When you enroll in college, you have a lot on your mind: which major to choose, what classes to take, and how to foot the bill. But one important topic often gets overlooked: health insurance. As a result, coverage remains elusive for too many students. According to a recent survey, 14% — about one in seven — college students are uninsured.
Whether you’re 18 and right out of high school or pushing 30 and getting your master’s, you need health insurance. This guide gives you a look at the health insurance landscape, from the ins and outs of the Affordable Care Act to other options for college students.
Getting to Know the Affordable Care Act
The Affordable Care Act (ACA) was enacted by Congress in 2010 to provide lower cost health insurance to more people, expand Medicaid, and to support new healthcare delivery methods. The ACA has enabled millions of Americans, including college students, to get access to health insurance through public marketplaces.
The ACA brought a number of protections, including a ban on discrimination based on pre-existing conditions and a ban on gender discrimination in health insurance coverage. It also stipulated that most plans cover preventative care and mental health services, and it established minimum standards for care.
Another significant change that came from the ACA is the dependent coverage provision, which enables people 26 years old or younger to stay on their parents’ insurance plans. Plus, the Medicaid expansion extends coverage to childless adults with low incomes—which includes many college students—at little or no cost.
These two major elements of the ACA have helped close the gap in insurance coverage for college students in all 50 states and Washington, DC.
Where does the Affordable Care Act stand in 2022?
According to a summary of research completed by the Century Foundation and Young Invincibles, the ACA has significantly increased student coverage. “For most students, health insurance coverage increased by 10 percentage points from 2010 to 2018,” the summary states. Plus the ACA cut the national un-insurance rate for students in half and increased the number of students enrolled in Medicaid by five percent. The same study also found that employer-based coverage for students increased with the ACA, rising 4%, and that race-based gaps in coverage decreased.
For 2022, a number of positive changes have impacted the ACA. The American Rescue Plan Act (ARPA), which was brought about by the coronavirus pandemic, has resulted in greater access to plans, more flexibility in enrollment, and potentially lower costs—all big pluses for students. Many states have expanded their open enrollment periods, and students will find more plans with lower premiums and higher discounts, thanks to subsidies from the ARPA.
What’s more, the number of state-run health insurance marketplaces has increased, with Kentucky, Maine, and New Mexico now operating their own exchanges. Between state-run exchanges and healthcare.gov, you’ll find plenty of options.
Choosing a Health Insurance Plan in College
In addition to staying on your parents’ insurance or obtaining health insurance coverage through a state or federal exchange, you may be able to get coverage through your school. These student health plans, usually handled by the Student Health Services department, offer basic insurance that meets minimum requirements under the ACA.
Getting Health Insurance Through Your School
If you don’t have coverage through your parents, getting health insurance through your college is likely the best option. But do you qualify? And what options do you have?
Eligibility & restrictions
Typically you’ll enroll directly through your college or university. In most cases, you’ll need to take a minimum of 9-12 credits each semester. That said, check with your school on eligibility and to make sure that the plan you choose is ACA-compliant. In some cases, students considered to be low income may be eligible for tax credits or for low- or no-cost coverage through Medicaid or their state exchange.
If you have coverage through your employer, a state exchange, or Healthcare.gov, your insurance carrier may offer additional coverage, such as term life. This kind of add-on typically isn’t available with Medicaid plans, so it’s best to check directly with your insurance company to see what they offer.
If you want dental insurance, many of the plans offered through the marketplace allow you to purchase add-on dental coverage on top of your regular medical insurance premium. The same applies to employer-based health insurance; check directly with your insurer to understand your options.
If you’re covered under a Medicaid plan and are over 21, your state determines if dental care is included. For those under 21, Medicaid requires that dental care be provided under the Early and Periodic Screening, Diagnostic and Treatment benefit.
If you wish to opt out, which means not carrying any health insurance, there are some things to know. When the ACA was established, the law said that all adults had to carry coverage or face a tax penalty. However, that so-called “individual mandate” was struck down by the courts in 2019, meaning there’s no longer a federal penalty for not having health insurance.
However, some states—including California, Massachusetts, New Jersey, Rhode Island, and the District of Columbia—still have individual mandates with a tax penalty of up to $695 per uninsured adult. Check your state’s requirements and make sure you understand any potential penalties before opting out.
