How Do Catastrophic Plans Work

How Do Catastrophic Plans Work

There are many different definitions, acronyms, and jargon in the world of Reno health insurance. Even if you want a plan that covers catastrophic claims, you may not qualify for a ‘Catastrophic Plan’. So how do Catastrophic Plans work? Per the Affordable Care Act, people can apply for Catastrophic Plans if they meet one of the following eligibility requirements:

-The applicant must be under the age of 30 when enrolling in coverage


-The applicant must have an approved tax hardship exemption with the IRS

For a listing of tax hardship exemptions, you can read more on the exchange’s website.

How Do Catastrophic Plans Work with the Affordable Care Act

Most people assume Catastrophic Plans have no coverage except in extreme circumstances. Catastrophic Plans follow the same benefit and rule guidelines as every Qualified Health Plan. These policies include the 10 essential health benefits and cannot deny people based on preexisting conditions. Catastrophic plans allow members to use the doctor 3 times per year at the price of a copay. These 3 copays are not subject to any deductible requirements. Just like every other benefit on the plan, members will be required to satisfy a high deductible before receiving 100% in-network coverage after the third doctor visit. The deductible and maximum out of pocket are both set at $7,900 in the 2019 plan year for in-network services.

Because younger people enroll in these plans, for the most part, the premiums are much lower than non-Catastrophic plans in the market. Furthermore, these Catastrophic Plans do not allow you to add dependents to the policy. People applying for Catastrophic Plans will need to enroll as a member-only, even If they have a family. Lastly, Catastrophic Plans are not eligible for subsidies through the exchange.

How Do Catastrophic Plans Work with Employer Policies

Unfortunately, Catastrophic Plans are not available through health insurance small business plans. If an individual wants a Catastrophic Plan, they must buy one in the individual and family market.

Just like any health insurance Nevada plan, there are many factors to weigh when choosing the right policy. To find out more information about Catastrophic Plans, please give us a call today. As your health insurance broker, we do not charge any fees to help you find a plan.