Overview

• New hardship guidance lets people ineligible for premium tax credits or cost-sharing reductions enroll in catastrophic plans, including those with incomes below 100% or above 400% of the federal poverty level, with further expansion planned for some between 250% and 400% of FPL.
• Enrollment opens Nov. 1 on HealthCare.gov and participating state exchanges, with automatic online assessments for hardship eligibility and a paper option available.
• CMS says it acted in response to projected substantial 2026 premium increases across the individual market, as insurers seek roughly 18% median hikes and enhanced ACA subsidies are set to lapse at year-end.
• Because catastrophic plans sit in a separate risk pool, experts caution that healthier consumers may shift into them, potentially raising premiums for standard metal-tier plans and prompting insurers and actuaries to reprice offerings.
• Hospitals could see some relief in uncompensated care if more low-income patients gain coverage, though catastrophic plans carry very high deductibles and provide limited financial protection outside major medical events.