Student Health Insurance Guide
Reviewed by Laila Abdalla, Ph.D.
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- Despite being highly susceptible to illness, injury, and infection, college students are one of the most underinsured population groups.
- Students can often choose between several health insurance options, including Medicare, their parent’s health insurance, and school-provided insurance.
- Students should take proactive measures to help minimize risk and save on medical spending.
Health insurance helps cover the cost of medical treatment, doctor’s visits, prescriptions, and other health-related expenses. Colleges typically require students to either enroll in a student health insurance plan or prove that they are already insured through a different plan.
Although students may think they do not need insurance because they are in good health, they still face a high risk of injury and infection. Risky behaviors, participation in athletics, and auto accidents commonly lead to injuries that require medical attention.
Additionally, outbreaks of pathogens such as meningitis are relatively common on college campuses. Because of the exorbitant cost of medical care in the U.S., students without insurance are often left with high healthcare bills without the means to pay them off.
Students can choose from an array of health insurance options, including Medicaid, school-provided insurance, and their parents’ insurance. This guide explores these options in more detail.
Frequently Asked Questions
Why Do College Students Need Health Insurance?
Although access to health insurance in the U.S. has improved under the Affordable Care Act, 8.7% of students still lacked insurance in 2016, making college students one of the most underinsured population groups.
College students face a slew of health issues. Mental illnesses and related challenges often emerge during this time as a result of both stress and genetic predisposition. Students can also catch infections, such as mononucleosis, respiratory disease, and HPV. All of these illnesses require medical treatment.
Nearly all college students complain about significant stress, and many experience mental health issues as a result. Common challenges include anxiety, depression, eating disorders, and substance abuse. Additionally, psychiatric disorders, such as bipolar disorder and schizophrenia, often emerge when patients are in their early 20s.
Students experiencing such problems should seek strategies to manage their stress and seek aid from mental health professionals.
The Affordable Care Act (ACA)
Passed in 2010, the Affordable Care Act is a law designed to provide affordable health insurance to all Americans. Consumers receive tax credits based on their income, then apply these credits to help offset the costs of insurance. Individuals and families who earn too much to qualify for tax credits can still search for different insurance options through the ACA website.
The ACA sought to improve the quality of insurance by requiring insurance companies to meet a certain set of standards, including provisions for free birth control and coverage for preexisting conditions. The ACA also allowed young people to stay on their parents’ insurance until they turn 26.
Experts say the quality of student health insurance improved drastically under the ACA. However, the ACA also included an “individual mandate” that required all taxpayers to have insurance. Students received a tax penalty if they did not enroll in a health insurance plan.
The individual mandate was repealed, but colleges still require their students to have health insurance and automatically enroll learners in a health insurance plan. Students at most schools can opt out if they have insurance through their workplace or parents.
The Future of the ACA
Since the ACA was passed, certain politicians have repeatedly tried to repeal it. While the ACA has had a positive impact on students and low-income families, critics argue that middle-class families have been left behind.
“Repeal and replace” has been a slogan shared by many Republicans, but at this point, it’s uncertain what a potential replacement might look like. Additionally, about 62% of Americans support the ACA, and approximately 80% of Americans support protections for individuals who have preexisting conditions.
Regardless of any changes to the ACA, colleges will likely continue to require students to maintain health insurance and will offer a school-sponsored option.
To stay current on changes to healthcare in the U.S., visit healthcare.gov and follow news sites.
Student Coverage Basics: Where Do I Start?
When it comes to insurance, understanding its language and how it works goes a long way. At least half a dozen variables go into differentiating one policy from another, and each one carries its own financial implications.
A monthly premium is only the beginning of your out-of-pocket cost. If you cannot afford to pay the premium and the additional fees, you cannot afford the policy. Should you need medical treatment, understanding your obligations ahead of time can help you avoid a nasty surprise.
Must-Know Terms
To make an informed decision, it’s important to understand what you are being offered in exchange for your monthly premium. Before we examine your options in detail, take a moment to familiarize yourself with the basic terminology all insurers use.
