Women’s Health Nurse PractitionerKat Lindsay, CPC, CHDA
Assistant Health Director
College students need health insurance. According to a 2009 report, young adults between the ages of 19 and 29 are more likely to be uninsured than other group, yet are more likely to visit emergency rooms for treatment. Ending up in the hospital can mean thousands of dollars in medical bills. Insurance covers health costs and limits your liability. Of course, coverage varies according to the health insurance source and plan. Some plans cover “extras”-issues such as nutrition counseling, stress management, etc. In many cases, you can use financial aid to pay for your health insurance.
As of 2014, students are legally required to have health insurance coverage, whether it is a college-sponsored plan, a parent’s plan, Medicaid or individual health coverage. No matter which coverage you choose, it is important to understand the billing process and associated paperwork. In the case of health insurance, the devil really is in the details. Insurance companies make many billing mistakes in the US each year. In fact, it’s not uncommon to discover a bill for services you never received. At some point, you may even need to appeal a decision, especially if your insurance company denies you coverage for a particular service.
This guide aims to help college students understand their health care coverage options by:
“It’s important for college students to have insurance because things happen, even to healthy people. We’ve seen students who’ve needed trips to the ER, surgeries, ultrasounds and other diagnostic tests that, even with insurance, are costly.”
MSN, RN, APN-C
Women’s Health Nurse Practitioner
College students have four options for health insurance:
Each option has its own procedures, as well as advantages and disadvantages over the other programs:
|Individual Health Insurance||
Many schools offer enrolled students a college-sponsored health plan, which is not the same as employer-sponsored group coverage that colleges and universities offer their faculty and staff.
If your college offers a fully insured college-sponsored health plan, it must meet the Affordable Care Act requirements for Minimum Essential Coverage. Essential health benefits include:
Some school-sponsored plans include extra services such as:
However, if your school’s student health plan is self-insured, it might not cover essential health benefits. Each state is responsible for regulating student health plans within the state. Each school also has its own rules for eligibility. Check with your college or university to find out what type of student health plan they offer.
Often times the benefits of a college sponsored plan varies on whether the university offers a voluntary plan or requires proof of health insurance as a condition of enrollment. Typically, the college plan will work with the resources on campus to provide certain services and help keep costs down.
Assistant Health Director
Under the Affordable Health Care Act, children can remain on their parent’s health insurance plans until the age of 26, making it a convenient option for college students. You do not have to live in your parents’ home or be a dependent to be eligible; however, if you live in a different state, your parents’ plan may not cover medical care in the state where you attend college, or you may have to pay more for out-of-state services. Contact your parent’s health insurance company to find out what is covered and whether there is a network of participating providers accessible while you are away at school.
Until recently, Medicaid coverage was limited to children and pregnant women. Now students under the age of 65 in participating states may enroll if they earn up to 133 percent of the federal poverty level. If you are a dependent on your parents’ tax return, Medicaid determines eligibility based on your family’s household income. Former foster children can stay on Medicaid until age 26. To find out if you qualify for Medicaid coverage visit Medicaid.gov.
Now that the Affordable Care Act has gone into effect, you can purchase a policy on your own in your state through the health insurance Marketplace during Open Enrollment periods (starting November 15, 2014 for plans with effective dates starting January 1, 2015 or later). Depending on your income, you may be able to reduce the cost of plan premiums and/or cost sharing.
Individual health insurance is not the same as a college-sponsored plan. If you are eligible for a student health plan, you can still be eligible for Marketplace coverage and subsidies during Open Enrollment. However, you cannot voluntarily drop your student health plan coverage outside of Open Enrollment in order to qualify for Marketplace coverage and premium tax credits.
When you experience a Qualifying Event, such as moving to a new state or losing health insurance coverage, you may qualify for a special 60-day enrollment opportunity during which you can apply for Marketplace coverage and premium tax credits.
Young adults up to the age of 30 may choose to buy a catastrophic plan instead of a regular health insurance plan. These plans are not eligible for premium tax credits or cost sharing reductions. A catastrophic plan covers essential health benefits and requires the highest level of cost sharing allowable for essential health benefits. After you meet the deductible ($6,350 for 2014), the plan pays 100 percent of covered essential health benefit services for the remainder of the year.
For information about applying for individual health insurance through the Marketplace, visit Healthcare.gov.
If your income is too high to qualify for lower costs on coverage, you can buy health coverage outside the Marketplace, directly through an insurance company. You can also use an agent or broker, or an online insurance seller. Use the Plan Finder on the Marketplace website to preview outside plans.
Once you apply, it can take up to several weeks for a response. If you are approved, you will be given an effective date for when your health coverage starts.
Guide for college students that explains health insurance options2.How Health Reform Really Affects Student Health Plans
Discussion of the impact of Affordable Care Act on health insurance for college students3. University Health Insurance Inc. School-Sponsored Plans
Detailed health plan information for college-sponsored plans covered under University Health Insurance, Inc.4.Aetna Student Health Site
Detailed health plan information for college-sponsored plans covered under Aetna5.Affordable Care Act
US Dept. of Health and Human Services website about Affordable Care Act6. Kaiser Family Foundation Health Marketplace
Henry J. Kaiser Foundation FAQs about Health Marketplace for young adults and college students
For many students, college means taking control of their health for the very first time. Fortunately, in addition to covering care for chronic conditions such as asthma, most health insurance plans also provide wellness care. There are usually a number of holistic health services available on college campuses that are included with college-sponsored health plans. Other health insurance plans often include reduced rates for holistic services off-campus as well.
