What is Catastrophic Health Insurance in Texas?

In Texas, Catastrophic Health Insurance is a branch of health insurance that provides coverage to a policyholder in the event of sudden circumstances such as illness or disaster. Catastrophic Health Insurance is limited to individuals who meet specific eligibility criteria. The policy can be purchased through the federal or state Health Insurance Marketplace during the open enrollment period or during the special enrollment period (SEP).

Catastrophic Health Insurance is in different pool-risk to the metal-level plans. It meets the Qualified Health Plans (QHPs) requirements, but policyholders are limited to three primary care visits before meeting the yearly deductible. Generally, Catastrophic Health Insurance policyholders are not eligible for healthcare subsidies under the Affordable Care Act (ACA)

What is Considered Catastrophic Health Insurance?

In Texas, Catastrophic Health Insurance is a low-premium insurance plan with a high deductible that provides coverage for injuries and illnesses in cases of sudden disasters. With Catastrophic Health Insurance, you pay a low premium but pay out-of-pocket for most routine care treatments. Also, Catastrophic Health Insurance offers three primary care visits per year and does not provide coverage for medical conditions unless the policyholder has paid the deductibles in full.

Catastrophic Health Insurance is an insurance plan that does not belong to the metal-level plan but the general risk pool. The metal-level plan categorizes the percentage of cost the insurance pays based on the cost incurred by the policyholder. The metal-level plan is in the following groups:

• Bronze plan
• Silver plan
• Gold plan
• Platinum plan

In the metal-level plan, the percentage of the cost covered by the insurance company are in the orders: 60%, 70%, 80%, and 90% respectively for bronze, silver, gold, and platinum plans, while the policy owner pays the remaining costs.

Catastrophic Health Insurance does not fall within any metal-level plans sub-categories; it has a large deductible that a policyholder must meet before the insurance company steps in. There will be no additional charges for the rest of the year once the deductible payment is complete.

A Catastrophic Health Insurance policyholder is entitled to three primary care visits annually before paying the total cost of the annual deductible. Apart from some routine preventive and essential health benefits, the policyholder bears a significant part of the cost of most treatments.

What is the Purpose of Catastrophic Health Insurance?

The purpose of Catastrophic Health Insurance in Texas is to offset the costs of worst-case emergency medical treatments resulting from unexpected injuries and illnesses. Catastrophic Health Insurance also provides coverage for essential health benefits and certain preventive health care services.

What is Catastrophic Health Insurance for?

Catastrophic Health Insurance in Texas provides insurance coverage for treatments of illnesses of worst-scenario emergency cases for individuals below 30 years and for persons 30 years or older who meet certain criteria. Catastrophic Health Insurance provides health insurance protection for individuals who can not afford standard health insurance.

Catastrophic Health Insurance also provides essential health benefits to the policyholder under the Affordable Care Act (ACA)._ _Prior to 2019, if you did not have a health insurance plan when you could afford one, you had to pay the penalty; Catastrophic health insurance helped the insured avoid such penalties.

What are the Types of Catastrophic Health Insurance?

Catastrophic Health Insurance can be classified based on the health care provider as:

• Health Management Organization (HMO)
• Exclusive Provider Organization (EPO)
• Point-Of-Service plan (POS)
• Preferred Provider Organization

A health care provider can either be an in-network provider or an out-of-network provider. Insurance providers expect policyholders to use only in-network providers, and they give incentives in the form of lesser out-of-pocket payments for doing so.

Do You Need Catastrophic Health Insurance in Texas?

You do not need to have Catastrophic Health Insurance in Texas if you already have standard Health Insurance. Catastrophic Health Insurance offers similar coverage to the Affordable Care Act. It is an alternative for individuals who do not have any health insurance. Catastrophic Health Insurance is good for you if you do not have a health insurance plan but may need coverage for future expensive health care services.

Why Do You Need Catastrophic Health Insurance?

You need Catastrophic Health Insurance for medical emergencies that cost much more than your Catastrophic Health Insurance yearly deductible.

Catastrophic Health Insurance is designed for costly medical emergencies. For example, if you suddenly fall sick and the cost of treatment runs into several thousand dollars, Catastrophic Health Insurance will help you save on the medical bills.

In Texas, Catastrophic Health Insurance affords you free access to preventive care services and essential health benefits under the Affordable Care Act (ACA). Also, you are entitled to at least three primary care visits before paying up your yearly deductible.

