What Is Gap Health Insurance

Staff article
May 4, 2020

Gap health insurance is a supplemental plan to your current health insurance plan. When designed right, Gap insurance can help you save money and improve benefits.

How is this possible? The main drivers of health insurance premiums are the benefits but even more specifically, the deductible. The lower the deductible, the higher those health insurance premiums rise. If designed correctly, utilizing the combination of a major medical plan with the correct gap plan, can lower your deductible to essentially $0! Think, platinum benefits at bronze prices

A few years ago, most Gap plans were reimbursement plans. This meant you would have to submit a claim to the Gap Company. Then, after it was processed by your major medical they would reimburse you the benefits. Now, many Gap companies have their own ID cards, so that claims can be processed with both your major medical and gap carrier simultaneously. No reimbursement necessary!

Most Gap plans offer an inpatient benefit and an outpatient benefit. For example, you could have a Gap plan that covers $5,000 for inpatient hospital stay and $2,500 for outpatient benefits per calendar year. With this Gap plan if you had a $5,000 out of pocket maximum, you essentially just lowered your deductible to $0! The Gap plan will only cover whatever the major medical covers. They will follow your major medical’s benefit summary. Gap plans offer riders that can be added onto the basic plan, such as coverage for lab work and coverage for durable medical equipment.

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