While some college students are able to remain on their parent’s health insurance plan, some are responsible for getting their own health insurance for the first time. The current health insurance system in the U.S. can be a complicated system to navigate, so this guide is designed to help students understand the Affordable Care Act, how to choose the right plan, and common insurance terms that every patient should understand.
Navigating the Affordable Care Act
Health insurance can be confusing, especially for those who are getting coverage for the first time. This section explains what college students and recently grads can expect and the benefits that are still available to them through to the Affordable Care Act.
College students and recent graduates have a few choices for receiving health insurance. For those who are still in school, signing up for a student health plan through school is an affordable way to get the insurance they need. In addition, current students and recent graduates have the option to stay on their parents’ health care plans until they reach 26 years old. When people do this, they can either enroll in the insurance that their parents receive from their jobs or a plan parents purchase through the Health Insurance Marketplace. Marketplace plans are offered by the states and on the federal level if a state marketplace is not available.
Students and recent college graduates may be able to purchase their own coverage through the Health Insurance Marketplace. In order to find out what type of plans they are eligible for, people can visit HealthCare.gov and enter information about their income, the state they live in, and how many people live in their household. In addition, some people may qualify for a discount on their health insurance plans depending on their income, provided that they aren’t claimed as a dependent on their parents’ tax return.
Focus on ACA Changes
Since the change of administration in Washington, D.C., the Affordable Care Act has been modified. For example, one of the changes to the program is that the individual mandate has been eliminated, which means that people who do not carry insurance will no longer be required to pay a penalty when they file their taxes. In addition, changes to the law have resulted in increased premiums and shorter enrollment periods.
Although students and recent graduates can still receive their health insurance from the Affordable Care Act, it’s important for them to keep abreast of current developments at HealthCare.gov since the program is still evolving.
How to Choose & Purchase Student Medical Coverage
Choosing health insurance is an important decision that shouldn’t be taken lightly. In order to make an informed choice, it’s imperative for students and recent graduates to understand what their options are. The table below provides information on medical coverage avenues to help people make that choice.
|PURCHASE THROUGH SCHOOL||PARENT HEALTH PLAN||MEDICAID||MARKETPLACE|
|WORKPLACE PLAN||CATASTROPHIC PLAN|
|What is it?||Many colleges offer medical insurance plans to students, which may be funded directly by the school or through an insurance company.||College students can stay on their parents’ health insurance plans until they’re 26 years old – even after they graduate. They are also still eligible if they get married, have a child, or move out of their parents’ home.||Under the Affordable Care Act, Medicaid was expanded in order to provide coverage to low-income Americans.||People can purchase through the Health Insurance Marketplace on HealthCare.gov.||Workplace plans are an alternative for those who do not receive insurance from the Health Insurance Marketplace or their parents’ plan.||These plans are designed to protect against major, unforeseen medical expenses; basic coverage is much more limited, including certain kinds of preventive care and three doctor’s appointments.|
|How does it work?||The costs of school-based plans are charged with the institution’s other expenses, so students can apply loans to their health care coverage.||Students who are currently on their parents’ plan can remain on it. Those who are not already covered by their parents’ insurance can be added during open or special enrollment periods.||People who qualify can receive coverage for free, or at low cost.||People can get coverage through the marketplace run by their state, or the federal one if no state coverage is available.||People who work for companies that have at least 50 full-time equivalent employees are required to offer insurance.||People under 30 can purchase a catastrophic health plan, which is designed for those who cannot afford other types of coverage and need a plan with a low monthly premium.|
|Who is eligible?||Depending on the college, eligibility may be based on the number of credits the student is enrolled in.||Anyone under the age of 26.||Eligibility varies from state to state, but generally people must be 133 percent under the poverty level to receive Medicaid.||People who are U.S. citizens or nationals are eligible. However, those who are incarcerated or receiving Medicare coverage cannot get insurance through the marketplace.||Full-time employees or the equivalent. Those who work part time may be able to receive insurance from their employer based on the standards set by the organization. As a result, employees may be required to work a certain number of hours per week.||People under 30 or those of any age who cannot afford job-based insurance or a marketplace plan.|
|How can you get it?||Contact the school’s health center for information.||Anyone who is not currently on a plan can be added to their parent’s plan during the enrollment period.||People can apply directly through their local Medicaid office or through the Health Insurance Marketplace.||Contact HealthCare.gov.||Contact the company’s human resources department.||Contact HealthCare.gov.|
Busting 5 Health Insurance Myths
Since health insurance can be complicated, there are many myths associated with it. The following are some of those myths and the truth that students and recent graduates should know.
