About the Author
Expert Sources and Partners
- Rachel Bergeson, MD
Medical Director, Student Health Services
- Katherine R. Linsey
Assistant Health Director, Student Health Center
- Sarah Hanel, MHA
Director, Student Health Center
- Constance C. Menard, MD FAAP
Director, Student Health Services
- Alice R. Holland
Director, Student Health Services
- Doreen Perez, MS BSN RN-BC
Director, Student Health Services
University of North Florida
Introduction
It’s no surprise that health care and health insurance are not exactly at the top of the list of major concerns for first-time college-bound students. Accidents do happen, however, and illness and injury can strike people of all ages, including college students. Furthermore, caring for an illness, even a minor one, can result in serious financial consequences. So serious, in fact, that it could result in years of substantial lingering debt and could even stop a promising college career in its tracks.
Every college-bound student needs quality health insurance. Going off to school without it means taking a huge risk, one that many schools will not let you take. A large and growing number of colleges and universities today require that their students provide proof of health insurance coverage before they are allowed to step foot into a classroom. College heath service professionals agree that one of the best ways to keep a student in school is through illness prevention, and the best way to prevent illness is to make sure that every student can afford care.
Only a few years ago, students were limited to a small number of health insurance options. Now, it’s much more complicated. Today, insurance choices are abundant, with at least four major options available to the majority of college students in the United States:
- Parents’ health insurance plans
- School-sponsored health insurance plans
- Individual health insurance plans
- Enrollment through Medicaid
Each of these major plans comes with its own wide range of options and choices, with advantages and disadvantages. This comprehensive guide to student health insurance is designed to help individuals sort through these numerous coverage options and choose the one that best suits their needs. Specifically, the guide will:
- Outline the different plans available;
- Explain what a student health center is, and what care it does and does not provide;
- Review health insurance options for recent graduates;
- Offer a set of guidelines for evaluating a health insurance plan; and
- Provide a brief glossary of some of the most commonly-used health insurance terms.
In short, our goal is to make the process of choosing a student health insurance plan more approachable and less complicated.
Health Insurance Options for College Students
As mentioned, there are a number of health insurance options available to most college-bound students, each with its own specific requirements and provisions. Before choosing a plan, it is very important for individuals to check with their own college or university to determine the specific insurance requirements for that institution, as well as the options they provide and the forms of outside coverage they will accept.
Parents’ Health Insurance Plans
One of the very first provisions of the Affordable Care Act (ACA) to go into effect (back in 2010) allows children to remain covered under their parents’ health insurance until the age of 26. The provision applies to children under almost any circumstances, including those who are attending a college or university. Additionally, the provision applies to any parents’ plan, whether the plan is obtained through the parent’s employer or purchased individually within or outside the ACA’s Exchanges or Marketplace.
Remaining on a parent’s insurance plan is a very popular choice for students and parents alike. This is because there are a number of important advantages to this option, including cost. Under many employer-based plans, employees may be eligible for special family rates that make this option the most affordable. This is especially true for families with more than one dependent. There may also be tax advantages for parents since premiums for employer-based plans are paid through salary withholdings. In addition, coverage through a parent’s health insurance plan is likely to be more comprehensive than one obtained through an individual or school-sponsored program. There is also one more advantage, particularly for the student: convenience. Billings, claims and other paperwork are usually left for the parents to handle.
There are a few potential problems with this option, however. The biggest has to do with access. If a child is moving out-of-state to attend college, or within the same state but far away from his or her parents’ residence, finding a local doctor or facility within the insurance plan’s network of providers may be a problem. Larger insurers may have affiliation deals with other networks, but if not, a student may very well find themselves paying high out-of-pocket costs for lower-tiered levels of care. If that is the case, students would be wise to schedule routine preventative care visits while at home on vacation or visiting their parents in order to avoid the extra out-of-network expense.
Another potential problem is cost. Although remaining on a parent’s insurance might be cheaper, in some circumstances it might not. Parents with only one child, for example, may be able to find a less expensive alternative through school-sponsored or-now that the ACA is in effect-individual exchange-purchased plans. As always, it is critical to check the details of every plan, including the parents’ plan, to determine which is the most affordable.
School-Sponsored Health Insurance Plans
Student-sponsored health insurance has been around for many years. With the ACA now in full-effect, however, big changes are taking place with these plans, both in cost and benefits. Today, virtually all major colleges and universities, and many smaller ones, offer some form of school-sponsored health insurance. In most cases, these plans are administered in association with a large private provider, although a small number are self-insured by the school itself. In addition, schools often require their students to sign up for the school-sponsored plan, making payment for it a part of their regular tuition and fees. Most schools, however, allow students to opt-out of the school-sponsored program with proof of comparable coverage under an outside health insurance plan. Health care under school-sponsored plans is typically administered through a combination of services provided at on-campus health centers and a comprehensive network of off-campus doctors, hospitals and specialists.
