Health Insurance for College
College is a time for learning new things, broadening horizons, and functioning in the adult world – essentially it is a time to go from being dependent to becoming independent. While much of this experience is exciting, there are some aspects that can be daunting and where skill and know-how are required. Health insurance is a world that has to be circumnavigated, but that world is complex. This guide was written as a kind of map to help students navigate through the ocean of health care providers, language, costs and benefits, pros and cons. For those seeking to venture the high seas this map will also help break down the Affordable Care Act, how to sign up, and insurance while traveling internationally. We hope your journey finds its destination.
Health Insurance Options
The following are various types of health insurance plans that should be considered. There are advantages and disadvantages to each and a person’s individual needs and circumstances must be taken into account.
Parents Health Insurance Plan
If parent(s)/guardian(s) health insurance plan covers dependents, students usually can be added to their plan and stay on it until they turn 26. A parent(s)/guardian(s) can add their college-going child(ren) to their insurance during the plan’s yearly Open Enrollment Period or during a Special Enrollment Period. Make note that parent(s)/guardian(s) should check with the plan or their employer’s benefits department for details.
Generally, students on a parent(s)/guardian(s) plan can stay on until 26 years old, even if the following life changes occur:
- Get married
- Have or adopt a child
- Start or leave school
- Live in or out of students parent’s home
- Aren’t claimed as a tax dependent
- Aren’t claimed as a tax dependent
Advantages: This option can be simple, especially if students have already been covered by parents insurance. This way there are no changes and students will receive continuing coverage and see the same healthcare providers already established. Students will also save time and energy as they won’t need to apply for new coverage or shop around for other options.
Disadvantages: If students are attending college out of state, this could get complicated. Different insurance companies have various rules about out of state coverage. College-goers will also need to potentially switch healthcare providers, which again, could be complicated depending on the insurance company policy. Those who do not have chronic health problems could avoid some of these complications by scheduling doctor visits during breaks, saving the trouble of switching providers.
Student Health Insurance Plan
Most colleges and universities require students to have health insurance coverage. Many schools offer a school-sponsored health insurance plan that the student can sign up for. In many cases, if one declines the school-sponsored health insurance plan, they must provide proof of comparable coverage under another health insurance plan. College students can usually sign up for a school-sponsored health insurance plan upon admission or when they pay their tuition for the semester.
Advantages: Medical services are often rendered on campus and the plan premiums are affordable for college students. The plans are made for college students, and on campus help is readily available through student resource offices making convenient what could otherwise be lots of wait time.
Disadvantages: Not all school-sponsored plans cover medical services rendered off campus, and if students drop credit hours or graduate, they may lose their coverage. Also, coverage may not be comprehensive, and visits to off-campus doctors may not be covered. Each school’s plan is different, and figuring out all the details could be daunting and may not be worth it.
Health Insurance from Employment
For those students who are employed, health insurance may be available through their employer. This can be a great option for those fortunate to be in this situation, as company health insurance plans are usually comprehensive and accommodating.
Advantages: Companies usually help pay for some, if not all of the cost; these are group plans, so the cost can be lower. Human Resource Departments are available to help employees with questions and concerns.
Disadvantages: Most college students are not in an employment situation where benefits are provided being as full-time employment is usually required, something most college students choose not to do as managing full-time employment during the academic year is not feasible. Also to note is that students who start out with this type of insurance, and then decide to quit or get laid-off will have to look for other options, which depending on the timing, could be difficult.
Health Insurance Marketplace/Obamcare
The Health Insurance Marketplace is a service that helps people shop for and enroll in affordable health insurance. The federal government operates the Marketplace, available at HealthCare.gov for most states. Some states run their own Marketplaces. These services include provided websites, call centers, and in-person help. If students don’t have health insurance through a job, Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or another source that provides qualifying coverage, the Marketplace can help students receive coverage.
Advantages: If students have job-based insurance, they can buy a plan through the Marketplace, however, they will pay full price if the employer’s insurance doesn’t meet certain standards. The amount students pay for insurance depends on income. The Marketplace lets students access many different types of insurance through Medicare, Medicaid, and other programs.
Disadvantages: The website has been highly criticized as difficult to use and confusing. In addition, enrollment only occurs during special times which can be inconvenient if the student needs coverage immediately. Lastly, costs may be higher than other plans, and it can even sometimes be difficult to find a provider.
Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income individuals, families and children, pregnant women, the elderly, and people with disabilities. Students can qualify for Medicaid based on income, household size, disability, family status and other factors. These programs vary from state to state.
Advantages: Some states have expanded their Medicaid programs to cover all people below certain income levels. In states that have expanded Medicaid coverage, college students qualify based on income alone. If their household income is below 133 percent of the federal poverty level, students also qualify.
Disadvantages: These programs can be difficult to use due to the high volume of requests and clients they serve. Paperwork can be extensive as some states require monthly proof of income and will vary coverage from month to month.
Catastrophic health insurance is a type of medical coverage under the Affordable Care Act. This is a type of high-deductible health plan for people under 30 or those who qualify for a "hardship exemption." Catastrophic health plans cover the same minimum health benefits as other health plans including preventive services, emergency services, prescription drugs, and more. The difference with a catastrophic plan is that the client must pay for all health-care costs until they meet a high annual deductible. Only after the out-of-pocket spending reaches the deductible amount does the plan begins to pay for most covered health-care services.
Advantages: Catastrophic plans are designed to protect people in a worst-case scenario; for example, if one get into a medical emergency and their medical costs total thousands of dollars. That being said, students will save money monthly as premiums tend to be lower wit this type of plan. This is an affordable option that fulfills the federal requirements, and good for people who tend to be healthy.
Disadvantages: Students have to pay for all health-care costs out of pocket until they reach the plan's annual deductible, which is usually a several thousand dollars. Coverage also tends to be limited. Some colleges may not accept catastrophic care as health insurance, it is best to check with each school before proceeding with this option.
Health Sharing Option
Health Shares are voluntary nonprofit organizations (generally religious) of people who agree to share medical bills. There are four main ministries: Samaritan Ministries, Christian Healthcare Ministries, Christian Care Ministry, and Liberty HealthShare. Membership in Liberty HealthShare is open to anybody who agrees with their commitment to religious liberty, while the other three only accept members who are practicing Christians. The cost of joining each ministry varies, but is often around half of what an insurance policy might cost. Some charge more or less for membership according to age, and all of them have a “personal responsibility” amount similar to deductibles in conventional insurance. Members are able to submit their eligible medical bills to the ministry, and are reimbursed by other members, either directly or through the ministry’s central office.
Advantages: There are lower out of pocket “premiums,” and it is easy to work with health care providers. Most health care providers offer significant discounts for cash payments, both from paying up front and on installment options. Stated simply, it is easier for both patients and providers not to have to deal with insurance companies. Patients can choose their providers, and also use the benefits to see chiropractors, naturopaths, etc., services that many insurance companies won’t pay for. Many cost share programs adhere to a Christian lifestyle code of conduct and therefore do not have to be forced to pay for care choices against their conscience. Even though members are considered “uninsured,” they are exempt from Obamacare’s tax penalties.
Disadvantages: Patients must pay upfront, and have to wait to be reimbursed by the ministry. If students don’t have a credit card to pay with, they would need to have enough cash on hand. Since the Obamacare tax has kicked in, membership in these ministries has grown astronomically, and the companies are understaffed leading to members who reported difficulty on the service side of things.
About the Affordable Care Act
On March 23, 2010, President Obama signed the Affordable Care Act. The law put in place comprehensive health insurance reforms that “put consumers back in charge of their health care.” This is also referred to as ACA, PPACA, or “Obamacare”.
The law has 3 primary goals
- Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level.
- Expand the Medicaid program to cover all adults with income below 138 percent of the federal poverty level.
- Support innovative medical care delivery methods designed to lower the costs of health care.
How the health care law protects individuals
- Requires insurance plans to cover people with pre-existing health conditions, including pregnancy, without charging more.
- Provides free preventive care.
- Gives young adults more coverage options.
- Ends lifetime and yearly dollar limits on coverage of essential health benefits.
- Helps individuals understand the coverage purchased.
- Holds insurance companies accountable for rate increases.
- Makes it illegal for health insurance companies to cancel health insurance just because of sickness.
- Protects the client’s choice of doctors.
10 Important Facts about the Health Insurance Marketplace
- No one can be denied coverage on the marketplace for health related reasons.
- Premium costs are no longer based pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry.
- The only factors that can affect premiums of New Insurance Plans starting in 2014 are income, age, tobacco use, family size, geography and the type of plan students buy. This applies to all plans sold through the state’s health insurance marketplace.
- The marketplace is open to all Americans, but no one is required to use it.
