Accident-Only Insurance vs Major Medical Calculator
Accident-only policies pay scheduled benefits for injury-related events (ER, fractures, ambulance) but EXCLUDE illness. Much cheaper than major medical but with huge gaps.
| Days/events covered (after wait) | — |
| Gross payout | — |
| Capped at lifetime max | — |
| Annual premium | — |
| Break-even years (payout ÷ premium) | — |
| Net benefit (payout − premium years to event) | — |
Accident-Only Insurance pays a fixed dollar amount per qualifying event regardless of actual medical costs. Accident-only pays scheduled benefits for injury — never illness. It's supplemental — never a substitute for major medical insurance.
How It Pays
Policy pays 500/day or per-event for covered conditions. Payout is independent of actual medical bills — you receive the benefit even if insurance paid the hospital.
Waiting Periods
Most policies impose 0-30 day waiting periods before benefits begin. Pre-existing condition exclusions typically last 12-24 months from policy issue. Read the elimination period carefully.
Lifetime Maximum
Policies cap total payouts at a lifetime maximum ($25K-$250K typical). Once you hit the cap, coverage ends without refund of past premiums. Higher caps cost proportionally more.
Tax Treatment
Benefits paid for sickness/injury that's not reimbursed are generally tax-free under IRC §104. If the employer paid premiums with pre-tax dollars, benefits may be taxable. Confirm with a CPA.
Last updated May 2026. Sources: NAIC Consumer Info, IRC §104.