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Catastrophic Insurance Over 30?

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Question: I am eligible for catastrophic insurance due to my old plan being cancelled and my inability to find a plan that I can afford. I have been trying since December to find someone to quote me a price for catastrophic coverage and have yet to find anyone who can do that. Any suggestions on how to break through the Obamacare firewall and access these plans?

Answer: No over-30 rates or online applications available yet. Carriers are just beginning to set up application processes to open off-exchange catastrophic plans to new or current individual members, 30 years of age or older to apply if the attest to their plan being cancelled due to the ACA, and finding other plans unaffordable. So far, no news from Covered California about opening on-exchange catastrophic plans. Background: In late December, HHS released guidance that allow individual plan members with discontinued policies to be eligible for a hardship exemption from the individual mandate and enroll in catastrophic plans that were previously only available to individuals under 30.

7 Comments

Melanie … You leave out important information, such as your/your husband’s ages and your zip code. You also don’t mention whether you have an HSA Bronze plan, or a standard Bronze plan. And I assume your income for a household of two is in excess of $62,9200 — which would make you ineligible for premium tax credits.

An HSA would allow you to set aside money on a pre-tax basis and it remain untaxed if you use it to pay for medical expenses not paid by insurance.

“you might actually save a few dollars in the event of a catastrophic event by purchasing the bronze plan”

Generally, that is an accurate statement. What is also accurate to state is that purchasing a Silver, Gold, or Platinum plan will reduce your out-of-pocket costs and limit your total out-of-pocket expense in a year. Without knowing more about your situation, it is impossible to give you any specific guidance or solutions.

Anyone re-visiting this hardship discussion for the new open enrollment period. Our insurance doubled and is now at $1200/month— we are paying 12 thousand dollars a year for bare bones plan with a $6600 deductible! We are self-employed but married, so our business does not qualify for small business insurance on the CA exchange. Our health insurance premium for the year is now more than our San Mateo County property tax. Where do we find relief given that I’m told we do not qualify for a hardship? If $12,000k per year for insurance that we’ve, thankfully, never had to use isn’t a hardship, then I don’t know what is. All thoughts/ideas most appreciated.

Michael, I went back and did a comparison in my region and I see that you are correct about pricing — it depends on the company. I don’t know whether this holds statewide, but in my region HealthNet is selling the “Minimum” coverage for significantly less than their Bronze ($135 less for a 59 year old); Anthem’s minimum policy is almost $90 less than their Bronze; Blue Shield’s is only $20 less than their Bronze HSA; and Kaiser is actually charging a few dollars MORE for the “minimum” plan than they charge for their HSA.

So I guess it is going to depend on individual preferences and circumstances.

For my client there was about a $130 per month difference in premium rate between the Minimum Coverage Catastrophic plan and the Bronze plans. That’s significant.

For those of older age, there is a greater difference in premium between the Minimum Coverage plan and the Bronze plans.

Location will also be a factor as NoCal plan rates are generally higher than SoCal plan rates.

Max is right about the difference between Bronze & “catastrophic” — also, if you have the funds to do so, you’ll save a little more by going for an HSA plan and setting up & funding an HSA account.

This can be a good option for those of us who are older, and face higher premiums but do have some savings accumulated over the years. You can shift funds into an HSA account and get significant tax write-off for that. If you are just on the cusp for qualifying for subsidies, that HSA tax deduction might also make you subsidy eligible —so if you buy on-exchange you could end up getting a good size tax credit back in 2015. But even with no tax credit, the HSA would give you a tax benefit, plus the funds are available to spend toward your deductible or other medical expenses as needed.

Rates and listed benefits for the Minimum Coverage (or Catastrophic) plans are available (for those age 30 and older, as well as for those age 29 or younger) through the Covered California SHOP and Compare Tool.

Covered California SHOP and Compare Tool: http://www.coveredca.com/fieldcalc/#calculator

I am currently assisting my client with her federal application for a Hardship Exemption.

The web address for the Hardship Exemption Application is:
http://marketplace.cms.gov/getofficialresources/publications-and-articles/hardship-exemption.pdf

Also: How do I qualify for an exemption from the fee for not having health coverage? https://www.healthcare.gov/exemptions/

If you’re from California and call cms.gov in relation to this very (and their own) application, they will tell you to call Covered California… even though the application and instructions are from their website and must sent to them for processing the actual hardship exemption.

There is almost no difference between a bronze plan and a catastrophic plan premium. The only difference between the two is that the bronze plan has a $5000 deductible and $1350 in shared expenses to the $6350 stop loss limit. The catastrophic plan simply allows you the privilege of paying the entire $6350. There is not $100/month difference in monthly premiums (typically the CAT plan is only a few dollars less per month for persons under 30, it shouldn’t be that much more for persons over 30), and you might actually save a few dollars in the event of a catastrophic event by purchasing the bronze plan instead.

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