Myth:I’m young and healthy. I don’t need insurance.
Students who are young and healthy today may believe they don’t need health insurance. However, there is no guarantee that anyone won’t develop an illness and need treatment, or get into an accident that requires care. As a result, it’s important for young people to get insurance in case they end up needing health care services that they may not otherwise be able to afford.
Myth:The Affordable Care Act has been completely repealed.
This is false. However, there have been changes made to the legislation since the current administration took power. For example, people are no longer subject to tax penalties for not having insurance. Although college students and recent grads can currently get coverage through the Affordable Care Act, it’s important for them to keep up with what’s going on in case further changes are made.
Myth:If I have a pre-existing condition, I’m out of luck.
Under the Affordable Care Act, people cannot be turned down for insurance because they have a pre-existing condition. In addition, insurance companies are prohibited from charging these patients more or denying an insurance claim because of their pre-existing condition.
Myth:The best insurance is always through work.
Not necessarily. In some cases, people can get comparable coverage that is more affordable through the Health Insurance Marketplace.
Myth:Dental health coverage is not available through the Affordable Care Act.
That’s not true. The Affordable Care Act allows people to get dental coverage through certain health plans in the marketplace. In addition, there are stand-alone dental plans available. If people decide to obtain a separate dental plan, they will be required to pay an additional premium.
FAQ: Coverage for Recent College Grads
Graduating from college is an exciting time, so people may not necessarily be considering what they will do about their health insurance coverage during this stage of their life. However, it is still important for recent grads to make sure they have coverage in case the unexpected happens. This section answers some questions that people may have about getting health insurance after graduation.
Using Your Health Insurance
When signing up for health insurance for the first time, students and recent college graduates may not know how the process of using insurance works. In order to help those who are new to insurance, this section includes common terms people should know, as well as the steps for using insurance.
Health Insurance Glossary for College Students
This is the flat fee that patients are required to pay for the services they receive. The amount depends on the type of service provided. In some cases, a health care plan may not require co-payments.
A deductible is the amount that people are required to pay before an insurance provider pays for benefits. The amount of deductibles vary depending on the plan and last for the duration of the benefit period, which is generally a year.
Explanation of benefits:
Commonly referred to as the “EOB,” this is a form that the insured person receives from their insurance company that outlines how claims are processed and appealed. The EOB may come via email or through regular mail, but most insurance companies have EOBs available online.
Healthcare providers that are in-network are professionals who have agreed to offer services to a plan’s customers at a negotiated rate.
This is the maximum amount that customers are required to pay in deductibles. After this amount has been reached, the insurance provider pays for 100 percent of covered services.
When patients receive treatment from out-of-network providers, it means the professionals have not negotiated to offer services at a plan’s rate. As a result, patients pay more for the treatments they receive.
A premium is the amount that must be paid in order to keep insurance coverage. These payments may be due monthly, quarterly, or annually.
Preventive care is designed to keep patients in good health and avoid illness and disease through services such as annual checkups, mammograms, and colon cancer screenings.
A referral occurs when a doctor writes an order for a patient to receive services from another provider. For example, a primary care physician may refer a patient to a specialist for treatment of a specific issue.
When a patient gets urgent care, it means they have a condition that needs immediate treatment, but is not serious enough to require an emergency room visit.
Steps for Using Your Health Insurance
No matter where patients get their health insurance, there are procedures they need to follow in order to receive services. The following explains what some of those procedures are.
