Agents can enroll clients in catastrophic plans through HealthSherpa
HealthSherpa has the fullest integration possible with the federal Marketplace (HealthCare.gov), which allows our platform to handle catastrophic plan enrollments.
Below, we’ll cover catastrophic plan basics for agents and brokers, as well as how to complete these enrollments for eligible clients.
What is a catastrophic plan?
These are non-metal (e.g. Bronze, Silver) private health insurance plans that are also regulated under the Affordable Care Act (ACA). These plans cover at least 3 primary care visits before the deductible is met, essential health benefits, and certain preventative care services.
Generally, the premiums for catastrophic plans will be lower than metal-level plans, and every catastrophic plan is capped by an out of pocket maximum.
Are there any key differences between a standard ACA plan and a catastrophic one?
Catastrophic plans have very high deductibles that equal the annual out-of-pocket cap set by the ACA. For 2020, this limit was set at $8,150 for a single individual and $16,300 for any larger household. Another drawback is that catastrophic plans do not get premium or cost-sharing subsidies, and clients who enroll in catastrophic plans cannot contribute to a health saving account (HSA).
In addition, people need to meet one of the following criteria to be eligible for catastrophic plan enrollment:
– Be under 30 years of age
– Qualify for a hardship exemption
– Quality for an affordability exemption
Clients can be eligible for this last option if the exchange’s lowest cost plan would be more than 8.24% of their modified adjusted gross income in 2020.
If the client is not enrolling on HealthSherpa, they will need to complete a health coverage exemption form from HealthCare.gov and mail it to the Marketplace in order to browse their catastrophic plan options. Once the client has an Exemption Certificate Number, they can fill out the application then see catastrophic plans.
It can take up to four weeks to hear back from the Marketplace. As an agent, you should make sure these clients get the exemption form in the mail within the first two weeks of November to have a chance of enrolling before December 15th.
When should an Agent consider catastrophic plans for their clients?
Catastrophic plans make the most sense for clients who make above 400% of the federal poverty level, have very few medical needs, and are mainly concerned with avoiding major medical debt from serious illness or injury.
It’s possible that higher income clients who would pay the full premium should still choose a metal-level plan. A lower deductible may be more cost-effective if they expect to need healthcare services and prescriptions throughout the year.
Clients who are eligible for subsidies should consider metal-level plans first and, if they are eligible, Medicaid. Catastrophic plans may be a viable option for clients who fall in the Medicaid Gap.
How can ACA agents enroll their clients in catastrophic plans on HealthSherpa?
Any client under 30 is automatically eligible for a catastrophic plan, and they will be visible in the HealthSherpa quoter.
On HealthSherpa, you can automatically get your qualifying 30+ clients a health coverage exemption in the application. After it’s been granted, you and the client can choose a catastrophic plan by selecting ‘Change Plan’ from the review page.
Enrollment in a catastrophic plan can be confusing and challenging. As an agent or broker, you will be giving these eligible clients invaluable guidance, and HealthSherpa is ready to help you serve these clients as smoothly as possible.
Get started with catastrophic enrollments today
If you already have a HealthSherpa account, you can get started enrolling your clients who qualify today. Log in here to get started.
New to HealthSherpa? Don’t worry — it’s easy to get started with a free HealthSherpa for Agents account. HealthSherpa is an approved direct enrollment pathway for healthcare.gov, and we are able to help you enroll your clients directly on our site with Enhanced Direct Enrollment (EDE). Through a HealthSherpa account, you can enroll, track, and service your ACA clients year-round. Visit our HealthSherpa for Agents page today to learn more and sign up for an account.