The essential health benefits under the Affordable Care Act (ACA) include:

• Emergency services
• Laboratory services
• Outpatient care without having to be admitted (ambulatory services)
• Prescription drugs
• Chronic disease management (along with preventive and wellness services)
• Hospitalization (in the event of surgery and overnight stay)
• Pediatric services (including oral and vision treatments)
• Ante-natal and postnatal cares
• Rehabilitative and habilitative care services
• Mental health, substance abuse, and behavioral health care services.

The Affordable Care Act provides health insurance at the federal and state levels, primarily providing coverage at subsidized rates and eliminating discrimination against individuals with preexisting health conditions.

How Much Catastrophic Health Insurance Do You Need?

The amount of Catastrophic Health Insurance you need in Texas depends on your health status and projections for medical expenses within the policy term. If you are in constant need of routine preventive health care services or want to benefit from the ACA essential health benefits, you may want to consider a Catastrophic Health Insurance plan. However, Catastrophic Health Insurance has downsides; it comes with a high deductible, and you have to make out-of-pocket health care expenses equaling your yearly deductible before your coverage sets in.

Catastrophic Health Insurance can be helpful as a payment source for the ten different categories of health benefits listed in the Affordable Care Act. These are:

• Emergency Services
• Hospitalization (for cases involving an overnight stay)
• Prescription of drugs
• Laboratory services
• Mental health treatments (this also includes treatments for substance abuse).
• Pediatrics services
• Rehabilitative and Habilitative Services
• Prenatal and Postnatal care
• Outpatient Services (Ambulatory Services)
• Chronic disease management (Preventive and Wellness Services.

What Catastrophic Health Insurance Coverage Do You Need?

In Texas, the type of Catastrophic Health Insurance you need depends on the service provider. You may choose an out-of-network or an in-network service provider. If your insurance provider allows you to use out-of-network service providers, it may cost you more than using an in-network service provider, which the insurance provider strongly recommends.

Is Catastrophic Health Insurance Required by Law in Texas?

No, Catastrophic Health Insurance is not required under Texas laws. Standard health insurance policy will provide similar coverage to Catastrophic Health Insurance and more benefits. The significant advantage of Catastrophic Health Insurance is its low premium.

How Does Catastrophic Health Insurance Work?

With Catastrophic Health Insurance in Texas:

• You must be under 30 years, and if 30 years and over, you must have a hardship (or affordability) exemption.
• You pay a low premium but have a high deductible.
• Catastrophic Health Insurance provides free coverage for certain preventive care treatments and essential health benefits._ _For expensive health procedures, insurance coverage applies after the policyholder has met the deductibles.
• Catastrophic Health Insurance does not offer subsidies to offset the costs of treatments.

What is Covered by Catastrophic Health Insurance?

Catastrophic Health Insurance in Texas covers the following:

• Emergency health care costs
• Certain preventive health care treatments
• Certain preventive care treatments and screenings
• Essential health benefits
• At least three primary doctor's visits before the annual deductible payment are complete.
• Essential Health Care services
• Child care (pediatric) treatment.

What is Catastrophic Health Insurance Good for?

In Texas, Catastrophic Health Insurance is good for:

• Paying for the overwhelming cost of expensive medical emergencies caused by sudden illnesses or injuries Paying for certain preventive care services, which can be expensive if paid for out-of-pocket
• Avoiding penalties associated with not having a health policy.

What Does a Typical Catastrophic Health Insurance Include?

Catastrophic Health Insurance provides coverage for:

• Essential Health Benefits as stipulated in the Affordable Care Act
• Certain preventive care services
• At least three doctor’s visits before completing the deductible payments.
• Emergency health issues whose costs exceed the annual deductible of the policyholder.

Who is Covered by Catastrophic Health Insurance?

Catastrophic Health Insurance in Texas covers the individual policyholder listed in the policy document. Unlike some health insurance plans, Catastrophic Health Insurance provides coverage on an individual basis irrespective of how the plan is bought (by the individual or through an employer). There are no family or group plans.

What Types of Items Does Catastrophic Health Insurance Cover?

Catastrophic Health Insurance covers expenses associated with sudden worst-case medical issues such as:

• Unexpected accidents like life-threatening automobile accidents that may require complex surgeries
• Illnesses requiring transplants or freaky accidents requiring a visit to the emergency room (ER)

A Catastrophic Health Insurance policy can offset the high cost of a heart, kidney, or liver transplant. Similarly, Catastrophic Health Insurance can cover the costs of treating severe injuries sustained from activities such as sports and entertainment.