The University of Florida does offer a handful of health insurance options as well as allowing students the freedom to purchase their own or to remain on their parents’ insurance plan if they wish. Our main goal is to ensure they have adequate coverage so they can be successful academically. We have all heard the nightmares of uninsured or underinsured students who either delay care or receive care and are burdened with medical debt. Both can be detractors of education.
As with all of the other major options, student-sponsored health insurance plans offer a variety of choices, and come with a number of unique advantages and disadvantages. The biggest advantage may be cost. Since these plans are made available exclusively for students, who tend to be younger and in relatively good health, the overall per-individual cost of actual services provided is lower than that for the older (and less healthy) population as a whole. Additionally, school-sponsored plans may be more cost-effective since they focus on those health services most in-demand by college students, such as immunizations, gynecological services and treatment for upper respiratory infections.
While focusing on the most in-demand services may mean lower costs, it also means that the breadth of benefits of school-sponsored plans may be limited compared to other options. Another possible disadvantage is that these plans often only cover currently-enrolled full-time students. If a student drops classes and falls below a stated minimum of credits, for example, he or she may also lose his or her insurance coverage. Lastly, in most cases, this coverage ends when the student graduates.
The ACA has thrown a few more wrinkles into the school-sponsored insurance option. Under the ACA, all student health plans must now meet all ACA coverage requirements and provide all mandated benefits, including providing coverage for pre-existing conditions. Unfortunately, these additional expanded benefits have resulted in higher premium costs. Fortunately, as of January 2014, many students can now apply their financial aid to the cost of their student health insurance.
Individual Health Insurance Plans
With the exception of those persons who are eligible for Medicaid, or choose to forego insurance entirely (and, thus, face possible ACA tax penalties for non-coverage), students not covered under their parents’ insurance or through a school-sponsored plan are left with one option: individual health insurance coverage. Individual health plans, of course, have been around as long as there has been health insurance. As with school-sponsored insurance, the ACA has brought major changes to the individual-plan market, along with a huge expansion in coverage choices.
Although individual health plans may be purchased directly from an insurance provider, the vast majority of insurance seekers are likely to shop for their plan through one of the Exchanges or online Marketplaces established under the ACA. Information regarding the Exchange/Marketplace options available in each state can be found at www.healthcare.gov.
Individual health plans purchased from an ACA Exchange or Marketplace are not, by definition, student plans, but may still offer insurance at a price lower than plans sponsored by a student’s college or university. This is particularly true for individuals who opt for a “catastrophic” plan. Under the ACA, a catastrophic plan covers essential health benefits, providing a “safety net” form of coverage in case of an accident or serious illness. Premiums for catastrophic plans may be lower than for other health plans, but they also come with much higher deductable costs and limited benefits. Catastrophic plans are available to people 30 years old or younger, as well as older individuals who qualify for a “hardship exemption”.
Students considering the individual insurance plan option through an ACA Exchange/Marketplace should be aware of a couple of possible pitfalls. First, anyone applying for an individual health plan may only do so in his or her state of residency. Students who are residents of one state and attending college in another will likely run into the same problem of finding services within their plan’s network as those who are covered under a parent’s policy, leading to high out-of-pocket costs for care received while at school. Second, while all plans offered by Exchanges are fully compliant with ACA minimum coverage requirements, they may fall short of coverage requirements established by a particular college or university campus. It is therefore crucial that a student check the specific coverage requirements of his or her school before purchasing an individual insurance plan.
Enrollment Through Medicaid
Prior to the ACA, low-income adults without children did not qualify for Medicaid. Through the ACA today, 26 states have chosen to expand Medicaid to all adults at or below 133 percent of the federal poverty level (currently, that equates to approximately $15,500 for an individual and $31,700 for a family of four.) It is possible, therefore, that a student who meets eligibility guidelines (and lives in a state that has chosen Medicaid expansion) may be eligible for expanded Medicaid health coverage. There are additional non-financial criteria that are used in determining Medicaid eligibility, including federal and state requirements regarding residency, immigration status and U.S. citizenship documentation. Anyone interested in applying for expanded Medicaid coverage should visit his or her resident state’s Medicaid website for specific state eligibility requirements and coverage details.
