HHS expands access to catastrophic coverage

WASHINGTON — The U.S. Department of Health and Human Services announced it is implementing measures to expand access to more catastrophic health coverage through HHS’ new hardship exemption guidance. This guidance streamlines access to catastrophic coverage for consumers who are ineligible for advance payments of the premium tax credit or cost-sharing reductions.

Through these efforts, more Americans will be able to qualify for catastrophic health coverage based on need, beginning November 1^st with the start of open enrollment. Catastrophic plans generally have lower monthly premiums, are designed to protect consumers from very high medical costs in the event of serious illness or injury, and are required to cover three primary care visits pre-deductible. Consumers under the age of 30 have always been eligible for catastrophic plans through HealthCare.gov.

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. Catastrophic plans are specialized plans that provide all essential health benefits required under the Affordable Care Act, including full access to preventive services without cost-sharing, while maintaining lower premium structures designed for financial accessibility. Importantly, these plans offer comprehensive coverage designed specifically to protect consumers against serious illness or injury scenarios that could result in devastating medical expenses in an already unstable market. With a hardship exemption, eligible consumers can enroll in a catastrophic plan through HealthCare.gov.

How Americans can apply

Beginning November 1, 2025, consumers can apply for the hardship exemption in two ways:

• Apply online for Marketplace coverage on HealthCare.gov or through a certified partner. Household income will be reviewed as part of the application process.
• Submit a hardship exemption form by mail.

HHS’ hardship exemption guidance for catastrophic coverage can be viewed on CMS.gov at: https://www.cms.gov/marketplace/resources/regulations-guidance#Health-Insurance-Marketplaces

A fact sheet on HHS’ hardship exemption guidance for catastrophic coverage is available at: https://www.cms.gov/newsroom/fact-sheets/expanding-access-health-insurance-consumers-gain-access-catastrophic-health-insurance-plans-2026