Medical Insurance for College Students:

A Comprehensive Guide

College students are required to have health insurance coverage. They have a variety of options, including a college-sponsored plan, a parent’s plan, Medicaid and individual health insurance. This guide discusses the available options, explains how to understand the paperwork involved with health insurance and provides expert advice, including resources.

ABOUT THE AUTHOR

Jennifer Koebele has more than a decade of experience researching and writing about topics related to higher education and health insurance for college students. She’s a former elementary school teacher with a Master of Science in Education.

EXPERT SOURCES

Clarissa Fay, MSN, RN, APN-C

Women’s Health Nurse Practitioner

Kat Lindsay, CPC, CHDA

Assistant Health Director

TABLE OF CONTENTS

Introduction

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:

  • Describing the current insurance landscape for college students
  • Discussing what is and what is not covered in a typical health plan
  • Explaining the billing and paperwork involved with health insurance
  • Providing expert advice and health insurance resources

“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.”

Clarissa Fay
MSN, RN, APN-C
Women’s Health Nurse Practitioner

Health Insurance Options for College Students

College students have four options for health insurance:

  • College-sponsored plan
  • Parent’s plan
  • Medicaid
  • Individual health insurance

Each option has its own procedures, as well as advantages and disadvantages over the other programs:

Option Advantages Disadvantages
College-sponsored Plan
  • On-campus medical services
  • Billed with tuition
  • May cover extra programs
  • Often less expensive than parents’ plan
  • May not cover off-campus services
  • Must meet school’s eligibility rules
  • Often need to pay upfront
  • Coverage varies by school
Parent’s Plan
  • Convenient
  • Paperwork sent to parents
  • Can remain on plan until age 26
  • May be more expensive
  • Not always accepted in other states
Medicaid
  • Expanded eligibility rules
  • Former foster children can remain on plan until age 26
  • Dependents must qualify based on total family income
  • Many states don’t participate
Individual Health Insurance
  • Special student rates
  • Reduced premiums based on financial need
  • Cannot be denied coverage for pre-existing conditions
  • Minimum Essential Coverage requirements
  • Optional catastrophic coverage
  • Open enrollment dates are limited

Option #1: College-sponsored plan

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:

  • 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

Some school-sponsored plans include extra services such as:

  • Access to travel assistance services
  • Massage therapy and acupuncture benefits
  • Discounts on vitamins
  • Weight loss programs

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.

Kat Lindsay
CPC, CHDA
Assistant Health Director

Option #2: Parent’s plan

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.

Option #3: Enroll Through Medicaid

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.

Option #4: Individual Health Insurance

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.

Next Steps:

  1. Find out the cost and coverage under your parent’s plan
  2. Find out the cost and coverage of your college-sponsored plan
  3. If it is Open Enrollment, or you have a Qualifying Event, find out the cost and coverage of several plan options
  4. Make sure your insurance coverage includes services in the state where you are attending college
  5. Compare premium fees and benefits before making a decision

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.

Additional Resources
1. eHealth Insurance Services Buyers Guide

Guide for college students that explains health insurance options

2.How Health Reform Really Affects Student Health Plans

Discussion of the impact of Affordable Care Act on health insurance for college students

3. 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 Aetna

5.Affordable Care Act

US Dept. of Health and Human Services website about Affordable Care Act

6. Kaiser Family Foundation Health Marketplace

Henry J. Kaiser Foundation FAQs about Health Marketplace for young adults and college students

Not just for the sick: Health and wellness insurance for 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.

Nutrition Services

Many colleges offer nutrition education and counseling that does not require health insurance coverage. Services may include:

  • Weight management
  • Vegan and vegetarian lifestyle
  • Gluten-free living
  • Blood pressure and cholesterol regulation

Weight Loss/Fitness

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.

Stress Management

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

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.

Stop Smoking

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.

Medical billing breakdown: Understanding forms, bills and other (stuff)

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.

Health Insurance Enrollment Form

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.

Claim Form

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:

  • Date of Birth
  • Address
  • Phone
  • Gender
  • SS number
  • Employer Name, Address, Phone
  • Insurance ID number
Section 2:

Patient- Fill out this section with your own:

  • Relationship to insured
  • DOB
  • Address
  • Phone
  • Gender
  • Student Status
Section 3:
  • Signature

Most insurance companies require an itemized bill with all claims. The bill should include the following information:

  • Insured name
  • Date of Service
  • Patient name
  • Type of service/procedure code
  • Charge for service
  • Health care professional name/credentials/Tax ID number
  • Health care professional address
  • Diagnosis code

Explanation of Benefits

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:

  • Federal Tax ID Number: For the physician or hospital where you received treatment
  • Check Number and Amount: Paid to physician or hospital on your behalf
  • Patient ID: Assigned by your insurer
  • Member Number: Assigned by your insurer
  • Date and Place of Service: When and where treatment occurred
  • Submitted Charges: Amount the physician or hospital billed you for service
  • Negotiated or Allowed Amount: If the provider was in-network, they negotiated the fee for this service. Otherwise it is the most your insurance company will cover for this service.
  • Copayment: The amount you paid at your visit toward the final bill
  • Not Payable Amount and Reason: The amount the insurer will not pay and the reason(s) why
  • Deductible: The amount you must meet before the insurer will begin paying benefits
  • Coinsurance: The amount of money you must pay for covered medical services after you meet your copayment or deductible.
  • Patient Responsibility: Total amount for which you are responsible, including copay, deductible, coinsurance and any amount not covered
  • Payable Amount: Total amount the insurer will pay for this service
  • Claim Adjustments: Any adjustment that impacts the amount the insurer will pay. For example, the amount paid by other insurance carrier or amount previously paid on same claim.
  • Issued Amount: Check total

What if there is a billing error?

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:

  1. Ask your physician for a letter explaining why it was necessary to use that treatment.
  2. Write a detailed letter explaining your appeal, including:
    • Dates
    • Physician’s name
    • Service details
    • Claim numbers
  3. Make a copy of both letters before sending the originals to the insurance company’s appeals address.
  4. Send the envelope through certified mail so that you have a dated receipt.
  5. Follow up after 30 days if you haven’t gotten a response.

Glossary of Terms

Premium

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.