The following is a summary of student health care insurance options:
| Parents’ Health Insurance Plan | School-Sponsored Health Insurance Plan | Individual Health Insurance Plan | Enrollment in Medicaid | |
|---|---|---|---|---|
| Eligibility | All children under 26 years of age, regardless of student status. | Typically, full-time students at a college or university that offers a sponsored plan. | Anyone. | Individuals who meet certain financial and non-financial federal and state qualifications. |
| Advantages | – Possible lower costs and tax advantages. – Comprehensive coverage. – Convenience. | – Lower costs due to low-risk student pools. – Cost savings from student-focused services. | – Large variety of options and benefits. – Low premium costs for “catastrophic” plans. | – Very low health care costs. – Coverage for many who would otherwise go without. |
| Disadvantages | – Possible higher costs under certain circumstances. – Out-of-network coverage and cost problems for students far away from home. | – Limited coverage. – Lost coverage if full-time enrollment is not maintained. -Coverage terminated upon graduation. | – Only available in state of residence. – ACA plans may not meet minimum coverage requirements at specific schools. | – Limitations on types of treatments covered. – Expanded ACA coverage not available in many states. |
There is, of course, one other option: choosing to forego health care insurance coverage all together. Under the ACA, most Americans are now required to have health insurance or pay a tax penalty, known as the “individual shared responsibility payment”. There are a number of exemptions from payment of the penalty, however, and some students may qualify for an exemption, including those who are members of a federally-recognized Indian tribe or one of several religious groups. An individual may also qualify for an exemption if the lowest-priced coverage available would cost more than eight percent of his or her household income, or if he or she does not have to file a tax return due to an income level below the filing threshold. Bear in mind, however, that a student will still need to meet his or her college’s minimum health insurance coverage requirement, if there is one, in order to remain in school. Students who choose to go without insurance will have to pay for all health care services out of their own pockets.
Additional Resources:
- Enroll America
Enroll America is a non-profit 501(c)(3) organization whose goal is to maximize the number of Americans who are enrolled in and retain health coverage. Enroll America’s website provides profiles and other information for each individual state aimed at helping the uninsured obtain health insurance coverage.
- Medicaid.gov
Medicaid.gov is the official Federal government’s “one-stop-shop” for information regarding Medicaid, the Children’s Health Insurance Program and the Basic Health Program. Students interested in finding out if they are eligible for Medicaid coverage will find a wealth of information here to get them started.
- MedlinePlus
MedlinePlus is a service of the National Institutes of Health (NIH). Its website acts as an information clearinghouse for patients and families on a wide range of health-related topics, including health insurance.
- YoungInvincibles.org Finding Health Insurance Toolkit
Young Invincibles is a national organization committed to expanding economic opportunity for young Americans aged 18 to 34. This site provides several resources, including a mobile app that students and others can use to discover health insurance options and find local health care services.
- What if I don’t have health coverage – Healthcare.gov
Choosing to forego health care coverage in 2014 may result in a penalty fee. Learn more about the consequences, including how fees are calculated and whether you qualify for an exemption.
How to Use Your College Health Center
Student health (or health services) centers can be found on almost all college and university campuses today. A student health center typically serves as the primary provider of health services for all students enrolled on its campus, regardless of a student’s health insurance type or status. The range of services provided by student health centers varies widely depending on the particular campus, but the following services are commonly available:
- Urgent Care:
Urgent care is the care provided for injuries and illnesses serious enough to require immediate attention, but not serious enough for an emergency room visit. Examples of problems requiring urgent care include: strep throat; upper respiratory infections; ear infections; urinary tract infections; pink eye; sexually transmitted diseases; and muscle sprains and strains. Student health center doctors and nurse practitioners evaluate a patient’s condition and will either treat that condition or refer the patient to an off-campus provider for further treatment.
- Preventative Care:
The goal of a student health center is to keep its patients healthy and in class. As a result, a great deal of care provided at these centers is focused on student well being, health maintenance and preventative care issues. Common preventative services offered include physicals, immunizations, gynecological care, contraception, and nutrition and healthy student counseling.
Services provided by many, but not all, student health centers include:
- Mental health screenings and counseling
- Broken bone casting
- Lab work and X-rays
- Basic dental work
- Pharmacy
- Crisis counseling
Services typically not provided at student health centers include:
- Emergency care
- Care for major or chronic illnesses (cancer, major diseases, etc.)
