Catastrophic Plans

Catastrophic plans are a fifth type of plan. Although they have the lowest monthly cost, the benefits are primarily limited to emergency situations, and you must meet certain eligibility requirements. As their name suggests, these plans provide health coverage during "worst-case "emergency scenarios. Catastrophic plans have the most affordable monthly rates, even lower than the rates of Bronze plan, however, their out-of-pocket costs tend to be the highest. Also unlike the metal plans, preventive care benefits are limited. To qualify for a Catastrophic plan, you must either be under the age of 30, or have a hardship exemption at any age.

You may qualify for a hardship if you are experiencing:

  • Homelessness;
  • An eviction/foreclosure;
  • A notice of shutoff from your utility company;
  • Domestic violence or a death in the family;
  • A natural or man-made disaster.
  • Bankruptcy or substantial debt from medical expenses;
  • An increase in expenses due to caring for an ill, disabled, or aging family member;
  • Claiming a child as a tax dependent who was denied Medicaid or CHIP;
  • If you won an appeal for previously being denied a qualified health plan, but were denied eligibility at the time;
  • You lost coverage in the past, but found qualified health plans to be unaffordable;
  • Some other hardship related to obtaining health insurance.

A catastrophic plan provides the same Ten Minimum Essential Benefits as the other metal level plans, requires a high deductible to be met before the plan pays for health care costs. However, the deductible does not have to be paid for the following:

  • 3 annual primary care visits
  • Preventive care

Primary care visits are visits to the doctor, or other healthcare provider who serves as the primary point of consultation for healthcare services. Preventive care includes medical services that prevent illness or disease from occurring, but doesn’t include care related to existing health problems or new medical problems that develop.

It’s important to note that catastrophic plans don’t qualify for Premium Tax Credits or Cost-Sharing Reductions. Before enrolling in a Catastrophic plan, you should confirm that you wouldn’t pay less for another metal level plan that is eligible for premium tax credits and cost-sharing reductions, as this would increase your level of coverage without increasing costs.

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