Health insurance is complicated enough, but it becomes even trickier when you’re trying to balance affordability with protection. One option that’s often overlooked is catastrophic health insurance. These plans come with low monthly premiums and very high deductibles, making them more of a safety net for worst-case scenarios rather than everyday healthcare.
Starting in late 2025, the rules around who can sign up for catastrophic coverage will change, opening the door for more people to qualify in 2026. Here’s a breakdown of what these plans are, who can get them, and how the new rules could affect your choices.
2026 Rule Changes
Beginning November 1, 2025, federal guidelines will expand access to catastrophic health plans. Previously, eligibility was mostly limited to people under 30 or those who qualified for special hardship exemptions. With the new updates, adults who are not eligible for Affordable Care Act (ACA) subsidies due to income may also qualify.
Key changes include:
- Income-based exemptions: Adults with incomes too low or too high for ACA subsidies will now be considered under hardship rules. CMS also plans to widen access for people above certain income thresholds who don’t receive cost-sharing benefits.
- Simplified applications: HealthCare.gov will automatically check for hardship eligibility during the enrollment process. Mail-in applications will still be available for those who prefer.
- Age flexibility: While the automatic qualification under age 30 remains, adults 30 and older will have an easier path if they can’t access subsidies.
- Expanded definition of hardship: Rising insurance costs alone can now count as a hardship, not just extreme situations like homelessness or bankruptcy.
These updates will apply across federally run marketplaces, participating state exchanges, and even some off-exchange options.
What Is Catastrophic Health Insurance?
Catastrophic coverage is offered through the ACA marketplace and is designed as a last-resort protection plan. The trade-off is simple: you’ll pay less each month, but you’ll be responsible for most costs until you hit the very high deductible.
Standard features include:
- Lower premiums compared to other ACA plans
- Deductibles in the thousands of dollars (often over $9,000)
- Coverage of all essential health benefits once the deductible is met
- Three free primary care visits each year
- Preventive care services at no cost
These plans are built for unexpected medical emergencies rather than routine care.
Who Qualifies?
Right now, you can qualify if you:
- Are under 30, or
- Have an approved hardship exemption, or
- Have an affordability exemption (when the lowest-cost plan is still too expensive compared to your income)
2026 updates will expand this list. Adults who don’t qualify for subsidies because their income falls below or above the ACA subsidy thresholds will automatically be considered for hardship status, making it easier to access catastrophic coverage.
What’s Covered—and What’s Not
Like other ACA plans, catastrophic coverage includes the 10 essential health benefits, such as:
- Emergency care
- Hospitalization
- Prescription drugs
- Maternity care
- Preventive services
What you’ll pay for out of pocket:
- Additional doctor visits beyond the three included
- Specialist appointments
- Non-preventive tests and procedures
- Services not defined as essential (for example, chiropractic care)
Enrolling in a Catastrophic Plan
- If you’re under 30: These plans will appear automatically when shopping through HealthCare.gov.
- If you’re 30 or older: Currently, you need to apply for a hardship or affordability exemption. Starting in 2026, those ineligible for subsidies due to income will be automatically flagged and allowed to choose catastrophic coverage online. Applications will also remain available by mail.
Alternatives to Explore
If a catastrophic plan doesn’t fit your situation, consider:
- Staying on a parent’s plan until age 26
- Student health plans (if you’re enrolled in school)
- Employer-sponsored insurance
- Standard ACA bronze, silver, or gold plans (subsidies can make these surprisingly affordable)
- Health care sharing programs (though these aren’t insurance and don’t guarantee payment)
Common Questions
What exactly is catastrophic health insurance?
It’s a low-premium, high-deductible plan that covers essential ACA benefits and three primary care visits per year. It’s mainly for financial protection in emergencies.
Who can get it?
Currently, people under 30 or those with hardship or affordability exemptions. From late 2025, more adults over 30 will qualify if their income excludes them from ACA subsidies.
What does it cover?
All ACA-required essential benefits, preventive care, and three primary care visits.
How do you apply?
If you’re under 30, you can enroll directly online. If you’re older, you’ll need an exemption. Starting in 2026, the system will automatically apply hardship rules if your income makes you ineligible for subsidies.
The Bottom Line
Catastrophic health insurance can be a lifeline for those who can’t access ACA subsidies but still need coverage for major medical events. With expanded eligibility rules in 2026, more adults will be able to take advantage of these plans. Still, before enrolling, compare catastrophic coverage against subsidized ACA marketplace plans to make sure you’re getting the most value and protection for your money.
