Short Term Health Insurance

Compare Gap Health Insurance with ACA or Obamacare Health Insurance

Compare Gap Health Insurance with ACA or Obamacare 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

From 2014 through 2018, it was neessary to be enrolled into an ACA compliant plan to avoid tax penalty. However for 2019 onwards, the penalty has been removed. Therefore, whether you enroll into ACA compliant plan or short term medical insurance, you will not have to pay the tax penalty.


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 without visiting a PCP (primary care provider) for referral first.

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 a Special Enrollment Period 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.

Learn More

Why purchase insurance from Insubuy®?

Same Price. Better Service.®

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

Learn More

Visiting USA?

Healthcare costs are very high in the U.S.

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

Learn More

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.

Learn More

New immigrant to USA?

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

Purchase new immigrant medical insurance to bridge the gap.

Learn More

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.

Learn More

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.

Learn More

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.

Learn More

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.

Learn More

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.

Learn More