Catastrophic Health Insurance

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A Catastrophic Situation Requiring Health Insurance

What Is Catastrophic Health Insurance?

Catastrophic health insurance is a type of health insurance plan typically designed to provide essential coverage in the event of major illnesses or injuries. These plans are often more affordable than comprehensive plans, but may not cover preventive care services or have higher out-of-pocket costs. Such plans can be beneficial for those looking for basic coverage at a lower price who otherwise do not qualify for ACA subsidies or Medicaid. It’s important to pay careful attention to what your plan does and does not cover when making a decision about whether catastrophic health insurance is right for you.

We want to learn about catastrophic health insurance because it can provide essential coverage for individuals and families in the event of a serious illness or injury. This type of plan typically has lower monthly premiums than other more comprehensive plans, but may not cover certain types of care. It’s important to weigh the pros and cons carefully before deciding if catastrophic health insurance is right for you. Depending on your lifestyle and medical history, this type of plan might be a good choice if you are looking for basic coverage while potentially saving money on premiums.

What Does Catastrophic Health Insurance Cover?

The word catastrophic is a little misleading because when you think of catastrophic you think of medical emergencies that could mean the difference between life and death. However, catastrophic plans were created under Obamacare, and therefore need to cover the same minimum essential benefits all other ACA plans need to cover. Read more about minimum essential coverage here to find out exactly what will be covered under your catastrophic plan.

Catastrophic health insurance plans typically cover essential medical services such as doctor’s visits, hospitalization and emergency care. They may also provide coverage for certain prescription drugs and preventative care services, such as vaccinations. In addition, some catastrophic health insurance plans will also pay a portion of the costs associated with mental health disorders and substance abuse treatment. These plans typically have high deductibles and lower monthly premiums, but they can still provide the necessary financial protection in the event of an unexpected illness or accident.

What Does Catastrophic Health Insurance Not Cover?

Catastrophic health insurance plans generally do not provide coverage for services such as cosmetic surgery, fertility treatments, or elective procedures like laser eye surgery. In addition, they typically do not cover routine visits to the doctor or dental care. Additionally, preventive care services like vaccinations, screenings and annual check-ups may not be covered by a catastrophic health plan. These plans are designed to protect against major medical expenses in the event of a serious illness or accident, but they do not cover all medical expenses.

Who Should Consider Catastrophic Health Insurance

Catastrophic health insurance provides you with the same comprehensive and quality coverage you would get with any other health insurance plan. While these plans are going to be your cheapest option for monthly premium payments, they can end up costing you more in the long run if you end up having to pay your high deductible.

Catastrophic health insurance plans are typically available to people under the age of 30 or people who can demonstrate a financial hardship. These plans may also be available to individuals who have opted out of ACA-compliant health coverage due to religious beliefs or those with approved exemptions. Individuals must also meet certain citizenship requirements in order to qualify for catastrophic health insurance. Ultimately, it is important to carefully review your plan details and eligibility requirements before making a decision about whether this type of coverage is right for you.

If you are going to consider a catastrophic plan, you want to make sure it’s going to be a good fit for you before signing up for coverage, and you also want to make sure you are eligible. Here is a list of people who should consider catastrophic coverage.

Anyone under 30 years old: If you are under 30, you are eligible for catastrophic plans regardless of their financial situation. You just want to make sure you don’t have an extensive medical history because those high deductibles can end up costing you.

Anyone who qualifies for a hardship exemption: Regardless of your age, you still may be eligible for catastrophic coverage if you can’t afford other health insurance options. Keep reading for a list of exemptions.

Can You Get Catastrophic Coverage Over 30?

Yes, you can get health insurance over the age of 30.

The purpose of the Affordable Care Act was to provide affordable health insurance to everyone. If you can’t afford health insurance, rather than foregoing coverage, you may qualify for a hardship exemption. The following are some examples of what would qualify you for a hardship exemption, but for a full list, you can read more here.

  • You are currently homeless or have recently been homeless.
  • You have been evicted from your home, or have recently been evicted.
  • You were are or have been a victim of domestic violence. If you are currently a victim of domestic violence you can seek help here.
  • You have recently experienced the death of a family member.
  • You have current outstanding medical bills you have not been able to pay.

If you do qualify for a hardship exemption, it would be worth exploring federally funded health insurance programs like Medicaid and Medicare. You may be eligible for subsidized health coverage that will cost you little to no money. You also may be exempt from any health insurance penalty should you choose to go without coverage for the year.

