GAP Insurance Coverage

Medical gap insurance is a supplemental health plan that acts as a cushion for people and businesses who carry high-deductible health care plans. Simply put, it’s like insurance for your insurance.

Gap insurance policies are not major medical insurance, and they come with very limited benefits. In most cases, that means that no matter the severity of your situation, your gap insurer plan will only pay you a set amount. And because the plans do not meet the standards set by the Affordable Care Act, consumers can’t use gap insurance policies as a stand-alone insurance without facing a tax penalty.

The main purpose of medical gap insurance is to lower your overall out-of-pocket costs by providing funds to pay for a large deductible and other out-of pocket costs until your main insurance policy kicks in.

More Americans are switching to high-deductible health plans to lower their monthly premium costs. But the lower sticker price can eventually come back to bite you. The average annual deductible for an employer-provided individual health plan is $1,478 and even higher for families.

To help deal with increasing out-of-pocket costs, more Americans may turn to “gap insurance” plans (also known as supplemental health plans). According to a report released this year by insurance company Aflac, 79% of workers said they saw a growing need for supplemental insurance plans to help cover expenses their primary insurance does not cover compared to 64% a year ago, and 60% of those said it was because of rising medical costs.

There has been buzz around gap plans for more than a decade, says Rhett Bray, president of BeaconPath, a Mission Viejo, Calif.-based employee benefit consulting firm. But interest really boomed around 2013, with the rollout of the federal health care marketplace and growing popularity of high-deductible plans.

In 2016, more than 90% of people who purchased health plans on the health care exchange chose plans with deductibles of $3,000 or higher. Plans with high out-of-pocket costs have grown increasingly popular with workers who receive benefits through their employer. Of those who receive employer-provided coverage, 29% chose a high-deductible health plan in 2016, a 5-point rise from a year earlier.

“It’s hard to cover an individual’s complete medical needs in an affordable way if you’re just bringing them through a major medical plan,” said Bray. He says that as costs increase, supplemental insurance policies will be “a big tool in the toolbox that most of us as brokers will continue to bring to the table.”