Understanding the intricacies of healthcare systems in the United States can be daunting. Studies have shown that adults between the ages of 19 and 34 have some of the highest uninsured rates (15.6% uninsured) of any other age group in the United States, according to the United States 2019 American Community Survey. It’s important to understand the healthcare options available to college students to better understand the complexities of how healthcare and higher education intersect.
In 2010, the federal Patient Protection and Affordable Care Act, amended by the Health Care and Education Reconciliation act was signed. Within what is commonly known as the Affordable Care Act (ACA), are several provisions intended to expand access to healthcare and insurance programs and emphasize health and wellness among individuals. One of the provisions found in the ACA directly affects individuals between the ages of 18 and 26, whotend to have the highest rates of being uninsured.
Prior to the ACA, several health plans and insurers were able to remove adult dependents, regardless of higher education enrollment by the age of 18, as they were deemed adults. However, the ACA now requires insurers to offer coverage for dependent individuals until the dependent reaches the age of 26. This has allowed families and students who would otherwise age-out, to continue to receive coveragemuch further into their undergraduate or graduate experience, or even until after graduating college.
Most colleges and universities require their students to carry some form of health insurance. As such, this raises concerns for students who may or may not be able to opt into their parent’s health insurance plan for other reasons. There are several opportunities for health insurance coverage to meet various needs of students. Many universities offer campus health insurance that is separate from their university’s mandatory health fee. Most student health plans are regulated by the ACA, and thus cover the ten essential health benefits set forth by the ACA. However, it’s important for students to understand that some of these student health plans are deemed a short-term policy and therefore don’t have to be ACA compliant. These student health plans are set by their institution and can vary widely with some plans offering comprehensive coverage to others offering limited benefits accompanied by high deductibles and out-of-pocket costs.
When understanding the best healthcare option for students, we need to consider a few areas: How can we help support students who are independent or are unable to be on a parent or guardian’s policy? Is the student studying out of state? Is a student eligible for Medicaid due to tax reporting procedures? How does maternity and contraceptive coverage play into choosing between a parent-sponsored plan vs a school-sponsored plan? Is the student going to be studying abroad? These are just a few of the factors that we need to think about to understand how higher education can affect the healthcare options available to a market that is typically considered the most uninsured.
Let’s consider the example ofa 20-year-old student, who is studying out-of-state. If this student is claimed as a dependent on their parents’ or guardians’ taxes, and if they are also insured as a dependent, they may technically meet the minimum requirements for health insurance coverage by the school. This example is complicated however, because most of the hospitals or clinics at the out-of-state university would be considered out-of-network. If providers are considered out of network for the student, this can lead to soaring medical costs for even routine doctor visits. This means that the student needs to weigh their options and determine if it makes sense to purchase the school insurance plan, in addition to their current coverage. If this student is independent from their parents and has their own individual health care plan or is potentially uninsured, the student may be eligible for other healthcare options such as Medicaid.
There are several regulations surrounding Medicaid policy that may allow an individual to be eligible. If an individual is claimed asa dependent on their parents’ tax returns, that individual may not be able to claim Medicaid as the parents’ income would not be included in their application for eligibility. If the student was not listed as a dependent for tax-purposes, they may qualify for Medicaiddepending on their income level. What if they don’t qualify for Medicaid? If they don’t qualify, then the student needs to look at purchasing the school’s health insurance plan, or a potential private health insurance plan that offers in-network providers for that area.
Private colleges and universities that are religiously affiliated are exempt from providing certain procedures and coverage, such as access to contraception. This was upheld by the Supreme Court in Little Sisters of the Poor v. Pennsylvania in 2020, where it established that colleges and universities may avoid offering types of contraceptive coverage if they have a religious or moral objection. This creates another obstacle that some students need to understand and think about when they are researching their college’s respective student health insurance plan.
This just scratches the surface of some of the complexities of modern-day health care policies that individuals may face during their time in college. Regulations and conversations regarding insurance continue to evolve. It is important to understand these processes and opportunities for adequate healthcare coverage to better serve and understand how schools can support the well-being of their students.
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