What is a Catastrophic Plan for Health Care Coverage?

 NC residents who are under the age of 30 or have hardship exemptions may purchase “catastrophic” health plans, which will protect them from very high medical costs.

Under a catastrophic plan, you will generally be required to pay all of your medical costs up to a certain amount. Typically, this amount will be several thousand dollars. Any costs for essential health benefits over that amount are generally paid by the insurance company.

Usually, these policies will have lower premiums than a comprehensive plan, but they lack the enhanced features of a comprehensive plan. Essentially, catastrophic plans protect you from worst-case scenarios. Additionally, catastrophic plans cover preventive care. In the NC health care Marketplace, catastrophic policies cover three primary care visits a year at no cost, as well as free preventive benefits.

What are Free Preventive Services?

All plans purchased through the NC Health Insurance Marketplace, and many other plans, must cover the following preventive services without charging a copayment or coinsurance, even if you haven’t met your yearly deductible:

  1. Abdominal Aortic Aneurysm One-Time Screening (for men of specified ages who have ever smoked)
  2. Alcohol Misuse Screening and Counseling
  3. Aspirin Use (to prevent cardiovascular disease for men and women of certain ages)
  4. Blood Pressure Screening (for all adults)
  5. Cholesterol Screening (for adults of certain ages or at higher risk)
  6. Colorectal Cancer Screening (for adults over 50)
  7. Depression Screening (for adults)
  8. Diabetes (Type 2) Screening (for adults with high blood pressure)
  9. Diet Counseling (for adults at higher risk for chronic disease)
  10. HIV Screening (for everyone ages 15 to 65, and other ages at increased risk)
  11. Immunization Vaccines (for adults — doses, recommended ages and recommended populations vary)
  12. Obesity Screening and Counseling (for all adults)
  13. Sexually Transmitted Infection (STI) Prevention Counseling (for adults at higher risk)
  14. Syphilis Screening (for all adults at higher risk)
  15. Tobacco Use Screening (for all adults and cessation interventions for tobacco users)

Am I Qualified for a Catastrophic Plan?

When you fill out a Marketplace application, you’ll see catastrophic plans listed as coverage options if you qualify for them. If you don’t qualify, you won’t see them listed.

Keep in mind that if you buy a catastrophic plan in the Marketplace, you can’t get lower costs on your monthly premiums or out-of-pocket costs based on your income — you will be required to pay the standard price for the catastrophic plan.

To learn more about catastrophic health coverage, whether you qualify, and how you will be covered, contact Independent Benefit Advisors at (919) 303-9690.

Independent Benefit Advisors helps people understand their health care coverage options, including catastrophic plans. We offer insurance assistance to individuals and businesses in ApexRaleighDurhamCaryCharlotteFuquay-VarinaGreensboroRockyMountSanfordWake Forest, and other locations in North Carolina.