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Textbook
1. General Insurance Concepts
2. Producer Roles and Receipt Types
3. Principles of Life Insurance
4. Underwriting
5. Term Life Insurance
6. Whole Life Insurance
7. Variable Insurance Products
8. Group Life Insurance
9. Life Insurance Provisions
10. Annuities
11. Taxation of Life Insurance Products
12. Qualified Retirement Plans
13. Health Insurance Basics
14. Required Policy Provisions
15. Optional Policy Provisions
16. Medical Expense Insurance
17. Group Health Insurance
18. The Affordable Care Act (ACA)
19. Disability Income Insurance
20. Accidental Death and Dismemberment Insurance
21. Long Term Care Insurance
22. Dental Insurance
23. Section 125 Plans and Limited Policies
24. Federal Government Programs
24.1 Federal Health Insurance Basics
24.2 Medicare and Military Insurance
25. Medigap and Medicaid
26. Health Insurance Taxation
Wrapping Up
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24.1 Federal Health Insurance Basics
Achievable Life & Health
24. Federal Government Programs
Our Insurance Life & Health course is in "early access"; the content on this page is a work-in-progress.

Federal Health Insurance Basics

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The federal government plays an important role in providing health insurance benefits. The Social Security system is officially known as OASDI (Old Age, Survivors, and Disability Insurance). Later, when Medicare was added in 1965, the acronym OASDHI came into use to include “Health Insurance.” Under this system, Social Security provides disability income benefits, and Medicare provides health coverage. Disability income coverage may be available to fully insured workers who also meet strict disability criteria… Medical expense reimbursement coverage is offered to most people age 65 and older, those under 65 who have received Social Security disability benefits for 24 months, and individuals with End-Stage Renal Disease (ESRD), including those on dialysis.

The federal government administers:

  1. Disability Income Coverage
  2. Medical Expense Reimbursement Coverage

Additionally, the federal government provides military health coverage through TRICARE and the Veterans Health Administration, but these are not part of OASDHI.

The federal Social Security system was created in the 1930s to serve as a base upon which the private sector was expected to build a more substantial program of personal savings and insurance protection. Social Security is an entitlement, which means that every working American who contributes can expect to receive some benefits out of it.

The program is known as OASDI (Old Age, Survivors, and Disability Insurance). In practice, you will sometimes also see the acronym OASDHI, which adds “Health Insurance” to reflect Medicare. OASDHI/OASDI is funded by payroll taxes paid by employers and employees. The tax is deducted from a worker’s earnings, up to a maximum level known as the “maximum taxable wage base.”

Before a person will qualify for any Social Security benefits, he/she must be at least currently insured. To be currently insured, a person needs a minimum of 6 credits in the preceding 13 quarters. This means the person must have been working and paying OASDHI taxes for at least 6 of the last 13 calendar quarters. To be fully insured and thus eligible for disability and retirement benefits, a person must have forty credits (though disability requirements may vary by age; exam texts usually simplify this to 40 credits). A person can earn no more than four Social Security credits in a calendar year.

Disability insurance provided through OASDHI is based on requirements that are much more stringent than those found in commercial disability income policies. To qualify for Social Security disability benefits, the insured worker’s disability must be expected to last at least 12 months or result in death and prevent him/her from engaging in any gainful activity or occupation. There is also a 5-month waiting period before benefits commence (payments begin in the sixth month following the onset of the disability).

Lesson Summary

The federal government provides health insurance benefits:

  • Disability Income Coverage
  • Medical Expense Reimbursement Coverage

(Military health programs exist but are separate from OASDHI/OASDI.)

Social Security is based on payroll taxes paid by employers and employees, with eligibility criteria:

  • Currently insured with a minimum of 6 credits in the last 13 quarters
  • Fully insured with forty credits (used for retirement; disability credits may vary by age, but are simplified to 40 credits in exam prep)

Social Security disability benefits have stringent requirements, including a 5-month waiting period.

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