This is part of Tonic’s Healthcare Guide series. See the other guides here, and find the glossary here. Download the PDF version of this guide here and a find a PDF of the master document here.
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About 13 percent of people ages 18 to 24 don’t have health insurance, according to the National Center for Health Statistics 2014 survey. But you need it, whether that’s through a plan you buy on the Affordable Care Act marketplace, a student health plan, or through the insurance your parents get from work. (Plus, if you’re uninsured in 2018, you’ll have to pay a penalty on your 2019 taxes—assuming you make enough money to file.)
Here are some common questions about getting covered:
My school is charging me a student health fee. What does that cover? Do I still need insurance?
Yes, you still need insurance for things like emergency room care and services the health center doesn’t cover. The student health center fee ensures that students who pay it have access to many health services on campus. (Most full-time students are required to pay this fee, if not, you’d have to pay per visit.) While some services, like routine doctor visits, vaccinations, or short-term counseling may be covered by this fee, others, like X-rays, prescriptions, or visits to specialty doctors, may not be. The price of non-covered services will depend on your health insurance.
Look at the details about what’s covered at your school and what’s not—this should be outlined on the school website. (Side note: One benefit of the health fee, as explained below, is that it means you can use health services—mental health, too—and your parents won’t know any of the specifics.)
What are the pros and cons of buying a plan my school sells?
We’ll talk about your parents’ insurance in a second, but first it’s worth considering school plans. “Most major four-year colleges offer student health insurance,” advises Erin Hemlin, the national director of training and consumer education at Young Invincibles, a young adult research and advocacy group. These plans usually count as qualifying health coverage to avoid the tax penalty.
It’s likely you can use the school’s health resources for things like check-ups or gynecological exams, STI screenings, treatment for illnesses, sleep issues, lab work/X-rays, regardless of having a student plan or not. The clinic may offer services on a sliding fee scale or for cheap, but find out what those costs are before you get sick, says Cheryl Fish-Parcham, director of access initiatives at Families USA.
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However, the benefit of a student health plan is that they’re often inexpensive and good quality, something that radically changed after the passage of Affordable Care Act (ACA). “Before the ACA, more than half the student plans were dangerous,” says Stephen L. Beckley of Hodgkins Beckley Consulting LLC, a healthcare management and benefit consultant group that specializes in higher education. (Previously, many had “gotchas” like excluding coverage of pre-existing conditions, he says.)
Today, luckily, things are different. “Student health plans can be exceptional value, even if you still have eligibility under your parent’s employers plan,” Beckley says. “It’s not uncommon to hear from parents they’re saving significant dollars going to a student plan.” (Yes, you can stay on a parent’s plan until age 26, but it’s not free; more on that below.)
Sometimes students are automatically enrolled in student healthcare plans—and thus charged for them—unless they specifically opt out of coverage. For some schools that is true when it comes to full-time students, and you’ll have to fill out a waiver to opt out. In other schools you’ll go through an enrollment process where you either choose to enroll or waive coverage. Either way, it’s not some sneaky system to insure you, Beckley says, but rather to make sure that you have a health plan in place.
Anticipate what your health needs may be. Then, check out the Summary of Benefits Coverage to determine exactly what the plan covers and what the deductible is. (In schools that offer excellent health programs, this will easily be found on their website). Does it cover doc visits? Prescription drug coverage? X-rays? Lab tests? Vision and dental? And check out the coverage dates, if it’s full-year, school year, or what happens if you’re not enrolling until the spring semester.
Next, learn about what the copays are for medical and mental health visits at the Student Health Center and other in-network providers, as well as for emergency room visits. (While the campus health center may be the main resource, student health plans don’t limit you to only campus care.) You’d need to compare these all of these costs—copays, deductibles, and premiums, or the cost of the plan—to whatever a parent’s plan charges to find out if a student plan is truly a better deal.
Most school plans are also designed to cover you when you return home (even if it’s in another state) or go abroad. “These often cover better than employer plans, providing worldwide coverage, including medical evacuation back home if you’re in another country,” Beckley says.
Can’t I just stay on my parent’s plan?
If your parent is insured through their employer, the ACA says you can stay on their plan until you’re 26. (And you can stay on it even if you get married, have a child, move out of their house, or—yep—start school.) All your parent has to do is add you on their application during open enrollment to get you covered, and then they’ll pay a higher amount from their paychecks. Open enrollment usually starts in November, so if you’re not already on their plan, coverage wouldn’t kick in until January of the following year.