- If people already have insurance they can keep it.
- Individuals and families earning less than 400 percent of the Federal Poverty Level can get cost assistance through the marketplace.
- ObamaCare’s first open enrollment ran from October 1st, 2013 to March 31st, 2014. Open enrollment for 2015 runs from November 15th, 2014 to February 15th, 2015. There are both annual open and special enrollment periods.
- Medicare, health insurance marketplaces, and employer based insurance also have open enrollment periods. Medicaid, CHIP and non-subsidized private insurance outside of the marketplace are not subject to mandatory enrollment periods, although most ObamaCare-compliant plans known as “Minimum Essential Coverage” can only be purchased during open enrollment inside and outside of the marketplace.
- Potential clients can get an estimate of what their health insurance will cost on the marketplace by going to www.healthcare.gov. Importantly, applying and enrolling in a plan are not the same thing. Individuals are free to shop around for plans during open enrollment.
- Many states have their own marketplace, but healthcare.gov is the official health insurance marketplace.
How to Get Health Insurance
The following are various types of health insurance plans that should be considered. There are advantages and disadvantages to each and a person’s individual needs and circumstances must be taken into account.
1. Recognize the Importance
Heading off to college is all about expanding one’s perspective, taking responsibility, and learning how to live. For many incoming college students, this is the first time entering the “real world” and can be challenging. One aspect of this change is that many haven’t had to think about health insurance. Health insurance is something mom and dad have always dealt with and provided. Students need to transition into taking responsibility for their own insurance as one of the first steps into the “real world.”
2. Learn the Vocabulary
The health insurance world has a language of its own, and students need to learn the important terms. What is a premium, deductible, and copay? If students don’t know the terms, making decisions will be difficult. Making informed decisions about healthcare is important. When the office manager at the doctor asks if the deductible has been met, students need to understand what that means, or they will be left dazed and confused.
3. Research the Options
Obviously, there are an abundance of health insurance options available. What works well for one person may not be the best decision for another. Someone who struggles with chronic health conditions will need more comprehensive coverage than a 20-year old who never goes to the doctor. The Health Insurance Marketplace is a good place to start as the website offers valuable comparisons of different options. Don’t be afraid to take some time to do some sleuthing.
4. Seek Advice
Once students know the insurance jargon, and have looked into some options, consult the experienced. Talk to parents, a guidance counselor, and anyone else who may have advice to offer. The health insurance world is confusing, and people who have spent years in the world of deductibles and premiums have valuable advice. Otto Von Bismarck said, “The wise man learns from the mistakes of others.”
Now that students have researched the options and sought the counsel of others, it’s time to fill out an application and get the process started. Most companies offer online applications. Block out at least 30 minutes to sit down and work. Dedicate focused time and make sure that the application is properly submitted and all pertinent information is accurate. Don’t rush as small errors could cause problems in the long run.
6. Stay Organized
Keep all of relevant papers and information in one place. Get a file folder, label it “Insurance,” and store everything regarding health insurance in it. Most likely, will send a booklet describing coverage and how to use it. It would be wise to locate this somewhere handy for that first trip to the doctor. Keep all bills, description of benefits, and correspondence in the folder as well. Dealing with doctors and insurance can change from a maze of confusion and frustration into a calm river boat cruise.
7. Have a Plan
Especially for incoming freshmen, college graduation seems like a distant dream, but in reality, it is just around the corner. The years truly fly by. Once an insurance option is chosen for the college years, students can focus on their studies. Depending on what option chosen, it is worth considering how the plan may roll nicely into a post-college insurance option. Have some options brewing to save considerable time and effort in the future.
Important Health Insurance Terms
- Actuarial Value- The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70 percent, on average, clients would be responsible for 30 percent of the costs of all covered benefits.
- Appeal- A request from the client to the health insurance company or the Health Insurance Marketplace to review a decision that denies a benefit or payment.
- Authorized Representative- Someone who the insured choose to act on their behalf, like a family member or other trusted person.
- Benefits- Someone who the insured choose to act on their behalf, like a family member or other trusted person.
- COBRA - A federal law that may allow employees to temporarily keep health coverage after employment ends.
- Claim - A request for payment that clients or the health care provider submits to the health insurer.
- Copayment- A fixed amount clients pay for a covered health care service after they’ve paid their deductible. Copayments (sometimes called "copays") can vary for different services within the same plan, like drugs, lab tests, and visits to specialists.