Remember: You cannot be denied insurance coverage because of a pre-existing condition such as asthma, diabetes, or mental illness on the Health Insurance Marketplace.
Health care is available through the Health Insurance Marketplace or your private individual health plan of choice regardless of your health under the Affordable Care Act. That means that insurers cannot issue exclusion periods or increase your premiums for pre-existing conditions such as asthma. Under this law, you have access to covered services immediately, which includes lab work and prescriptions.
Many colleges offer nutrition education and counseling that does not require health insurance coverage. Services may include:
Weight loss benefits offered with health insurance discounts include various diet programs and services, such as the “Living Healthy Naturally” program offered through Blue Cross Blue Shield or “The Aetna Weight Management Discount Program,” included with some college-sponsored plans. Most campuses have fitness centers open to all students at reduced rates. In addition, many health insurance plans include discounts for services at major fitness centers.
A study by the American Psychological Association (APA) found 70 percent of college students admit stress is a problem. High stress levels can result in impaired concentration, weight gain and depression. Many campuses run stress relief programs through the student health center such as the “Be Well Do Well” program at Berkeley. Stress management programs may also include access to massage therapy, acupuncture and other stress management techniques.
Mental health and substance abuse services, including behavioral health treatment, are included in the Minimum Essential Coverage benefits under the Affordable Care Act. However, your insurance company determines the number of visits allowed, your inpatient and outpatient coverage, and in-network and out of-network providers. You may also need preauthorization from the insurance company before making an appointment. Check with your insurer for more information.
Many health insurance plans cover some kind of tobacco cessation service, such as the Quit Tobacco Cessation Program, a one-year program with personal coaching, interactive web tools and motivational materials to create healthy habits. Medicaid includes coverage of tobacco cessation medications in all states.
Understanding medical bills, enrollment forms and other medical-related paperwork is important when it comes to health insurance. Below is a review of some of the things you should know.
College-sponsored plan: Your school will usually automatically enroll you in a college-sponsored plan unless you fill out a waiver and show proof of other health insurance.
Parent’s Plan: Your parent’s will fill out the paperwork to add you to their plan.
Medicaid: Go to the Medicaid section of the Health Care Marketplace for enrollment instructions.
Individual Coverage: Enroll at Healthcare.gov, or call 1-800-318-2596, 24 hours a day, 7 days a week (TTY: 1-855-889-4325). A customer service representative will work with you to complete the application and enrollment process, or apply by mail with a downloaded application form and instructions.
Your in-network or out-of-network provider will usually file a claim form for your services and send it directly to the insurance company. However, you may have to fill it out on your own at some point, so it is a good idea to be familiar with one. The following information is usually required:Section 1:
Insured- If you are on a parent’s plan, you will need to fill in this section with his or her:
Patient- Fill out this section with your own:
Most insurance companies require an itemized bill with all claims. The bill should include the following information:
Shortly after you receive medical treatment from a physician, hospital, or other provider, you will receive an Explanation of Benefits (EOB) from your health insurance company. The EOB explains what medical treatments and services the insurance company paid on your behalf. If you paid for the services upfront, you will also receive a reimbursement check.
An EOB includes several important pieces of information:
Hospitals and medical facilities can be hectic work environments so, unfortunately, billing mistakes sometimes occur. Always ask for an itemized bill after medical services, especially after a hospital stay. It’s the only way you can see specific charges. Sometimes a practitioner will bill for a more expensive service than was actually performed. This may be due to a billing code error. Contact your physician if you have any questions about individual charges.
Keep your itemized bill so that you can compare it to the EOB when it arrives. If you notice any discrepancies, contact your health insurance company right away. If a service is denied coverage for any reason it, always challenge the decision. Many times services are denied due to clerical errors. The best case scenario is they will approve the service and if they don’t, you are no worse off. Call the insurance company to see if you can clear it up over the phone. If it cannot be resolved over the phone, you may need to appeal, which usually involves the following steps and information:
The monthly amount you pay the health insurance company to maintain coverage. A higher premium tends to mean lower deductibles, while a lower premium tends to mean higher deductibles, but that may not always be the case.Deductible
The amount of money your health insurance company requires you to pay out-of-pocket before they begin paying for claims. Premiums and copayments are not usually included when deductible is being figured out. Higher deductible plans usually have a lower premium.Out-of-pocket
The money you pay-and the health insurance company does not pay-for your medical expenses. Your health insurance company sets a maximum out-of-pocket cap, which is the money you are required to pay toward your claims (including deductibles, copayments, and coinsurance but not premiums) in a single year. Usually, once you reach the maximum the insurance company pays any additional charges in full for the rest of the year.Co-payment
The amount of money you must pay up front when receiving a specific medical service. For example, your copay may be $15 for office visits or $10 for prescriptions. Every plan varies.Co-insurance
The amount of money you must pay for covered medical services after you meet your copayment or deductible. For example, a visit may cost $100. If you met your deductible and subtract your copayment of $15, the bill is $85. However, your insurance company may limit your coverage to 80% of charges. In this case, you would need to pay the remaining 20%, even though you met your deductible.