age and health when you enroll.
So, is a critical-illness plan something you should consider? Read on.

More about critical-illness coverage

Most people live longer these days because of many factors, including medical advances, routine screenings, and better diagnostics. But this may also mean that people’s chances of experiencing a critical illness during their lifetime can increase.
Critical-illness plans usually cover illnesses such as cancers, heart attacks, and strokes. Depending on the particular insurance company and policy, critical-illness coverage could also include kidney failure, multiple sclerosis, paralysis, Alzheimer’s disease, major organ transplant, blindness, and deafness.
The insurance payout can benefit your health in that you could use it to seek alternative or experimental treatments or use a specialist outside of your preferred provider network. Financially, a payout can help you pay medical bills not covered by your major medical insurance; pay routine bills while you’re unable to work; or pay for travel if you must seek treatment away from your hometown. In addition, critical-illness policies can help protect you from medical cost inflation and provide you with critical resources while you recuperate.
Since the critical-illness insurance benefit is primarily a set payout, the premiums for critical-illness plans can be quite a bit lower than for major medical plans, making it an affordable and wise investment for many people. (However, it is not a replacement for a major medical plan.)

High costs of critical illnesses

Critical illnesses are now common, but the good news is that, with modern medicine, many more people survive these conditions than ever before. For example, according to the American Association for Critical Illness Insurance (AAFCII), the five-year cancer survival statistics have topped 66 percent.
But survival doesn’t tell the complete story. Survivors of cancer and any critical illness face tremendous financial pressures on themselves and their families. Patients often require alternative sources of income to maintain family lifestyles or just cover basic services and expenses during long periods of recuperation.
Important statistics from the AAFCII about critical illnesses and their related costs include the following:

  • Medical expenses are responsible for more than 66 percent of all bankruptcies.
  • 85 percent of breast cancer victims survive five years or more.
  • More than one in three heart attack victims survive.
  • Four out of five cancer patients lose income due to their diagnoses.
  • Severe illness can reduce a typical family’s income by more than $12,000 per year, even if all medical expenses are covered.
  • Critical-illness insurance allows people to purchase coverage from $5,000 up to $1 million at affordable rates.
  • 75 percent of people who learn the facts about critical illness insurance find the concept appealing.

 Advantages of critical-illness coverage

Critical-illness policies were first offered in the United States during the 1990s, and more than 600,000 Americans now have critical illness protection in excess of $11.5 billion dollars. The lump-sum disbursements that are paid to policy holders allow them to pay insurance premiums, make up coverage shortfalls, supplement income, pay for travel while seeking treatment, and cover any incidental expenses and medications associated with recovering from illness.
Today, people insure their phones, laptops, clothes, computer devices, and pets, but often fail to ensure their health and financial well-being. Regardless of your current health insurance, disability coverage, or medical savings accounts, you could face severe financial difficulties if a critical illness strikes.
Ultimately, the decision whether to get critical-illness insurance depends on your risk tolerance, family situation, and financial profile. But given the potential costs and benefits, the coverage is certainly worth investigating.
National Cancer Institute,
American Association for Critical Illness Insurance,

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