The U.S. Department of Health and Human Services (HHS) announced that it is implementing measures to expand access to “more affordable” catastrophic health coverage through its new hardship exemption guidance. “More Americans will be able to qualify for catastrophic health coverage based on need, beginning November 1, with the start of open enrollment,” the announcement said.
Catastrophic plans generally have lower monthly premiums than other plans and very high deductibles. They are intended to protect consumers from very high medical costs in the event of serious illness or injury, while still requiring coverage of three primary care visits pre-deductible. “Consumers under the age of 30 have always been eligible for catastrophic plans through HealthCare.gov,” the announcement continued.
Catastrophic health plans cover the same 10 essential health benefits (EHBs) as other Marketplace plans. The 10 EHBs that HealthCare.gov lists are as follows:
- Ambulatory outpatient services
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage are not essential health benefits)
Additional benefits that plans may offer include dental coverage, vision coverage, and medical management programs for specific needs like weight management, back pain, and diabetes.
Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits and medical and surgical benefits, according to HealthCare.gov. Parity financial protections include deductibles, copayments, coinsurance, and out-of-pocket limits. Treatment protections include limits to the number of days or visits covered. Required authorizations before treatment are addressed as part of care management protections.
Marketplace plans are available in four categories (or “metal levels”): Bronze, Silver, Gold, and Platinum. Catastrophic plans are a fifth category available to people under 30 and some people with limited incomes, according to HealthCare.gov. Categories vary by the plan’s share and the consumer’s share of costs for covered services.
“Under new HHS guidance, consumers may qualify for a hardship exemption to purchase a catastrophic plan on or off the Exchange if they are determined or expect to be ineligible for APTC or CSRs based on their projected annual household income,” the announcement stated.
Beginning November 1, 2025, consumers can apply for the hardship exemption by applying online for Marketplace coverage on HealthCare.gov or through a certified partner. A review of household income is part of the application process. Consumers can also submit a hardship exemption form by mail.
HHS is also simplifying the process by streamlining the review of paper applications to reduce the administrative burden on consumers, the announcement stated.
The announcement HHS Expands Access to Affordable Health Insurance was released on September 4, 2025 (accessed September 4, 2025).
The Centers for Medicare & Medicaid Services fact sheet Expanding Access to Health Insurance: Consumers to Gain Access to ‘Catastrophic’ Health Insurance Plans in 2026 Plan Year was released on September 4, 2025 (accessed September 4, 2025).
The list of 10 Essential Health Benefits is posted at HealthCare.gov (accessed September 10, 2025).
For more information, contact: Office of Communications, U.S. Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244; 202-690-6145; Website: https://www.cms.gov/marketplace/resources/regulations-guidance#Health-Insurance-Marketplaces
November 2025 00US25EUA0044