Navigating changes in CMS guidance for catastrophic plans

On September 4, the Centers for Medicare & Medicaid Services (CMS) introduced updates to catastrophic plans that broaden access to health benefits beginning in the 2026 plan year.

Important changes:

• Individuals earning below 100% or above 250% of the Federal Poverty Level (FPL) can now qualify, despite not being eligible for ACA subsidies or cost-sharing reductions.
• Catastrophic plans were primarily for those under 30 or those meeting narrow hardship exemptions.
• These plans include essential health benefits and cover at least three primary care visits before the deductible.

Please be aware: Catastrophic plans are not eligible for broker commission or broker bonus programs for new or renewing business effective January 1, 2026.

Please reach out to your Anthem representative if you have any questions.