Filling Insurance Gaps Can Save You From Unexpected Medical Costs

Filling Insurance Gaps Can Save You From Unexpected Medical Costs

1000 682 Satta Sarmah Hightower

A lot of Americans have trouble paying off their medical debt — 79 million, to be exact.

People accumulate this debt for several reasons, but it often has something to do with insurance, or rather the lack of it. Being underinsured can leave you with gaps in your coverage that increase your out-of-pocket costs. But health insurance gap coverage in the form of a supplemental policy can help you fill these gaps so you don’t end up with an unexpected medical bill you can’t afford.

What Is a Coverage Gap?

Say you have a serious fall and need to go to the hospital. No worries there — you know your health plan includes coverage for hospital visits. One quick ambulance ride and you’re good to go. It’s only when you get home and see your bill that you realize your mistake: Your hospital visit may have been covered, but your ambulance ride wasn’t. Now you’re stuck with a bill you didn’t expect (and definitely didn’t budget for).

Of course, coverage gaps can vary from person to person. A plan that fails to cover maternity care might not matter to one person but could make all the difference to an expecting mother. Some gaps — like if you lose your job and are no longer covered under an employer-sponsored plan — are huge, while others — like the lack of a certain specialist in your network — are fairly small. But if your only choice to receive a specific procedure is with an out-of-network provider, then it doesn’t matter that your gap spans only one medical service. That coverage gap may have backed you into a fairly expensive corner.

How to Identify Coverage Gaps in Your Plan

If you’re not sure what your insurance covers, review your plan with your health needs in mind. You might never need to see a hematologist, but if you have a chronic heart condition and you’re considering visiting a cardiologist, that’s a great place to start checking your coverage. You probably have a stack of health plan brochures lying around somewhere — those are a gold mine of information. You can also easily find this information online in the benefits overview section of your insurance company’s online portal. When in doubt, call your insurance company. They can tell you exactly when you’re covered and when you aren’t.

Make sure to dig into the details of your plan. For example, your insurer may cover 100 percent of the costs for office visits and preventive services but only 85 percent of the bill for an outpatient surgery after you’ve met your deductible.

Some health insurance companies also offer online cost estimator tools, so you can calculate how much it might cost to see a certain provider. Getting all this information before you need care can help you better identify your coverage gaps and fill them.


How to Fill Gaps in Your Coverage

Once you know what gaps exist in your plan, you can be proactive about addressing them.

Supplemental insurance, like fixed indemnity, critical illness or accident insurance, can help fill health care coverage gaps. All of these policies offer cash payouts for specific situations and services. For example, critical illness pays you if you get sick and can’t work. That money can help absorb any medical expenses your primary health plan won’t cover or go toward making up for lost wages.

Getting a supplemental plan can help you avoid the financial hardships that come with having inadequate coverage. Before you sign up for a plan, it’s always a good idea to read the fine print and find out whether the policy offers coverage that actually aligns with your health care needs. If it doesn’t, consider getting a different plan — or have health insurance gap coverage like a backup supplemental plan to make sure you don’t get stuck with an unexpected bill.

Satta Sarmah Hightower

Satta Sarmah Hightower primarily focuses on health care, technology, and personal finances.

All stories by:Satta Sarmah Hightower

Satta Sarmah Hightower

Satta Sarmah Hightower primarily focuses on health care, technology, and personal finances.

All stories by:Satta Sarmah Hightower