Catastrophic Health Insurance

What is catastrophic health insurance and how does it work? Read on to find out.

Catastrophic health insurance plans have low month-to-month expenses and extremely high deductibles. Thus catastrophic health insurance plans can often prove to be quite an affordable way to shield yourself from a lot of harmful situations, such as becoming truly ill or sustaining injuries. In any case, you pay most routine clinical costs yourself. On the off chance that you can’t stand to purchase health insurance through your employer or from the Health Insurance Exchange, you might have the option to purchase a fundamental health plan covering primary health benefits for unforeseen ailments or mishaps. It’s imperative to see how these plans work and what they may cost before you get them.

What is catastrophic health insurance?

Catastrophic health insurance is an economical inclusion alternative intended to provide the coverage you need and to shield you from significant clinical costs. In return for a low premium, you’ll have a high deductible and pay the greater part of your clinical expenses from your own pocket until you reach it. It is a kind of clinical service open to individuals under 30 years of age and adults of all ages who have a federally-backed general hardship exclusion. As compared to most metal-level marketplace plans, catastrophic health insurance has lower premiums. However, it has the greatest deductible and out-of-pocket maximum. In addition to this, it bodes well for certain individuals who have little to spend on month-to-month charges yet who would prefer not to abandon health insurance.

These plans are intended to shield you from outrageous cash-based expenses for catastrophic health occasions. They still have to meet the base fundamental benefits under the Affordable Care Act (ACA). However, you will by and large experience high cash-based expenses before you reach your (extremely high) deductible. In comparison to some standard health insurance plans, catastrophic plans pay fewer health costs (copays, solutions, and so on) before you reach your deductible. Obviously, even one significant mishap could result in you reaching your deductible rapidly. Although you will be protected afterward, you’d have to spend a ton of cash before you get to that point. On the positive side, your low expenses will balance a portion of these expenses.

Catastrophic health insurance is the least expensive metal-level insurance plan. However, it still incorporates similar fundamental health advantages as other health plans under the Affordable Care Act (ACA). Moreover, they are only accessible for individuals below 30 years of age or those who qualify under a difficulty exclusion or in light of the fact that they can’t bear the cost of employer or marketplace insurance alternatives.

Furthermore, catastrophic plans likewise give inclusion to three primary care visits each year and free preventive administrations. Primary care visits incorporate clinical tests, checkups and everyday consideration while preventive care incorporates screenings and vaccinations. These two advantages are incorporated with each catastrophic arrangement regardless of whether the deductible for the arrangement has not been met. Notwithstanding, when the three primary care visits have been utilized, at that point it is your duty to pay for extra consideration visits until the deductible has been met.

Medicare and short-term catastrophic coverage

Medicare catastrophic coverage is a type of extra coverage that falls under a Medicare drug policy. Catastrophic inclusion guarantees that you pay a little coinsurance sum for medications that are covered once you surpass more than $5,000 using cash on hand. Short-term catastrophic health insurance isn’t an item that is offered under the ACA or in insurance marketplaces. All things considered, short-term health insurance is a different item that can be utilized to give transitory inclusion on the off chance that you are overcoming an issue between health insurance plans for emergency situations.

For instance, to fill a gap in inclusion when changing from a previous arrangement to Medicare inclusion once you hit the age of 65. This is not the same as catastrophic plans, which are a more extended and more perpetual method for health insurance. Catastrophic plans likewise give extra advantages like full inclusion of maternity and infant care, which is excluded from short-term health insurance.

Understanding catastrophic health insurance

When he proposed a bipartisan bill for catastrophic health insurance inclusion in October 1973, was when Senator Abraham Ribicoff also first presented catastrophic health insurance. The inclusion was intended to be for laborers who were financed by payroll taxes and for Medicare recipients. Presently, catastrophic health insurance accessibility fluctuates from one state to another. Certain states have no plans, some have few plans and some have multiple choices to browse from. In addition to this, catastrophic plans can be PPO or HMOs, and charges differ on the basis of the insurance organization and area. In the event that you purchase this type of plan, you will not have the option to benefit from any health insurance premium tax credits you may be qualified for dependent on your salary. This implies that a few buyers can improve inclusion at a lower cost by picking a bronze arrangement and utilizing the subsidies.

If you meet all requirements for catastrophic health insurance because of an overall hardship exemption does not mean that you need to purchase a catastrophic approach. On the off chance that you have the exemption, you’re not needed to purchase health insurance at all. However, if you prefer, you can likewise purchase an alternate kind of strategy, for example, a bronze arrangement.

Furthermore, having catastrophic inclusion, or some other health insurance can help you save some cash. This is because you’ll get your insurance organization’s arranged rate for services, which is commonly limited. Due to ACA rules, catastrophic plans additionally give you 100% inclusion for in-network preventive consideration administrations prior to meeting your deductible and admittance to the ten fundamental health benefits, subject to your deductible. The charges can appear as though a misuse of cash in the event that you don’t have to utilize your insurance much, yet you would prefer not to go uninsured and risk genuine monetary and clinical issues.