Other Common Ways to Get Health Insurance as a Student
Besides getting insurance through your school, the most common avenues for college students to obtain health insurance are through a parent’s health plan, employer-based plans, a state insurance exchange or Healthcare.gov, or through Medicaid. Here’s a more detailed rundown of each:
Under the ACA, dependents can stay on their parents’ insurance plan until age 26. The insurance can be either an employer-based plan or health insurance purchased through a state marketplace or Healthcare.gov. The rules are explained here; after you turn 26, most likely you’ll be required to get your own plan.
If you’re a dependent, you may qualify for the Children’s Health Insurance Program (CHIP), which offers many free services. Costs vary by state, so contacting a state healthcare navigator or an expert through Healthcare.gov is the best place to start.
With an employer-based plan, if you work full-time your employer may contribute part of the premium. This can reduce your cost overall, but remember that you may lose your coverage if you switch to part-time hours or leave your job.
Health insurance is available to college students in all 50 states and the District of Columbia through public marketplaces/exchanges. Some states operate their own exchange, while others participate in the national exchange at Healthcare.gov. It’s also important to understand if your state participated in the Medicaid expansion, which may help if you have a lower income. For more information on state exchanges, start here.
Less Common Options for College Students
For some students the options listed above might not be the best choice. If you haven’t found the right fit, keep reading for a few more options.
Catastrophic Health Insurance
Catastrophic health insurance plans are a low-cost option that some students under 30 might want to consider. These plans include some preventative care services, but with a deductible of $8,700 for 2022 you’ll pay out-of-pocket for most of your expenses unless you have a major medical event. To learn more about these plans, look here.
The ACA included an expansion of Medicaid, which enables more people with lower incomes to obtain health insurance coverage. Medicaid assistance can include reduced marketplace premiums, Medicaid-based plans, and CHIP plans. This useful calculator will help you understand more about Medicaid eligibility based on your income.
Buying & Using Healthcare: Step-by-Step
Getting health insurance coverage is important. But sometimes it’s hard to know what the first step is. In addition to the links and resources in this article, search online for your state’s programs to learn what’s available on the exchange/marketplace. Plus you can look at Healthcare.gov for guidance and speak to a healthcare navigator through your state or through Healthcare.gov to walk through your options.
If you’re considering getting coverage through your school or your parents’ employer, be sure to check out their website and/or call for assistance—you might be surprised at the help that you’ll receive.
Enroll in your health plan prior to the deadline
There are important deadlines for health plan enrollment. These vary by state, but they’re usually from November 1 to January 15 of each year. However, there are also special enrollment period exceptions, such as a major life change or becoming eligible for Medicaid or CHIP. If one of these exceptions occurs, you’ll be able to get coverage almost any time. Get details here.
Understand your premiums and note your due dates
Once you have a plan, review the documentation that your insurance company or provider gives you. This will have important information about your premiums, due dates, and what you can expect to pay in out-of-pocket expenses.
It’s always useful to keep this information on hand, whether on paper or stored digitally. Set calendar reminders to make sure you don’t miss any important payments.
Choose your primary care physician and schedule an appointment
Most healthcare organizations allow you to choose a primary care physician (commonly called a PCP). Before choosing your doctor, review their background, qualifications, and areas of specialty to decide if they seem to be the right doctor for you.
The next step is making an appointment, which you can do via phone or through the online scheduling systems that most medical groups use. Signing up for text or email notifications from your doctor’s office can help you stay on track.
Become acquainted with your explanation of benefits (EOB)
When you receive healthcare services, an explanation of benefits (EOB) will follow via postal mail or online document delivery. The EOB documents the services you’ve received, what the insurance company will pay, and the portion of the bill that you’re responsible for under the terms of your plan.
An EOB is not a bill, but it does show who has paid what and offers a useful tool for keeping track of your expenses.
Keep your insurance card on you
It seems obvious, but keeping your insurance card in your wallet, purse, phone case, or backpack makes sense. If you’re in an accident or are unconscious, first responders or others can see that you have coverage. Some healthcare providers may offer a digital card, which you can store in your mobile phone’s wallet. It’s also a good idea to have a photo of your card, which you can store on your phone and/or your computer.
Make sure your pharmacy is contracted with your insurance company
Checking to make sure that your favorite pharmacy works with your insurance company is important. This ensures that prescriptions are ready for you when you need them. If you need to find another pharmacy, the time to do it is before you get sick!
Begin taking advantage of your new health coverage
Once you have coverage, using your healthcare benefits is the next step. All marketplace plans offer ten essential benefits plus a wide range of preventative services, including vaccinations, STD testing, disease screening, and more.
