health Insurance Article

The Complete Guide To College Students & Healthcare Reform

College is an exciting time in a young adult’s life and many feel that they’re invincible. Besides, who else can stay up until 4am, eat 3 pieces of pizza, and ace an exam the next morning? student health 300 However, even though students are young and generally suffer fewer illnesses and accidents than older people, the college environment places them at an increased risk, so health insurance is a necessity. Unfortunately, student health insurance plans up until now haven’t provided the level of coverage many students needed, and for non-traditional students, the search for affordable health insurance has been especially difficult.

With the passage of the Affordable Care Act (ACA), changes geared toward students have already started. Just one portion of the ACA as it pertains to college students dramatically changed students’ affordable accessibility to health insurance when raising the age a student can stay on a family policy to 26. It’s also affected colleges — many universities have provided comprehensive health plans for students, but with the passage of the ACA, many university health plans aren’t up to par with federal regulations. This means change is brewing within colleges and universities as well as your average health insurance plan. Students may feel as if they’re forever young, but time marches on, and as 2014 approaches and the individual mandate becomes law, students will benefit from knowing their options, because change, it is a comin’.

Do College Students Really Need Health Insurance?

What could possibly go wrong in college? Aside from catching every cold and flu thanks to the sardine boxes called dorm rooms, or making the silly decision to slide down that banister at a frat party, college students could technically and safely go without health insurance, right? That’s not true though, and the reason a college student should have health insurance isn’t to avoid being ‘fined’ come tax time now that health insurance is going to be required.

Unbeknownst to invincible college students across the country, there’s an alarming number of health problems college students regularly face. “Living in a closed environment like a college dormitory introduces a whole set of college health issues that college-age kids do not have to deal with at home,” says Guys Napolitana, MD, chairman of the primary care department at Lahey Clinic in Burlington, Massachusetts. If you’re uninsured, these incidents can put you in deep debt, along with other long term consequences. If you think student loans are bad, try adding thousands of dollars in medical bills to them. Working to pay all that off isn’t exactly how you want to spend the rest of your twenties, is it? For some perspective on just how vital health insurance can be for college students, here are some common college illnesses and average treatment costs to mull over:

  • Meningococcal Meningitis: Most schools require students receive a vaccine to guard against this illness, but each year, 100-125 students are infected. With insurance, vaccines can be as low as $15. Without, they can run close to $150.
  • Colds & Flu: Because students share close quarters, the common cold is that much more common. If someone gets a case of the flu, it can spread like good gossip. Student health centers normally offer the flu vaccine, and some pharmacies offer the vaccine for a reasonable price. If you get the flu though, expect to pay with or without insurance. The average cost for an insured, sick person is around $130, but one out of three flu sufferers spend anywhere between $250 to $1K recovering.
  • Foodborne Illnesses: Contaminated surfaces spread common symptoms of food poisoning like nausea and diarrhea quickly, contaminating more common spaces like bathrooms. Remember you mother’s words and wash your hands. One study estimates that food poisoning costs the US over $77 billion annually,  an average of $505 per person.
  • STDs and HIV: This is the topic no one wants to talk about, but must be addressed. College students are at the highest risk of contracting STDs, but with health insurance, testing and preventive measures, like counseling and condoms, are available free of charge or at a significantly reduced rate. Without insurance, testing can cost anywhere from $50 to $400 depending on the provider and the tests you take. Additionally, some health insurance plans will cover birth control. Health insurance allows students to take safety into their own hands and can help prevent serious illnesses like HIV – a disease with monthly treatment costs averaging $2K-$5K that must be taken for the rest of your life.
  • Mononucleosis: Yup, the kissing disease is still around. Caused by the Epstein-Barr virus, the most common symptom is exhaustion, and this illness can last a long time. While prescription medicines normally don’t cure it, consider the costs of having to drop out of college and/or work for an extended period of time because you got ‘cooties.’ That’s not the Spring Break you want – it would only put you behind in the long run and your life would be on pause.
  • Strep Infections: This sickness can only be treated with antibiotics, commonly treated with Amoxicillin, which, without insurance, is only around $20.With insurance, it’s even cheaper though, and every college student knows $20 equals a lot of Ramen Noodles, a college diet staple.
  • Dating Violence: According to one study, 69.8% of college women have at least one experience with sexual violence from the age of 14 through the last year of college. Consisting of mental, physical, and/or sexual abuse, dating violence can cause symptoms ranging from broken bones, mental distress, and depression. Those without insurance may be reluctant to seek help that could prevent more serious issues later in life, and no tub of Ben & Jerry’s will help prevent the severity that failing to treat such ailments can bring.
  • Accidents: Commonly related to alcohol abuse, almost 600K students each year are injured after consumption. Just getting stitches can run an uninsured student anywhere from $200 to $3K – with that, a college student could buy Ramen for their whole dormitory.  Additionally, the prevalence of alcohol in the college scene is cause for alarm. A few drinks here and there shouldn’t have long term effects, but the CDC claims that multiple deaths and traffic related accidents for college age students can be traced back to binge drinking, which can lead to long term issues of alcoholism and other health related issues. Drugs are also common on your average college campus. 22.9% of students meet the medical definition of a drug addict, and even if you don’t go to the Betty Ford Clinic, rehabilitation therapy is expensive. For a full year of methadone maintenance, average cost of treatment is $4,700 per patient.

