The web browser you are using will no longer be supported by Cigna.com. To continue accessing the site without interruption, please upgrade your browser to the most recent version.
What is Catastrophic Health Insurance

Article | July 2018

What is Catastrophic Health Insurance?

Catastrophic health insurance is a type of health plan that offers coverage in times of emergencies as well as coverage for preventive care. Catastrophic health plans typically come with low monthly premiums and a high deductible. You pay for any emergency medical care you receive until you meet your deductible and most preventive care is covered at 100%. Catastrophic health coverage is available to people under 30, who are looking for minimal coverage and low monthly premiums, and, to those of any age who are eligible due to financial hardship.

What do catastrophic health plans cover?

Catastrophic insurance coverage helps you pay for unexpected emergency medical costs that could otherwise amount to medical bills you couldn’t pay. It also covers essential health benefits, including preventive services like health screenings, most vaccinations, your annual check-up, and certain forms of birth control.

What don’t catastrophic health plans cover?

Your catastrophic health plan doesn’t cover emergency care until you’ve met your deductible. And there may be certain limits on preventive care and number of covered visits to a primary care provider (PCP), depending on the plan.

It’s important that you understand what is and is not covered by your particular plan.

What kind of medical care is covered by catastrophic health insurance?

Once you meet your plan deductible, catastrophic coverage would pay for accidents, unexpected injuries, sudden emergency illnesses, etc. These plans also provide 100% coverage for certain preventive care services—annual check-up, flu shot, certain types of routine screenings, and more.

Most catastrophic plans also cover you for at least three visits to a primary care doctor.

Do I qualify for catastrophic insurance?

You must either be under 30, or qualify for a hardship exemption. Usually, an exemption means that you can’t afford health care insurance because you’ve recently been homeless, declared bankruptcy, or meet other qualifying criteria.

How do I qualify for an exemption so that I can get catastrophic health coverage?

There are two main types of exemptions that would help you qualify for catastrophic insurance: personal hardship and affordability exemptions. You could qualify for either exemption depending on the details of your specific situation.

Some common hardship qualifications include:

  • Homelessness
  • Bankruptcy
  • Domestic violence
  • Death of a close relative
  • Utility services being shut off
  • Eviction
  • Home foreclosure
  • A fire or a natural- or human-caused disaster that results in substantial property damage

There are also affordability exemptions. This means that your income is not enough to be able to afford regular health care coverage. If you qualify for an exemption, you would claim it on your annual tax return and get money back.

How do I apply for an exemption?

To apply, you must fill out an application and submit it to the Exchange. You can find forms on the Healthcare.gov site. You’ll receive a notification in the mail from the Exchange letting you know if you qualify for the exemption or not.

If your priority is finding insurance with a low monthly fee, catastrophic insurance may be right for you. To qualify for catastrophic insurance, you must be under 30, or, qualify for a hardship exemption. The application is approved or denied based on the details of your specific circumstances.

If I qualify for an exemption, can I get catastrophic health insurance?

If you are approved for either a hardship or affordability exemption, it means you may then get a catastrophic health insurance plan, if you choose.

Catastrophic health plans can help protect you from high emergency medical costs, while also covering some essential health benefits like an annual check-up, certain preventive services, and at least three primary care visits before you have met your deductible. However, if you anticipate costs associated with managing a chronic health condition, you may save more with another type of health plan.

The information on this page is not legal or tax advice. The content is for general information and educational purposes only, and you are urged to consult a tax professional concerning your own situation. Cigna assumes no responsibility for any circumstances arising out of the use, misuse, interpretation, or application of any information supplied here.