Can I buy a “catastrophic” plan?



People under 30 and people with hardship exemptions may buy a "catastrophic" health plan. This type of plan mainly protects you from very high medical costs.

Important. Marketplace Open Enrollment ended March 31. You can still buy a Marketplace health plan only if you qualify for a special enrollment period. You can apply for Medicaid and CHIP any time. Learn about special enrollment periods and other coverage options after Open Enrollment. Open Enrollment for 2015 coverage starts November 15, 2014.

Protection from worst-case scenarios

A catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. (Some care is paid for before you reach this limit, known as a deductible. See “Catastrophic plans cover prevention and some primary care” below.)

After you reach your deductible, costs for essential health benefits are generally paid by the plan.

Catastrophic plans usually have lower monthly premiums than a comprehensive plan, but cover you only if you need a lot of care. They basically protect you from worst-case scenarios like serious accidents or illnesses.

Catastrophic plans cover prevention and some primary care

In the Marketplace, catastrophic plans cover 3 primary care visits per year at no cost, even before you’ve met your deductible. They also cover free preventive services.

If you buy a catastrophic plan in the Marketplace, you can’t get lower costs on your monthly premiums or lower out-of-pocket costs based on your income. Regardless of your income, you pay the standard price for the catastrophic plan.

Catastrophic plans for people 30 and over

  • People 30 and over with a “hardship exemption” may be buy a catastrophic plan. Hardship exemptions from paying the penalty are granted to some people based on income or other factors that prevent them from getting coverage. Learn about the 14 types of hardship exemptions.
  • If your individual insurance plan has been cancelled and you believe other Marketplace plans aren't affordable, you can apply for a hardship exemption. This will allow you buy a catastrophic plan.

Learn if you qualify for a catastrophic plan in the Marketplace

When you fill out a Marketplace application you'll see catastrophic plans listed as options if you qualify for them either by age or because you have a hardship exemption. If you don’t qualify for a catastrophic plan, you won’t see them as an option.