What Are My Coverage Options?
Once forced to choose between expensive, high-deductible, single-payer insurance and whatever coverage a school wanted to offer, college students now have better choices for health insurance. College students generally have four options for health insurance:
- Remain on the family plan
- Purchase student insurance
- Purchase an individual plan on the open market
- Enroll in Medicaid
Parent’s Health Insurance
Under the ACA, students can stay on their family’s insurance plan until they turn 26. Students can stay on a parent’s insurance, even if they file their taxes as financially independent from their parents. Learners who choose this option typically need to submit paperwork to their college opting out of the school insurance.
For many students, this is the best option, in terms of both ease and affordability. Depending on your age and circumstances, your family may continue to pay the same rate as before.
Students who attend college in the same state where their family lives benefit from this plan. Learners can continue to access the same network and health providers that they did before. Students under 26 often take advantage of this option.
Student Health Insurance
Most colleges offer health insurance to their students, and many automatically enroll all new learners in a student health insurance plan (SHIP). Learners can use financial aid to help offset the cost of their SHIP.
Under the ACA, these plans typically must cover:
Ambulatory patient services- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Many different students choose this option, including those from uninsured families, those who do not wish to stay on their family’s plan, and those who attend an out-of-state school. Learners 26 and over — particularly those who earn too much to qualify for tax credits — can also save money through this option.
Individual Plan on the Open Market
Students can also use the ACA Marketplace to search for their own health insurance plan. Applicants who earn wages between 100% and 400% of the poverty line receive tax credits that help reduce the cost of insurance. However, not all schools accept this form of insurance; some may require a SHIP or a family plan.
Depending on the particular plan and each student’s chosen school, ACA Marketplace plans may be more or less expensive than SHIPs.
Although unusual, some colleges do not offer school health insurance. The ACA Marketplace is a good option for these learners, as well as those who are 26 or older.
The ACA Marketplace can prove especially useful for students who earn very little money. Low-income students can pay extremely low rates of just a few dollars per month.
Medicaid
Medicaid provides free and low-cost insurance to those who earn below 133% of the federal poverty level. Individuals with this form of insurance can access full, comprehensive healthcare services at little to no cost. As such, for those who qualify, Medicaid is the cheapest option.
Wider Medicaid coverage has helped increase the number of insured college students. However, not all states elected to expand Medicaid benefits when the ACA was passed. Students interested in this option need to check their state’s requirements.
Medicaid is the best health insurance for college students with no income. Learners who are 26 and older (who cannot join their family’s plan) often take advantage of this option. Pregnant people and people with a disability also have special eligibility for Medicaid.
Students with chronic health issues enjoy significant benefits from Medicaid — they only pay a very small amount (or nothing) each time they see the doctor or visit the hospital.
What Else Should I Consider When Choosing A Plan?
As you weigh your options, carefully consider your circumstances. Ask yourself the following questions, which apply to any individual in the process of choosing health insurance:
- Am I generally healthy or do I have a chronic illness or other condition that requires medical monitoring?
- What are the deductibles for each type of service?
- What coinsurance is offered after I meet my deductible?
- What copays can I expect for office visits or emergency room services?
- Do I want prescription coverage?
- Are there tweaks to my policy that can increase or decrease my deductibles?
- What is the maximum out-of-pocket expense where my plan begins to cover everything?
- How restricted is my provider network?
- Can I use on-campus health services for most medical needs or do I need to find a provider off campus?
Coverage for Recent Grads or Special-Status Students
Traditional undergraduates often have an easier time acquiring health insurance than their peers in less conventional circumstances. Depending on individual plan provisions, students who live off campus, attend classes part time, or are older than 25 may not qualify for the student healthcare plans discussed above. Fortunately, these students have other options.
The demands of work and family prohibit many students from pursuing a degree on a full-time basis. Fortunately, the educational system has made great strides to offer alternative means of learning to adult learners through distance education, evening and weekend classes, and extended programs designed for part-time students.
