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catastrophic plan

What is a catastrophic plan?

In addition to the Platinum, Gold, Silver and Bronze individual health insurance plans became available starting in 2014, the ACA allows catastrophic plans for people under age 30, or for those 30 and older who qualify for a hardship exemption (available through the exchanges, based on income) from having to maintain health insurance coverage or pay a penalty.

Catastrophic plans cover preventive care and up to three primary care visits per year before the deductible, but virtually all over covered services are paid out of pocket until the insured meets the out-of-pocket maximum.

Bronze, silver, gold, and platinum plans have specified actuarial value ranges. Catastrophic plans don’t have a designated actuarial value range, but they must have actuarial value below 60 percent (since that’s the target for bronze plans), and they must also conform to the ACA’s maximum out-of-pocket rules. So in 2018, for example, a catastrophic plan cannot have an out-of-pocket maximum in excess of $7,350.