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Health Care Reform:

Health Insurance & Affordable Care Act

Back to ACA Health Insurance Terms List

Catastrophic plan

A catastrophic plan is a health plan that generally comes with a lower monthly premium (the price you pay to have health insurance) than bronze, silver, gold, or platinum-level policies.

The deductible for a catastrophic plan, however, is high -- equal to the maximum annual out‐of‐pocket limits allowed under the Affordable Care Act. In 2015, those deductibles could be as high as $6,850 for an individual and $13,700 for a family.

These health plans are required to cover at least three primary care visits per year before requiring you to first meet your deductible. When you see your doctor, you are also covered for preventive care at no cost to you at the time of the visit.

Catastrophic plans cover the essential health benefits that all policies sold through your state Marketplace must include. However, you do have to pay the full deductible before the plan helps pay for any care other than preventive services and the three primary care visits allowed

A catastrophic plan is not available to everyone. You are eligible if:

  • You are younger than 30.

  • You are over 30 but approved for a “hardship exemption.” 

  • You can't afford another type of health insurance.

  • You are getting insurance for a family in which each person is younger than 30.

  • You can find a catastrophic plan in your state's Marketplace, under individual coverage. For this type of plan, you cannot get a tax credit or lower out-of-pocket costs based on income.


Health Insurance Terms

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