Catastrophic health insurance plans have low monthly premiums and very high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. But you pay most routine medical expenses yourself. Show
Who can buy a Catastrophic plan
If you qualify to buy a Catastrophic plan, you’ll see them displayed when you compare plans in the Marketplace. How much Catastrophic plans cost
What Catastrophic plans cover
What kind of medical care is covered by catastrophic health insurance?Once you meet your plan deductible, catastrophic coverage would pay for accidents, unexpected injuries, sudden emergency illnesses, etc. These plans also provide 100% coverage for certain preventive care services—annual check-up, flu shot, certain types of routine screenings, and more. Most catastrophic plans also cover you for at least three visits to a PCP. Do I qualify for catastrophic insurance?You must either be under 30, or qualify for a hardship exemption. Usually, an exemption means that you can’t afford health care insurance because you’ve recently been homeless, declared bankruptcy, or meet other qualifying criteria. How do I qualify for an exemption so that I can get catastrophic health coverage?There are two main types of exemptions that would help you qualify for catastrophic insurance—personal hardship and affordability exemptions. You could qualify for either exemption depending on the details of your specific situation. Some common hardship qualifications include:
There are also affordability exemptions. This means that your income is not enough to be able to afford regular health care coverage. If you qualify for an exemption, you would claim it on your annual tax return and get money back. How do I apply for an exemption?To apply, you must fill out an application and submit it to the Exchange. You can find forms on Healthcare.gov. You’ll receive a notification in the mail from the Exchange letting you know if you qualify for the exemption or not. If your priority is finding insurance with a low monthly fee, catastrophic insurance may be right for you. To qualify for catastrophic insurance, you must be under 30, or, qualify for a hardship exemption. The application is approved or denied based on the details of your specific circumstances. If I qualify for an exemption, can I get catastrophic health insurance?If you are approved for either a hardship or affordability exemption, it means you may then get a catastrophic health insurance plan, if you choose. Catastrophic health plans can help protect you from high emergency medical costs, while also covering some essential health benefits like an annual check-up, certain preventive services, and at least three primary care visits before you have met your deductible. However, if you anticipate costs associated with managing a chronic health condition, you may save more with another type of health plan. M is insured under a Basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim amount M is eligible for? Determined by the terms of the policy Which of the following can an individual use their medical flexible spending account to pay for? Vitamins and supplements Prescription drugs Household expenditures Cosmetic procedures The first portion of a covered expense that the insured is required to pay before Major Medical Coverage applies is called the Which of the following BEST describes a Hospital Indemnity policy? Coverage that reimburses an insured for surgeon expenses Coverage that pays a stated amount per day of a covered hospitalization Coverage that replaces lost income due to hospitalization Coverage that pays for hospital room and board Coverage that pays a stated amount per day of a covered hospitalization M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim? $1,600. In this situation, $2,200 - $200 deductible x 80% = $1,600. Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)? Employee funds the HRA entirely Employer funds the HRA entirely HRA's can be offered with other health plans HRA's allow reimbursement for eligible medical expenses Employee funds the HRA entirely. This is inaccurate. HRA plans are employer-funded medical reimbursement plans. Which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness? Major Medical Hospital Expense Surgical Expense Hospital Income The phrase "This policy will only pay for a semi-private room" is an example of a(n) internal limit. Certain types of expenses may have limits placed on the dollar amount of certain services or on the type of service provided. Which of the following individual health insurance policies will provide the broadest protection? Hospital Expense Surgical Expense Major Medical Limited Sickness A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will Continue Coverage but exclude the heart condition. If the insured did not cite the condition on the application and the insurer did not exclude the condition, the pre-existing condition provision still applies. Exclusions are subject to the "time limit on certain defenses" provision, however. S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a High-deductible health plan. To be eligible for a Health Savings Account, an individual must be covered by a high-deductible health plan (HDHP), must not be covered by other health insurance (does not apply to accident insurance, disability, dental care, vision care, long-term care), must not be eligible for Medicare, and can't be claimed as a dependent on someone else's tax return. Which of the following statements BEST describes dental care indemnity coverage? Services are reimbursed before the insurer receives the invoice Services are reimbursed after insurer receives the bill In-network dentists must always be used Very limited list of providers Services are reimbursed after insurer receives the bill Which of the following phrases refers to the fees charged by a healthcare professional? Deductible Coinsurance Usual, customary, and reasonable expenses Hospital expense Usual, customary, and reasonable expenses All of the following statements about Major Medical benefits are true EXCEPT The deductible can be expressed as a fixed dollar amount The benefit period begins only after a specified amount of expenses have accrued Benefits are generally expressed as a percentage of eligible expenses Benefits have no maximum limit Benefits have no maximum limit, They do have a limit A Health Reimbursement Arrangement MUST be established By the employer. HRAs are employer-established benefit plans that must be funded by the employer. What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? Dread disease insurance. Dread disease insurance provides benefits for ONLY specific types of illnesses such as cancer or stroke.
Which of the following types of policies frequently uses the term "deductible"? Major Medical policy Basic Surgical policy Basic Hospital policy Worker's Compensation Major Medical policy. Most major medical benefits begin to be paid after the deductible is satisfied.
An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses? $3,000. In this situation, the insured is responsible for $1,000 deductible + 20% of the remaining bill = $3,000. In Major Medical Expense policies, what is the intent of a Stop Loss provision? Limits an insured's out-of-pocket medical expenses A characteristic of Preferred Provider Organizations (PPOs) would be Discounted fees for the patient. Under Preferred Provider Organizations, patient fees are discounted in return for using listed providers. Which of the following situations is a critical illness plan cover?Critical-illness plans often cover diseases like cancer, organ transplant, heart attack, stroke, renal failure, and paralysis, among others. There is no coverage if you're diagnosed with a disease that isn't on the specific list for your plan, and the list of covered illnesses varies from one plan to another.
What type of policy would only provide coverage for specific types of illness?A critical illness plan covers a specific disease or condition and pays you a lump sum following the diagnosis of a covered illness. Critical-illness plans cover conditions like cancer, organ transplant, heart attack, stroke, renal failure or paralysis.
What is the difference between major medical and catastrophic coverage?Catastrophic plans differ from major medical health insurance in that they offer a very limited range of benefits. These plans will typically cover expenses associated with a hospitalization, surgery, major illness, or injury. However, they will not cover preventive care or minor health issues.
Which of the following was developed to cover the costs of catastrophic expenses from illness or injury?Health insurance protects you from catastrophic bills in case of a serious accident or illness.
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A catastrophic illness would be BEST covered by which of the following health insurance Plans
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