What Is Catastrophic Insurance, and What’s Covered?

Jan. 7, 2015

“Catastrophic insurance.” Sounds scary, doesn’t it? But catastrophic insurance is a special kind of health insurance coverage consumers can purchase on the federal marketplace. “Hey, Doc” the Texas Medical Association’s education campaign, explains catastrophic insurance and what it covers in this week’s Q&A.

What is catastrophic insurance?

Catastrophic insurance is meant to be a sort of safety net that covers you when something like a major accident or serious illness comes up.

It covers only three regular doctor visits a year and certain preventive care. So your monthly charge, or premium, might be lower for catastrophic insurance, but you likely will have to pay higher costs out of your own pocket before full coverage kicks in for things like essential benefits. And if you buy one of these plans, you won’t be eligible for any financial assistance to help pay for it.

In the marketplace, catastrophic plans are mostly available to people under 30 years old; people who don’t earn much; and people who experience certain hardships, like homelessness, bankruptcy, or unexpectedly high medical bills.

If you are older than 30, you might also qualify temporarily to buy catastrophic insurance if you have an old policy that was canceled for not meeting the new ACA standard, and you can’t afford anything else.  

What is covered by this insurance?

All plans in the marketplace have to offer what’s called “essential health benefits.” This is a basic package covering 10 different categories:

  • Doctor visits;
  • Hospital visits;
  • Prescription drugs;
  • Lab tests;
  • Emergency room visits;
  • Care when you are pregnant and when you have your baby;
  • Care for children;
  • Preventive services that help you stay healthy, like shots and screenings;
  • Mental health care, like counseling; and
  • Treatments that help you recover from injuries.

Some plans might cover more than that, but that’s the minimum. You can also find dental coverage in the marketplace, either included in a plan you buy, or separately.

Marketplace plans also must cover what are called “preexisting health conditions.” This means they must cover you even if you are already sick or pregnant.

See each week’s “Hey, Doc” Q&A and a lot more at texmed.org/Heydoc as well as in TMA’s patient blog at MeAndMyDoctor.com. And TMA’s “Hey, Doc” videos help people understand how to navigate the marketplace.

TMA’s “Hey, Doc” content schedule through January:

Jan. 14: Who can sell me insurance through the marketplace? How do I pick a plan? How many plans can I pick? Can I keep the plan I have now?

Jan. 21: Who will take care of me? What are the networks? How do I pick a doctor? Where can I find this information?

Jan. 28: Can I keep my doctor or hospital when I sign up? How do I find out if my doctor is on my insurance plan’s list? What should I do if I thought my doctor was included but really isn’t?

TMA is the largest state medical society in the nation, representing more than 48,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.



Brent Annear
phone: (512) 370-1381
cell: (512) 656-7320
Brent Annear  

Marcus Cooper
phone: (512) 370-1382
cell: (512) 
Marcus Cooper  

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Check out  MeAndMyDoctor.com for interesting and timely news on health care issues and policy. 

Last Updated On

March 15, 2018