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What is a Catastrophic Illness?

By Lily Ruha
Updated Mar 03, 2024
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A catastrophic illness is a serious health condition that requires extensive medical care and hospitalization. This type of illness usually imposes a significant financial burden on the patient and/or his medical insurance provider. Examples of catastrophic illness include coma, various cancers, stroke, and debilitating heart conditions. A medical condition falls into the category of catastrophic illnesses if it prevents the individual from working, functioning normally, and meeting his financial responsibilities.

Cancer is one example of a catastrophic illness. Some cancer patients require a wide range of treatments, such as surgery for tumor removal, chemotherapy, and radiation to eliminate the cancer cells. In terminal cases of the disease, the patient sometimes needs hospitalization and 24-hour care. A cancer patient with good health insurance might have coverage for much of his treatment costs. For the cancer patient without insurance, he must find a way to pay for extensive treatments or allow the disease to go untreated.

The challenges of catastrophic illnesses are numerous. A patient who has suffered a stroke might possibly have lost the use of important bodily functions. The inability to move one side of the body, for example, can be debilitating for the individual’s chances of working and supporting himself financially. He may possibly need assistance to carry out day-to-day tasks, requiring the full-time attention of a nurse or relative. His challenges and burdens might be physical, work-related, and financial.

Being in a coma is considered a catastrophic illness because the patient requires extensive monitoring and hospitalization. The condition can continue indefinitely and, in some cases, there is no indication of recovery. Comas are brought on unexpectedly and can result from excessive alcohol intake, drug abuse, stroke, or accidents causing head injuries. Some coma patients recover quickly but others can remain in a coma for years. Extensive care and costs are associated with comas in all cases because patients must be fed and monitored continuously.

Health insurance for catastrophic illness is designed to ease the financial burden on individuals and their families in the event of unexpected illness. Insurance premiums for these types of policies usually cost less for younger age groups and for those with no existing health issues. Individuals who are older and have pre-existing cancer or heart-related conditions generally pay more for this type of insurance. Catastrophic illness insurance typically covers some portion of hospitalization expenses, in-home care, doctor’s visits, and lab exams. The cost and extent of this type of coverage varies by insurance company and by policy.

The Health Board is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.

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Discussion Comments
By Pippinwhite — On Apr 15, 2014

And some insurance companies have a cap on insurance, so if the person exceeds the cap, they have to start paying for their treatments out of pockets. Catastrophic health insurance is a good idea.

I have seen people who have held all sorts of benefits and fundraisers for friends and family members, to help them pay for medical bills. Often, the stories are downright pitiful, when someone has worked hard their whole life, and is suddenly disabled by illness, unable to work, and out of insurance. It's heartbreaking.

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