Monday, December 16, 2013

ACA's ban on health insurance

For those 30 and older (counting from "the beginning of the plan year"), catastrophic health insurance is not an option under the Affordable Care Act. For those under 30, catastrophic plans are still allowed.

From the text of Public Law 111-148 (emphasis added):

SEC. 1302. ESSENTIAL HEALTH BENEFITS REQUIREMENTS.

(e) Catastrophic Plan-
    (1) IN GENERAL- A health plan not providing a bronze, silver, gold, or platinum level of coverage shall be treated as meeting the requirements of subsection (d) with respect to any plan year if--
      (A) the only individuals who are eligible to enroll in the plan are individuals described in paragraph (2); and
      (B) the plan provides--
        (i) except as provided in clause (ii), the essential health benefits determined under subsection (b), except that the plan provides no benefits for any plan year until the individual has incurred cost-sharing expenses in an amount equal to the annual limitation in effect under subsection (c)(1) for the plan year (except as provided for in section 2713); and
        (ii) coverage for at least three primary care visits.
    (2) INDIVIDUALS ELIGIBLE FOR ENROLLMENT- An individual is described in this paragraph for any plan year if the individual--
      (A) has not attained the age of 30 before the beginning of the plan year; or
      (B) has a certification in effect for any plan year under this title that the individual is exempt from the requirement under section 5000A of the Internal Revenue Code of 1986 by reason of--
        (i) section 5000A(e)(1) of such Code (relating to individuals without affordable coverage); or
        (ii) section 5000A(e)(5) of such Code (relating to individuals with hardships).
    (3) RESTRICTION TO INDIVIDUAL MARKET- If a health insurance issuer offers a health plan described in this subsection, the issuer may only offer the plan in the individual market.

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