Catastrophic health plans are primarily available to individuals under 30 years old, or those 30 and older who qualify for a specific hardship or affordability exemption.
Catastrophic health insurance plans are designed to protect you from very high medical costs in the event of a serious illness or injury. They typically feature low monthly premiums but come with very high deductibles. This means you generally pay for most of your routine medical care out-of-pocket until your deductible is met.
Eligibility Criteria for Catastrophic Health Plans
Eligibility for these plans is specific and generally falls into one of two main categories:
| Category | Age Requirement | Additional Conditions |
|---|---|---|
| Young Adults | Under 30 years old | No additional conditions are required for individuals under the age of 30 to qualify for a catastrophic health plan. This option is often suited for young adults who want protection against high-cost medical emergencies but prefer lower monthly payments. |
| Individuals 30 and Older | 30 years or older | Must qualify for a hardship exemption or an affordability exemption. These exemptions are granted to individuals who face specific circumstances that make obtaining affordable health coverage challenging or impossible. |
Understanding Hardship and Affordability Exemptions
For individuals aged 30 and above, eligibility hinges on receiving an official exemption from the requirement to have minimum essential health coverage. These exemptions are granted due to a variety of challenging circumstances, including:
- Unaffordability of Coverage: If the lowest-priced plan available through the Health Insurance Marketplace, after considering any subsidies, is still deemed unaffordable (exceeds a certain percentage of your household income).
- Economic Hardship: Experiencing financial difficulties, such as homelessness, eviction, or filing for bankruptcy.
- Certain Other Hardships: This can encompass a range of difficult life events, such as:
- The death of a family member.
- Natural disasters causing significant damage.
- Domestic violence.
- Having your health insurance plan cancelled and no other affordable options available.
Practical Insight: Obtaining an exemption typically requires applying through the Health Insurance Marketplace and providing documentation to support your claim. Once approved, you receive an Exemption Certificate Number, which you can then use to enroll in a catastrophic plan.
For more details on these plans and their suitability, you can visit resources like healthinsurance.org.
