QUESTION

What is a Catastrophic Health Plan?

Individuals with no coverage | Comparing Plans: Benefits and Costs |
ANSWER

A “Catastrophic Plan” is a qualified health plan offered through the Marketplace that covers essential health benefits and requires the highest level of cost-sharing allowable for essential health benefits. In 2024, under a “Catastrophic Plan,” the annual deductible for covered services is $9,450 for an individual. After you have satisfied the deductible, the plan will pay 100 percent for covered essential health benefit services for the remainder of the year. Three primary care visits and many recommended preventive services will be covered before you meet your deductible, and your plan must comply with federal requirements to prevent surprise medical bills in certain care settings and circumstances even if you have not yet met your deductible. “Catastrophic policies” may also be sold by insurers outside of the health insurance Marketplace.

Not everybody will be allowed to buy Catastrophic Plans; they are only for adults up to age 30, although adults of any age can buy a Catastrophic Plan if they receive an affordability exemption (if either Marketplace coverage or employer-sponsored coverage is determined unaffordable) or they receive a hardship exemption from the Marketplace. (45 C.F.R. § 156.155; 42 U.S.C. §18022 (c), (e); CCIIO, Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing, Reduced Maximum Annual Limitation on Cost Sharing, and Required Contribution Percentage for the 2024 Benefit Year.)

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