Gap Health Insurance

Yes, some medical gap insurance plans have a lifetime maximum limit on the benefits they will pay for eligible expenses. The lifetime maximum limit amount for your policy is determined by the plan you choose. If your policy has a lifetime benefits limit, once the policy has paid its maximum amount of benefits, the policy will terminate. If your policy has an annual limit, once you’ve reached your benefits limit for the policy term, you won’t have access to benefits until it’s time to renew your policy. Remember, you could have a limitation on coverage for pre-existing conditions with new or renewed policies.

Here, “gap” insurance refers to a category of supplemental health insurance products. These types of plans may pay lump sum benefits when you experience a covered accident or illness. This type of plan is designed to supplement your major medical insurance plan coverage, not replace it. Generally, gap health insurance benefits can help cover out-of-pocket expenses (such as deductibles, copayments or coinsurance) that you may incur before your major medical insurance plan begins paying its share of your covered expenses. Please note that the type of supplemental gap insurance described here is not the same thing as a Medicare Supplement (“Medigap”) plan. Individuals that are not eligible for Medicare may still be able to obtain a supplemental gap policy.

No, gap health plans are not qualified health plans under the terms of the Affordable Care Act (ACA). Rather, they are designed to supplement the benefits you receive from your ACA plan.