How Students Benefit from the ACA

The ACA provides more opportunity for college students to find affordable healthcare plans, and it may not involve your college’s health insurance option. Here are several ways the ACA’s college student measures are actually something that provides a variety of options that weren’t as readily available or realistic before.

  • Preventive Care: It’s true that college students are generally healthy, but it never hurts to get into the habit of taking care of yourself on a regular basis. In addition to eating healthy and exercising, which some college students do, regularly attending the doctor helps maintain health – unfortunately something college students bypass until absolutely required. Before the ACA, certain kinds of services weren’t available though, but now services for smoking cessation, diet and weight loss, and substance abuse are even considered preventive and are therefore free.
  • Pre-Existing Conditions: While this is a benefit for everyone, and although many college students are less likely to have pre-existing conditions serious enough to be turned down for health insurance, there are still a few college students that face that exact problem. Consider those with something like asthma, for example. It was probably pretty difficult to find affordable insurance – or sometimes coverage at all — pre-ACA. It’s important to note too that not all students are traditionally coming right out of high school. Some return for graduate work or are finally getting an undergraduate degree after being in the workforce for years. Denying insurance coverage due to pre-existing condition made it difficult to obtain care for those that actually needed it the most. Now, it’s a thing of the past for everyone, including college students.
  • Parents Coverage: Reminiscent of the days when a parent could write a permission note for a child to skip school or be late to class, the ACA has a permission slip for students too – being able to stay on their parents’ health insurance policies, which solves many students’ problems. This perk even extends beyond college though – it’s especially advantageous for recent grads having problems finding jobs with benefits. Eric Oakland, a benefits consultant with Ruggeri Consulting, said, “If a student can’t find the perfect job right away, then it allows them to be more selective in their choice, because one of the major expenses they would face would be taken care of by being on their parents plan.” However, just be aware of where your parents’ plan is accepted. If you travel several states away, depending on their plan, your insurance may not be accepted. Unfortunately, sometimes even the campus health center may be considered out of network.
  • Loan Repayment for Medical Students: As the ACA pushes preventive care, there will need to be a surge of primary care physicians entering the health care workplace. To help encourage future doctors, the bill provides funding for the National Health Services Corps Students to Service Loan Repayment Program. While that sounds like a mouthful, it’s actually a program working to place newly qualified doctors in underserved areas. In exchange, students can receive up to $120K to repay their loans. Only a certain amount of rewards are given out each year, but progress must start somewhere, and a benefit like that may help students put their days of Ramen Noodles  behind them sooner rather than later.
  • Improved School Health Plans: Currently, university health plans aren’t sufficient for students that suffer serious accidents or have ongoing illnesses. Stephen Beckley, a health care management consultant for colleges and universities summed that up neatly, saying, “Sixty percent of the plans out there are pure junk.” According to a Government Accountability Office study, almost all plans have maximum benefit limits on a condition basis and maximum lifetime benefits. The ACA will force schools to adopt a medical loss ratio of 80-85%, meaning anywhere from 80-85% of premiums must go directly to healthcare, and additionally, the ACA eliminates lifetime caps.