Does Catastrophic Health Insurance Cover Emergency Health Care?

Yes. Catastrophic Health Insurance provides coverage for medical emergencies as an essential health benefit. In the event of a medical emergency, you can visit the hospital without seeking approval from your insurance provider.

Does Catastrophic Health Insurance Cover for Pre-Natal and Post-Natal Care?

In Texas, Catastrophic Health Insurance covers the period between pregnancy and after childbirth. Like every other health insurance plan in the insurance marketplace. The benefits also extend to the newly born.

Does Catastrophic Health Insurance cover Mental Health?

Yes, it covers mental health treatments. Behavioral health treatments, including counseling and psychotherapy, are covered by Catastrophic Health Insurance in Texas, including substance abuse treatments.

Does Catastrophic Health Insurance Cover Ambulatory Patient Services?

Catastrophic Health Insurance covers ambulatory (outpatient services) in Texas. Some injuries and illnesses may not require the hospitalization of the policy owners. Such medical care services include doctor's visits for checkups and emergency room treatments that do not require sleeping over at the hospital.

What is Not Covered by Catastrophic Health Insurance?

Catastrophic Health Insurance does not cover more than three primary care visits before the policy owner meets the annual deductible. Additional visits must be paid out-of-pocket by the policyholder. Though with some policy plans, what is not covered may depend on the insurance company, but generally, Catastrophic Health Insurance in Texas does not cover the following treatments:

• Non-life threatening cosmetic surgeries
• Abortion
• Fertility treatments
• Weight loss surgeries.

What Does Catastrophic Health Insurance Typically Exclude?

Catastrophic Health Insurance excludes coverage for:

• Non-emergency related health issues
• Pre-existing health issues
• Cosmetic surgeries such as breast augmentation
• Routine preventive care services
• Annual medical examinations
• Payments for prescription medications

In Texas, Catastrophic Health Insurance only pays for emergency health cases. The policyholder pays for most preventive health care services.

What is the Most Common Use of Catastrophic Health Insurance?

In Texas, Catastrophic Health Insurance payouts are used to settle the medical bills incurred from emergency medical treatments. Catastrophic Health Insurance provides coverage for unexpected illnesses such as heart attacks and cancer, and also injuries from an automobile accident. The insurance coverage sets in once the policy owner pays the annual deductible (these includes copay and coinsurance)

What is the Difference Between Catastrophic Health Insurance and Major Health Insurance?

The following are the differences between Catastrophic Health Insurance and other health insurance plans:

• Unlike other types of health insurance, Catastrophic Health Insurance does not follow the metal-level plan structure. Catastrophic Health Insurance is a one-tier structure where an individual pays a low premium for a high deductible.
• Catastrophic Health Insurance is only available to individuals under 30 years and those over 30 years but with a hardship exemption.

Do I Need Catastrophic Health Insurance if I Have Short-Term Insurance?

Yes, you may need Catastrophic Health Insurance if you have a short-term insurance plan. A short-term insurance plan is a low-premium plan like Catastrophic Health Insurance, but with limited coverage. It is usually a temporary solution to the loss of coverage. Unlike Catastrophic Health Insurance, short-term health insurance usually does not cover the following:

• Mental Health issues
• Pre-natal and Post-natal care
• Drug prescriptions for outpatients.

When Does Catastrophic Health Coverage Begin?

In Texas, Catastrophic Health Insurance coverage begins when the policyholder pays the total yearly deductibles. Catastrophic Health Insurance deductibles are the total out-of-pocket medical expenses a policyholder must make before having coverage for catastrophic incidents.

What Happens if You Don't Use Catastrophic Health Insurance?

If you do not file a claim under your Catastrophic Health Insurance policy despite having reasons to do so, you will not get a refund. Not filing a claim indicates you did not suffer from any illness or injury. Hence, you are not qualified for any compensation from the insurance company.

If you cancel the policy that has been already prepaid, you will receive a refund of the unused premium from the insurer. Usually, it is mailed via a paper check to the mailing address listed on the policy.

Who Can Get Catastrophic Health Insurance in Texas?

