Government Coverage Is a Joke: Make Your Own Plan

By: Stanley B. Greenfield, RHU

Do you know the definition Social Security uses to determine if you are disabled? I’m glad you asked, because here it is:

“The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which has lasted or could be expected to last for a continuous period of 12 months or result in death. The impairment must be so severe that the individual is unable to engage in substantial gainful work that exists in the national economy regardless of where or not: such work exists in the immediate area in which the applicant lives, a specific job vacancy exists, or the applicant would ever be hired.”

Interesting. Very interesting. That opening line is a real killer. That means if you have a heart attack and you are only out for ten months, no benefits for you. Even an accident that results in multiple compound fractures which keeps you bed-ridden for eight months gets you nothing. If you do in fact qualify for the medical definition of Social Security, you then must qualify for the “working” section of the definition. You must be unable to do any gainful work, regardless if there is a job available for you, in your area or even 500 miles away! Wonderful.

Still have any thoughts of depending on Social Security to supply you with any disability benefits? (Personally, I wouldn’t depend on them for anything, except raising the cost for that benefit every chance they get!) If you do, I suggest you go back and read the definition of disability again and again until you understand it. You do have two chances for benefits: slim or none at all!

So what is a person to do if you can’t depend on a government program to provide coverage when you need it? (A government program you can depend on? That’s a joke!) Some of you have decided that since you belong to a specific group or association, that if they offer a group disability program, that it must be good. That’s about as smart as saying that since I pay taxes, everything the government offers must be good! I suggest that you do yourself a favor and if you have such a plan, maybe it’s time you pulled that policy out and reviewed it to see what they will pay, when they will pay, and—best of all—why they will pay. You may be in for a few surprises.

First of all, what constitutes a disability? I have seen some wild definitions in some of these “good” plans from various groups and associations. Don’t waste your time looking at the proposal from the company. They are trying to sell you with it and will only point out all their “goodies,” never their “shadow” side. You need to read the policy. In that you will find “the good, the bad, and the ugly!” Some of these plans lure you in with a low rate to start the plan and as you get older, the rates go up and up. I would suggest that you see what the rates can go up to before you buy any plan, group or otherwise.

What if they decide that they are losing money on the group? Can they cancel all of the policies? Yes, they can, and that includes yours. At that point, if you are uninsurable, you are back where you started from: naked, no coverage, and not a chance of getting any. Wonderful. “But Stanley,” you say, “my group would never offer a plan like that.” Oh, yeah? Better read your policy again. That’s in all of the group policies.

Here’s another question you might be asking: “What if I am disabled and Social Security does in fact pay me a benefit. Will my group policy reduce my benefit?” That is very possible. They might even reduce your benefit if you are still drawing any money from your practice or any retirement plan. Like I said: read your policy. Some policies even state that if you have a long-term benefit, they are still only going to pay for a total of 12 months in your lifetime for any musculoskeletal and connective tissue disorders of the neck or back. Isn’t that a cute one? You “buy” long-term coverage, and that’s what you “think” you have until you have a claim, and then you find out it will only pay for a TOTAL of 12 months.

By the way, if you ever terminate your membership in the group or association that is offering you the plan, your plan terminates, too.

Okay, we have looked at all the “bad news” with these plans; now what? I would suggest that you first pull out all of your disability plans and do a review. What company are they with? Is it a high rated company that will still be around if you have a claim? How have they “rated” you as a Chiropractor? Are you lower than a used car salesman? No kidding—I have seen worse. Just because you have an older policy does not mean that it is a “good” policy. I have seen some that are real dogs. Is the coverage still adequate? Any bells and whistles that are costing you money but are not worth keeping? What is the premium? Can you save by changing the premium mode? Do you have a separate overhead policy to cover your office overhead? You should. Are your policies set up so that you get the benefits tax free? Very important! Consult a professional today to see if your plan is right for you.