Mutual of Omaha Hospital Protection: What Medicare Agents Should Know About This Hospital Indemnity Plan
Guest post by Aaron Arenbart.
Mutual of Omaha's Hospital Protection plan is an individual hospital indemnity policy. It pays scheduled cash benefits when a client is hospitalized for a covered illness or injury. It is not a Medicare Supplement, and it is not a substitute for comprehensive health coverage.
Medicare Advantage members still face inpatient copays, observation cost sharing, and an annual out-of-pocket maximum. Original Medicare members with a high-deductible Medigap plan face their own gaps. A hospital indemnity policy can put cash in the client's hands when those bills show up, but only if the agent sizes it to real numbers.
This article walks through what Mutual of Omaha publishes about Hospital Protection, how the base plan and riders work, and what to verify by state before you quote. Every product fact below comes from Mutual of Omaha's public producer and consumer materials, linked in each section.
What Hospital Protection is
Hospital Protection is underwritten by Mutual of Omaha Insurance Company, Omaha, Nebraska. Mutual of Omaha's consumer hospital indemnity page lists it as policy form HI25 or state equivalent (for example HI25-50246 in Florida, HI25-50253 in North Carolina, HI25-50245 in Texas), with rider forms 0YV1M through 0YV9M or state equivalent.
The carrier's Hospital Protection Product and Underwriting Guide (form 633738_0926, producer use only) sets the core frame:
The policy is guaranteed renewable. The consumer page adds that it is guaranteed renewable for life as long as premiums are paid on time and there has been no material misrepresentation.
Issue ages 18 to 85, with guaranteed issue for ages 64 to 74.
Target market: Medicare-age clients looking to supplement high-deductible Medicare Supplement plans or Medicare Advantage plans.
Premiums are unisex, based on issue age, do not vary by tobacco use, and are based on the application date, not the effective date.
No policy fee. A household discount of up to 7% is available in most states.
Applications are e-App only. No paper applications or wet signatures.
The CMS fact sheet on short-term and fixed indemnity coverage (March 28, 2024) frames the category: hospital indemnity and other fixed indemnity insurance is a form of income replacement when a health event happens, and it is not a substitute for comprehensive coverage.
How the base benefits are built
The client first picks how the hospital confinement benefit pays, per the Product and Underwriting Guide:
Daily benefit: $100 to $1,000 per day, in $10 increments, with day options of 3 through 10, 15, 20, or 31 days.
Lump sum: $100 to $3,000, in $50 increments.
Hospital confinement means an inpatient stay of at least 24 hours for a covered injury or sickness. The client can receive benefits for the full number of days selected in each period of confinement. That period starts when the client is confined and ends after 60 consecutive days with no additional hospital confinement, whether or not the selected days were used up.
The guide lists no waiting period. Benefits start as soon as coverage is issued, subject to the pre-existing condition limitation covered below.
Three built-in benefits ride along with the base plan:
Observation stay. Starts at six hours of observation. After 24 hours it is treated as hospital confinement. It pays 100% of the daily hospital benefit for the lesser of five days or the base day option selected, and the guide's built-in benefits page describes the five days as per calendar year. It does not stack with the confinement benefit. The plan pays one or the other.
Mental health. $175 per day, up to seven days per calendar year.
Pet boarding. $75 per day, up to 14 days per calendar year, at a licensed establishment with a receipt.
The Medicare Solutions Product Portfolio (form 627312, revised August 2025) confirms the same base options and states that benefits are paid directly to the client.
Optional riders (additional premium)
Riders cost extra, vary by state, and must be selected at the time of application. The guide states they cannot be purchased or changed after the policy is issued, so the rider conversation happens once. From the Product and Underwriting Guide:
Ambulance and Emergency/Urgent Care. $100 to $500 in $100 increments. Ambulance, ER, and urgent care are each payable four times per calendar year. Urgent care pays 50% of the chosen amount. Air ambulance pays 10 times the chosen amount.