Catastrophic Health Insurance is suitable for you if you:

• Are healthy
• Have no preexisting conditions
• Take only non-costly prescription drugs
• Do not make frequent visits to the doctor
• Can only afford the low premium for an insurance coverage
• Do not qualify for Medicaid
• Are not qualified for a subsidy because of income level.

Who Qualifies for Catastrophic Health Insurance?

You are eligible for Catastrophic Health Insurance in Texas if you are under 30 years or over 30 years and qualify under one or more of the following hardship exemptions:

• Experienced domestic violence
• Filed for bankruptcy
• Homelessness
• Death of a family member
• Increase in expenses incurred from caring for a disabled family member
• Ineligibility for Medicaid
• You experienced an artificial or natural disaster that caused sizable damages to property
• Facing eviction or foreclosure.

Who Needs Catastrophic Health Insurance?

Catastrophic Health Insurance is good for individuals receiving expensive medical treatments for illnesses or injuries from artificial or natural disasters. The Cost of treatments like surgical operations resulting from injuries sustained from accidents caused by disasters such as fire outbreaks, earthquakes, and floods can be overwhelming without an insurance policy.

Who Should Get Catastrophic Health Insurance?

You should get Catastrophic Health Insurance in Texas if:

• You want insurance coverage for medical emergencies
• You are willing to pay for other health service expenses out-of-pocket.
• You are under thirty years
• You are 30 years or above but have hardship or affordability exemption

Catastrophic Health Insurance is also valuable if you are healthy and do not require frequent doctor's visits.

Individuals who have expensive medical needs and can afford to pay the high deductible associated with Catastrophic Health Insurance can get Catastrophic Health Insurance. Consult a Texas licensed insurance agent for advice and further clarification on Catastrophic Health Insurance.

What are the Benefits of Catastrophic Health Insurance?

In Texas, the benefits of Catastrophic Health Insurance include coverage for certain preventive health care services and essential health services. Catastrophic Health Insurance also offers three doctors visits before the deductibles yearly. Consult a licensed insurance agent who can educate you on what you stand to benefit from purchasing a Catastrophic Health Insurance policy.

PROs and CONs of Catastrophic Health Insurance in Texas

The Pros and Cons of Catastrophic Health Insurance in Texas include:

PROs of Catastrophic Health Insurance

• Catastrophic Health Insurance provides coverage for medical emergencies
• It allows you to access specific preventive care treatments
• It provides you the opportunity to visit doctors

Before 2019, Catastrophic Health Insurance was a relatively cheap way of avoiding healthcare mandates or penalties for not having a health insurance plan.

CONs of Catastrophic Health Insurance

• Catastrophic Health Insurance has a very high deductible
• It only provides coverage after paying the deductible
• It offers only three doctor's visits before completing the deductible
• Coverage for preventive care services is limited
• It has a high out-of-pocket payment

Before choosing a health insurance plan in Texas, speak to a state-licensed insurance agent who can help select the right plan tailored to your needs.

Is it Worth Getting Catastrophic Health Insurance in Texas?

Catastrophic Health Insurance is worth getting for healthy individuals who do not run up costs for regular medical treatments. It may be more beneficial to younger individuals (who are assumed to be healthier) than older people. Catastrophic Health Insurance is a way for making plans for future severe medical issues.

What Happens if You Don't Have Catastrophic Health Insurance?

If you do not have Catastrophic Health Insurance and do not have an alternative plan, you will pay expensive emergency health treatments out-of-pocket. If you can not afford Catastrophic Health Insurance or a standard health plan, you can most likely qualify for government subsidies for ACA-compliant plans or you can get a short-term health insurance plan.

Discuss your situation with a knowledgeable independent health insurance professional, who can suggest the best options to suit your specific needs.

Why is Catastrophic Health Insurance Important?

Catastrophic Health Insurance is important because, with its low premium, you can pay for expensive health care treatments which you may not be able to afford out-of-pocket payments.

What Happens When Your Catastrophic Health Insurance Lapses?

When your Catastrophic Health Insurance lapses, you will get a notification from your insurance company giving you a grace period to pay up or lose your insurance coverage. The grace period for Texas is 31 days. Failure to pay up the outstanding premium within the grace period will lead to loss of coverage.

Consult a Texas licensed insurance agent for comprehensive information on how to avoid lapse of your Catastrophic Health Insurance coverage. They can also assist in reinstating your insurance coverage if it lapses.