Understanding Health Insurance as a Student: A Comprehensive Guide

Below is a list of important terms to know as you’re exploring student health insurance.

• Advance Premium Tax Credit (APTC): A discount you can apply in advance of your insurance premium; when you apply for coverage on the marketplace, you estimate your income for the coming year, and if it’s low enough, you qualify for the credit. If, at the end of the year, your income was more than your estimate, you pay back part of your APTC.
• Children’s Health Insurance Program (CHIP): If you’re 19 or younger, you may qualify for CHIP, meaning your parents can pay a minimal price for your health insurance and can enroll you anytime. To qualify for CHIP, your parents must earn too much to qualify for Medicaid but not enough to pay for private health insurance.
• Coinsurance: After you meet your deductible for healthcare services that are covered by your insurance, coinsurance is an additional percentage you might have to pay, depending on your plan.
• Copay: After you meet your deductible for healthcare services that are covered by your insurance, copay is a fixed amount you might have to pay, depending on your plan. Most plans will have either a copay or coinsurance, not both. Typically, the lower your premium, the higher your copay, and vice versa.
• Cost Sharing Reduction Subsidy: “Cost sharing” is a blanket term that includes copayments, coinsurance, and deductibles — in other words, after you’ve met your premium each month, and you go to the doctor (or receive other healthcare services), you share additional costs for your care with your insurance company. If your income is low enough, you may qualify for the cost sharing reduction subsidy, which lowers the amount you pay.
• Deductible: Your out-of-pocket expense for services that are covered by your insurance.
• Dependent: If you’re a parent, you claim your kids as dependents on your taxes, which, depending on your income level, may qualify you for a credit to lower the cost of your kids’ health insurance. If you’re under 26, you can remain on your parents’ health plan as a dependent.
• Group Plan: A healthcare plan provided by schools, employers, and other organizations. Under the ACA, employers with 50 or more full-time employees must offer health insurance to 95 percent of their full-time employees.
• Health Savings Account (HSA): Some high deductible health plans on the marketplace offer an HSA, which allows you to put earnings into an account expressly for the purpose of paying for certain medical expenses. The IRS doesn’t tax money you put into an HSA. Some employers offer an HSA (meaning they match the amount you put into it each month), and some financial institutions do as well.
• In-Network: Your insurance company partners with certain providers, facilities, and suppliers who form a network.
• Marketplace: The federal government’s online service where you can shop for health insurance and enroll in various plans. Phone and in-person assistance is also available, and you can find out whether you qualify for Medicaid or CHIP, as well as other subsidies. Some states have their own marketplaces as well.
• Medicaid: A federal program offering free or cheap healthcare for individuals and families who qualify due to low income, disabilities, pregnancy, or old age. You may not be able to receive Medicaid if your state hasn’t expanded coverage.
• Out of Network: Providers, facilities, and suppliers that are not partnering with your insurer. You pay more for healthcare from out-of-network providers than for in-network providers.
• Premium: The amount you pay for health insurance each month.
• Preventive Care: Healthcare services — such as check-ups, screenings, and counseling — you receive to help prevent future problems. The majority of health insurance plans, including those on the marketplace, cover preventive care at no cost to you.
• Student Health Insurance Plan: A healthcare plan for full-time university students. At most public universities, full-time students are required to have health insurance and will automatically be enrolled in student health insurance unless they waive it and do one of the following:
  • Enroll in a plan via federal or state marketplace
  • Qualify for Medicaid or CHIP
  • Remain on their parents’ health plan

The Affordable Care Act helped a lot of students get health insurance: In 2010, before the ACA went into effect, over 19 percent of college students were uninsured, but by 2016, that number dropped to 8.7 percent.

Still, college students remain the largest group of uninsured Americans. Most universities will require you to have health insurance, and the ACA has several provisions designed to help make this affordable and achievable.