If you are a degree-seeking student taking a minimum of six credits, most schools will offer student health insurance to you. Depending on the school, you can meet this requirement in any learning format — sometimes even online.
Check with your prospective schools to find out their particular policies. Students who don’t take at least six credits per semester may fall back on insurance plans offered independent of their school, whether by purchasing an individual plan or by using a family plan for as long as they can.
Strategies for Managing Health Expenses
The passage of the ACA has helped reduce insurers’ methods of extracting money from your wallet. Many industry standards, such as charging higher premiums for policyholders with preexisting conditions, are no longer legal. Still, insurance carriers are for-profit corporations, and you need to approach your policy options as carefully as you would any other major purchase.
Make a Wise Policy Choice
First-time policy buyers can follow a few rules of thumb to avoid overpaying for their coverage:
- Be wary of add-ons or riders that come with extra fees. Make sure you need the extra layers of protection they offer you. If you do not, try to negotiate a plan with a lower premium and forego extra coverage.
- Resist the urge to choose a plan with a low monthly premium and a high deductible. Even if you are in perfect health, an accident can happen in a second. A very high deductible could haunt you for years.
- Be a conscientious consumer. File claims accurately and promptly and read your statements and records of service. Ask questions when you are confused. Many insurance companies will reward you for spotting a billing error.
Minimize Medical Expenses
Once you have found a policy that matches your needs, the best way to save on costs is to avoid using your policy more than necessary. You cannot prevent every illness or injury, but there are proactive measures that can minimize your risk and maximize your spending dollars.
Smart, preventive steps can impact your body and your bank account. Avoid copays and other expenses by practicing healthy living.
If you need to access your health plan benefits, do so wisely. Start with your primary care provider or student health center before you see an expensive specialist. Request generic medication whenever possible. Follow your medical professional’s instructions so that you are back on the road to health as soon as possible.
Additional Resources
Selecting a health insurance plan can be daunting. Educating yourself about the ins and outs of coverage plans takes time, but the more time you spend doing research, the better the chance you have of staying safe, healthy, and financially secure.
Selecting a health insurance plan can be daunting. Educating yourself about the ins and outs of coverage plans takes time, but the more time you spend doing research, the better the chance you have of staying safe, healthy, and financially secure.
HHS.gov
HHS.gov is the home site for the Affordable Care Act and its implementation. Visit this site to learn more about health insurance terminology and current events in our evolving healthcare system.
Healthcare.gov
On this site, you can access the health insurance Marketplace, explore the plans available to you, get insurance price quotes, and identify important deadlines.
HealthFinder
This extensive site offers quizzes and other interactive tools to help you learn to manage your health. Detailed articles on various health-related topics are also available.
Centers for Medicare and Medicaid Services
On this site, you can find out if you can apply for Medicaid as a student and learn more about what Medicaid offers in your state.
Student Health Insurance
This site offers information specific to the healthcare needs of students. In addition to insurance-related concerns, eHealth offers informational articles on staying healthy in a collegiate environment.
Health Coverage Options for College Students
This site provides detailed information about the ACA and its effect on your options.
Next Steps
This is the ACA’s official resource for college graduates. You can learn about your health plan coverage options and places to find low-cost healthcare services in your area.
Editor’s Note: This article contains general information and is not intended to be a substitute for professional advice. Please consult a professional advisor before making decisions about health-related or legal issues.
Reviewed by:
Laila Abdalla obtained her Ph.D. in English from McGill University in Montreal, Canada. For over 21 years at Central Washington University, she taught undergraduate and graduate courses in her subjects, along with classes on successful writing. Laila has devoted her teaching and leadership to matters of equity, diversity, and inclusion.
She is committed to her students’ complete experience above all, raising awareness of BIPoC issues in language, community, and culture. She leads with equity in management and nonprofit volunteering, and continues to develop her own understandings of these complex issues in her lived experiences and professionally.
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