Insurance Options For Traditional College Students

The ACA is affecting college based plans in several ways, but some universities are feeling the crunch, which ultimately affects students. Meeting minimum federal limits might mean one of two things for some colleges — prices increase or health insurance isn’t offered. One university, Bethany College in Kansas, decided not to offer a health insurance plan to their students. Before the ACA, the college payout was limited to $10K — an amount a college student likely wouldn’t reach unless an emergency happened, and that plan cost $445 annually.

Tobin Van Ostern, a policy manager for Campus Progress, recognizes that many students don’t meet policy limits, but then again, some do. “A school that has a very low lifetime or annual limit, yes, that doesn’t impact many people but for the students who are on the plan and hit that maximum, that’s sort of a life changing, life altering event that has huge consequences in their lives.” Now, the ACA requires that payment caps start at $100K – a far cry from $10K – but raises Bethany College students’ premiums to $2K – a far cry from $445.

Many students are already swimming in student loans, so the idea of spending more for health insurance isn’t appealing. The idea is to get away from Ramen Noodles, yet simultaneously obtain great health insurance – but is it possible? As it turns out, it definitely is. If your college is in a similar situation and eliminates health insurance completely, you can still find coverage elsewhere.

  • Parents’/Family Plans: Now that this is a valid option for many students, it’s worth examining how it could affect you, both positively and negatively. While your parents’ coverage will provide comprehensive protection, it may cost more depending on the insurance plan. Some policies cover a set number of dependents for a flat rate while others charge an extra premium for dependent coverage. Depending on the regulation of the insurance provider, staying on your parents’ health insurance may affect your status as an independent or dependent student. Ask your insurance company and school how one affects the other. If parents are okay keeping a student on their plan, and the limitations are minimal, this could be the best health insurance plan for a traditional student.

  • Individual/Private Plans: Another area of healthcare greatly affected by the ACA, individual health plans will still be offered, but there’s also the added choice of state exchange plans. While individual plans have traditionally been affordable for young, healthy adults, state exchanges will be an option perhaps even more affordable. This may be a valid choice if a college plan is too expensive and if parents can’t provide health insurance. “If you’re young, you do want to go on the exchanges because you’ll qualify for subsidies,” says Jen Mishory, of Young Invincibles.
  • Coverage through Employers: For most traditional college students, this isn’t possible. For non-traditional students attending school part-time, this may be the best route. Group health insurance provides comprehensive coverage, and also offers the perks of maintaining low premiums, co-pays, and deductibles. The downside? Working and going to school at the same time is rougher than listening to a German professor shout Deutsch at you at 8AM. Even worse, there’s the issue of losing a job and trying to afford to pay for school and health insurance.
  • Medicaid: Another portion of the ACA expands Medicaid, which is currently being left for states to decide. With this expansion, the eligibility limit for application is 133% of the Federal Poverty Level. In 2012, if college students made under $14,856 a year, they’d be eligible for the program. Although this gives students another option, there are some things to keep in mind:

    • Will Medicaid meet student health insurance requirements?
    • Will Medicaid cover network doctors and specialists?

    For years, this has been the only health insurance policy for low income students, but unfortunately, still hasn’t met the demands for comprehensive healthcare.

Choosing the Right Health Insurance Plan

Understandably, sorting through the details of multiple health insurance policies isn’t exactly the image most college students envision what’s supposed to be the best years of their life, but there are resources available now that aren’t to be taken for granted. Ask your parent’s for help (as hard as it may be since you undoubtedly want to prove how independent you are), and ask your university for educational material. Most of all, don’t be afraid to question insurance companies. Sadly, too many use a ‘don’t ask, don’t tell’ policy, and you definitely want to keep these questions in mind:

  • How long are you covered? Some plans only provide coverage while school is in session.
  • Is your health plan required to meet state and federal mandates for coverage limits?
  • Are dental and vision plans included or available?
  • What kind of provider network is offered?
  • What is the deductible amount?
  • What is the co-pay amount?
  • How far does coverage extend?