- Treatment by specialists
Basic health center services are commonly provided free of charge to students who are required to pay a health services fee each semester as part of their normal tuition and fee charges. Additional payment is typically required for services such as lab tests, prescription medications, medical devices, casting, and others. It is, therefore, highly recommended (and often required) that students maintain health insurance to help pay for these additional services, as well as for all off-campus medical treatment received.
Additional Resources:
- American College Health Association (ACHA)
The American College Health Association is a non-profit organization for college and university health professionals. The ACHA’s website provides information for professionals and students alike, including publications and brochures on a number of student-related health issues.
- The Jed Foundation
The Jed Foundation is a non-profit organization whose mission is to promote emotional health and prevent suicide among college and university students. The foundation provides a number of helpful resources to students including ULifeline, an online source for those seeking help for emotional problems and mental health conditions.
Getting Insured After Graduation
One of the first hard tasks that a recent graduate will have to take on is finding new health insurance. Many will bite the bullet and simply go without until they land a job with benefits. However, going without health insurance, even for a short time, is risky. Fortunately, recent graduates have a number of options to consider:
Option #1: Your Parent’s Health Insurance
Prior to the ACA, a college graduate would be dropped from a parents’ policy the moment he or she could no longer be considered a dependent. Today, however, any child is allowed to remain on that policy until he or she reaches the age of 26. For many graduates, this coverage fills the gap between college and that first real job with health care included as a benefit. A parents’ plan additionally comes with the advantages of affordability and comprehensive coverage that a new job seeker would be unlikely to find elsewhere.
Option #2: Individually-Purchased Health Insurance
Young and healthy college graduates ages 26 and older may find that purchasing a traditional individual health insurance policy is their best choice. Through an ACA Exchange/Marketplace, recent graduates should be able to find a variety of relatively affordable quality coverage options to choose from. In addition, an individual plan may be the only real option available to many since a large number of employers do not offer employee-based insurance, and even if they do, that plan may be more expensive and offer limited coverage compared to an individually purchased one.
Option #3: Short-Term Health Insurance
If an individual is certain to soon be working for an employer that provides health insurance benefits, he or she may want to consider short-term health insurance to bridge the gap. Short-term plans are usually six months in duration, but may offer coverage up to 12 months. These plans are designed to protect against unforeseen illnesses and injuries, and therefore do not include coverage for preventative care.
Option #4: Employer-Based Plans
Most Americans get their health insurance through an employer-based plan. Once a graduate has started that first big job, however, he or she should carefully go over the details and costs of that plan before signing up. Because of the ACA, young employees may be able to find a better, more affordable plan on their own.
This chart summarizes the advantages and disadvantages of the above-listed options:
| Parents’ Health Insurance Plan | Individually-Purchased Health Insurance | Short-Term Health Insurance | Employer-Based Plans | |
|---|---|---|---|---|
| Advantages | – Convenience. – Affordability. | – Great choice for long-term coverage. – Price. | – Convenient for short-term needs. | – Convenience. – Affordability. |
| Disadvantages | – Ends when child turns 26. | – Responsibility for finding coverage rests with individual. | – Cost. – Short-term only. – Limited coverage. | – Individual plans may be cheaper for young, healthy employees. |
Additional Resources:
- FAQ: A Young Adult’s Guide to New Health Insurance Choices
Offered by National Public Radio (NPR), this site provides answers to frequently asked questions about health care reform for young adults. Links are included to additional information from individual stations throughout the nation.
- Health Insurance for Young Adults
This healthcare.gov site provides useful information for young adults seeking health insurance under the ACA. The site includes answers to a number of questions such as, “Why should I have health coverage?” and “What are my birth control benefits?”
Now that health insurance is mandated, take responsibility in reviewing what plans cover and what the cost comparison is. Depending on what your health care needs are, or what you expect them to be in the future, don’t ‘short-change’ your benefits. You never know what your future health needs will be.
- Young Adult Coverage – HHS.gov
This Federal government site offers information regarding young adult coverage, primarily aimed for those individuals who plan to remain on, or be added to, their parents’ health care plan. A link to FAQ’s regarding the ACA and young adults is featured.
- Young Adults and the Affordable Care Act Factsheet
This fact sheet from whitehouse.gov provides information on the ACA for young adults. Topics covered include access to insurance and tax benefits for adult child coverage.
How to Evaluate a Health Care Plan
The following is a list of useful tips to help students and recent graduates determine which health insurance plan is right for them:
Cost
Consider all costs related to health care and insurance including monthly premiums, total annual deductibles, copayments, out-of-pocket maximums, and health account options (such as Health Savings Accounts, Flexible Spending Accounts (FSA), and Health Reimbursement Arrangements). For young, healthy students and graduates, plans with low premiums and higher out-of-pocket costs may be the most affordable.