Major medical catastrophic health plans

According to the law, a major medical catastrophic health plan should meet the entirety of the ACA’s inclusion necessities, yet it will just cover three primary care visits each year prior to when the arrangement’s deductible is met. In return for higher cash based expenses, the regularly scheduled installment for catastrophic health plans is normally lower than what an individual will pay for a major medical arrangement with a metal-tier rating, similar to a Bronze, Silver, Gold, or Platinum health plan. Catastrophic plans contrast from other significant clinical plans in a couple of ways:

  • No tax penalties: Due to the fact that major medical catastrophic health plans follow ACA guidelines, registering for a catastrophic health plan will shield you from uninsured tax penalties, if you consistently keep up your inclusion throughout the year.
  • Under 30: All candidates on the arrangement should be younger than 30 years old. Hardship exemptions might be accessible for those who are older than 30 if non-catastrophic major medical plans within your locale are highly expensive.
  • Primary care visits: In any event, these plans should likewise cover three primary care visits each year before you meet your deductible.
  • No subsidies: Although catastrophic major medical plans do meet the entirety of the ACA principles for inclusion, they can’t be bought utilizing an Obamacare premium tax credit.

What other types of catastrophic coverage are available?

People with, or without major medical health insurance might need to consider different types of health insurance that give assurance from high cash based expenses for serious diseases and wounds. Although catastrophic health insurance plans fluctuate a lot, they by and large incorporate the accompanying:

  • Critical illness insurance: This arrangement pays you a single amount in the event that you are diagnosed with coronary failure, stroke, cancer, and/or certain other serious ailments.
  • Accident insurance: This arrangement gives you a cash payout if there should be an occurrence of covered accidents (separate from your car crash inclusion).
  • Fixed-benefit indemnity clinical insurance: This arrangement gives cash payouts in the event that you experience the ill effects of certain diseases or wounds covered by your approach.

Know that these different types of catastrophic inclusion don’t meet the base fundamental inclusion needed by the Affordable Care Act. Therefore, in the event that you have a catastrophic arrangement, you may in any case be dependent upon the tax punishment in the event that you simultaneously don’t have a significant clinical insurance plan.

What does catastrophic health insurance cover?

Like all insurance plans offered under the ACA, catastrophic plans should cover certain preventive administrations at no expense for you, whether or not you have met your deductible. These for the most part incorporate essential benefits and protection administrations like shots, vaccinations, and screenings, yet a full list of things that are covered are still accessible at They additionally cover fundamental health benefits like crisis administrations, care for substance misuse, pregnancy, and maternity or infant care.

Notwithstanding, the plans from various insurance transporters may somewhat vary. It’s essential to check the subtleties for any arrangement before you get it. Major medical plans should likewise cover three visits to your primary care physician before you meet your deductible. Other than these benefits, you’ll pay your clinical costs from your own pocket until you meet your deductible. After that point, catastrophic insurance should cover similar fundamental health benefits as other health marketplace plans, including:

  • Hospitalization
  • Mental health/substance abuse
  • Ambulatory patient services
  • Emergency services
  • Pregnancy and maternity/newborn care
  • Prescription drugs
  • Extra benefits, like birth control or breastfeeding coverage
  • Laboratory services
  • Rehabilitative services
  • Preventive/wellness services
  • Pediatric services
  • Dental or vision coverage (based on your state’s requirements for minimum coverage)

Moreover, you will not have any coinsurance or copay on these services once you have reached your deductible.

What doesn’t a catastrophic health plan cover?

The high deductible for a catastrophic plan is the reason why you have to pay for almost everything from your own pocket except for the basic preventive care until you reach your deductible. So in case you receive emergency care that is lower than your deductible, you will have to pay all of it from your own pocket.

How much does catastrophic coverage cost?

Catastrophic insurance plans vary from other metal level plans because of their low month to month charges and higher deductible levels. A deductible is the measure of cash you pay from your own pocket for clinical costs before the insurance plan pays anything. Month to month expenses are normally low. However, you can’t utilize a superior tax credit to decrease your expense. On the off chance that you fit the bill for an exceptional tax credit dependent on your salary, a Bronze or Silver arrangement is probably going to be of superior worth.

  • For 2019, the deductible for all Catastrophic plans is $7,900.
  • For 2020, the deductible for all Catastrophic plans is $8,150.

After you spend that much, your insurance organization pays for every covered assistance, with no copayment or coinsurance. For instance, in North Carolina, the least expensive health insurance plan is the Blue Value Catastrophic arrangement. This health insurance plan has a yearly deductible of $7,900 and a cash-based limit of $7,900 also. The expense of this catastrophic health insurance plan for a 40-year-old male would at least be $231.32 per month.

