How It Works
The InPocket Plan is secondary insurance (sometimes called a gap plan) that works alongside your ACA medical plan to bring down your overall costs. The amount you ultimately pay for medical insurance is made up of several parts. Most people just think about the monthly premium, but you’re also responsible for paying the deductible, co-insurance, and co-pays.
The most important number is actually the maximum out of pocket.
This is the amount that you’ll be responsible for if you have larger medical claims (things like maternity, injuries, heart attack, etc.). And, after all, isn’t that the main reason to have “major medical” insurance?
With ACA plans, the maximum out of pocket is usually quite high (over $9,000 for Bronze Plans). That means that even with major medical insurance, you might be responsible for paying almost $10,000 in hospital bills – and most people can’t afford a bill like that!
The InPocket Plan helps you keep more of that money in your pocket by bringing down that “maximum out of pocket” number.
So for a relatively small amount per month, you could save thousands of dollars per year!
And unlike most gap plans on the market (which tend to have a very narrow focus), the InPocket Plan covers almost everything that your ACA plan covers. So it can save you money on almost every medical claim!
This 2-minute video helps illustrate the concept:
What is covered?
Everything applied to the major medical deductible, coinsurance, or occurrence copays (emergency room, hospital admission, surgery).
| Standard Covered Services | |
|---|---|
| Inpatient – Physicians & Facilities | Labs, X-rays, Testing, Pathology |
| Maternity Services | Major Diagnostic & Imaging |
| Emergency Room Services | Physical Therapy |
| Outpatient – Physicians & Facilities | Chiropractic Services |
| Outpatient Surgeries | Ambulance Services |
| Home Healthcare | Durable Medical Equipment |
| Mental & Behavioral Health Services | IV Therapies & Infusions |
| Substance Abuse Treatment | Chemo & Radiation Therapy |
| Dependent Pregnancy | In-Office Physician Procedures |
| HSA Compatibility | No Exclusion for Pre-Existing Conditions |
What is not covered?
Professional Fee in the Doctor’s Office.
In basic terms, our plan will cover X-Rays, Labs, etc. covered by the primary major medical plan but this plan does not cover the professional fee in the doctor’s office. It does cover professional fees in the hospital and surgery centers.
Prescription Drugs.
Rx is not covered by this plan. We often recommend GoodRx, which greatly helps to cover prescriptions that do not have a copay tied to the Major Medical Plan.
| Non-Covered Services |
|---|
| Professional Fee in Doctor’s Office |
| Services Excluded from Major Medical |
| Rx Drugs |
How does InPocket compare to other supplemental (Gap) products?
| Sickness | Accident | Hospital Indemnity | Critical Illness | Cancer | InPocket |
|---|---|---|---|---|---|
| Hospital Stay (Sickness) | Certain Amounts (typically $250 to $1000) |
||||
| Knee Replacement | Only Inpatient (Portion) | ||||
| Cataract Surgery | |||||
| Hip Replacement | Only Inpatient | ||||
| Pregnancy | |||||
| Physical Therapy | |||||
| Cancer Treatments |
How does the Claims Process work?
In most situations the claims will be paid directly to your provider. Click here to learn about the claims process.