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).
Changes Effective November 1, 2025 (Based on CMS Announcement)
Beginning with the 2026 Open Enrollment Period, the following updates will take effect:
- Expanded eligibility for catastrophic plans:
- Consumers who are ineligible for premium tax credits (APTC) or cost-sharing reductions (CSRs) due to projected income can now qualify for a hardship exemption to enroll in catastrophic coverage.
- A hardship will now be anyone that has income below 100% of the federal poverty level or anyone over 400% of the federal poverty level.
- Streamlined hardship exemption process:
- Consumers can apply online via HealthCare.gov or through certified partners.
- Alternatively, they can submit a paper application by mail.
- HHS is simplifying the review process for paper applications to reduce administrative burden.
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- Broader access to affordable coverage:
- This change is aimed at helping individuals who face unexpected financial hardship and are otherwise left without affordable insurance options. ARTICLE
- Broader access to affordable coverage: