Typically, only people under 30 can buy such a plan. Those over 30 may be allowed to enroll if they qualify for an exemption. Qualifying for a catastrophic health insurance plan often requires an individual to meet specific requirements such as homelessness, eviction, or bankruptcy.
Types of Exemptions Available
Catastrophic health plans are only available for people over 30 if they qualify for an exemption from the age criteria. There are two types of exemptions that you can apply for.
Types of Exemptions For Getting Catastrophic Health Insurance Over 30
This exemption aims to help those who cannot afford a health insurance plan.
One may qualify for this exemption when the cheapest health coverage option available to them (through the Marketplace or their employer) costs more than 8.09 percent of their household income.
This exemption aims to help those suffering from financial hardship and other life circumstances that affect their ability to get health insurance of any kind. Below are examples of what counts as hardship:
How to Apply For An Exemption When Above 30 Years Old
Searching for federal forms on the web can be a time-consuming process. In this section, find a step-by-step guide to finding the correct website, filling out the form, and submitting it to the proper authorities. You can even find a direct link to a downloadable PDF copy of the documents below.
Step 1: Visit the Health Insurance Marketplace Website
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Step 2: Locate and Download the Correct Form(s)
- Once the new webpage opens, click on the “Health coverage exemptions, forms & how to apply” link on the left-hand side. Here, you will find more information about the types of exemptions and links to the respective forms.
- Based on which exemption you choose to apply for, find and click on the link titled “Get the application form and instructions” under each of the respective exemption sections. Once you click on the link, you will see a new webpage with links to download a PDF version of both forms.
- While there is only one form for hardship exemptions, those applying for an affordability exemption need to choose between two forms based on their state of residence. The website explicitly tells you which form is appropriate for which state.
|Type of Exemption||State of Residence||Link to Form|
|Hardship Exemption||All U.S. states.||Exemption application (PDF)|
|Affordability Exemption||Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming.||Exemption application (PDF)|
|California, Colorado, Idaho, Kentucky, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, Vermont, and Washington.||Exemption application (PDF)|
Step 3: Fill Out the Form and Mail It
- Once you have filled out the form, you need to print out a hard copy.
- Locate the mailing address of the Health Insurance Marketplace on the form and mail your filled-out form to that address.
Catastrophic Health Plans Frequently Asked Questions (FAQs)
In this section, find a list of some frequently asked questions about the catastrophic health plan and the related extension forms.
What do I do if I need help with the exemption form?
If you need more help filling out or locating the form, you may try the following.
- Visit www.healthcare.gov/exemptions.
- You may call the Marketplace Call Center for assistance at 1-800-318-2596.
- You can also find trained Marketplace employees in your area to get help in person. Visit the Marketplace’s Local Help website or call their Call Center for more information.
- If you need help in another language, call the Marketplace at 1-800-318-2596 to get free language assistance.
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Who should get a catastrophic health plan?
Catastrophic health plans are designed to help those under 30 years to pay for unexpected or emergency medical expenses they are unable to afford. However, if you are above 30, the exceptions stated above will allow you to get a catastrophic health plan.
What does a catastrophic plan cover?
Such a plan only covers all the essential health benefits as identified by the ACA. These include the following ten categories.
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitation services and devices
- Laboratory services
- Preventative and wellness services and chronic disease management
- Pediatric services
When enrolled in a catastrophic health plan, you will receive a rather restricted range of benefits and coverage until you reach your high deductible.
Choosing to enroll in a catastrophic health plan can be a great move if you are someone who is facing emergency medical costs or you anticipate that your medical expenses will increase significantly in the near future. Even if you are over the age of 30 years, you may still be eligible to enroll in a catastrophic plan if you qualify for a hardship or affordability exemption. Make sure to educate yourself about all the available options before deciding.
If you cannot afford insurance or want to have supplemental coverage, Mira can help. Mira offers exclusive health benefits for an average of $45 per month and with no deductible, including affordable urgent care visits, low-cost lab testing, and discounted prescriptions. Our care navigation team can also help you find affordable healthcare services in your area! Sign up today to get started.
Girisha is a second-year graduate student at Columbia University, pursuing a Master's in Public Health. She is excited to combine her passion for Public Health and writing with the hopes of delivering quality health information, one article at a time!