What is catastrophic health insurance?

A catastrophic health insurance plan is an ACA plan that offers low monthly premiums with a high deductible. It’s designed to provide a low-cost alternative for people who don’t anticipate a lot of regular healthcare costs.

Catastrophic plans cover preventive services at no cost and at least three primary care visits each year that are not subject to the deductible. These benefits help you access basic care, but the high deductible means you're responsible for most other medical expenses until you reach the plan's limit.

What does catastrophic health insurance cover?

Catastrophic health plans cover up to three doctor visits each year, as well as routine vaccines and preventive care. They cover the same 10 essential health benefit categories required of other ACA Marketplace plans.

The 10 essential health benefit categories include:

  • Emergency services
  • Outpatient care and physicians
  • Hospitalizations
  • Pregnancy, maternity and newborn
  • Mental health and substance abuse disorder
  • Prescription drugs
  • Rehabilitation services
  • Lab work
  • Preventive, wellness and chronic disease management
  • Pediatric services, including dental and vision

What does catastrophic health insurance not cover?

A catastrophic plan won’t cover anything other than three office visits and preventative care until your deductible is met. Like other ACA plans, catastrophic plans also exclude certain services, such as cosmetic surgery that isn't medically necessary.

Who qualifies for a catastrophic health plan?

People under 30 qualify for catastrophic health plans without an exemption. If you're 30 or older, you need an approved hardship or affordability exemption to enroll. 

Possible reasons for hardship exemptions are:

  • Eviction
  • Homelessness
  • Facing eviction or foreclosure
  • Bankruptcy
  • Domestic violence
  • Damage to your home in a disaster
  • A sudden need for you to care for a disabled or aging family member

Go to your state’s health insurance exchange to see if you qualify for a hardship exemption. Catastrophic health plan quotes should appear when you search for plans if you’re eligible. If you don’t see the option, you can request a hardship exemption.

How much is catastrophic health insurance?

The average lowest-cost catastrophic health plan costs $346 per month for a 27-year-old in 2026, according to KFF, compared with $369 for the lowest-cost unsubsidized bronze plan in areas where catastrophic plans are available 

Catastrophic plans have a $10,600 individual deductible and a $21,200 family deductible in 2026. Only preventative care and three office visits each year are exempt from the deductible.

For comparison, here's the average monthly cost for other ACA tiers:

  • Lowest-cost bronze plan: $456
  • Lowest-cost silver plan: $611
  • Lowest-cost gold plan: $615

One benefit of a catastrophic health plan is that, unlike other ACA tiers, it doesn't have coinsurance. It will cover you at 100% after you meet the deductible.

How to get a catastrophic health plan

If you qualify, you can get a catastrophic health plan through your state’s ACA marketplace, also called the exchanges. You can start by going to healthcare.gov, which will help you find your state’s page.

If you are applying for a hardship exemption, you can complete an application and submit it to your state. 

Is catastrophic insurance worth it?

Catastrophic health insurance is worth considering if you want low monthly premiums, rarely need medical care, and have savings to cover high out-of-pocket costs. If you need regular prescriptions or ongoing treatment, a bronze or silver ACA plan could save you more on healthcare. 

Catastrophic health insurance provides preventive care and protection in emergencies. However, if you have prescriptions or have a condition that requires regular doctor visits, catastrophic health insurance is likely not a good fit for you.

There are other options to consider, some of which are low-cost:

  • Medicaid. Medicaid is a federal/state health insurance program for low-income Americans. 
  • Other ACA plans. Subsidies are available if you meet income requirements, which can make other ACA plan options more affordable.
  • Short-term health insurance. Short-term health plans have low premiums but are limited and are only a temporary solution.
  • COBRA. If you recently lost your job, you may be eligible for COBRA, which allows you to keep your former employer’s health insurance, but is very expensive.

Catastrophic plans are one way to get affordable health insurance, but you may not qualify. Even if you do, out-of-pocket costs are high when you need care, so make sure to weigh the pros and cons of catastrophic health insurance before you buy.

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