- Deductible - The amount the insured pay for covered health care services before the insurance plan starts to pay. For example, with a $2,000 deductible clients pay the first $2,000 of covered services, and then the insurance begins to cover health care costs (most services have a copayment).
- Essential Health Benefits - A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.
- Family and Medical Leave Act (FMLA) - A Federal law that guarantees up to 12 weeks of job protected leave for certain employees when they need to take time off due to serious illness or disability, to have or adopt a child, or to care for another family member. When on leave under FMLA, clients can continue coverage under their job-based plan.
- Grandfathered Health Plan- As used in connection with the Affordable Care Act: A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act.
- Health Savings Account (HSA)- A type of savings account that allows the insured to set aside money on a pre-tax basis to pay for qualified medical expenses if they have a “high deductible” health insurance plan.
- Lifetime Limit - A cap on the total lifetime benefits clients may get from the insurance company. After a lifetime limit is reached, the insurance plan will no longer pay for covered services.
- Medically Necessary- Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
- Network - The facilities, providers and suppliers the health insurer or plan has contracted with to provide health care services.
- Open Enrollment Period - The yearly period when people can enroll in a health insurance plan.
- Out-of-Pocket Costs- The client’s expenses for medical care that aren't reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that are not covered.
- Pre-Existing Condition - A health problem the client had before the date that new health coverage starts.
- Prior Authorization - Approval from a health plan that may be required before the insured get a service or fill a prescription in order for the service or prescription to be covered.
- Primary Care Provider - A physician, nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.
- Qualifying Health Coverage - Any health insurance that meets the Affordable Care Act requirement for having coverage. If clients have qualifying health coverage, they don’t have to pay the penalty for being uninsured.
- Referral - A written order from the client’s primary care doctor to see a specialist or get certain medical services. In many Health Maintenance Organizations, clients need to get a referral before receiving medical care from anyone except the client’s primary care doctor.
- Special Enrollment Period - A time outside the yearly Open Enrollment Period when clients can sign up for health insurance. A person can qualify for a Special Enrollment Period if they’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.
International Health Insurance
- Check with the Existing Insurer - 1.Chances are, students may be able to continue the same coverage they have currently have while in another country. Call the insurance company and talk to them about the options. Students may have to pay out-of-network premiums, which are higher than in-network, but it may be worth it if students are able to maintain the same coverage.
- School-based Coverage Students who are enrolling in another institution may be able to get health insurance through that school. Host schools may offer helpful insurance options for international students and may have programs specially designed for short-term coverage. Check with the host school about potential short-term coverage during the stay.
- Travel Insurance - When students buy travel insurance, generally, short-term health care coverage is part of the insurance. This usually is not comprehensive coverage, but will include coverage at local hospitals as well as medications that are available in that specific country. When buying travel insurance, talk to the agent specifically about health care coverage.
- International Student Insurance - A company that offers insurance specifically for students who are studying abroad. They are set up to help students who are traveling internationally, and can help pick the best coverage for their specific situation.
International Students in the US
5 Things to Know
- When students come to United States from foreign countries, they are legally required to buy health insurance, just like their American counterparts. Insurance is usually bought through the school they are attending.
- International students who do not buy health insurance may put their college enrollment at risk.
- The insurance plan must cover at least $100,000 for accidents and illnesses, along with mental health and medical evacuation coverage.
- International students do not have to buy insurance through their school. They can shop around and buy it from an insurance company. Not all insurance companies will cover international students, but it is worth looking into.
- Health insurance is required for every semester or term students are enrolled in college.
Stay Informed: Required Immunizations for College Students
Although requirements vary from state to state, most states require the following immunizations before going to college:
- Measles, Mumps, and Rubella (Typically referred to as MMR)
- Hepatitis B
- Tetanus, Diphtheria, Pertussis (Typically referred to as Tdap)
- Varicella, or proof of having the disease
- Meningococcal conjugate vaccine (Protects against Bacterial Meningitis)
- Seasonal flu vaccine is recommended annually , though not required
- Student Health Center: The best place to start to inquire about health insurance options is at the institution students will be attending. Health Centers provide important information about required immunizations, coverage, and where to find medical help. They can also provide health services on campus to save a trip to the doctor.
- Financial Aid Office: Students can talk to the Financial Aid Office about purchasing health insurance from the school as well as policies regarding coverage requirements. Students who may struggle to pay monthly premiums can talk to the Financial Aid Office about payment options.