Gap Health Insurance: The Secret Sidekick to Your High-Deductible Plan
By Daniel Petkevich
Jul 14, 2025
An overview of the important things to know about Gap health insurance.
Why You Might Need a “Sidekick”
Speak with a Medicare Advocate
High-deductible health plans (HDHPs) keep monthly premiums low—then wallop you with a deductible that can reach $1,650 for individuals or $3,300 for families in 2025, with out-of-pocket maximums as high as $8,300 and $16,600.
Gap health insurance steps in like a financial airbag, paying some or all of those surprise bills (deductibles, copays, coinsurance) before you’ve hit the HDHP limit. Think of it as the bridge over the budget-busting gap between “I need care” and “my big plan finally kicks in.”
How Gap Coverage Works
You get a bill—urgent-care visit, lab test, hospital stay.
Your primary HDHP applies the charge toward your deductible.
Your gap policy reimburses part—or sometimes all—of that bill up to the limits you chose.
Every policy is different, so read the fine print: some pay a fixed dollar amount per type of service, others reimburse a percentage of your actual bill.
Who Finds It Useful
Families with kids who treat waiting rooms like second homes.
Anyone planning a big surgery this year.
People stuck with a skim-py HSA balance (or none at all).
Employees offered an HDHP + gap combo by their employer.
Typical Cost
Nationwide quotes hover around $50 per month—cheap enough that, paired with an HDHP, many people still come out ahead versus a richer PPO.
Gap Insurance vs. Medigap (Don’t Mix These Up!)
Gap insurance is for any age group and pairs with employer or ACA plans to tame deductibles.
Medigap is strictly for people on Medicare and fills Parts A & B cost-sharing. Totally different markets, totally different rules.
If you’re shopping for Medicare coverage, head over to our Medigap guides instead.
When a Gap Plan Doesn’t Make Sense
You have a well-funded HSA that already covers your deductible.
Your employer offers a low-deductible plan at a reasonable premium.
You rarely see a doctor and could self-pay the occasional visit.
You need robust mental-health benefits—most gap policies exclude them.
Pro tip: Run the numbers. Add your HDHP premium + gap premium. If the total is lower than what you’d pay for a traditional PPO—and you like the extra peace of mind—you’ve got a winner.
How to Shop Smart
Check payout style. Fixed-benefit or actual-expense reimbursement?
Look for yearly benefit caps. Make sure they match your risk tolerance.
Confirm network rules. Some gap policies mirror your main plan’s network; others don’t care.
Ask about waiting periods for pre-existing conditions.
Compare quotes just like you would for regular health insurance—prices vary widely.
Need a Hand?
While Fair Square specializes in Medicare, we’re happy to point you toward vetted brokers who handle gap policies every day. Call 888-376-2028 and we’ll connect you.
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