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Catastrophic health insurance plans are low-cost health plans aimed at people under 30 and those who qualify for a hardship or affordability exemption.

While catastrophic health plan premiums are low, these plans have very high deductibles.

Catastrophic plans offer the same coverage as all Affordable Care Act plans, including no-cost preventative care, but most other care is subject to the deductible. Read on to find out how a catastrophic health plan works and who qualifies.

KEY TAKEAWAYS
  • The maximum age to qualify for a catastrophic plan is 30 unless you qualify for a hardship or affordability exemption.
  • Premiums for catastrophic plans are low, but there is a high deductible.
  • Like all ACA plans, catastrophic health insurance provides preventative care at no cost, and three office visits a year are also exempt from the deductible.
  • Catastrophic plans are best for people who don’t need a lot of regular medical care.

What is catastrophic 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.

What does catastrophic insurance cover?

These plans cover up to three doctor visits each year, as well as routine vaccines and preventative care. Catastrophic health insurance also covers the 10 essential services required by the ACA:

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

All other medical care is covered once you meet the deductible.

What does catastrophic health insurance not cover?

A catastrophic plan won’t cover anything other than the requirements listed above until your deductible is met. 

In addition, exclusions on catastrophic plans are similar to any other health insurance plan. Plans may vary by provider, but most don’t cover elective procedures, such as cosmetic surgery. Experimental treatments are also commonly excluded.

Who qualifies for a catastrophic plan?

Unlike other health plans, the ACA limits catastrophic health insurance to only two groups of people:

  • People under 30
  • People over 30 who qualify for hardship and affordability exemptions

Possible reasons for hardship exemptions are:

  • Eviction
  • Homelessness
  • Facing eviction or foreclosure
  • Bankruptcy
  • Domestic violence
  • Damages 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.

Catastrophic health insurance costs

A 2022 eHealth analysis found that the average cost of catastrophic insurance is $173 a month.

However, catastrophic plans have a much higher deductible, $8,700 in 2022 according to the Kaiser Family Foundation. Only preventative care and three office visits each year are exempt from the deductible.

Compared to the monthly rates for the other ACA plans, a catastrophic plan is very affordable:

  • Lowest-cost bronze plan: $329
  • Lowest-cost silver plan: $428
  • Lowest-cost gold plan: $462

One benefit of a catastrophic health plan is that, unlike other health plans, catastrophic health insurance 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 based on hardship, you can fill out an application requesting a hardship exemption and submit it to your state. 

Is catastrophic health insurance worth it?

Catastrophic health insurance isn’t for everyone. Even if you are eligible, this type of plan might not be a good fit for you.

Catastrophic health insurance offers preventive care and protects you in case of 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.

Sources:

  1. Catastrophic Health Insurance: Definitions and costs
  2. What is a Catastrophic Health Plan?
  3. Average Marketplace Premiums by Metal Tier, 2018-2022

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