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What is the ACA’s catastrophic plan and who is eligible?

  • By
  • contributor
  • October 2, 2015

Q. I’ve always had a high deductible plan, and I’m happy with my coverage. I’ve heard that the ACA allows for a catastrophic plan. Is that the best option for me?

A. The catastrophic plan is available to people under age 30, or people 30 and older who qualify for a hardship exemption (which means that due to economic hardship, the person would not be required to have health insurance or pay a penalty for failing to do so).  Regardless of age or income, catastrophic plans are also available for people whose health insurance policy is being cancelled because it’s not ACA compliant.

Catastrophic plans are available both in and out of the ACA’s health insurance exchanges, but hardship exemptions for those 30 and older must be obtained from the exchange.

If you’re eligible for a catastrophic plan and shopping for health insurance in your state’s exchange, you’ll see that option in addition to the Bronze, Silver, Gold and Platinum plans. If you’re not eligible, it won’t show up as an option.

Catastrophic plans will cover all of the essential benefits defined by the ACA, after the out-of-pocket maximum ($6,850 for an individual in 2016) is reached. Catastrophic plans cover up to three primary care visits per year with no cost-sharing, and preventive care with no cost-sharing, but virtually all over services will be paid by the insured until the deductible is met.

Premium subsidies are not available for catastrophic plans (nor are cost-sharing subsidies, which are only available on Silver plans). Depending on your income, you may be eligible for a subsidy that you could apply towards a metal-rated plan. This might make a Bronze or Silver plan even more affordable than a catastrophic plan.