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Compare Gap Health Insurance with ACA or Obamacare Health Insurance

Compare Gap Health Insurance

Although both gap health insurance and ACA health insurance plans (or Obamacare) are considered major medical insurance plans, there are significant differences between them. You should carefully analyze your situation to determine which plan is right for you.

Minimum Essential Coverage (MEC)

ACA health insurance plans are guaranteed issue; you can’t be denied coverage based on pre-existing conditions. ACA health insurance plans must provide the following 10 essential health benefits:

  • Outpatient care (doctor visits or other services that don’t require hospital admission)
  • Emergency room visits
  • Inpatient care (treatment in the hospital)
  • Maternity and newborn care (pre-natal and post-natal care)
  • Mental health and substance use disorder services including behavioral health treatment, counseling and psychotherapy
  • Prescription drugs
  • Physical and occupational therapy, speech-language pathology, psychiatric rehabilitation and more. These services and devices would help you recover if you are injured or have a disability or chronic condition.
  • Laboratory tests
  • Preventive and wellness care including counseling, screenings and vaccines to keep you healthy and care for managing a chronic disease.
  • Pediatric services including dental and vision care

Gap health insurance plans, on the other hand, have several limitations.

Tax Penalty

Keeping ACA health insurance year-round is necessary to avoid tax penalties. Being enrolled in a gap health insurance does not allow you to avoid ACA tax penalties.

However, there are numerous exemptions for ACA tax penalties:

  • You were not enrolled in ACA health insurance plan for less than three months in a calendar year. Short term health insurance is currently allowed for up to three months.
  • Your income is below the tax filing threshold, so you don’t file an income tax return.
  • The cost of enrolling in ACA coverage is more than 8% of your household income.
  • Your application for Medicare or Children’s Health Insurance Program (CHIP) coverage was denied.
  • You experience certain hardships such as homelessness, medical debt or bankruptcy.

There could be other reasons you would be exempt from the tax penalty. You should discuss your specific situation with an attorney or tax professional.

Availability

You can only enroll in ACA plans during an annual open enrollment or during Special Enrollment, if you qualify. With gap health insurance, you can enroll whenever you like, and coverage can start from the next day onward.

Federal Tax Subsidies

When purchasing ACA health insurance, depending on your income and household size, you may qualify for federal tax subsidies.

When purchasing gap health insurance, however, no one is eligible for federal tax subsidies to offset the premium. In most cases, the gap health insurance premium is significantly lower than ACA health insurance.

Choice of Healthcare Providers

In many states, ACA health insurance plans only provide HMO plans which don’t cover out-of-network doctors. HMO plans also prevent you from visiting a specialist before visiting a PCP (primary care provider) for referral.

On the other hand, most gap health insurance provides the flexibility to visit any doctor. Many gap health insurance plans are PPO plans that have a wide variety of healthcare providers across the country that you can visit without a referral from a PCP. Of course, if you visit providers within the PPO network, your out-of-pocket expenses will be even lower.

Prescription Drugs

While ACA insurance plans are required to cover prescription drugs, most gap health insurance plans don’t cover prescription drugs, and some cover only inpatient prescription drugs.

Pre-Existing Conditions

Depending on any pre-existing conditions, you may be declined from receiving gap health insurance coverage. If you are approved for gap health insurance, pre-existing conditions will not be covered.

ACA health insurance plans, on the other hand, are guaranteed issue. You can’t be turned down for pre-existing conditions, and they will be covered as long as you continue paying the premium. You can also make changes to your plan during open enrollment or Special Enrollment if you qualify.

Higher Needs

Those with certain chronic medical conditions, complex medical needs or poor health should enroll in an ACA plan; gap health insurance doesn’t cover these needs. Further, if you have had these pre-existing conditions within the past five years, you may be ineligible to enroll in gap health insurance.

Of course, everyone who is eligible for an ACA plan should enroll as soon as possible.

Did you know?

Prices are regulated by law.