However, know that while the law says young adults can remain on their parent’s plan, there’s no requirement that employers need to make a contribution to coverage for dependents, Beckley says. “Over the last two decades, many employers have quit funding dependent coverage,” he says. That means your coverage could be a lot more expensive than theirs is. Have your parents look at their paycheck, which should list how much each family member’s health insurance costs. (During open enrollment, the employer should also have information on costs for dependents.) Another thing to check: if you’re on your parent’s plan, are you insured by the same company? Some employers offer different coverage for their employees and their family members, he says.
If your school is in another state, call the insurance company to make sure that you’ll have a network of providers accessible in the area, Hemlin says. It’s possible you’re on a state- or regional-based network that’s more restricted. And it will hardly do you any good if you have insurance but there are no doctors or hospitals you can go to near your school.
Is there a world in which having both plans is a good idea?
If you’re covered under your parent’s plan, you’re likely better off making a choice between a student plan or staying on their employer plan. Having both probably doesn’t make sense for most young people, Beckley says, unless you have a chronic health condition that’s managed with a lot of routine doctor’s visits and expensive medications. In that instance, the student plan would pay for your services first and then the employer plan would kick in. “For the most part, you’d wind up with 100 percent coverage,” he says.
What do I do if I don’t have the option of a parent’s plan or buying a student health plan?
If your school doesn’t offer insurance and getting on a parent’s plan isn’t an option for you, you can buy your own insurance. As Healthcare.gov points out, you can either get this on your own or be included on your parent’s application if you’re under 26. Most likely, you or your parents will sign up during Open Enrollment, unless they qualify for a special enrollment period for certain life events. For instance, if you lose student health insurance for whatever reason, get married, or have a baby, you can buy a Marketplace plan in a special enrollment window.
When you’re shopping for insurance, Hemlin says to ask yourself these three things:
What’s the benefit package? Make sure the services covered are what you need—and what you anticipate you may need. Marketplace plans have to cover things like prescription drugs, mental health services, and maternity care, and, but you’ll have to check to see if they offer additional benefits like dental or vision, or medical-management programs if you’re treating specific conditions like diabetes.
What does the network of providers look like? Can you actually access the doctors based on geography or your personal circumstances? If you’re spending summers back home in one state and going to school in another, make sure there are providers in both areas.
Am I eligible for discounted coverage? If you’re working part time and aren’t eligible for insurance through your employer, you may be able to get a discount plan, according to Healthcare.gov. Or you may be able to qualify for Medicaid in your state if you can establish permanent residency.
As Hemlin points out, you shouldn’t just go for the cheapest plan. “Even if you consider yourself young and healthy, we know people can get into an accident at any time and have to pay thousands of dollars in a deductible,” she says.
That’s why people are overwhelmingly enrolled in Silver Health Plans, a mid-range plan with moderate monthly premiums. You may also be able to save on out-of-pocket costs if you qualify for extra savings based on your income. These savings are known as “cost-sharing reductions” and basically they’re a discount that lowers what you pay for deductibles, copays, and coinsurance—but only for silver plans, she says. Need help? Check out the Get Covered Connector tool from Young Invincibles, which will help connect you to local aids who can help you with your application.
This probably goes without saying, but if you’re new to buying your own insurance, you want to make sure that you keep up with paying the premiums. If you have a break in payments (usually up to 90 days) and are dropped from your plan, you will have to wait until the next open enrollment period to get insured again, Fish-Parcham says.
I can’t afford any of these options. I’ll just have to risk it and be uninsured, right?
There are other ways to get covered. If you make less than $16,573 a year (138 percent of the federal poverty level), you’re eligible for Medicaid in more than 30 states as long as you’re not a dependent on someone else’s insurance, Fish-Parcham says. If you have Medicaid and your school is in another state, you may consider transferring Medicaid coverage to the other state, but first, consider if you’re planning on going home during the summer and also look at what your new state’s income guidelines are for Medicaid.
What about those cheap, short-term health plans that Trump approved?
Short-term health plans offer coverage for limited periods of time (three months), though Fish-Parcham says that new rules may make them available for longer. “We caution people to be very wary of these. They do not include mental health coverage or sports injuries of the most part. There are many holes that would be especially problematic for a young person,” she says. (They’re already effectively banned in five states and restricted in others.)