As for financial concerns, the ACA aims to make healthcare affordable, but coverage still isn’t free. It’s probably the last thing you want to do, but if you’re stuck between a rock and a hard place, health insurance can be included in a student’s additional expenses budget, meaning loans can be used to pay for coverage. In fact, many colleges automatically total this into the cost of attendance, which is why colleges require students to opt out of school-provided coverage if students plan to purchase health insurance elsewhere.

Regardless of which policy you opt for, read the fine print for exclusions and benefits caps. Yes – it may put you to sleep faster than some of your classes do, but it’s a good habit you absolutely need to get into. After all, college is all about learning and building a foundation to grow upon – the earlier you start deciphering insurance policies, the better. After you’ve excitedly added health insurance policies to your summer reading list, there are a couple things to watch out for. Lucky for college students (and for most people all over the country), the ACA requires the health insurance version of ‘Cliffs’ Notes now. The ACA mandated that all insurance plans come with a Summary of Benefits and Coverage form (SBC), which provides an easy to understand outline of benefits. This lists deductible amounts, benefit caps, and referral requirements, and if there’s still a term you don’t understand, don’t worry — the SBC comes with a glossary.

Insurance Options for Non-Traditional Students & Recent Graduates

  • International Students: Of course, not all students come directly out of US high schools. That doesn’t change the fact that health insurance is still needed, and it may be difficult for you to read insurance policies, and it may be even more difficult for international students to do so, but there are health insurance options for international students too. Students from other countries need comprehensive health insurance, but don’t qualify for the plans available to traditional students. Instead, they need to purchase international student health insurance. Plans can be purchased from a variety of providers, but colleges may have providers they work with and recommend. Most insurance plans require student visas and full-time enrollment. These plans generally cover preventive and emergency care as well as hospitalization, but sometimes only for a certain period of time depending on the stipulation of the plan. Some plans even pay for family members to visit during hospitalization.
  • Students Studying Abroad: For American students studying abroad, health insurance is still just as important. Sometimes colleges offer travel health insurance plans, including short-term policies, but if not, double check your current policy. Some may cover out of country travel — others may not. Any type of student travel health insurance is pretty similar to an international student policy, providing comprehensive coverage and evacuation and hospital treatment. Like all plans, there are maximum benefits, deductibles, and co-pays.
  • Non-Traditional Students: Until recently, non-traditional students had a hard time finding affordable healthcare. Without parental health insurance or a full time job, many remained uninsured. When the ACA simply raised the age one can be insured until under parents’ policies, that alone helped many non-traditional students. Non-traditional students are quite varied, so the surplus of options now are welcomed by students. Consider a single mother working through college while keeping a full time job that doesn’t offer health insurance. Small businesses with fewer than 50 employees aren’t required to offer health insurance, but in 2014, state health exchanges will be available, offering employees an affordable way to get health insurance.
  • Recent College Graduates: If you’re graduating before 2014 and are still under 26, try to remain on your parents’ insurance. Of course, the hope for many graduates is that the graduation celebration will be followed by a job. If your job offers group health insurance, go for it. Otherwise, here are options for the remainder of 2013:

    • COBRA: If you were insured under a family plan and are no longer eligible, you can purchase this federal insurance plan. It’s very expensive because you’re responsible for the entirety of the premium but it’s better than being uninsured.
    • Individual Policy: Purchase a short term policy that will cover you until the state exchange plans take effect. Selecting a high deductible health insurance plan will be cost effective and your premium shouldn’t exceed over $200 per month if you’re young and healthy.

While the ACA is trying to make healthcare affordable and available for those trying to obtain educations, the main way to save on health insurance is nothing anyone would learn in a class – be healthy. It’s that simple. That doesn’t eradicate all possibilities of illness or injury, but it’s a great start, and that’s what college is all about.

Follow Desiree on Twitter @DesireeBaughman.

To learn more about the ACA in general and as it applies to college students, check out these resources: U.S. Department of Health and Human Services | Affordable Care Act and Student Health Insurance

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