Healthcare Fact & Fiction: Common Misconceptions
Many misconceptions center around health insurance for college students. Quite often those misconceptions can be cleared up through simple research, whether online or by talking to a healthcare navigator at an exchange or a representative at your insurance company. The following are some key misconceptions and their explanations.
The cheapest policy is the best policy
The cheapest health insurance plan is not always the best policy.
For example, a high-deductible plan with a low monthly premium might cost you when you need care the most. With just one medical incident, your out-of-pocket deductible costs could exceed the price of a plan with a higher premium and a lower deductible. Copays for low-cost plans can be higher at the time of service, and many bargain plans don’t cover prescription drugs.
Look closely at the total costs you’re likely to pay based on how many times you think you’ll need medical care over the year. A bargain isn’t a bargain if the numbers don’t add up.
I’m young and healthy so health insurance isn’t necessary
Many young people—college students included—think that they’re invincible. And while your body may be resilient when it comes to minor scrapes and bruises or colds and flu, you can’t fix something like a broken bone, a disease, or a chronic condition with just R&R.
The average doctor visit costs about $171 without insurance, and treatment for even simple issues can run into the hundreds or thousands of dollars. A major accident could be a financial and medical setback with years-long implications. That’s why everyone should be covered, no matter their age—because taking the risk just isn’t worth it.
I have corporate health insurance and don’t need personal health coverage
Even though you have health insurance through your employer, that policy may not cover all your out-of-pocket costs like copays, deductibles, and coinsurance. In addition to covering those out-of-pocket expenses, some supplemental insurance plans provide financial assistance for living expenses—including lost wages—in the event of a serious injury or illness.
I have a pre-existing condition so I can’t get health coverage
One of the foundational elements of the Affordable Care Act is that pre-existing conditions are not a reason for insurance companies to charge higher premiums or to deny coverage to individuals or their dependent children.
Health insurance covers 100% of my medical bills
Having health insurance doesn’t mean that all of your medical bills are covered. You’re likely to pay a portion of each visit or procedure you receive.
ACA-approved plans available in the state or federal marketplaces cover “essential health benefits,” which include outpatient care, lab tests, prescriptions, wellness services and preventative care, emergency room visits, hospitalization, pre-natal and baby care, mental health and substance abuse treatment, medical devices for disabilities or chronic conditions, and dental and vision care for kids.
What health insurance usually doesn’t cover at all includes elective surgeries, cosmetic procedures, and experimental treatments. Check with your insurance provider regarding costs and your obligations before receiving treatment.
The Affordable Care Act is no longer active
Sometimes called Obamacare, the ACA is still very much in effect. The original law was passed by Congress in 2010, and though there have been challenges to the ACA (including the individual mandate), most of the ACA remains in effect. In fact, as of January 2022, a record number of people signed up for the ACA in the latest enrollment period, making the program as strong as ever.
Maternity costs are not covered
The ACA covers a broad range of services for maternity and newborn care. Pregnancy isn’t considered a pre-existing condition, and healthcare coverage cannot be denied due to being pregnant.
Expert Q&A: Navigating the Health Insurance System
Tim Connon is an entrepreneur born in Florida. His father was a top salesman, and Tim had dreams of one day being just like his dad. From his early 20s to mid-30s, Tim achieved this dream in the life insurance field and became the founder of ParamountQuote.
Christian Worstell is a licensed insurance agent and a senior staff writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options. His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to healthcare and finance blogs. Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
What are the best options for health insurance for college students?
Connon: The two best options for college students are Major Medical Affordable Care Act plans and Short Term Medical plans.
Worstell: You’re allowed to remain on your parents’ health insurance plan as a dependent until the age of 26, so often the best option for a college student needing health insurance is to just remain on their parents’ plan. Some colleges offer a student health insurance plan that covers basic needs at a low premium.
How can college students choose the kind of health insurance plan that is right for them?
Connon: The best way to choose a plan is by individual needs. If a college student is currently being treated for pre-existing conditions and needs insurance to cover these conditions and any medications, then a Major Medical Affordable Care Act plan is perfect for them. If they are healthy and just want something temporary until they find an employer that will cover them on their group health insurance plan, then they should get a Short Term Medical plan.
Worstell: It’s important for college students to consider the network of doctors and other healthcare providers that accept a particular plan before enrolling. Some college campuses are more remote and may not have an abundance of healthcare facilities nearby. Plus, many college students lack transportation.
It’s also a good idea to determine how often you utilize healthcare. If you’re in good health and don’t engage in any particularly risky or dangerous activities, you might be better served by a plan with a low monthly premium and a higher deductible. If the opposite is true, it may be more cost efficient to enroll in a plan with a higher premium but a lower deductible. If you take prescription medication, make sure it’s covered by the plan before enrolling.
