HHS Expands Access to Affordable Health Insurance

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

Through these efforts, more Americans will be able to qualify for catastrophic health coverage based on need, beginning November 1st 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.

“Catastrophic coverage offers affordable health insurance for younger Americans and those facing hardship to have security when they need it most,” Secretary of Health and Human Services Robert F. Kennedy, Jr. said. “Expanding access to catastrophic coverage is another step in making health insurance more affordable, building on the progress made since the passage of President Trump’s One Big Beautiful Bill.”

“President Trump promised to give Americans real choices in health care, and today we are delivering on that promise,” said Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz. “By expanding access to catastrophic plans, we are making sure hardworking people who face unexpected hardships can get affordable coverage that protects them from devastating medical costs. This change reflects our commitment to lowering costs, strengthening program integrity, and ensuring every American has a pathway to coverage that fits their needs without burdening taxpayers.”

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 is also simplifying the process by streamlining the review of paper applications to reduce the administrative burden on consumers. This change will make it easier for individuals experiencing hardship and seeking a catastrophic plan to access the full range of catastrophic coverage options available to them.

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