What is Catastrophic Health Insurance?

What does catastrophic health insurance mean?

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. It's a type of high deductible health plan (HDHP).

How does catastrophic health insurance work?

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. It's also available to individuals of all ages who are eligible due to financial hardship.

Who qualifies for catastrophic insurance?

The following people may be eligible:

• People under age 30
• People who 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.

What does catastrophic health insurance cover?

Catastrophic insurance coverage helps you pay for unexpected emergency medical costs that could otherwise add up to medical bills you couldn’t pay.

It also covers essential health benefits, including preventive services like:

• Health screenings
• Most vaccinations
• Annual check-ups
• Certain forms of birth control.

What isn’t covered by catastrophic health plans?

Your catastrophic health plan only covers emergency care after 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 to understand what is and is not covered by your particular plan. Contact your health insurance company for more details.

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, such as your 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 PCP.

How do you 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 personal 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 you apply for an exemption?

To apply, you must fill out an application and submit it to the Health Insurance Marketplace^® (also called the Exchange). You can find forms on HealthCare.gov. You’ll receive a notification in the mail from HealthCare.gov letting you know if you qualify for the exemption or not.

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.

Is catastrophic insurance right for me?

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.

If your priority is finding health 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.

However, if you anticipate costs associated with managing a chronic health condition, you may save more with another type of health plan.

Catastrophic Health Insurance FAQs (Frequently Asked Questions)

Catastrophic vs. Bronze Plans: What's the difference?

Catastrophic and bronze plans both offer health coverage, but they work differently.

Catastrophic plans typically have lower monthly premiums and the highest deductibles. Bronze plans usually cost more each month but cover more of your costs before you meet the deductible.

Can anyone enroll in a catastrophic health plan?

No. Catastrophic health insurance is available to people under age 30 or those who are eligible for a hardship or affordability exemption under Marketplace rules.

Is catastrophic health insurance a good choice if you need regular care?

Catastrophic plans may not be ideal if you expect to visit the doctor often or need ongoing treatment. This is because you have to pay most costs out of pocket until the deductible is met.