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

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.
Generally, no. Healthcare expenses related to pre-existing conditions are not covered by medical gap plans.
Typically, yes. Medical gap plans are designed to help cover out-of-pocket expenses associated with a major medical plan, not as a stand-alone insurance plan.