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Wellpoint Essential Catastrophic (+ Incentives)

Wellpoint

Starting at

$475

/month before subsidy

Key facts

Wellpoint Essential Catastrophic (+ Incentives) is a 2026 Catastrophic HMO health insurance plan from Wellpoint, sold on the ACA Marketplace in Florida under plan ID 44228FL0040004. The monthly premium starts at $475 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $10,600 ($21,200 for a family), and the individual out-of-pocket maximum is $10,600 ($21,200 for a family). After the deductible, coinsurance is 0% for covered in-network care. The plan is HSA-eligible, so it can be paired with a Health Savings Account.

Plan ID
44228FL0040004
Plan year
2026
State
Florida
Metal level
Catastrophic
Plan type
HMO
HSA-eligible
Yes

Individual Deductible

$10,600

Family: $21,200

Out-of-Pocket Max

$10,600

Family: $21,200

Coinsurance

0%

You pay after deductible

Network Type

HMO

FLN002

Cost Sharing
What you pay for common services (after deductible unless noted)

Medical Services

Primary Care Visit$40.00
Specialist VisitNo Charge after deductible
Urgent CareNo Charge after deductible
Emergency RoomNo Charge after deductible

Prescription Drugs

Generic Drugs0.00% Coinsurance after deductible
Brand Name Drugs0.00% Coinsurance after deductible
Specialty Drugs0.00% Coinsurance after deductible
What you'd typically pay
Standardized coverage examples from this plan's official Summary of Benefits & Coverage — your estimated out-of-pocket cost in three common situations (in-network).

Having a baby

Normal delivery

$10,660

your estimated cost

Deductible
$10,600
Copays
$0
Coinsurance
$0

Managing type 2 diabetes

A year of routine care

$5,320

your estimated cost

Deductible
$5,200
Copays
$100
Coinsurance
$0

A simple fracture

ER visit + follow-up

$2,800

your estimated cost

Deductible
$2,800
Copays
$0
Coinsurance
$0
Is your medication or doctor covered?
Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.
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Official Plan Documents
Published by Wellpoint. These are the authoritative source for coverage details.
Summary of Benefits & Coverage (SBC)Standardized cost & coverage summaryPlan BrochureFull plan details from the insurerDrug FormularyCovered prescriptions & drug tiers
Who This Plan Is Best For

This Catastrophic HMO plan is ideal for healthy individuals who want the lowest monthly premium and can handle higher out-of-pocket costs if they need care.

Consider this plan if you:

  • Rarely visit the doctor beyond annual checkups
  • Have savings to cover the $10,600 deductible if needed
  • Primarily need coverage for unexpected emergencies
  • Want to minimize monthly healthcare expenses

This summary is generated based on plan attributes for educational purposes only.

Worst-Case Monthly Cost
What you'd pay if you hit your out-of-pocket maximum

If you max out this year

$1,358/month

Annual Premium

$5,700

OOP Maximum

$10,600

💡 What this means:

With a $10,600 deductible, you pay 100% of costs until you've spent that much. After that, you pay 0% (coinsurance) until you hit $10,600 total. Then insurance covers everything else for the year.

More plans from Wellpoint in Florida

View all Marketplace plans in Florida

Frequently asked questions about Wellpoint Essential Catastrophic (+ Incentives)

How much does Wellpoint Essential Catastrophic (+ Incentives) cost per month?

Wellpoint Essential Catastrophic (+ Incentives) from Wellpoint starts at $475 per month before any subsidy in Florida. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.

What is the deductible for Wellpoint Essential Catastrophic (+ Incentives)?

The individual medical deductible is $10,600, and the family deductible is $21,200. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.

What is the out-of-pocket maximum for Wellpoint Essential Catastrophic (+ Incentives)?

The most you would pay in a year for covered in-network care is $10,600 for an individual and $21,200 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is Wellpoint Essential Catastrophic (+ Incentives) HSA-eligible?

Yes. Wellpoint Essential Catastrophic (+ Incentives) is a qualified high-deductible health plan, so you can pair it with a Health Savings Account (HSA) and pay for eligible medical expenses with pre-tax dollars.

What type of network does Wellpoint Essential Catastrophic (+ Incentives) use?

Wellpoint Essential Catastrophic (+ Incentives) is a HMO plan. HMO plans generally require you to use in-network providers and to get a referral to see a specialist, in exchange for lower costs.

Understand what you'd actually pay

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Important Notice

Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.