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Catastrophic plans

What is catastrophic health insurance?

Catastrophic health insurance is a plan for individuals under 30 and those with extreme financial hardship. Catastrophic coverage protects members from the costs of worst-case scenarios, providing coverage for hospitalization or serious illnesses.

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Who qualifies for a catastrophic health plan?

A catastrophic health insurance plan may be the best option if:

  • You’re under the age of 30.
  • You’re over the age of 30, AND you qualify for an exemption due to extreme financial hardship.

How does catastrophic health insurance work?

Members pay a monthly premium for coverage. In addition to the premium, individuals with catastrophic coverage pay all their health care costs until they meet the individual deductible amount ($9,100 in 2023). Families with catastrophic coverage will pay all their health care costs until they meet the family deductible amount ($18,200 in 2023). Once the deductible is met, the plan will begin to pay its share for covered services.

Some items and services will be covered even if the member hasn’t yet met their deductible. But a copayment or coinsurance may apply. For example, catastrophic plans cover certain preventive services without cost-sharing and before the deductible has been met. See a list of covered preventive services.

Simple Saver EPO Catastrophic plan

AmeriHealth offers the Simple Saver EPO Catastrophic plan to individuals and families who qualify.

Simple Saver EPO catastrophic1
Member pays in-network
Deductible Individual: $9,100
Family: $18,200
Primary care physician visit $30 copay, no deductible for the first three visits per calendar year, then remaining visits are covered at 100% after deductible
Specialist visit No charge after deductible
In-patient hospital services, including maternity No charge after deductible
General prescription drugs No charge after deductible

What are the pros and cons of catastrophic health insurance?

  • Pro: Catastrophic plans have lower monthly premiums than plans in the metallic categories.
  • Con: Catastrophic plans have much higher deductibles and out-of-pocket costs than plans in the metallic categories. This could mean high costs if you get sick or hurt.
  • Con: The Simple Saver EPO catastrophic plan does not have out-of-network coverage, except for emergency care services.

What do catastrophic health insurance plans cost?

Catastrophic plan monthly premiums are based on age and household size. Refer to the Monthly Premium Rate Card to view and compare monthly premiums.

What are my other health plan options?

AmeriHealth offers a variety of EPO health plans for individuals and families. No matter which of our EPO plans you choose:

  • You are not required to select a primary care physician.
  • You do not need a referral to see a specialist.
  • Some plans have an option to open a tax-advantaged health savings account (HSA).

Do I really need health insurance?

The State of New Jersey has an individual health insurance coverage mandate, which requires New Jersey residents to have health insurance or possibly pay a fine. This helps keep insurance premiums lower for individuals because it pools together all the health care consumers in a given area — both those who are likely to have very few medical issues and those who are likely to have very many.

1 Catastrophic plans are only available for qualified individuals.