Pros And Cons Of Catastrophic Health Insurance

Catastrophic coverage may not be right for everyone, but it’s still an affordable health insurance plan you want to consider. Before signing up for any plan, it’s important to weigh the pros and cons, and the same is true for catastrophic health insurance.

Can You Get Catastrophic Coverage Over 30?

  • The biggest benefit of all is that you will be covered if there is ever a medical emergency.
  • Catastrophic plans are some of the most affordable plans available.
  • You have access to comprehensive health coverage that includes preventive care and other benefits.

Cons of Catastrophic Coverage

  • If there ever is a medical emergency, you will end up paying more than you would with other health insurance options.
  • May leave out important health benefits like coverage for prescription medication.
  • You don’t have the ability to apply for federal subsidies through the health insurance marketplace.

Will Catastrophic Health Coverage Qualify Under Obamacare?

Yes, catastrophic health insurance plans meet all of the federal requirements to be considered qualifying health coverage. If you are eligible and choose to enroll in one of these plans you will be exempt from paying any tax penalty from the individual mandate.

Can You Get A Subsidy For Catastrophic Insurance?

Unfortunately, you can’t apply or receive a government subsidy or premium tax credit if you choose to enroll in a catastrophic health insurance plan. However, if you are eligible for a subsidy through the marketplace, you may find it’s cheaper for you to enroll in a lower tiered plan. For example, a Bronze Plan or Silver Plan may be cheaper with a subsidy than a catastrophic plan. Make sure to work with an experienced health insurance agent or broker to maximize your savings.

Can You Get A Subsidy For Catastrophic Insurance?

Catastrophic plans are purchased through the marketplace, and therefore can only be purchased during the Open Enrollment Period each year. Typically Open Enrollment will begin on November 1 and run through December 15.

If you qualify for a Special Enrollment Period you will also be eligible to sign up for catastrophic coverage. Special Enrollment Periods open up all marketplace plans to you for a 60-day window after you experience a qualifying life event. For a list of qualifying life events, you can look here, but some examples include:

  • You recently lost your health insurance coverage.
  • You had a change in your household size, including marriage, a newborn child, or adoption.
  • You recently moved or had a change in residence.
  • You just became a US citizen and are now eligible for coverage.
  • You recently lost your job.

How Much Does Catastrophic Health Insurance Cost?

The average monthly cost for catastrophic health insurance for someone age 30 is $267. It is expected to be lower than previous years. This is due to an increase in competition among private insurers, as well as the introduction of new insurance options, such as exclusive provider organizations (EPOs) and health maintenance organizations (HMOs). Additionally, many of these plans are federally subsidized. As a result, they often have more competitive premiums and out-of-pocket costs than other types of health plans. Ultimately, your exact cost will depend on your age, where you live, and the type of coverage you choose.

How Much Are Catastrophic Plan Deductibles?

While the costs for catastrophic premiums may vary, the deductibles will be the same across the board. According to the health insurance marketplace, deductibles for all catastrophic plans in 2017 were $7,150. That means before your health insurance kicks in to cover medical expenses, with the exception of the minimum essential benefits, you will have to pay $7,150 out-of-pocket.

How Do I Get Catastrophic Health Insurance?

If you’re looking to apply for catastrophic coverage, you will first have to meet the eligibility requirements and make sure that this is the right plan choice for your needs. The next step would be to create a health insurance marketplace account to view the different coverage options in your area. Once you find the plan you want, all that’s left to do is enroll.

How Do I Get Catastrophic Health Insurance?

For the most part, you can compare all the health insurance plan quotes directly through the marketplace, including catastrophic plans. However, you don’t have the ability to compare catastrophic health insurance quotes with private health insurance quotes and benefits.

While catastrophic health insurance may be the cheapest option for you through the marketplace, more and more Americans are finding that they can save money by signing up for plans outside of the marketplace.

So when you are comparing catastrophic health insurance quotes, make sure to look over all of your options, because you may find something cheaper. First Quote Health makes it easy for you to review the plans available in your area, so you can compare them your quotes through the marketplace. All you have to do to get started is enter your zip code, and you can even get covered today.

Frequently Asked Questions


In the medical field, the term catastrophic refers to any severe illness or injury that requires an extended hospital stay or recovery process. These illnesses or injuries are typically accompanied by expensive medical costs.


The catastrophic cap is the maximum amount of money you will pay out-of-pocket for the year.


Unfortunately, you can’t pair a catastrophic health insurance plan with a Health Savings Account (HSA). However, if you are looking to use an HSA to help with your medical expenses, you may benefit from a number of high deductible policies that can be paired with an HSA.


No, there are cheaper options than catastrophic coverage both through the marketplace and private sector.

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