Health Insurance Coverage Gaps Prevent Patients From Qualifying

How can you expect to get the health care you need if you don’t have health insurance coverage? Even when individuals manage to find insurance plans that cover their medical needs, there are still gaps in coverage that can prevent them from getting the care they need. If you’re struggling with these gaps in your own health care coverage, these four tips will help you qualify for health insurance coverage so you can finally get the treatment you deserve and need.

What Are The Benefits Of Having Health Insurance?

Many of us rely on our employer for health insurance, but there are also plenty of other options. When it comes to picking a health insurance plan, however, you’ll want to be sure that your coverage includes as many benefits as possible. You can’t get every benefit under every plan — after all, they aren’t all created equal. So here are some common benefits you should look for in a healthcare plan

Does Healthcare Cost Too Much?

The fact is, patients, don’t realize how their health insurance coverage gaps prevent them from qualifying for low-cost healthcare at Federally Qualified Health Centers (FQHCs). When people get sick, they visit an emergency room and receive care that can cost $700 or more. However, a trip to an FQHC could have cost as little as $45. Why are so many people missing out on cheaper healthcare? One reason is that in order to qualify for low-cost healthcare at an FQHC, you need to make under 200% of the Federal Poverty Limit ($22,040/year) which automatically disqualifies a large portion of Americans who earn above it but still struggle to pay bills each month.

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The Government Steps In

The government is stepping in to prevent what amounts to a health insurance coverage gap. Under previous laws, if an employer offers affordable health insurance, employees who choose not to enroll aren’t eligible for federal subsidies under Obamacare. That means that while many companies will be required to offer affordable health insurance by 2016 or pay a fine, their employees may not have access to subsidies (and thus wouldn’t qualify for help purchasing it). It turns out that might not be legal. On Wednesday night, President Obama wrote a memo directing federal agencies—including IRS—to make sure individuals can get subsidies even if they opt-out of their employers’ plans.

The Key Points To Consider When Looking For A Health Plan

When trying to figure out if a health plan is right for you, you should consider not only what it will cost but also how it will help you address your healthcare needs. If you’re considering an HMO, PPO, or some other type of insurance plan, make sure that it will offer coverage in your area and that its network of doctors, hospitals, and specialists is one that meets your needs. For example, if you know that a particular hospital or specialist is critical to your care, look for a health plan that covers those providers and facilities. Or, perhaps your work offers a good reimbursement rate through their policy; in those cases look at plans based on how they would fit with your employer’s overall offerings.

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What Is Covered By Different Types Of Health Plans?

The most common types of health insurance plans you’ll encounter are HMOs, PPOs, and POS plans. Each type comes with its own set of coverage gaps that can leave you uncovered when it’s time to pay for your healthcare. Before you sign up for a plan, make sure you’re clear on what is covered and what isn’t. Read up on how each type works before making a decision about which one is right for you.

Will Someone Else Have To Pay For My Care?

A common mistake that patients make is believing that someone else will pay for their care. If you don’t have health insurance coverage and can’t pay for your own care, chances are someone else won’t be able to either. For example, in some cases, a third party may be liable for medical bills; however, there are usually very specific requirements associated with being able to collect from them. This makes it unlikely that anyone other than yourself could actually foot your bill. If you don’t have health insurance coverage through an employer or another source, you need to budget accordingly—and think twice before making unnecessary healthcare-related purchases.

What If I Change Jobs?

If you leave a job with health benefits, COBRA allows you to remain on your former employer’s health plan for up to 18 months. But you may be responsible for some of the costs, which can be very expensive. If you become eligible for Medicare before exhausting your coverage through COBRA, it is considered creditable coverage and may allow you to enroll in an exchange plan without a waiting period or any premium penalty. The same is true if you have been covered by TRICARE or VA health care.

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Is There Anything Else I Should Know About Medical Expenses?

The cost of medical care has ballooned over recent years, and we can’t always predict what a trip to see a doctor or hospital will end up costing. In many cases, your health insurance plan may cover some costs but leave others out in order to lower monthly premiums. Medical bills are easy to overlook when they’re lumped into one section of your credit report (known as an itemized listing) under a line item that reads other expenses, but it pays to read through them carefully. After all, unexpected gaps in coverage could mean you don’t qualify for new credit if you try to take out a loan soon after an expensive treatment or procedure.


According to USA.gov, many types of health insurance coverage gaps exist, from income-based to geographic. Some of these gaps prevent patients from qualifying for comprehensive plans that might otherwise offer coverage for their treatments or health conditions. If you’re looking for ways to close healthcare coverage gaps and prevent your or a loved one’s medical history from keeping you off affordable insurance, it might be time to consider other affordable health care options like short-term health insurance plans. Short-term health plans can help you qualify for temporary healthcare coverage regardless of your medical history and are a great solution if you need some extra protection between open enrollment periods.



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