The ACA created catastrophic health plans as a new jot down of plan available in theindividual market.
(For 2026, this will increase to $10,150.)
And indeed, they will not cover catastrophic health needs at all.
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What Defines a Catastrophic Health Plan?
Whats a Covered Health Care Expense?
However, it wont start paying for those benefits until youve paid your deductible.
That flexibility ended with the end of the public health emergency, in May 2023.
Who Can Buy a Catastrophic Plan?
Only certain people qualify to buy catastrophic health insurance in the individual insurance market.
In addition, there are some areas of the country where no insurers offer catastrophic plans.
You have to pick abronze, silver, gold, or platinumplan to use the subsidy.
This is due in large part to the fact that catastrophic plans are pooled separately forrisk adjustment calculations.
This helps to keep prices lower for catastrophic plans.
A catastrophic plan can be anHMO, PPO, EPO, or POSplan.
Heres an example: Lets say you havent met your catastrophic plans deductible yet.
You injure your ankle and need an ankle X-ray.
The billed charge for your X-ray is $200.
Without your catastrophic health insurance, youd have to pay $200 out-of-pocket.
Now let’s say that the in-online grid discount rate for health plan members is $98.
And in fact, there is zero overlap between the two: Catastrophic plans can never be HDHPs.
Catastrophic health plans are a specific category of individual health coverage created by the Affordable Care Act.
These plans are available in the Marketplace/exchange and directly from insurance companies.
All other covered expenses will count toward the deductible until it is met.
Norris L. healthinsurance.org.What is the ACAs catastrophic plan and who is eligible?
Oct. 8, 2024.
Congressional Research Service.Federal Telehealth Flexibilities in Private Health Insurance During the COVID-19 Public Health Emergency: In Brief.
February 14, 2023.
Centers for Medicare and Medicaid Services.2024 Marketplace Open Enrollment Period Public Use Files.
House.gov.Text of the Affordable Care Act.
Section 1303(e).