Skilled Nursing Facility. $100 to $500 per day in $10 increments, with coverage for days 1-20, days 21-100, or days 1-100. Requires a covered hospital stay of at least two days, with SNF care beginning within 30 days of discharge.
Outpatient Surgery. $250, $500, $750, or $1,000 for surgery in an ambulatory surgical center or outpatient hospital facility. Maximum two surgeries per calendar year, one payment per day.
Lump Sum Cancer. $2,500, $5,000, $10,000, $15,000, $20,000, or $25,000, plus a separate $600 skin cancer benefit. 30-day waiting period, first-ever diagnosis only, extra application questions and underwriting review. The rider terminates once the benefit is used.
Guaranteed Purchase Option. Increases the hospital confinement daily benefit by 15%, up to five times or until age 85, whichever comes first. Total increases cannot exceed 75% of the original daily benefit. Added premium is based on original issue age, with no additional underwriting.
Outpatient Therapy. $50 to $250 per session in $10 increments for occupational, physical, or speech therapy, for 15 or 30 days per calendar year. Includes five chiropractic days per year. No hospital stay required.
Major Diagnostic Testing. $100 to $500 in $100 increments, maximum two tests per calendar year. Covered tests include CT, MRI, PET, angiogram, CT angiogram, EEG, and EKG.
Home Health Care. $50 to $250 per day in $10 increments, up to 30 visits per calendar year. Requires a two-day covered hospital or SNF stay, care beginning within 30 days, and a cognitive impairment or inability to perform two of six activities of daily living.
Prescription Drug. Reimburses $15 per generic and $30 per brand-name prescription, up to a $250 or $500 calendar-year maximum. The guide says it can supplement a stand-alone Part D plan but should not be marketed as a prescription drug plan replacement.
Mutual of Omaha's Guaranteed Purchase Option rider flyer (form 637493) shows the math with its own hypothetical: a $500 daily benefit becomes $575 after one exercise. The client does not have to exercise it every year, and rider premium continues until the rider is canceled.
Pre-existing conditions, exclusions, and underwriting
The guide will not pay for loss from a pre-existing condition unless the loss occurs six months or more after the policy date. A pre-existing condition is one for which medical advice, diagnosis, care, or treatment was recommended or received within six months before the policy date. The state grid notes no pre-existing limitation for ages 65 and older in North Carolina.
Base plan exclusions include loss while the policy is not in force, services that are not medically necessary, war, military service, cosmetic or experimental treatment, intentionally self-inflicted injury, drug abuse, alcoholism or chemical dependency, and normal pregnancy or childbirth.
Outside the 64 to 74 GI window, every health question must be answered. The guide's underwriting section lists declines for:
Any history of AIDS, ARC, or HIV.
A two-year lookback on conditions including COPD and other chronic respiratory disease, heart attack, heart surgery, stroke or TIA, internal cancers, chronic kidney disease, Alzheimer's, dementia, Parkinson's, MS, and ALS.
A most recent A1C of 7.0% or higher.
Any hospitalization or home health care in the past 12 months.
The guide says that list is not all-inclusive. Coming from the carrier relationship side, I never assume a GI window applies in every state. This one does not. The guide shows no GI period in Delaware or Utah.
State differences that change the quote
The state grid in the guide is not a footnote. A few examples:
Not available: New Mexico, Puerto Rico, and the U.S. Virgin Islands. California, Massachusetts, and New York were listed as pending.
New Jersey: 31 days only, $40 to $250 daily benefit, no lump sum, no mental health or pet boarding benefit, and no riders.
Idaho: no mental health or observation benefit, and no riders.
Florida, Pennsylvania, and Texas: the daily benefit is $15 for the remainder of the 31-day maximum confinement period. In Kansas and New Hampshire, that figure is $50.
Connecticut and Kansas: most riders unavailable, and urgent care is not included in the ambulance rider.
Household discount: not offered in Minnesota, Montana, or Washington, with different eligibility wording in several other states.
