{"id":11348,"date":"2020-05-09T15:21:48","date_gmt":"2020-05-09T19:21:48","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=11348"},"modified":"2020-07-02T13:19:20","modified_gmt":"2020-07-02T17:19:20","slug":"catastrophic-health-insurance","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/catastrophic-health-insurance\/","title":{"rendered":"What is catastrophic health insurance?"},"content":{"rendered":"

Your health insurance, over time, is a malleable thing. It can change for several reasons\u2014either you\u2019ve started a new job, or moved states, or your old plan was canceled, for example. But the downside is that sometimes, that change means you can no longer afford traditional insurance. Luckily, there\u2019s another option for some of us: catastrophic health insurance.<\/span><\/p>\n

What is catastrophic health insurance?<\/b><\/h2>\n

Catastrophic health insurance is an <\/span>alternate form of health <\/span>insurance that offers limited emergency and preventive care coverage. You\u2019ll generally pay a lower premium in exchange for much higher deductibles. The plans generally only cover the basic needs listed above, so you won\u2019t get the same benefits as you\u2019d get from a traditional, more comprehensive insurance plan. Catastrophic plans are a safety net in case of an emergency.<\/span><\/p>\n

Most people looking for catastrophic coverage are doing so because they either can\u2019t afford regular coverage from a major medical plan, don\u2019t want coverage from a major medical plan, or don\u2019t qualify for government assistance like Medicaid or subsidies from the Affordable Care Act Marketplace.<\/span><\/p>\n

With catastrophic care plans, you have to pay for every medical expense until you reach your deductible <\/span>with a couple of exceptions<\/span><\/a>\u2014at least three primary care doctor visits are covered in full as well as the <\/span>10 essential health benefits<\/span><\/a> laid out by the Affordable Care Act. Those include immunizations, an annual check-up, certain cancer screenings, mammograms, ambulance services, pregnancy, surgery, lab work, and rehabilitation services. It covers some prescriptions, but you\u2019ll have to check your plan formulary to determine if yours are.<\/span><\/p>\n

So what\u2019s not covered? Basically everything else, until you reach your deductible. That means if you need to see a healthcare provider for something, like a mild infection or a broken finger, and you\u2019ve already used your three appointments, you\u2019ll likely pay for everything out-of-pocket. If you have to go to the emergency room, you will pay for the full cost until you meet your deductible. Unless it\u2019s one of those three visits or covered essential care, you\u2019re on the hook. After you meet the deductible, coverage kicks in and everything is covered in full.<\/span><\/p>\n

Catastrophic coverage plans last an entire year. Because the coverage is so minimal before you meet your deductible, it\u2019s often not worth it for someone unless they expect (or at least have a concern) they\u2019re going to have major medical expenses that year. That being said, it might be better for you than having no insurance at all, so be sure to explore every option in full.<\/span><\/p>\n

How do I qualify for catastrophic health insurance?<\/h2>\n

Many adults can qualify for catastrophic health insurance, but you have to meet certain conditions.<\/span><\/p>\n

Age<\/h3>\n

If you\u2019re under 30, and either don\u2019t want or can\u2019t get Medicaid, you may qualify for a catastrophic plan.<\/span><\/p>\n

Hardship<\/h3>\n

If you\u2019re over 30, you have to qualify for a hardship exemption. That means there\u2019s a circumstance outside your control that stops you from getting a major medical health plan. Here are <\/span>14 scenarios from the Marketplace<\/span><\/a> in which you would qualify you for a hardship exemption:<\/span><\/p>\n

    \n
  1. Homelessness<\/span><\/li>\n
  2. Eviction or foreclosure<\/span><\/li>\n
  3. Receiving a shut-off notice from your utility company<\/span><\/li>\n
  4. Domestic violence<\/span><\/li>\n
  5. Death of a family member<\/span><\/li>\n
  6. Fire, flood, or another disaster that created substantial damage to your property<\/span><\/li>\n
  7. Bankruptcy<\/span><\/li>\n
  8. Substantial debt from medical expenses<\/span><\/li>\n
  9. Unexpected increases in expenses because you\u2019re a caregiver for an ill, disabled, or aging family member<\/span><\/li>\n
  10. A child as a tax dependent (who\u2019s ineligible for Medicaid and CHIP coverage), and another person is required by court order to give medical support to the child<\/span><\/li>\n
  11. Eligibility from an appeals decision for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren\u2019t enrolled in a QHP through the Marketplace<\/span><\/li>\n
  12. Your state didn\u2019t expand eligibility for Medicaid, so you\u2019re ineligible<\/span><\/li>\n
  13. The exemption for “grandfathered” individual insurance plans is no longer available for 2017 and later<\/span><\/li>\n
  14. Other hardship, not captured by these categories\u00a0<\/span><\/li>\n<\/ol>\n

    What is the average cost of catastrophic health insurance?<\/b><\/h2>\n

    Overall, catastrophic health insurance is generally more expensive out of pocket than you\u2019d pay otherwise, even though premiums are lower than typical major health insurance plans. Here\u2019s the typical breakdown.<\/span><\/p>\n