Who is eligible for catastrophic health insurance?

The premium sum you pay every month for health care is by and large lower than for other QHPs. However, the cash based expenses for deductibles, copayments, and coinsurance are for the most part higher. To be qualified for catastrophic health insurance, you should be either younger than 30 years old or meet all requirements for a hardship exemption in light of the fact that the Marketplace established that you can’t bear the cost of health inclusion. A hardship exemption is characterized as a monetary circumstance that keeps you from purchasing higher-inclusion health insurance. A few reasons you might have the option to purchase catastrophic insurance by fitting the bill for the exemption include:

  • Being homeless
  • Utility company issued a shutoff notice
  • You were evicted
  • Domestic abuse
  • Death of a family member
  • Experienced a natural disaster that caused damage to your property
  • Filed for bankruptcy

In the event that you and any remaining people covered by your health plan are under 30, you might be qualified to buy a catastrophic health plan. In the event that you are more than 30 years old and keen on catastrophic health inclusion, you should fit the bill for a hardship exemption. A few instances of hardship exemptions are in the event that you were homeless over the last three years or on the off chance that you were found ineligible for Medicaid on the grounds that your state didn’t develop its Medicaid program.

It is likewise conceivable to get a hardship exemption on the off chance that you had a health insurance strategy that was dropped between enlistment periods. For instance, your bronze metal level approach was as of late dropped on the grounds that you couldn’t pay out the month-to-month expenses. For this situation, you would have the option to apply for the hardship exemption during an uncommon enlistment period and then later buy catastrophic health insurance through off-marketplace foundations.

On the off chance that you think you may fit the bill for an exemption due to monetary hardship, you’ll need to apply for a hardship exemption through the Marketplace. On the off chance that you get a notification expressing that you meet all requirements for a hardship exemption, you have the alternative to buy a catastrophic insurance plan, and an eHealth authorized insurance specialist would be eager to assist you in finding an arrangement that may work for you, or on the other hand you can decide to join up with a major medical arrangement.

In addition to this, you must remember that on the off chance that you meet all requirements for lower healthcare costs due to salary (otherwise called a subsidy), you can’t apply these investment funds towards a catastrophic health plan. This incorporates premium tax credits and cost-sharing subsidies. So you’ll pay the standard premium sum for your catastrophic insurance plan, paying little mind to your salary level.

How to buy catastrophic health insurance?

Before you can buy catastrophic health insurance, you should apply through your state’s health insurance exchange. Enlistment for the hardship exemption incorporates an online application measure where you portray your present hardship. Once your hardship is approved, you will get an exemption certificate number and can join up with the catastrophic health insurance plan based on your personal preference. In the event that you are more than 30 years old and have not petitioned for this exemption, at that point you won’t have any significant bearing for a catastrophic arrangement on your state’s insurance commercial center. Consequently, it is critical to petition for this exemption on the off chance that you need to buy a catastrophic health insurance strategy.

Do I need catastrophic health insurance?

A catastrophic health insurance plan is ideal for people who can’t bear the cost of a conventional health insurance plan yet are searching for health inclusion for critical clinical circumstances. On the off chance that you don’t consistently go to the doctor, need a cheaper health insurance plan, or are not worried about paying for minor health costs from your own pocket, at that point a catastrophic health insurance plan might be ideal for you. However, there are a couple of contemplations to make prior to buying catastrophic health insurance.

Your deductible and cash based costs will probably be higher if you had a conventional health insurance plan. Regardless of whether you pick a catastrophic arrangement or something else, ensure you’re safeguarded and that you could bear the cost of it on the off chance that you needed to settle up to your most extreme cash based sum. Like other health insurance plans, you can just buy catastrophic insurance during an open enlistment period, or after a qualifying occasion. In the event that you’d like to gather more data about catastrophic health insurance plans, contact

Alternatives to catastrophic health insurance

Catastrophic plans are less expensive than numerous different plans, yet they may not give the inclusion that you need. A few people with a hardship may likewise track down that catastrophic inclusion is still excessively costly. However, there are two or three alternative choices to consider. In the event that you buy a more customary health insurance plan, yet you can’t bear the expenses, one alternative is a premium subsidy. A premium subsidy lessens your month to month premium installments. Formally, it is a tax credit — the advance premium tax credit (APTC) — and you get cash back when you guarantee it on your government tax return.

You may meet all requirements for an endowment if your family pay is 100% to 400% over the federal poverty level. Premium subsidies can’t be utilized on catastrophic plans, however they can assist you with managing the cost of an arrangement with better health inclusion that would be excessively costly for you in one way or the other. You may likewise meet all requirements for Medicaid, which gives healthcare inclusion at low or no expense. Numerous states have expanded Medicaid, because of an arrangement of the Affordable Care Act that expanded Medicaid qualification for people and families who make less 138% of the federal poverty level.

