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If you’re young or experiencing financial hardships, and the “metal plans” offered through the Marketplace are too expensive for you, you may be eligible for a “catastrophic” plan.
Catastrophic plans offer protection from worst case scenarios like a serious accident or illness. They tend to have lower monthly premiums but they only cover your costs after you’ve used a lot of care, making them a poor option for someone who sees the doctor or a specialist slightly more than average. This plan also requires you to pay your medical costs up front before hitting your deductible.
Although this plan at its core is very basic, it does cover preventative services and three primary care visits per year at no extra cost. However, unlike the metal plans, the plan does not offer the discounts through tax subsidiaries.
Because this is the most bare-bones plan the Marketplace offers, you must be under 30 or fall under one of the 14 hardship exemptions including:
1. You were homeless 2. You were evicted in the past 6 months or were facing eviction or foreclosure 3. You received a shut-off notice from a utility company 4. You recently experienced domestic violence 5. You recently experienced the death of a close family member 6. You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property 7. You filed for bankruptcy in the last 6 months 8. You fell into debt due to medical expenses you pay in the last 24 months 9. You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member 10. You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you don’t have the pay the penalty for the child. 11. As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace 12. You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act 13. Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable 14. You experienced another hardship in obtaining health insurance
Keep in mind that as you are shopping for health insurance, just because you may qualify for a catastrophic plan doesn’t mean that it will be the best fit for you. Do your research by assessing your medical needs and picking the plan with the lowest rate that can easily accommodate your healthcare needs.