You cannot find a lower price anywhere for the same product.

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Why purchase insurance from Insubuy®?

Same Price. Better Service.®

There are many advantages in purchasing from Insubuy® and no disadvantages.

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Visiting USA?

Healthcare costs are very high in the U.S.

Buy U.S. based visitors insurance and enjoy your trip.

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Traveling abroad?

Did you know that your insurance may not cover you abroad or that it may only provide limited coverage?

Purchase travel medical insurance that includes emergency medical evacuation.

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New immigrant to USA?

You would not be eligible to enroll in Medicare for the first 5 years.

Purchase new immigrant medical insurance to bridge the gap.

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Going on a vacation?

You could lose your non-refundable trip costs if you had to cancel your trip.

Buy a trip cancellation insurance package plan and be worry-free.

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Are you an exchange visitor to USA?

The U.S. Department of State requires all J visa holders to purchase compliant insurance.

Buy J visa medical insurance to meet your requirements.

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Traveling to Europe?

Schengen countries require most non-US citizens to purchase Schengen visa insurance.

Make an instant purchase online and get instant visa letter.

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Traveling frequently throughout the year?

You don’t need to purchase travel insurance for every trip.

Purchase annual multi trip travel insurance for your travels.

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International student in the U.S.?

Most schools require international students to purchase health insurance.

Purchase international student health insurance that meets most school requirements.

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To continue with the application please scroll down to confirm this notice

CALIFORNIA RESIDENTS SPECIAL NOTICE

1. THE INSURANCE POLICY THAT YOU ARE APPLYING TO PURCHASE IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS.

2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS.

3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED.

4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR “SURPLUS LINE” BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER 1-800-927-4357. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC’S INTERNET WEB SITE AT WWW.NAIC.ORG.

5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE’S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC’S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER, OR “SURPLUS LINE” BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: www.insurance.ca.gov.

8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER’S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU.

07/11
LSW1146D

Cuba Notice

Travel to Cuba remains subject to restrictions imposed by U.S. sanctions, administered by the US Treasury. Only those who qualify for travel authorized under US Treasury's regulations and who comply with the terms of such authorization can legally travel to Cuba. Individuals traveling to Cuba must meet the following criteria in order to qualify for travel authorized under one of the general licenses outlined below:

Criteria for travel authorized by the US Treasury

If you have read and agree to the terms of both Notices: California and Cuba, please click the continue button if you wish to complete the application process. Otherwise, please click cancel to abort the application process.

To continue with the application please scroll down to confirm this notice

CALIFORNIA RESIDENTS SPECIAL NOTICE

1. THE INSURANCE POLICY THAT YOU ARE APPLYING TO PURCHASE IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS.

2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS.

3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED.

4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR “SURPLUS LINE” BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER 1-800-927-4357. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC’S INTERNET WEB SITE AT WWW.NAIC.ORG.

5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE’S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC’S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT, BROKER, OR “SURPLUS LINE” BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER.

7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: www.insurance.ca.gov.

8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER’S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU.

07/11
LSW1146D

If you have read and agreed to the terms of this notice and wish to continue, please click the continue button. Otherwise, please click cancel to abort the application process.

Cuba Notice

Travel to Cuba remains subject to restrictions imposed by U.S. sanctions, administered by the US Treasury. Only those who qualify for travel authorized under US Treasury's regulations and who comply with the terms of such authorization can legally travel to Cuba. Individuals traveling to Cuba must meet the following criteria in order to qualify for travel authorized under one of the general licenses outlined below:

Criteria for travel authorized by the US Treasury

I certify that I have read the above and that all individuals applying for coverage qualify for travel authorized under one of the general licenses per US Treasury regulations.

Reset Application

Pressing “CONFIRM” will reset the whole application and erase all the data previously entered.

If you have already saved this application, you will still be able to retrieve the application with the information previously entered. Details for retrieval would have been given at the time of saving, which can be done any time after the initial quote.