Speaking of mental health, what’s the deal with mental health care on campus?
College may be the first time you’re managing and responsible for your own health and mental health without involvement from your parents, notes Victor Schwartz, a clinical associate professor of psychiatry at the NYU School of Medicine and chief medical officer at The Jed Foundation, a nonprofit dedicated to promoting mental health and suicide prevention for teens and young adults.
“The demand for mental health care services is exploding. Having a student plan with strong long-term counseling is integral, but not all colleges offer this,” Beckley says. Schwartz adds, “The most serious problems that emerge in students is more likely to be in the mental health arena, and these are fairly common. According to data from the National College Health Assessment, 40 percent say they experienced anxiety or depression significant enough to interfere with their functioning.”
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It’s critical to know how and where to get support. Thing is, Schwartz adds, there is no national standard that enforces the type and availability of services on campus. Rather than assume what your school provides, you should just ask about their counseling services.
The benefit to getting counseling on campus is that “their services may allow you to see a practitioner sooner and with the same level of quality as in the local community,” Schwartz says. The on-campus center can also coordinate with the school if you need specific accommodations or need to take a leave of absence for mental health reasons.
However, if you have an existing mental health issue, you should know that school resources are designed to provide short-term care, he says, meaning they’re not intended for people who are already diagnosed. In that case, you should work out a plan with your current mental health team about how to best continue your care (where to go, how often, etc) before arriving on campus.
Ideally, the health center and counseling center at a university are integrated, Beckley says. “This is a standard in primary care that college health has been slow to adopt,” he says, noting that Colorado State University, Cornell University, and the University of Minnesota are all examples of schools that provide excellent integrated care. Ask your school if that’s the case and how these services work together.
What can I keep confidential from my parents even if I’m on their insurance?
If you’re over 18, you’re an adult. Know that health privacy and confidentiality laws protect your health and mental health records, according to a 2016 report from the National Alliance on Mental Illness (NAMI) and the JED Foundation. (The laws in question are the Family Educational Rights and Privacy Act, or FERPA, and the Health Insurance Portability and Accountability Act, or HIPAA).
There’s an exception, though. If you use your parents’ insurance to get healthcare, your parents will probably receive an explanation of benefits (EOB) that outlines which services were provided and how much the insurance company covered. Schwartz says this is one of the reasons most colleges charge student health fees rather than a fee for each health or counseling visit—if no bill is generated, then the visit can remain private.
But that privacy protection could work against you in certain cases. “These laws safeguard your information, but they can also prevent colleges from contacting your parents if you are facing significant challenges or a serious mental health condition,” the report states.
Before getting any type of care, it’s a good idea to write directives out ahead of time by completing an authorization form that instructs providers when they can contact your parent or guardian about a health or mental health problem, Schwartz says. Your school may have one of these forms available, but you can also find one on page 23 of the NAMI/JED report.
If you experience a health or safety emergency or mental health crisis, your provider can independently decide to communicate the issue with your parents, based on the severity of the situation, and also taking into account the climate at home. If the counselor has reason to believe that this information would be damaging to you if your parents were involved, then they may opt to not contact them. State laws can also kick in and prevent this communication, which is why you’ll need to fill out that authorization form if you want your parents to be informed in case of emergency.
If your parent is worried about you and calls the counseling center asking if you’ve recently been seen (or, likewise, wants information from the health center), the school won’t release that info without consent from you. They may instead speak to your parents in more general terms, e.g. that school health staff have been in contact with you and you are okay. That said, your parents can share any information with the school’s health center or Dean of students that they deem helpful—like prescription medications and past treatment—and the school can “accept” it.
Should I really be considering healthcare when I’m choosing a school?
It may be too late to say this but, if you’re still choosing a school (or will be next semester/year), consider the robustness of the health and counseling services when making your decision, Beckley says. “How well a college provides for health will vary dramatically from campus to campus, and it speaks to how they value the wellbeing of students,” he says.
On campus tours, they should stop at the health center and emphasize the great services it provides. You can also get a feel for this by looking at a school’s website, which should outline the student health benefits.
More Tonic Healthcare Guides:
If You Have a Mental Health Issue
Glossary of Health Insurance Terms
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