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 2021, those deductibles could be as high as $8,550 for an individual and $17,100 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 must apply for a hardship exemption through

  • Your old insurance plan was cancelled because it’s not compliant with ACA rules and you can’t afford a Marketplace plan. 
  • You can't afford another type of health insurance.You must apply for a hardship exemption through

  • 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.

WebMD Medical Reference Reviewed by Sarah Goodell on June 21, 2021


SOURCES: Society for Human Resource Management.

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