Gap Health Insurance

Supplemental insurance to help fill the gaps in your major medical plan
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Individual Marketplace major medical deductibles in 2020 range from $1,519 (Gold plan) to $6,506 (Bronze plan).[1]

Do you have enough money (or funds in a health savings account) to meet your annual major medical deductible if you have a covered accident or critical illness? If not, think gap health insurance.

For example, gap insurance can include critical illness + accident insurance coverage that provides a fixed lump-sum benefit as a result of a covered critical illness. This lump-sum payment can be used any way you see fit. Accident coverage is available for covered expenses incurred, up to a maximum benefit limit, whichever is less.

What Gap May Cover
  • Broken bones

  • Life-threatening cancer

  • Heart attack

  • Kidney failure

  • Stroke

  • Coma

  • Coronary bypass

  • Loss of sight, speech or hearing

  • Major organ transplant

  • Paralysis

  • Severe burn

What Gap May Not Cover
  • Preventive care such as routine physicals

  • Any non-medically necessary or experimental procedures

  • Injuries or illness related to participating in extreme or dangerous activities (rock climbing, skydiving, private aviation, etc.) or sustained at work or under the influence of drugs or alcohol

  • Medical expenses incurred prior to the policy effective date or after the expiration date

Pros and Cons of Gap Health Insurance

  • You choose how to use benefits payments – There is no restriction on how to use the money you receive, whether for medical costs or to pay for groceries.
  • Apply year-round – There is no official open enrollment period and, in most cases, coverage begins the next day after you enroll online.
  • A plan for every budget – There are different levels of coverage to meet different needs.
  • Keep your doctor – No provider network limitations for fixed indemnity plans means you can visit your preferred healthcare provider.
  • Unlike ACA plans, premiums are based on age and health – The younger and healthier you are the lower your monthly premium, conversely, older and sicker individuals will pay more.
  • Pre-existing conditions are not covered
  • Not ACA-qualifying major medical coverage – Gap insurance is a form of supplemental health insurance, not ACA-qualifying major medical coverage.

Find Answers to Gap Health Insurance Questions

Medical gap plans usually do not limit benefit payments based on doctor and hospital networks, so you are free to visit your preferred healthcare provider. Be sure to check specific details for any gap health insurance policy you are considering purchasing.
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.
You may choose to have your medical gap insurance benefits paid to you or to your provider.

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