Insurance Health Insurance What Is Catastrophic Health Insurance? By Janet Hunt Janet Hunt Twitter Janet Hunt is an expert in car insurance, homeowners insurance, and health insurance with over 20 years of experience covering trends, regulations, and writing company reviews. Her lengthy career in insurance includes stints in customer service and selling personal lines of insurance. She earned her Property and Casualty license in 1995. learn about our editorial policies Updated on October 9, 2022 Reviewed by Anthony Battle Reviewed by Anthony Battle Anthony Battle is a CERTIFIED FINANCIAL PLANNER™ professional. He earned the Chartered Financial Consultant® designation for advanced financial planning, the Chartered Life Underwriter® designation for advanced insurance specialization, the Accredited Financial Counselor® for Financial Counseling and both the Retirement Income Certified Professional®, and Certified Retirement Counselor designations for advance retirement planning. learn about our financial review board Fact checked by David Rubin Fact checked by David Rubin Facebook Instagram Twitter David J. Rubin is a fact checker for The Balance with more than 30 years in editing and publishing. The majority of his experience lies within the legal and financial spaces. At legal publisher Matthew Bender & Co./LexisNexis, he was a manager of R&D, programmer analyst, and senior copy editor. learn about our editorial policies In This Article View All In This Article How Does Catastrophic Insurance Work How To Get Catastrophic Insurance Frequently Asked Questions (FAQs) Photo: kupicoo / Getty Images Definition Catastrophic health insurance is an inexpensive coverage option designed to protect you from major medical expenses. In exchange for a low premium, you'll have a high deductible. As a result, you'll pay most of your medical costs out of pocket until you reach it. Key Takeaways Catastrophic health insurance is a low-cost health care plan; it covers very few medical expenses until you reach a high deductible.These plans are only available to people under age 30 or those who qualify for a hardship or affordability exemption.After you reach your high deductible, a catastrophic plan covers all of the essential benefits of a traditional health plan.Catastrophic plans do not qualify for government tax breaks or subsidies. How Does Catastrophic Health Insurance Work? Like all insurance plans offered under the ACA, catastrophic plans must cover certain preventive services at no cost to you, whether you have met your deductible or not. They generally include basic shots, immunizations, and screenings. A full list is available at HealthCare.gov. Major medical plans must also cover at least three visits to your primary care doctor before you meet your deductible. Note Under the ACA, the deductible for all individual catastrophic insurance plans in 2023 is $9,100 for an individual and $18,200 for a family. That would be the most you'd pay out of pocket in one year. Other than those benefits, you'll pay your medical expenses out of pocket until you meet your deductible. After that point, catastrophic insurance must cover the same essential health benefits as other health marketplace plans, including: Ambulatory patient services Emergency services Hospitalization Pregnancy and maternity/newborn care Mental health/substance abuse Prescription drugs Rehabilitative services Laboratory services Preventive/wellness services Pediatric services Additional benefits, such as birth control or breastfeeding coverage Dental or vision coverage (based on your state’s requirements for minimum coverage) Once you've reached your deductible, you'll have no coinsurance or copay on any of these services. Note The availability and cost of catastrophic health insurance plans vary by provider and state. Availability is also limited to a few groups: people under age 30; those who qualify under a hardship exemption; or those who cannot afford employer or marketplace insurance options. How Do HSAs Fit In? If you are employed and covered by only a high-deductible health plan, you can combine a catastrophic health care plan with a health savings account (HSA), which allows you to set aside tax-free money to apply toward medical costs. An HSA can help you pay for any of your out-of-pocket health expenses under a catastrophic health insurance plan. How To Get Catastrophic Health Insurance Many insurance providers offer catastrophic health care insurance. If you already have insurance, check with your provider to see its available plans and how much they cost. If you don't want to use your provider, you can shop on the federal government's health care marketplace or that of your state. Before you purchase a catastrophic plan, keep in mind that your deductible and out-of-pocket expenses will likely be higher than if you had a traditional plan. Important No premium tax credits or ACA subsidy payments are available to apply toward the premium for catastrophic health insurance plans. If you qualify for a subsidy, a bronze- or silver-level traditional plan may cost less and cover more than a catastrophic plan. Whether you choose a catastrophic plan or something more, make sure you can afford it if you have to pay up to your maximum out-of-pocket amount. Like other health plans, you can only purchase catastrophic insurance during an open enrollment period or after a qualifying event. If you’d like more information about catastrophic health plans, visit HealthCare.gov, or call 800-318-2596. Frequently Asked Questions (FAQs) How much does catastrophic health insurance cost? The exact cost of catastrophic health insurance coverage will vary according to details such as where you live. In general, you can expect catastrophic health insurance premiums to cost much less than a standard health insurance plan. The average health insurance plan premium cost in 2021 was $7,739 for singles and $22,221 for families. What does catastrophic health insurance cover? Catastrophic health insurance plans must cover all the services required by the ACA. In general, these services include preventative services, pregnancy care, prescription drugs, and laboratory services. The ACA designates three separate lists of preventative services that must be covered—one for all adults, one for women, and one for children. Was this page helpful? Thanks for your feedback! Tell us why! Other Submit Sources The Balance uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. HealthCare.gov. "Deductibles and Your Marketplace Health Insurance." HealthCare.gov. "Catastrophic Health Plans." HealthCare.gov. "Out-of-Pocket Maximum/Limit." HealthCare.gov. "What Marketplace Health Insurance Plans Cover." HealthCare.gov, "Catastrophic Health Plans." HealthCare.gov. "Health Coverage Exemptions, Forms & How to Apply." Internal Revenue Service. "Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans (2021)," Pages 3-4. Kaiser Family Foundation. "2021 Employer Health Benefits Survey." HealthCare.gov. "Preventative Health Services."