Gap Health Insurance

The premium amount for your medical gap insurance plan is based on factors such as your:

• Chosen plan benefits
• Age
• Health status
• Location

Because gap health insurance policies offer limited benefits rather than the same coverage as ACA plans, premiums for this type of plan are typically lower than ACA plan premiums. The best way to learn about medical gap insurance premium costs and coverage options is to obtain a medical gap insurance quote. Or call 888-855-6837 to speak with a licensed agent.

Benefits are based on the specific medical gap plan you choose. To understand exactly what is covered and what is excluded, carefully review any policy you’re considering purchasing. In general, many gap health insurance plans provide benefits for the following types of illnesses and accidents:

• Life-threatening cancer
• Heart attack
• Stroke
• Kidney failure
• Coronary bypass
• Coma
• Broken bones
• Severe burn
• Paralysis

The above lists are only examples. For more details about available plan options, call 888-855-6837.

If you experience a covered illness or injury, with some gap policies, you receive a lump sum benefit payment that you may use to help cover out-of-pocket expenses associated with your major medical plan, such as deductible, copayment and coinsurance amounts. Once your medical gap policy has paid the maximum benefits allowed under the plan for the year, no more benefits are available until the next policy year. No Coordination of Benefits Your gap health insurance benefits ordinarily do not coordinate with your major medical insurance coverage. Coordination of benefits is the process of determining which insurance benefits will be applied first, second, third, etc., when you have multiple insurance plans.^[2] Rather, your medical gap plan benefit amount is determined by the eligible expenses you incur and your policy’s benefit limit, rather than being based on the amount not covered by your ACA plan. Gap Health Insurance Examples Let’s say you’ve purchased a medical gap plan that has a lifetime limit of $10,000 in benefits for covered illnesses or injuries, and are enrolled in a bronze plan with the average 2019 deductible of $6,258.^[3] If you suffer a heart attack and incur the typical hospitalization and related costs of $20,246 associated with this condition,^[4] your medical gap policy will pay $10,000 in benefits. You will still have $10,246 in costs, most of which will likely be covered by your major medical policy after the deductible has been satisfied. Now let’s look at how that same medical gap plan would pay benefits for another, less-costly eligible expense. If you break your arm and incur the average costs of $2,500 for non-surgical treatment,^[5] your medical gap policy will pay $2,500. As long as you continue to pay your gap health insurance premiums, your policy will have $7,500 available to be paid as benefits for future expenses associated with an eligible illness or injury.