What Is the Maximum Age for Qualifying for a Catastrophic Plan?

Catastrophic health plans represent a specific type of health insurance designed to provide a financial safety net against high medical costs. These plans cater to individuals primarily seeking protection from unforeseen, significant health events rather than comprehensive coverage for routine medical care. They offer a distinct approach within the broader landscape of health insurance options available to consumers.

Understanding Catastrophic Health Plans

A catastrophic health plan is a form of health insurance structured to cover significant medical expenses resulting from severe illness or injury. Its fundamental purpose is to act as a financial safeguard for major emergencies, providing coverage once very high out-of-pocket costs are met. A defining characteristic of these plans is their combination of relatively low monthly premiums with a very high deductible. This means policyholders pay less each month, bearing a substantial amount of medical costs themselves before the insurance begins to pay. These plans are mandated to cover essential health benefits as defined by the Affordable Care Act (ACA).

Eligibility Requirements

Eligibility for catastrophic health plans is specifically defined by federal regulations. These plans are generally available to individuals who are under 30 years of age. This age criterion aims to provide a lower-cost insurance option for younger individuals.

However, individuals aged 30 or older may also qualify under specific circumstances through exemptions. Two primary types of exemptions exist: the affordability exemption and the hardship exemption. An affordability exemption can be granted if the lowest-priced health coverage available to an individual, whether through a Health Insurance Marketplace or employer-sponsored plan, would exceed a certain percentage of their household income. For 2025, this affordability threshold is set at 9.02% of household income.

A hardship exemption is available for individuals facing difficult life situations that prevent them from obtaining affordable health insurance. Qualifying situations include homelessness, eviction or foreclosure, utility shut-off notices, domestic violence, death of a close family member, substantial property damage from a disaster, bankruptcy, or significant medical debt. To obtain a hardship exemption, an application must be submitted, and if approved, an Exemption Certificate Number (ECN) is issued, which is needed to enroll in a catastrophic plan.

Key Financial Features

The financial structure of catastrophic health plans is distinguished by their high deductible. This deductible represents the amount an individual must pay out-of-pocket for covered medical services before the insurance plan starts to contribute. For instance, in 2025, the annual deductible for an individual under a catastrophic policy is $9,200, which also serves as the annual out-of-pocket maximum. This means once the deductible is met, the plan covers 100% of essential health benefits for the remainder of the year. The out-of-pocket maximum for an individual is set to increase to $10,600 in 2026.

Despite the high deductible, catastrophic plans provide coverage for certain preventive services at no additional cost, even before the deductible is met. These services include annual check-ups, routine screenings, and vaccinations. Catastrophic plans also cover at least three primary care visits per year, with some cost covered by the insurer before the deductible is satisfied.

Enrolling in a Catastrophic Plan

Catastrophic health plans can be purchased through the Health Insurance Marketplace, a platform for individuals to compare and enroll in health coverage. Enrollment occurs during the annual Open Enrollment Period. For 2025 coverage, the Open Enrollment Period runs from November 1 to January 15. Selecting a plan by December 15 allows coverage to begin on January 1 of the following year.

Outside of this standard period, individuals may still be able to enroll during a Special Enrollment Period (SEP). A Special Enrollment Period is triggered by qualifying life events that significantly change an individual’s life situation or health coverage needs. Examples of such events include losing existing health coverage, getting married, having a baby or adopting a child, or permanently moving to a new area. If a qualifying life event occurs, individuals have a 60-day window from the event date to apply for a Special Enrollment Period and select a plan.