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What is GAP health insurance coverage?

Dino Christoforakis
Dino Christoforakis

Editor in Chief & Licensed Insurance Agent.

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  • GAP insurance coverage can cover “gaps in your health insurance policy
  • GAP insurance won’t replace your primary health insurance
  • GAP insurance claims are the insured’s responsibility
  • GAP health coverage can provide affordable peace of mind


GAP insurance is designed to help the insured manage the gaps in their health insurance coverage. GAP insurance is most popular with individuals who have insurance through their employer. Employers often pay or allow their employees to pay for GAP coverage to supplement their health insurance deductibles.

Many Americans are settling for insurance policies with large deductibles because they can’t afford anything more. Unfortunately, these same people don’t realize that GAP health care coverage may be able to help them save money on deductibles without paying outrageous amounts for health insurance.

The additional policies are used to cover a variety of out-of-pocket costs and are raising in popularity to keep health coverage affordable. Click here to compare free quotes now and find affordable gap health insurance your state!

What’s making GAP health insurance so popular?


GAP health insurance is rising in popularity with those that don’t qualify for a subsidy because health insurance costs are growing.

People who are faced with high deductibles are eyeing GAP insurance as a way to reduce their financial risk in case they have to use their medical insurance. But, insurers need to know that there are cons associated with this type of coverage.

What You Need to Know Before You Buy GAP Insurance

Before you buy GAP health care coverage, there are a few things you need to know. First, GAP insurance is not the same thing as health insurance. GAP insurance is a “limited benefit” policy. What this means is no matter how bad your situation is, the policy will only pay a pre-determined amount of money towards the claim. No matter what type of health insurance you have, your primary coverage will always be required to pay first.

GAP insurance coverage is not the same as a mini-med policy. Before the Affordable Care Act, mini-med policies were very popular.

After the Affordable Care Act was put into effect, mini-med policies were determined to be illegal.

Buying a GAP insurance policy alone does not satisfy the Affordable Care Act requirements for coverage. What this means is that a person cannot forgo traditional health insurance and only purchase a GAP policy. Additionally, the policy a person purchases from an insurance company must meet Affordable Care Act requirements.

Are GAP policies worth it?


Even though a GAP policy combined with traditional health care premiums will usually cost less than a policy with a low deductible many people still ask themselves whether it’s worth it or not to buy additional coverage. Whether this is the right solution for everyone depends on a person’s particular situation.

Insured individuals with a high deductible and extensive or ongoing medical conditions may benefit greatly from GAP insurance coverage. Meanwhile, individuals who are relatively healthy and have no planned medical expenses might not save much or any money by adding a GAP policy. But since no one usually plans a medical emergency it might be worth paying for a policy to cover the difference simply for the peace of mind.

For example, if someone purchases GAP insurance simply for the peace of mind, they will be grateful they have it if their appendix decides to erupt or they fracture a foot while walking the dog.

While GAP insurance isn’t designed to cover every gap a person may incur with their health insurance, it is designed to reduce the financial impact a person could incur in this situation thanks to high deductibles.

For those without a savings account or funds to cover a large medical bill, a GAP policy could be what helps them avoid bankruptcy or financial distress.

If you have medical procedures or services scheduled, it’s important to realize whether the service will be covered by your GAP policy before you attempt to use it. Since policies vary greatly based on elective and non-elective services, it is up to the insured to determine whether a particular service is eligible to be paid under a GAP policy.

Policies are even subject to change from one calendar year to the next, so it is important to make sure you always check policies before applying or renewing.

Who files GAP insurance policy claims?



When you use your health insurance card at a doctor’s office or hospital, the provider or facility usually files the claim on your behalf. Shortly after the claim is submitted, you will receive an Explanation of Benefits (EOB) showing how much the insurance paid towards your claim and what your out-of-pocket expenses, including deductibles, coinsurance, and co-payments could be.

To file a GAP policy claim, the insurer will take the EOB and submit it to the provider. When the insurer signed up with the provider, they should have been told when and where to access required paperwork for claim submission.

When filling out a GAP claim form, the insured can opt to have the reimbursement check to the provider or directly to themselves. When a reimbursement check is mailed to the insured and not the provider, it is the insured person’s responsibility to pay any outstanding balances.

Ideally, after all the information above is considered, it’s obvious premium efficiency is the best way to develop a cost-effective strategy for your budget. To determine what policies will meet your medical and financial budgets, it’s necessary to combine the cost of a high deductible and compare it to the cost of a gap insurance plan.

If the gap insurance plan premiums are less than a high deductible, it makes sense to add the additional coverage to avoid the burden of high medical bills.

Are GAP Policies Affordable?

Once insured individuals begin to realize they need a GAP policy, they are eager to find out if they can afford the coverage. Premiums for GAP coverage vary greatly from one policy carrier to another. Components of policy price can increase or decrease depending on where and whom you buy the coverage for and from.

Find GAP coverage today by entering your zip code below and comparing online quotes for for free!

[su_spoiler title=”References:” icon=”caret-square” style=”fancy” open=”yes”]

  1. http://www.npr.org/sections/health-shots/2016/09/13/493695824/would-you-like-some-insurance-with-your-insurance
  2. https://www.healthcare.gov/fees/plans-that-count-as-coverage/
  3. http://kff.org/health-reform/perspective/what-is-a-mini-med-plan/
  4. https://www.irs.gov/affordable-care-act/individuals-and-families/aca-individual-shared-responsibility-provision-minimum-essential-coverage
  5. http://time.com/money/3093276/short-term-health-plans-offer-relief-significant-gaps/


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