In Texas, the cost of a Catastrophic Health Insurance plan differs depending on age, location, and insurance provider. The average price is less than the bronze plan, which is the lowest of the metal-level categories in the Marketplace. It comes with a low premium but a very high deductible. The average monthly premium for Catastrophic Health Insurance in Texas is $195, with a deductible of $8,700 (in 2022). Your deductible is the out-of-pocket spending you make on your health plan that is not reimbursed by the insurance company.
Before signing the policy document, a policyholder and the insurance provider must agree on the premium for coverage. Contact a state-licensed health insurance agent for detailed and up-to-date information on the cost of Catastrophic Health Insurance coverage.
The amount you pay for Catastrophic Health Insurance in Texas depends on your location, age, and insurance provider. Prices increase with age since you become a higher risk as you get older. Young individuals are considered healthier and less prone to sudden illnesses than older adults.
As a Catastrophic Health Insurance policyholder, you can only enjoy the benefits of the policy after paying your full annual deductible before you can get insurance coverage. You pay for most services out-of-pocket until you meet your yearly deductible. Contact a Texas-licensed insurance agent to find out the current cost of premiums and deductibles in your location.
The cost of a Catastrophic Health Insurance plan is the sum of all the monies you spend to get health care service under the insurance plan. To calculate the total cost of your Catastrophic Health Insurance policy, sum up the cost of the monthly premium and your out-of-pocket payments.
A Catastrophic Health Insurance premium is an agreed upon amount you pay monthly to an insurance company in exchange for coverage and to keep your policy active.
A Catastrophic Health Insurance deductible is the amount you must pay out-of-pocket, before the insurance plan starts to provide major coverage.
Your out-of-pocket payments are the monies you pay from your pocket for services received. For your Catastrophic Health Insurance, you bear the full cost of your treatments until you have spent the amount totaling your yearly deductible. The out-of-pocket max for 2022 was $8,700. After you have spent this amount on your health treatment, the insurer steps in. Beyond the out-of-pocket max, the insurance company will pay 100 percent of the cost of treatments if you use in-network care providers.
Copayments and Coinsurance
Both of the following are paid in addition to the plan’s deductible:
On average, Catastrophic health insurance in Texas costs about $195 monthly with an annual deductible of $8,700 for 2022. However, if you are young, healthy, and do not need frequent medical attention, you will spend less money on Catastrophic health insurance. You can save on out-of-pocket payments for doctor's appointments. Make sure to shop around to find the insurance provider that offers the most affordable rate before buying a plan.
In Texas, typical Catastrophic health insurance depends on how often you visit the doctors. Two different policyholders may end up spending different amounts on their plans even if they use the same insurance company and are paying the same amount as premiums.
If you have an insurance plan and end up not being ill or injured all year round, the cost of your policy for the year is the sum of your premium. On average, it may cost a policyholder who does not use the coverage $2,340 yearly ($195 x 12 months).
However, if you must visit the doctors, in addition to the premium, you will have to pay the full cost of healthcare until you spend the amount equal to the plan’s deductible. For catastrophic health insurance to start providing full coverage, you will need to pay the monthly premiums, plus the deductible ($8,700 in 2022). After the deductible is met, the insured may be still responsible for copay (if required by the plan).
The deductible of catastrophic health insurance matches the maximum allowable Max-out-of-Pocket (MOOP) permitted under the Affordable Care Act for the year. This means that in 2022, in the worst-case scenario, if you got seriously injured or sick, and had to be hospitalized and treated, your total expense on catastrophic health insurance and healthcare for the year was not to exceed $11,040 plus a minimal copay, that may be required by some plans:
$2,340 in annual premiums + $8,700 deductible + copays. Most Catastrophic health insurance copays in Texas are $0 to 20 per doctor's visit.
In Texas, the key factors that determine the premium you pay for catastrophic health insurance coverage are age, the insurance provider and the type of health care plan you choose. Older individuals are believed to be more prone to ill health, and hence, a greater risk. Insurance companies charge higher premiums for older individuals.
Catastrophic health insurance coverage is usually offered to individuals under 30 years (unless other eligibility requirements have been met). For instance, comparing the premiums (see note) for two males: 20 and 29 year old both living in San Antonio Texas, and thinking of purchasing catastrophic health plans from the same providers. The premiums may vary based on the insurance and the type of health care plan, but all things being equal, the older individual always pays more.
For the 20 year old on an Exclusive Provider Organization (EPO) plan, it may cost between $190 and $210, while the 29 year old pays between $220 and $240 for the same coverage.
(Note: Mentioned premiums reflect the plans that were available through the Texas health marketplace in 2022.)
Yes, Catastrophic Health Insurance has a high deductible. It is a low premium, high deductible emergency-case scenario insurance plan. It provides similar health benefits to the regular health insurance plan but only after the insured has paid the full deductible.
No. Since the deductible for all catastrophic plans is set every year, it cannot be adjusted. Every year a new (and usually higher) limit is set.
In the past, catastrophic health insurance deductibles were:
2022 - $8,700
2021 - $8,550
2020 - $8,150
2019 - $7,900
Most importantly, unlike the rest of the Affordable Care Act plans purchased on and off the health marketplace, catastrophic health insurance is expensive because it does not allow government subsidies, which make healthcare more affordable to lower income Texas residents.
