Gap Plans

Gap plans are designed to lower the out-of-pocket maximum of an Affordable Care Act plan (you must have an Affordable Care Act plan to qualify), and the InPocket plan (a newly introduced gap plan that is available from the Morgan-White Group) is available to purchase for anyone up to age 64. The plan automatically renews each calendar year and can be kept until the first of the month a person turns age 65.

The InPocket plan works as a secondary plan to an Affordable Care Act plan. Providers are instructed to submit claims to both the primary Affordable Care Act carrier AND the InPocket plan.

The least expensive Affordable Care Act plans (Bronze and Silver) have very high out-of-pocket maximums, but purchasing Gold or Platinum plans (which have lower out-of-pocket maximums) can be cost-prohibitive. Purchasing an InPocket gap plan is an excellent way for those who don’t qualify for Silver Level Cost Sharing Reduction plans to lower their out-of-pocket maximums. Coverage for office visit copays (or professional fees in a doctors’ office or medical clinic), outpatient prescription drugs, and charges for services not covered in the Affordable Care Act plan are not included in the InPocket plan.

The InPocket plan is a separate plan from an Affordable Care Act plan and has its own deductible and out-of-pocket maximum. There is an individual deductible (there’s a choice of a $1,000, $1,500 or $2,000 deductible) and a family deductible which is 2 times the individual deductible. There is also a choice of two different out-of-pocket maximums ($4,000 and $6,000) to choose from, and plans can be bought for subscriber only, subscriber and spouse, subscriber and child(ren), or the entire family. These plans are guaranteed issue (i.e., there are no pre-existing condition limitations), which is how Affordable Care Act plans also work. Once the Affordable Care Act plan (the primary plan) pays, the InPocket plan then pays. You must meet the InPocket plan deductible, and then the plan pays 100% of all expenses covered by your Affordable Care Act plan—excluding professional fees in the doctor’s office or medical clinic and outpatient medications-- up to the out-of-pocket maximum for the InPocket plan.

Even if your ACA plan has a deductible, the InPocket plan will pay for covered medical expenses not paid for by the ACA plan once you meet the deductible for the InPocket plan. [Professional fees in the doctor's office or medical clinic (including copays) and outpatient medications are excluded from coverage under the InPocket plan.]

As an example, if you have an Affordable Care Act plan with a $9,450 individual out-of-pocket maximum (the maximum individual deductible permitted by the Affordable Care Act for 2024) and you choose an Inpocket plan with a $1,000 deductible and $6,000 out-of-pocket maximum, in effect you’re reducing your out-of- pocket maximum to $4,450 (i.e., $9,450 less $6,000 plus the $1,000 deductible), even if your ACA plan includes a deductible. Remember that professional fees in the doctor’s office or medical clinic and outpatient medications are excluded from InPocket plans.

The effect of the InPocket plan is to lower your total out-of-pocket (OOP) maximum for covered medical expenses from the out-of-pocket maximum of your Affordable Care Act plan.

The plan is available in Florida (which previously did not permit offering Gap plan coverage), about 20 other states, and will be made available in additional states as plans are approved by state insurance commissions. Contact us at 786-970-0740 to determine if an InPocket plan is or will soon be available in your state.

See this brochure that explains more about how this plan works: https://inpocketplan.com/how-it-works. When you open the link we suggest you access the link that contains the two-minute video explanation.

How To Enroll

You can enroll in an InPocket plan by going to https://insuranceforeveryone.com/, entering your zip code and date of birth, and clicking the Medical icon underneath “View Quote.” Also, enter whether you want your spouse and/or children covered, requested effective date (you can buy a plan up to midnight Central time on the 20th of a month for the first of the following month, and you can also buy with an effective date for any of the three succeeding months).

There is a one-time $35 enrollment fee. If you also want to purchase one of the other plans listed on the site (Dental, Vision, Identity, and/or Telemed) you can do so on this site and avoid separate enrollment fees for the other plans. If you want help in enrolling or have any questions, please call us at 786-970-0740.