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Catastrophic Health Insurance Explained

by | Dec 25, 2024

Is Catastrophic Health Insurance Right for You?

If you have a tight budget and are researching affordable health insurance options, you have likely come across catastrophic health insurance. These policies have low monthly payments, making them an attractive option for budget-savvy shoppers, but they are not good options for everyone.

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Catastrophic Health Insurance Explained

What Is Catastrophic Health Insurance?

Catastrophic health insurance is a health insurance plan with a high deductible and low monthly premiums. These plans are primarily intended for young adults under age 30 who are less likely to experience an unexpected event. For those over age 30, catastrophic health insurance is available, but those who want this coverage must qualify for a hardship exemption.

Like major medical health insurance plans, catastrophic health insurance covers the 10 essential health benefits outlined in the Affordable Care Act. However, if you have this type of plan, your out-of-pocket costs for services are considerably higher than with regular health insurance. These plans typically have high deductibles, which is the amount that you must pay for any services you receive before coverage kicks in. For example, with a $8,550 deductible, your health insurance will not cover services such as lab tests, hospital stays or emergency care until you pay $8,550 out of pocket for medical care. Of course, you’ll be extended their network pricing which is tremendous help which lowers the bill substantially.

Depending on your health insurance plan, some services may be covered under catastrophic insurance even before you meet your deductible. In most cases, policyholders are covered for three primary care visits per year and free preventative services such as immunizations and certain screenings.​

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Is Catastrophic Health Insurance Good Coverage?

Catastrophic health insurance coverage may not be well-suited for everyone, but that does not mean that the coverage is not good. These plans provide the same scope of coverage that major medical health insurance does; it just has higher up-front costs until you’ve hit your “out of pocket maximum”.

If you are under age 30, you do not need a lot of medical care and rarely visit a doctor and you can handle high out-of-pocket medical costs, then catastrophic insurance may be a good option. It is much better than going uninsured.

However, if the primary reason that you are considering this coverage is that you cannot afford costlier health insurance, you’ll most definitely want to speak with one of our licensed agents. You may be eligible for Government assistance to help you afford a lower deductible lower cost plan. If the unexpected happens and you are suddenly facing a serious injury or illness, your out-of-pocket medical costs will only be a second thought, your health will be more important in the moment. Having a catastrophic plan even though it’s a higher deductible will still be a great blessing to have.​

What If I Need More Coverage?

Before signing up for a catastrophic health insurance plan, talk to one of our health insurance agents about options that are comparably affordable and provide more coverage. If you cannot afford high monthly premiums, you may qualify for federal subsidies that greatly reduce monthly out-of-pocket costs or Medicaid.

Finding the Right Health Insurance with Nevada Insurance Enrollment

Health insurance does not have to be a financial burden. At Nevada Insurance Enrollment, our health insurance agents help you assess your needs and budget and choose the right plan for you.

You Can Still Buy Health Insurance From a Local Agent

You Can Still Buy Health Insurance From a Local Agent

The way health insurance is being marketed may give you the wrong impression that Nevada Health Link is the ONLY place to buy health insurance these days, but that is NOT the case. You can continue to buy your health insurance from the same agents and agencies you’ve always bought your health insurance from.

Is Health Insurance Worth The Cost?

Is Health Insurance Worth The Cost?

If you experience a more extensive medical emergency and require hospitalization, hospital bills may quickly become a burden. A three-day stay, for example, could set you back about $60,000 depending on what tests are ordered and what happens during your stay.

What is Co-Insurance?

What is Co-Insurance?

Co-insurance means two parties will be paying for the bill. “Co” means joint, mutual, two, or more. The health insurance company will usually pay the larger amount (example 70%) and you as the member will usually pay the lesser amount (example 30%). This would be considered co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible is met.

 

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Things Potentially NOT Covered By Your Health Insurance

To be fair, in recent years, health insurance companies have made strides towards transparency. If you have an ACA-compliant plan, there are many services that your health insurance is legally required to cover, taking some of the guesswork out of budgeting for health expenses.

Medical Loss Ratio

This Medical Loss Ratio states that when a family or individual buys a medical plan, 80% of every dollar collected and paid to an insurance company MUST pay medical claims/research. So that leaves the insurance company to pay ALL of their expenses with the remaining 20%. .20 cents on the dollar for their employees, buildings, broker costs, etc.

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