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13116: Catastrophic Health Care Plans (ACA)


ACA

What is a catastrophic health care plan and how does a taxpayer get one?
 

A catastrophic health plan is one that meets all the requirements applicable to other Qualified Health Plans (QHP) but does not cover any benefits other than prevention and some primary care.

In the Marketplace, such plans cover three primary care visits per year before the plan’s deductible is met. Some preventative services are free. For a list of these services see the HealthCare.gov page Preventative Care Benefits.

The premium amount paid each month is generally lower, but the out-of-pocket costs for deductibles, copayments, and coinsurance are generally higher.

A catastrophic plan generally requires the insured to pay all medical costs up to a certain amount (the deductible), which is usually several thousand dollars. After deductible is reached, costs for essential health benefits are usually paid by the plan.

For more information visit this HealthCare.gov page:  Catastrophic health insurance plans.

How To Qualify

To qualify for such a plan, an applicant must be under 30 years of age or receive a hardship exemption because the Marketplace has determined the applicant is unable to afford health coverage.

How To Apply

When the applicant fills out a Marketplace application, catastrophic plans will be listed as an option if the applicant qualifies.


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