Mapping the cash benefit to the client's coverage
Hospital indemnity pays cash on a covered trigger. It does not erase Medicare Advantage cost sharing, and it is not Medigap.
For calendar year 2026, KFF's Medicare Advantage analysis states that MA out-of-pocket limits may not exceed $9,250 for in-network services, and the average in-network limit is $5,421. That federal ceiling is context, not a target for the daily benefit.
On the Original Medicare side, Medicare.gov lists a 2026 Part A deductible of $1,736 per benefit period. It also notes that Medicare Advantage plans may charge copayments during the first 60 days.
Here is the napkin math, as a hypothetical. If a client's Evidence of Coverage shows a $300 per day inpatient copay for days 1 through 5, a $300 daily benefit with a 5-day option lines up with that copay schedule. That is $1,500 of cash on a five-day stay. It is still cash to the insured, not a payment to the hospital.
Then check observation. Hospital Protection's observation benefit starts at six hours, so compare it to the plan's observation cost sharing in the EOC, not just the inpatient line.
What it does not do
Say these limits early:
Not a Medicare Supplement and not a Medigap replacement.
Not a replacement for Medicare Advantage or Original Medicare.
Riders cannot be added after issue.
The Prescription Drug rider is not a Part D plan.
Benefits, riders, GI, and pre-existing rules change by state.
The Medicare.gov Medigap page explains what Medigap does when a client needs help with Original Medicare cost sharing. Different product. Different rules.
Keep compliance clean. Complete a Scope of Appointment that covers every product you plan to discuss, including hospital indemnity. Keep Medicare plan and ancillary discussions clearly separated in your notes. Never present fixed indemnity as a Medicare plan or a government benefit.
What to verify before you quote
State availability and your appointment.
Policy form HI25 or the state equivalent, and rider forms 0YV1M through 0YV9M.
Day options and benefit ranges from the current state materials and the carrier's quoting tool.
Observation, mental health, and pet boarding availability in that state.
Riders and state carve-outs, picked at application because they cannot be added later.
GI eligibility (64 to 74, not in Delaware or Utah) and underwriting answers for everyone else.
Pre-existing limitation for the client's state.
The client's Evidence of Coverage for inpatient, observation, ER, ambulance, SNF, and outpatient surgery cost sharing.
Required fixed indemnity notices for your state.
If a detail is not in the current carrier packet, treat it as unverified.
Short FAQ
Is Hospital Protection a Medicare Supplement?
No. It is a hospital indemnity policy that pays scheduled cash benefits. It is not Medigap.
Is there a waiting period?
The guide lists no waiting period for the base plan. The six-month pre-existing condition limitation still applies in most states, and the Lump Sum Cancer rider has a 30-day waiting period.
Who gets the check?
The product portfolio states benefits are paid directly to the client.
Do benefits reset?
The guide pays up to the selected number of days in each period of confinement. A period ends after 60 consecutive days with no additional hospital confinement.
What ages are guaranteed issue?
Ages 64 to 74 in most states, per the guide. Delaware and Utah have no GI period.
Can a client add riders later?
No. The guide says riders must be selected at application and cannot be added or changed after issue.
The Bottom Line
Hospital Protection is a flexible cash hospital indemnity design built for Medicare-age clients. The daily benefit, day options, observation trigger, and rider menu are all measurable. Match a verified state schedule to a real Evidence of Coverage, a real budget, and a client who understands the limits.
Know the form. Know the state grid. Pick riders at application. Map the cash to the EOC.
If you want help building a compliant ancillary conversation alongside your Medicare book, book a call with Brock.
Product details are from Mutual of Omaha's Hospital Protection Product and Underwriting Guide (633738_0926), Medicare Solutions Product Portfolio (627312, revised August 2025), Guaranteed Purchase Option rider flyer (637493), the public hospital indemnity page at mutualofomaha.com, and the CMS, KFF, and Medicare.gov materials linked above, reviewed October 15, 2026. Benefits, availability, issue ages, and terms vary by state. Always confirm in current carrier materials.
