Enrolling In a Catastrophic Plan for 2023

You are eligible for a Catastrophic health plan if you are under 30 years of age or if you qualify for an exemption based on affordability or experiencing hardship. Catastrophic plans have low monthly premiums yet high deductibles. They are specific health plans found on the Marketplace or sold by insurers outside the federal or state-specific exchanges.  

How Do I Enroll In A Catastrophic Plan?

You will sign up following steps similar to enrolling in any ACA plan found on the Marketplace. Suppose you qualify to buy and enroll in a Catastrophic health plan. In that case, you will see the plan as an option displayed when you compare plans in the federal or your state's Marketplace.

Step 1: Know If You Qualify for a Catastrophic Health Plan

To qualify for a catastrophic plan, you must either be under 30 years old or qualify for a hardship exemption. If you are under 30 years of age, you do not need to qualify for an exemption to enroll in a catastrophic health plan. An exemption usually means that certain circumstances make you unable to afford health care insurance. Exemptions are based on one of two criteria: affordability and hardship.

1. Affordability refers to income-related hardships, and you would qualify for this type of exemption when the lowest-priced coverage available to you, through either a Marketplace or job-based plan, costs more than 8.09% of your household income.
2. Hardship exemptions are qualified for when you experience certain circumstances that prevent you from getting insurance. Some examples include:
   1. Homelessness
   2. Eviction, or facing eviction or foreclosure.
   3. A shut-off notice from a utility company
   4. Experiencing domestic violence
   5. Experiencing the death of a family member
   6. Experiencing a natural or human-caused disaster, having caused substantial damage to your property
   7. Filing for bankruptcy

Step 2: Apply for an Exemption (If Applicable)

Suppose you are over 30 years old and believe you qualify for an exemption to enroll in a catastrophic health plan. In that case, you must complete a marketplace application and an exemption and submit it to the respective healthcare exchange (federal or state-specific). The exchange will approve or deny your request based on the specific circumstances detailed in your application. Your approval or denial will be received by you in the mail, letting you know if you qualify. If you are approved for an exemption, you will also be provided with an Exemption Certificate Number to include in your tax returns. 

Step 3: Know When to Enroll in a Catastrophic Health Plan

You will enroll in a Catastrophic health plan when you would like any other plan - the open enrollment period. Open enrollment spans the months of November 16th, 2022, through January 31st, 2023. You will want to sign up for a Catastrophic health plan during this period. Also extremely helpful is understanding the key and recurring terms that will appear while searching for a plan. Keywords and their definitions, such as premium, deductible, and much more, can be found in this Mira article. Suppose you do not sign up for a plan during the open enrollment period. In that case, you may still be eligible to apply during a special enrollment period. You can qualify for special enrollment if you have experienced a qualifying life event.

Step 4: What to Consider When Browsing Catastrophic Health Plans

Catastrophic plans have low monthly premiums and high deductibles, protecting you from catastrophic events and worst-case scenarios. You are responsible for paying for most routine care to allow for this coverage in extreme events. Once you reach your deductible amount, your insurance company will pay for all covered services (essential benefits) with no copayment or coinsurance. There are certain aspects to consider when looking at catastrophic health plans. These include your budget and your provider preferences. 

Your budget: It is important to consider it because health coverage plans include premiums, deductibles, copays, and coinsurance. An analysis by eHealth found the average monthly premium for catastrophic health plans to be $173. However, for 2023, Catastrophic health plans will have an average deductible of $9,100, according to the Kaiser Family Foundation.

Provider preferences: Certain plans limit your choices of providers and may charge you more for having providers out of network. In contrast, other plans allow you to choose any provider. The four major types of plans are listed in the table below. A catastrophic plan can be an HMO, POS, PPO, or EPO.

Types of Health Insurance Plans

Source: Mira, Healthcare.gov

Exemption Expiration

Knowing how long your exemption will last is just as important as knowing if you qualify. There are different expiration timelines for both the affordability and hardship exemptions. They are as follows:

Source: Healthcare.gov

Catastrophic Plan Options

Blue Cross Blue Shield catastrophic health insurance was ranked the best catastrophic health insurance of 2023 by Investopedia and Forbes. Catastrophic health plans are usually HMOs and PPOs, as you will see in your marketplace. The tables below 1) summarize the rankings for 2023 catastrophic health plans and availability and b) compile the catastrophic health plan options found in the New York state marketplace for zipcode 10001.

Source: Forbes

Average Premium and Deductible for Catastrophic Health Plans in New York City

Source: NYStateofHealth

Mira & Catastrophic Health Plans

Catastrophic health plans protect you financially from major illnesses and injuries. Mira provides affordable and comprehensive coverage for preventative care, reduces prescription drug prices, and much more. With that being said, consider pairing Mira with catastrophic health insurance today so that you don’t have to go without basic healthcare while also being protected from catastrophic health expenses.

Catastrophic Insurance Plans

Catastrophic health plans are enrolled for that very reason - for catastrophes. They are health plans that offer coverage in emergencies but also provide coverage for preventive care. This plan offers lower-priced coverage that usually protects you from high medical costs if you get seriously hurt or injured. Once you reach your deductible, the plan will pay 100% for covered essential health benefit services you receive from in-network providers for the remainder of the year.

Essential Benefits and Coverage

Catastrophic plans do not vary from other metal tier plans because they cover the same set of 10 essential health benefits. Additionally, catastrophic health plans cover at least 3 primary care visits per year before you have met your deductible and other preventative services at little to no cost. These 10 essential health benefits include:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Pregnancy, maternity, and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

Catastrophic Plans Frequently Asked Questions (FAQs)

Consider this additional information when enrolling into a catastrophic health plan. 

Is a Catastrophic Health Plan Right For Me?

A catastrophic health plan may not be right for everyone. What’s best for you may not be best for another. This specific health plan may be right for you if:

• You want lower premiums
• You are generally healthy and rarely see a doctor
• You do not qualify for Medicaid
• You do not qualify for a tax subsidy based on income
• You are prepared to have high out-of-pocket expenses

Can I Use a Tax Credit To Pay For My Catastrophic Health Plan?

No. When you sign up for and enroll in a catastrophic health plan, you give up any tax credit you might be eligible for. You may not use premium tax credits or cost-sharing reductions with catastrophic health plans. When deciding if you want to enroll in a catastrophic health plan, keep this in mind; if you qualify for a tax credit, another plan type may be best for you.

Is a Catastrophic Health Plan the Same as a High-Deductible Health Plan?

High-Deductible Health Plans (HDHPs) differ from catastrophic plans insofar as they are designed to be paired with a Health Savings account (HSA). Both HDHPs and Catastrophic Health Plans have low monthly premiums and high deductibles. However, HDHPs can be HSA-eligible, meaning you can set aside pre-tax dollars to pay for qualified health expenses, while catastrophic plans are never HSA-eligible. 

Bottom Line

A catastrophic health plan is a specific type of health plan. Its primary purpose is to prevent you from paying unaffordable medical bills in extreme cases. You qualify for this plan if you are under 30 or eligible for an exemption based on income or hardship. You will pay out-of-pocket for any healthcare costs until you have met your deductible. Still, once you meet your deductible, your insurer will pay 100% of the essential health benefits as determined by the ACA.

With month-to-month, six-month, or year-long plans, Mira is a flexible and affordable option to pair with your catastrophic health insurance plan. Sign up today for an average of $45 per month, so you don't have to go without basic healthcare.