What is a gap plan?
"Gap plan" is a common name, not a legal one. Most gap plans are hospital indemnity or other limited-benefit policies. They pay a fixed amount when a covered event happens, for example a set amount when you're admitted to a hospital, or for a covered outpatient surgery. The amount doesn't depend on your actual bill.
Some gap plans are sold as group policies through an employer. Your agent will tell you exactly what kind of policy a plan is.
When a gap plan can be the right choice
- You picked a Bronze or other high-deductible plan to keep premiums low. You want help if a hospital stay or surgery means you hit the deductible all at once.
- You'd struggle to pay a large bill all at once. A fixed benefit paid to you can help with the deductible or coinsurance, or with rent and groceries while you recover.
- Your job-based plan has a high deductible, and your employer doesn't offer a gap or hospital plan.
- You want to compare costs. For some people, a lower-premium health plan plus a gap plan costs less per month than a higher-premium plan with a lower deductible. An agent can run the numbers both ways.
When an ACA plan, or a different ACA plan, is the better fit
- You don't have a health plan. A gap plan is not a substitute for one. Start with an ACA plan or job-based coverage.
- You qualify for cost-sharing reductions. If your income qualifies, a Silver ACA plan can come with a much lower deductible, which may help more than a gap plan.
- You have a health condition that's already being treated. Many gap plans don't pay for pre-existing conditions for a period after the policy starts. Ask first.
- You expect lots of small bills (office visits, prescriptions). Most gap plans pay for larger events, like hospital stays, not routine care.
- You have a Health Savings Account (HSA). Some gap plans can affect whether you can contribute to an HSA. Ask the agent, and check with a tax professional.
What it may pay for
Benefits vary by plan. Common covered events include:
- Admission to a hospital for a covered illness or injury
- Daily benefits while you're in the hospital
- Covered outpatient surgery
- Some plans: covered emergency room visits or diagnostic tests
The policy lists each covered event and the amount it pays.
What it doesn't pay for
- Your medical bills directly. It pays a fixed amount, which may be less than your actual costs.
- Events not listed in the policy. Routine care, prescriptions and many office visits usually aren't covered.
- Pre-existing conditions during the plan's waiting or exclusion period.
- Anything above the plan's limits per event or per year.
- Care during a waiting period right after the policy starts, if the plan has one.
How it compares to an ACA plan
A gap plan and an ACA plan do different jobs. An ACA plan pays your providers for a wide range of care and caps your yearly out-of-pocket costs. A gap plan pays you a set amount for specific events. It doesn't cover essential health benefits, doesn't have an out-of-pocket limit, isn't minimum essential coverage, and can't get premium tax credits. Think of it as a possible add-on to an ACA plan, not a choice between the two.
Costs and how it's priced
Gap plan premiums usually depend on your age, where you live, who's covered, and the benefit amounts you pick. Some plans ask health questions. Ask how premiums may change at renewal. An agent can show you prices and help you compare "health plan + gap plan" against other plan options.
How to enroll with a licensed agent
1. Tell us about your health plan: deductible, out-of-pocket maximum, and plan type. 2. Check whether a gap plan helps. If a lower-deductible or Silver plan with savings is a better deal, we'll say so. 3. Compare plans from the insurance companies we represent sold in your state: what each event pays, waiting periods, and exclusions. 4. Apply and answer any health questions truthfully. 5. Keep your policy and the list of covered events. File claims with the insurance company after a covered event.
Frequently asked questions
Is a gap plan health insurance?
It's a limited-benefit insurance policy, not comprehensive health insurance. It pays set amounts for specific events and is meant to go alongside a health plan.
Will a gap plan pay my whole deductible?
Not necessarily. It pays the fixed amount listed in the policy for each covered event. That may be more or less than what you owe.
Who gets the money?
Usually you do, unless you assign benefits to a provider.
Can I buy a gap plan without health insurance?
Some companies allow it, but we don't recommend it. A gap plan alone leaves you exposed to most medical costs.
Does it cover pre-existing conditions?
Often not at first. Many plans have a waiting or exclusion period. Ask before you buy.
Important information
This policy provides limited benefits. It has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. It is not comprehensive health insurance and may not cover pre-existing conditions during the policy’s pre-existing condition exclusion period. For costs and complete details of the coverage, call a licensed insurance agent at 1-877-861-3558.
Offered by First Health Solution, LLC d/b/a Health Enrollment, a licensed insurance agency (NPN 17718619). Insurance is underwritten by the insurance companies we represent. Not a government agency. Not available in all states.
Last reviewed October 2026. Not available in all states. This page is general information; see the policy for complete terms.