Here’s what the ACA does to encourage you to get health insurance:

• It allows you to be on your parents’ health insurance plan until you’re 26: According to Healthcare.gov, all your parents have to do is add you to their plan during open enrollment. If you lost your health insurance at some point, your parents can add you to their plan during a special enrollment period.
• It provides subsidies: According to the Obamacare Facts website, 60 percent of young adults have qualified for subsidies that lower the cost of insurance to $100 or less per month. Subsidies include the Advance Premium Tax Credit and income-based breaks. To see which subsidies you qualify for, apply for individual insurance during open enrollment at the Health Insurance Marketplace site.
• It endorses Student Health Insurance Plans (SHIP): Many SHIP meet federal guidelines for Minimum Essential Coverage, and become accessible once you are accepted and enroll at a university offering insurance to students.
• It includes Medicaid and CHIP: If you qualify for Medicaid or CHIP (Children’s Health Insurance Program), these programs also meet the Minimum Essential Coverage guidelines.

College students living in a different state than their parents can still be on their parents’ health insurance. However, if that’s you, be sure to look at the insurance plan’s provider network — it might not extend to your state, in which case you’d be better served by shopping on the marketplace and qualifying for subsidies.

Tip: If your household income is between 100 percent and 400 percent of the federal poverty level, look into a Silver Plan on the Health Insurance Marketplace. You can apply the cost sharing reduction subsidy with a premium tax credit to the Silver Plan. A Silver Plan also allows you to have a health savings account (HSA). All in all, this means a Silver Plan is very cost-effective.

Here’s a list of the various insurance plans you can choose as a student:

Independent Plan

There are two general types of independent plans: a marketplace plan or a private plan. Marketplace plan levels are Bronze, Silver, Gold, and Platinum. Bronze is the lowest level — it’s minimal coverage for a low premium price — while Platinum is the highest level with the highest premium price.

You can also shop for a private plan outside of the marketplace. To do so, contact an insurance agent, a broker, or simply do an online search for private health insurance plans in your state.

Family Plan

If you have kids or other dependents (people for whom you are the legal guardian and they legally qualify as being a dependent), you can qualify for a family plan, meaning you’ll enroll in a plan and pay a premium that covers yourself and your dependents. A family plan will also cover your spouse if they don’t have insurance and you need to include them. A family plan will cover whoever you claim as dependents, as long as they are under age 26. Or, if you are a dependent under 26, you can remain on your parents’ family plan.

Catastrophic Insurance

This is a marketplace insurance plan you can get if you’re under 30 or if you qualify for a hardship exemption (you can’t afford insurance due to extenuating circumstances). Catastrophic insurance is the cheapest, most minimal insurance possible. It has the highest deductible and therefore is meant to cover you only when catastrophe hits.

Medicaid

If you earn between 100 and 138 percent of the federal poverty level, and you live in a state that has expanded Medicaid coverage under the ACA (meaning your state accepts federal Medicaid funds), you qualify for Medicaid, which is a low-cost or free healthcare plan. You also qualify for Medicaid if you’re disabled or pregnant. If your state hasn’t expanded Medicaid coverage, and you’re in the gap that can’t afford health insurance but doesn’t qualify for Medicaid, you can get catastrophic insurance.

Be sure to understand health insurance, and don’t fall for any of these student health assumptions.

“I’m young and healthy — I don’t need health insurance.”

Public universities generally require you to have health insurance. Even if that weren’t the case, catastrophes still strike college students as much as they do other population groups, and insurance is there so you don’t have to pay extremely high medical bills for surgery or emergency care.

“I’m going to be stuck with a huge health insurance bill.”

Actually, the ACA offers many subsidies, exemptions, and ways to pay very little for health coverage. If you can’t afford a regular plan, apply for a catastrophic plan. If you’re in the income bracket that qualifies you for Medicaid in your state, you can pay nothing (or very little) for healthcare. If you’re under 26, your parents can keep you on their insurance. Additionally, student health plans are typically inexpensive because they are a gigantic group plan.

“My premium costs are only affected by the plan I choose.”

About 40 percent of people aren’t aware that being a smoker will increase their premium costs. If you admit you smoke, your premium costs go up. If you lie and then your insurer finds out you’re a smoker due to a medical issue, you could lose coverage altogether.

The key to getting the right health insurance for you is asking questions. With that in mind, here are some pertinent questions to ask.

What is the cost of staying on my parents’ plan versus the cost of another plan?