Level of Coverage vs. Patient Needs
Take a look at specific benefits included in a plan’s coverage. Determine which benefits you will likely use the most and exclude plans that include expensive benefits that you will likely never use. Consider whether or not specialized care, such as major surgery, maternity services or treatment for a chronic illness, will be needed and determine how that care will be provided.
Networks and Access to Doctors
Many plans require individuals to use doctors and facilities contracted by the insurer, commonly known as a “network of providers”. Additionally, some plans require insureds to choose a primary care physician who manages care and acts as a gatekeeper for referrals to specialists and others. If an insured prefers a specific doctor or facility, he or she should consider plans that include those providers in their networks.
Health and Wellness Benefits
Many plans include resources and tools aimed at keeping a person healthy, such as screening questionnaires, online coaching programs, weight loss calculators, discounts for gym memberships, anti-smoking programs, acupuncture and the like. Be sure to consider the wellness resources offered and which ones you will likely utilize.
Limitations and Exclusions
It’s just as important to know what an insurance plan does not cover as it is to know what it does. Often health insurance limits or excludes coverage for services related to such things as mental illness, elective procedures, substance abuse and some alternative therapies. Make sure to read the policy carefully to understand what services you will have to pay for out-of-pocket for.
Additional Resources:
- Health Insurance and Mental Health Services
This Federal government site offers answers to questions regarding mental health services and the ACA. Questions include, “How will the Affordable Care Act help individuals with mental health problems?” and “Does the Affordable Care Act require insurance plans to cover benefits?”
- National Committee for Quality Assurance (NCQA) Health Insurance Plan Rankings 2013-2014
The NCQA is a private 501(c)(3) not-for-profit organization dedicated to improving health care quality. It has evaluated over 500 health care plans, and provides here a summary of its findings.
- U. S. Department of Labor – Consumer Information on Health Plans
This Federal government site acts as a clearinghouse for consumer information on health plans, with literally dozens of links to materials on specific health care and health insurance topics. Although designed for government workers, the site’s resources are still valuable for anyone seeking information on health insurance.
- Womenshealth.gov – Health Insurance and Women Fact Sheet
This site provides a wealth of information regarding women’s health issues and insurance. Answers are provided to questions such as, “What are my health care options?” and “How do I choose a health plan?”
Glossary of Insurance Terms
Coinsurance: The amount that an insured is obligated to pay for covered medical services after the payment by the insured of any deductable or copayment. The amount of the coinsurance payment is usually expressed as a percentage of the total cost of a given specific covered service.
Copayment: A specific fixed charge that the insured may have to pay (usually at the time of service) for a specific medical service or supply, as required by the insurance policy.
Deductable: The fixed dollar amount that the insured must pay (usually annually) for health services before the insurer begins to pay for those services.
Emergency Care: Evaluation and treatment of an emergency medical condition administered to keep the condition from getting worse.
Network: The providers, suppliers and facilities that have been contracted by an insurer to provide health care services for the insured.
Nurse Practitioner: An advanced practice registered nurse who typically manages acute and chronic medical conditions, and is qualified to diagnose medical problems, order treatments, make referrals, and prescribe medications. Depending on the state, a nurse practitioner may or may not be required to practice under the supervision of a physician.
Out-of-Pocket Costs: Expenses paid by the insured that are not reimbursed by the insurer, including deductibles, coinsurance, copayments, plus all costs for services that are not covered.
Out-of Pocket Maximum/Limit: The most that an insured must pay (typically annually) for health care services and supplies before the insurer starts to pay 100 percent for those benefits. This limit does not include premiums.
Preexisting Condition: A health problem that existed prior to the start date of an insured’s new insurance policy.
Premium: The amount that must be paid by the insured to the insurer for the insured’s health insurance or plan. The premium is typically paid on a monthly basis, but is sometimes paid quarterly or even yearly. Premiums are often paid in full or in part by an employer as part of an employee’s benefits package, but may be paid by the employee or, if self-employed, but the individual.
Primary Care Physician: A physician who oversees and coordinates a range of medical services for a patient. The primary care physician typically serves as the patient’s main healthcare provider.
Urgent Care: Care for an injury, illness or other health condition so serious that a reasonable person would seek care right away, but not serious enough to require emergency room care.
Health care is very important. Students should value themselves enough to take care of their health. They’ve worked hard to earn their degree. Good health care with health insurance helps to ensure that they will be able to enjoy all of life’s rewards, which they so richly deserve.