Make sure you sign up for which insurance you choose by the deadline:
The enrollment period to sign up for insurance is determined by the plan, so people need to enroll by the deadline to ensure they get the plan they want. In some cases, there may be a special enrollment period that allows people to sign up after the main period deadline has passed.
Keep up with premiums:
In order to keep receiving their coverage, people must keep up with their premium payments. Late payments can result in an account being terminated.
Select a primary care doctor and understand how it works:
A primary care doctor will oversee all of the care that patients receive, so they are required to choose a physician. Insurance plans provide information on the available doctors so people can choose one they feel comfortable with.
Find a pharmacy that takes your insurance:
In order to pay the price for prescriptions that a health care plan offers, people should find a pharmacy that accepts their insurance. Patients can get a list from their insurance company, and they should keep in mind they will pay more if they get their prescriptions from a pharmacy that does not take their insurance.
Pay attention to your explanation of benefits (EOB):
People should understand what services are covered by their plan, so they should review their explanation of benefits and ask their insurance company any questions they have.
Understand what is and what is not covered:
Everyone has different needs, so they should understand what the plans they’re considering cover so they can make the right choice for them. When looking at plans, people should make a side-by-side comparison to understand what each plan does and does not cover.
Hang on to your insurance card:
When people sign up for insurance, they will receive a membership package that may include an insurance card. Patients should first make sure that all of the information on the card is correct and then hang on to the card because they will need it every time they visit a doctor.
Prepare for your first appointment:
When going to a doctor for the first time, it’s important for patients to provide their medical history, as well as their family’s, so the doctor is aware of any problems they may have. Also, patients should prepare a list of their concerns and goals they want to discuss.
Health insurance is a great safety net for students to have available when they get ill, but it’s also important for them to take steps to maintain their good health. In the guide below, we offer advice to students on how to adopt good eating habits, stay fit while on campus, and live an overall healthy lifestyle.
Experts Q & A
Learn more about how students can take charge of their health while attending college with our Student Nutrition and Fitness Guide
Catastrophic Health Plans
Readers can get information on who is eligible for catastrophic health plans, how much they cost, and what they cover on this page.
Coverage for Pre-existing Conditions:
On this page, HealthCare.gov discusses pre-existing conditions and health care coverage.
Dental Coverage in the Marketplace
This page from HealthCare.gov explains the dental coverage that is available through the Health Insurance Marketplace.
Destabilizing the Student Insurance Pool?
This article from Inside Higher Ed discusses how changes to the Affordable Care Act will impact college students.
Finding Health Insurance
This page explains the different types of health care coverage available, as well as how to choose and enroll in a plan.
Health Care Coverage Options for College Students
This website outlines the ways that students can get the health care coverage they need.
Maintained by the U.S. Centers for Medicare and Medicaid Services, HealthCare.gov provides comprehensive information on how to obtain and use health insurance.
HealthCare.gov - YouTube
HealthCare.gov’s YouTube channel has videos on how to navigate the Health Insurance Marketplace. Topics covered include preventive health care services, choosing a health insurance plan, and what to do after losing employer-based coverage.
Health Insurance Options for New College Grads:
This page gives new college graduates information on their insurance options.
Health Insurance Smarts - Health Insurance 101
K-State Research and Extension of Kansas State University provides a primer on how health insurance works on this page.
How to Get or Stay on a Parents’ Plan
College students and recent graduates can get information on how to stay on their parents’ insurance plan until they turn 26 on this website.
Medicaid & CHIP Coverage
This page explains CHIP and Medicaid coverage and how people can receive this type of coverage.
Mental Health & Substance Abuse Coverage
People can get information on the substance abuse and mental health treatments covered by the Affordable Care Act on this page.
NPR, Affordable Care Act
This page on NPR’s website has the latest news on the Affordable Care Act.
Preventive Health Services
The preventive health services the Affordable Care Act covers are outlined on this page.
Student Health Plans and the Affordable Care Act
This CMS.gov page explains student health care coverage through the Affordable Care Act.
Tips to get started in the Health Insurance Marketplace
Readers can get information about signing up for health insurance during the open enrollment period on this page.