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Health & supplemental
Health coverage, and the gaps it leaves
Major medical is the foundation. What surprises people is how much is still owed after it pays — and how much of that has nothing to do with hospitals.
Your foundation
The base layer
Individual and family major medical
Comprehensive health coverage, usually bought through the ACA marketplace where subsidies may apply based on household income. Covers doctor visits, hospital care, prescriptions and preventive care.
Open enrolment runs at a set time each year. A qualifying life event — losing job coverage, moving, marriage, a new baby — opens a special enrolment period outside it.
Where it's strong
- Required essential benefits, no exclusion for pre-existing conditions
- Subsidies can cut premiums substantially for many households
- Annual out-of-pocket maximum caps your worst-case year
What to watch
- Deductibles and coinsurance can still leave thousands owed
- Networks matter — out-of-network care can be billed separately
- You generally cannot enrol outside open enrolment without a qualifying event
Stopgap only
Short-term medical
Temporary coverage for a gap between jobs or before a plan starts. Cheaper than major medical, and much more limited.
Where it's strong
- Fast to start, low premium
- Useful for a genuine short gap
What to watch
- Can exclude pre-existing conditions outright
- Often excludes maternity, mental health and prescriptions
- Not ACA-compliant — not a replacement for major medical
- Availability and duration vary by state
The policies that fill the gap
These pay cash directly to you, not to the hospital. You decide what it's for — the deductible, the mortgage, childcare, or petrol to get to appointments.
Cash per day or per stay
Hospital indemnity
Pays a fixed amount when you are admitted — a lump sum on admission, a daily amount for each night, or both. Sits on top of your medical plan.
Where it's strong
- Pays regardless of what your health plan does
- Directly offsets a high deductible
- Money arrives as cash, for any purpose
What to watch
- Benefits are fixed amounts, not a share of the bill
- Usually requires an actual inpatient admission
- Waiting periods and pre-existing condition limits are common
Lump sum on diagnosis
Critical illness
Pays a single lump sum — often $10,000 to $50,000 — on diagnosis of a covered condition such as heart attack, stroke, or cancer. Paid on diagnosis, not on treatment cost.
Where it's strong
- Money arrives early, when income often stops
- Covers non-medical costs nothing else touches
- Pays on top of any other coverage
What to watch
- Only listed conditions qualify — read that list closely
- Definitions are precise; a mild event may not meet the policy's threshold
- Pre-existing conditions are usually excluded for a period
Focused cover
Cancer policies
A narrower version of critical illness, covering cancer specifically. Some pay a lump sum, others pay per treatment.
Where it's strong
- Lower premium than broad critical illness
- Sensible where family history is a real concern
What to watch
- Pays for nothing but cancer
- Skin cancers and in-situ diagnoses are often limited or excluded
Cash for injuries
Accident insurance
Pays set amounts for accidental injuries — fractures, burns, emergency room visits, ambulance rides, follow-up physiotherapy.
Where it's strong
- Inexpensive, and covers events that happen to healthy people
- Good fit for active households and children
- No health questions on most plans
What to watch
- Accidents only — illness isn't covered
- Benefits are scheduled amounts per injury type
Routine care
Dental and vision
Separate from medical, because medical plans generally exclude both for adults. Covers cleanings, fillings, crowns, eye exams, glasses and contacts.
Where it's strong
- Preventive care usually covered at or near 100%
- Predictable, low premium
- Makes people actually go
What to watch
- Annual maximums are low — often around $1,000 to $2,000
- Waiting periods on major work like crowns and bridges
- Orthodontics is often a separate rider
Protecting your income and your independence
Replaces a paycheque
Disability income
Pays a monthly benefit — typically 40% to 70% of income — if illness or injury stops you working. Short-term covers weeks to months; long-term covers years or to retirement.
For most working people this is the most overlooked policy on this page. Your ability to earn is the asset everything else rests on.
Where it's strong
- Protects the income that pays for everything else
- Own-occupation definitions pay if you can't do your job specifically
- Benefits are generally tax-free when you pay premiums with after-tax money
What to watch
- Definitions of disability vary enormously — this is the whole ballgame
- Elimination period means benefits start after a wait, often 90 days
- Occupation, income and health all affect eligibility and price
Help with daily living
Long-term care
Covers care that health insurance and Medicare largely do not: home care, assisted living, nursing homes. Triggered when you can't perform a set number of daily activities, or on cognitive impairment.
Modern versions are often hybrid — life insurance or an annuity with a long-term care rider — so the money isn't wasted if care is never needed.
Where it's strong
- Covers the single largest uninsured risk in later life
- Protects savings and spares family from becoming full-time carers
- Hybrid designs pay a death benefit if care is never needed
What to watch
- Premiums are significant, and traditional policies have raised rates historically
- Underwriting is strict — buy it while you're healthy or not at all
- Benefit triggers and elimination periods need reading carefully
How to think about the order.
Major medical first, always. Then whichever gap would actually hurt you: disability if you're working, hospital indemnity if your deductible is high, long-term care if you're protecting savings. Supplemental policies are only worth it when they solve a specific problem you can name.
Not sure which of these you need?
That's the normal starting point. Call and we'll work through it in about ten minutes — no obligation, and an honest answer if the right move is doing nothing at all.
888-343-4002Toll free — Monday to Friday, 9am – 6pm ET