If you’re under 26, you and your parents may be tempted to take advantage of the fact that you can remain on your parents’ plan. This is a good idea if you’re an online student and are remaining in the state where your parents are covered. But if you’re living in a different state than your parents, healthcare providers may be out of network, meaning you’ll pay more for care in that state.

You might be better off choosing a different plan on the marketplace, seeing which subsidies you qualify for, and then working out funding options to pay for that plan instead. Or, you could take advantage of your university’s healthcare plan. If you’re not in the same state as your parents, overall costs for a different plan may be cheaper than remaining on their family plan.

Is a part-time job a good idea?

Qualification for subsidized coverage is based on income, and you need to be able to estimate your earnings when you apply for a marketplace plan. Online courses make it easier to swing a part-time job. If you’d rather get a marketplace plan than be on your university’s plan, and qualifying for Medicaid is not an option, look into a part-time job.

Is a catastrophic plan a good idea?

If you’re over 26, healthy, have no dependents, and simply want minimal coverage in case of catastrophe, a catastrophic plan may be a good idea. However, although you’ll pay a low premium, keep in mind you’ll pay a very high deductible and copayment. What about occasional checkups and medications? Catastrophic plans aren’t good if you need the normal type of coverage most people need. Student health insurance from your university will cover things like mental health treatment, STD and AIDS testing, and a variety of other services you may need (be sure to review the Student Health Insurance Plan paperwork).

What if you’re a student studying abroad? In that case, here are the steps for accessing healthcare during your trip:

• If you’re on your parents’ plan, contact the insurance company. Give them the details of your trip and find out what they can do to accommodate your travel insurance needs.
• If you’re on a student health insurance plan, talk to your adviser. They’ll help you determine whether the university is providing international health insurance, and if not, whether there are any travel insurance companies partnering with the college to offer discounts on travel insurance. The study abroad program may also include insurance.
• If you’re on a marketplace or private plan, contact the insurer and find out about its travel insurance options. If it doesn’t have any, look at travel insurance plans from major insurers and compare rates.

Once you’ve looked at international health insurance from a travel insurer, find out about incorporating it into your study abroad program. You should be able to roll it into your study abroad package for a low rate.

If you need a more extensive option because you’re going to be abroad for longer than six months, look into global health insurance plans.

When it comes down to it, health insurance is a way to promote preventive care and make sure you’re not stuck with an entire medical bill.

As a student, you might be more concerned with the overall cost of your health plan, rather than the plan’s coverage details, which is why you choose a low premium or a catastrophic plan. Maintaining your health will keep you from paying a high deductible, a copay, or coinsurance, and will keep your healthcare costs low.

Refraining from smoking is one of the simplest ways to keep your premium low and to avoid health problems and costly medical bills.

The older we get, the more health concerns we have, and over 47 percent of students taking college classes are over 25. Many of them are nontraditional students, and those students can lead stressful lives because they’re often working and going to school at the same time. Stress can affect your health, and so can sitting in front of computer for too long. Balance out the stress and sitting time with these tips for maintaining student health:

• Exercise: Do your best to get about 150 minutes of moderate exercise per week, or 75 minutes of vigorous activity.
• Eat right: Plan your meals each week and set aside time to prep meals ahead of the week with fresh ingredients from the grocery store. Avoid fast food and processed foods. If you have the money and no time, consider ordering meals from companies that deliver fresh, healthy prepared meals to your door.
• Sleep: Over 30 percent of adults don’t get the sleep they need, yet sleep keeps you healthy and helps you get better grades. Set aside time for at least seven hours of sleep per night and shut down screen time at least an hour before bed.
• Care for your mental health: As mentioned, many health insurance plans offer free mental health counseling, which is a preventive service. But don’t wait until the burden of stress or other mental issues causes you to need counseling.
• Interact with other people: Online classes can leave you isolated. Meet with your professors via Skype, make time for your friends, attend a study group, study in a coffee shop where you can occasionally talk to other people, and try social sites like Meetup.com for social opportunities.
• Relieve stress: Consider mindfulness meditation, which is proven to lower stress. Don’t hold yourself to unrealistic standards and expectations, set your phone to “do not disturb” when you’re studying, take breaks, exercise, and use time management techniques.

Maintaining your physical and mental health can make your time as online student rewarding and lower your healthcare costs.