Moreover, you could be able to get a total exemption since health inclusion is excessively expensive. On the off chance that the most reduced expense – Bronze-level arrangement – in the Obamacare commercial center costs over 8.16% of your yearly family pay, you can fit the bill for a health inclusion exemption. The equivalent is valid if the most minimal expense plan from your boss costs over 8.16% of your family pay. The exemption implies that you will not need to suffer any consequence for being uninsured for the months that the inclusion was exorbitant.

Catastrophic insurance benefits

Catastrophic health plans cover similar minimum health benefits as other health plans under the Affordable Care Act, including preventive administrations, crisis administrations, professionally prescribed medications, and then some. The distinction with a catastrophic arrangement is that you should pay for all healthcare costs until you meet a high yearly deductible. Solely after your cash based spending arrives at the deductible does your arrangement start to pay for most covered healthcare administrations. The deductible doesn’t have any significant bearing to all benefits. Catastrophic health plans cover the accompanying benefits, regardless of whether or not you haven’t met your yearly deductible at this point:

  • Three primary care visits each year
  • Free preventive services needed according to the ACA, including specific screenings and vaccinations.

You’ll pay the full expense for any remaining healthcare administrations until you meet your yearly deductible. Other expense sharing costs, like copayments and coinsurance, are generally higher with this kind of plan. Notwithstanding, month-to-month charges will in general be lower as compared to major medical plans.

Catastrophic health inclusion is unique in relation to accident, critical ailment, or short-term plans; these sorts of inclusion will in general secure the policyholder in certain, restricted circumstances. For instance, critical illness plans guarantee the policyholder against some health diseases. Short-term plans give restricted, impermanent inclusion when an individual isn’t qualified to select a significant clinical health plan or believes that the inclusion will begin. For instance, you may try out a short-term arrangement to fill an inclusion gap before you’re qualified for Medicare. Conversely, catastrophic plans cover similar fundamental health benefits as significant clinical plans whenever you’ve met the yearly deductible.

Is a catastrophic health plan worth it?

Catastrophic health insurance’s low charges are intended for individuals who can’t bear the cost of the more costly inclusion plans. These arrangements’ essential inclusion is commonly worth it only when you are young, healthy, and once in a while discover the need to see a doctor. Inasmuch as you needn’t bother with clinical consideration, you would try not to pay for costs from your own pocket and would have the option to save some cash by paying lower expenses. It would not be a decent arrangement on the off chance that you are a senior who consistently needs clinical management or expensive memberships. A catastrophic arrangement might be great if:

  • You are not eligible for a subsidy on the basis of your salary. Or, you are eligible, but do not mind forgoing your right to those savings.
  • You want lower premiums or cannot afford more expensive coverage.
  • You want to be prepared against high medical bills in a “worst-case scenario.”
  • You are usually healthy and rarely see the doctor.
  • You are not eligible for Medicaid.
  • You don’t mind having high out-of-pocket costs.

Each circumstance is unique, and you’ll need to painstakingly consider your health needs, spending plan, and priorities to figure out what’s best for you. In the event that you have inquiries regarding catastrophic inclusion or other arrangement alternatives, go ahead and contact eHealth to talk about your necessities with an authorized insurance specialist.


Now that you have read this article, you know everything that you need about catastrophic health insurance. Catastrophic health insurance is a kind of clinical service that is available under the Affordable Care Act. This is a kind of high-deductible health plan for individuals who are less that 30 years old or the individuals who meet all requirements for a “hardship exemption.” Catastrophic plans are intended to secure you in the most dire outcome imaginable; for instance, in the event that you get into a health related crisis and your clinical costs are highly expensive. Month-to-month plan expenses will in general be lower, however for the most part you’ll have to pay for all health-care costs from your own pocket until you arrive at the arrangement’s yearly deductible, which is ordinarily at least several thousand dollars. Before you decide to buy catastrophic health insurance, make sure to do your proper research to ensure that you make the best choice.

John Otero

John Otero

John Otero is an industry practitioner with more than 15 years of experience in the insurance industry. He has held various senior management roles both in the insurance companies and insurance brokers during this span of time. He began his insurance career in 2004 as an office assistant at an agency in her hometown of Duluth, MN. He got licensed as a producer while working at that agency and progressed to serve as an office manager. Working in the agency is how he fell in love with the industry. He saw firsthand the good that insurance consumers experienced by having the proper protection. John has diverse experience in corporate & consumer insurance services, across a range of vocations. His specialties include Major Corporate risk management and insurance programs, and Financial Lines He has been instrumental in making his firm as one of the leading organizations in the country in generating sustainable rapid growth of the company while maintaining service excellence to clients.

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