Catastrophic health is expensive because it provides coverage for high-cost, worst-case emergency illnesses and injuries, whose costs are higher than the plan's annual deductible. If a catastrophic health Insurance policy owner spends the agreed deductible for the year, the insurance plan provides coverage for the rest of the year.
The number of times you visit the doctor is most likely responsible for the high cost of your catastrophic health insurance. Frequent visits may eventually lead you to make more out-of-pocket payments than you would have spent using more expensive ACA-compliant health plans.
Your location is another factor determining the cost of Catastrophic health coverage. If you live in a metropolitan area, you will pay more for insurance than someone in a rural area. The high cost of Catastrophic health insurance may also be a result of using out-of-network care providers. In-network care providers offer services at discounted rates, while out-of-network providers may charge whatever price they choose.
In Texas, the cost of catastrophic health insurance premiums increases or decreases based on the insured’s age and location. The older you are, the more you pay for coverage. Also, most times, individuals living in urban areas pay more for coverage than those in rural areas.
No, just like other ACA-compliant health plans, catastrophic health insurance does not go up after a claim. The monthly premium amount remains the same.
Making a claim will not increase the cost of Catastrophic health insurance in Texas. The premium remains the same until the annual renewal, at which point the newly established federal rates are offered.
Catastrophic health insurance costs will not go up if you contracted COVID-19. The policy covers all health-related issues once the policyholder meets the yearly deductible.
In Texas, the cost of your Catastrophic health insurance may be based on the types of health plan you choose. Texas has four catastrophic health plans:
The insured’s health care treatments can be handled by either an in-network or out-of-network provider. With an in-network plan, you use only doctors recommended by the insurance company for cheaper rates compared to out-of-network doctors.
Both HMO and EPO plans use in-network doctors, but HMO tends to be the cheapest of all the plans. Unlike HMO and EPO, out-of-network plans like PPO and POS plans allow you to use any doctor of your choice, but it will cost you more.
No, the cost of catastrophic health insurance does not go down. Instead, it goes up every year. The federally-set deductible is raised every year, resulting in increasing out-of-pocket expenses for the insured. In addition to the deductible, insurers adjust the cost of the plans annually. The annual increase or decrease of Catastrophic premium is usually expected within 3 percentage points of the previous year.
Just like with any type of insurance, the amount of catastrophic health insurance you need depends on your specific needs. Catastrophic insurance can help you get health coverage if you can not afford traditional health insurance due to the high premium cost. It offers similar benefits as other ACA-compliant health insurance plans on the Marketplace but limits the amount of covered primary care visits before the deductible is fully paid.
Make sure to discuss your coverage needs with a knowledgeable and experienced Texas-licensed health insurance agent, who can analyze your needs and advise on the possible solutions.
Most Texans who decide to get catastrophic health insurance coverage, do so to:
When looking at the locally available plans, the options will differ based on the:
The deductible does not change. It is the same across all the options.
Frequently, Texas residents who qualify for Catastrophic health plans also qualify for subsidies, which can make regular ACA insurance more affordable. Discuss your options with an experienced health insurance professional, who can guide you through the evaluation. Ask your agent to explain all the other options that can be purchased in Texas, to save money on health coverage: ACA, short-term, and supplemental health.
You can save on catastrophic health insurance by using only in-network health care providers also helps reduce the cost of treatments and save money. In-network service providers offer their services to the insurance companies at a discount. You can also save money by asking for a discount from your health care provider when paying out-of-pocket.
No, you cannot negotiate the cost of catastrophic health insurance. The deductible is federally-set and the premium rates are set by the insurer. However, while you are paying for services out-of-pocket until the deductible is met, you are paying a discounted rate, which was negotiated between your insurer and the doctors. This pre-negotiated rate is usually 10%-50% lower than if you would have come in to see the doctor without any health insurance coverage.
The best way to save on any insurance is to contact a knowledgeable and state-licensed insurance agent, who can analyze your situation and make professional recommendations based on the locally available options, based on your specific needs.
The most common way to save money on Catastrophic health insurance in Texas is to combine it with a Health Savings Account (HSA). You can use the HSA to save tax-free money to pay for your deductible, copayment, and coinsurance. Money from your Health Savings Account can help reduce your out-of-pocket medical costs.
If you can not afford Catastrophic health insurance, there are few other options available to you. You can access health care services via means such as:
If you do not have money, you can not get Catastrophic health insurance. You need money to pay for the premium and deductible. However, if you cannot afford it, you can get cheaper health care treatments if you are qualified for any of the following:
Unlike other types of Texas health insurance (like Short-Term health), catastrophic health insurance is paid monthly and does not offer an option to pay it annually, at a discount.
Catastrophic health insurance does not offer discounts Unlike the majority of Affordable Care Act (ACA) insurance on the individual marketplace Catastrophic Health Insurance does not allow the use of your premium tax credit even if you qualify for it. However, you pay less out-of-pocket by using only the in-network service providers recommended by your insurance company.
Speak with a Texas-licensed health insurance agent to go over the health insurance options based on your health and financial needs.