Are there ways that college students can keep their health insurance costs down?
Connon: Yes, when it comes to Major Medical plans, a student can apply for a subsidized policy based on their current income. This dramatically reduces the cost of their health insurance.
Short Term plans are cheaper if you only apply for the basic policy without any add-ons like dental or vision. Short Term rates are based on age, so the younger a student is the more affordable their rate will be.
Worstell: Younger people generally get lower rates; being in good health and not smoking can help you get the best possible rate. Most college campuses have a student health clinic that can remedy minor ailments at a lower cost than a hospital, doctor’s office, or public health clinic.
What mistakes do college students make when choosing health insurance?
Connon: sometimes college students mistakenly select a plan that doesn’t have their current doctor in the network or doesn’t cover their current medications. They can also mistakenly select a plan with high copays.
Worstell: Younger people typically are drawn to the monthly premium and often choose the cheapest plan. That is a wise choice in many cases, but not all. Those who are new to choosing their own insurance may not understand the importance of the plan’s network providers and network restrictions. Plus, it’s not uncommon for younger people to forget about dental and vision coverage, which are typically sold separately from health insurance or come available as an add-on.
How can they avoid these mistakes?
Connon: Students can avoid these mistakes by checking the insurance company’s website and searching their doctor’s name. They can also check which prescriptions are covered and the amount of copayments when seeing a doctor. If the student works with an insurance agent, the agent will do all of this on the student’s behalf.
Worstell: Do some quick brushing up on HMO vs. PPO and high-deductible plans. If you know those basics, you’ll avoid many of the most common mistakes. And be sure to have some awareness about dental and vision benefits. If you take a prescription medication, make sure it’s covered by your plan.
What are the most important things college students should know about health insurance?
Connon: The most important thing to know is that you will inevitably wind up switching health insurance every few years. Subsidized plans change and doctors leave health insurance networks on a regular basis. This means that, to stay with the same doctors and keep your premiums low, you’ll want to look into switching insurance plans every few years. Make sure you have a personal health insurance agent who can help you keep up with these changes and recommend new policies.
Worstell: The cheapest plan is not always the most cost-efficient plan. Typically low-cost plans have restrictions about where, when, and how the plan may be utilized. Last but not least, health insurance does not cover everything.
Mastering the Lingo: Health Insurance Glossary
Given all the complex definitions used in healthcare, understanding your health insurance can be challenging. However, this glossary will help you with some of the major terms, making you a better-informed user of health insurance.
|Allowed Amount||Sometimes referred to as eligible expense, payment allowance, or negotiated rate, the allowed amount is the maximum that your insurance will pay for a procedure or service.|
|Annual Deductible||Annual deductible is the amount that you’ll pay before your health insurance starts to pay for services.|
|Benefits||Benefits are defined as the healthcare services that are covered (paid for) through your plan.|
|Claim Form||A claim form is a request for payment from your healthcare provider to your health insurer to request payment for services.|
|Coinsurance||Coinsurance is the percentage of costs that you’ll pay as a plan member, usually after you’ve met your deductible.|
|Copay||A copay is a fixed amount that you pay for a covered medical service (such as a doctor’s appointment) after you’ve paid your deductible.|
|Cost-Sharing Reduction||Cost-sharing reduction is a discount that lowers your payment for deductibles, coinsurance, and copayments.|
|Deductible||The deductible is the amount that you pay before payments from your insurance plan begin.|
|Dependent||A dependent is a person who a relative or parent supports and may claim as a tax deduction.|
|Essential Health Benefits||As defined by the ACA, essential health benefits include outpatient care, lab tests, prescriptions, wellness services and preventative care, emergency room visits, hospitalization, pre-natal and baby care, mental health and substance abuse treatment, medical devices for disabilities or chronic conditions, and dental and vision care for children.|
|Exclusions||Exclusions are items not covered by your health insurance plan. These exclusions do not count toward your out-of-pocket maximum.|
|Explanation of Benefits||An explanation of benefits (EOB) documents services you’ve received, what the insurance company will pay, and the portion of the bill that you’re responsible for.|
|Federal Poverty Level||Federal poverty level is the income of a person or family that shows if they qualify for certain assistance programs and benefits.|
|Generic Drug||Generic drugs are bio-equivalent substitute drugs for name-brand drugs but at a lower cost. They are used in the same way, with the same strength and effectiveness as the name-brand drug.|
|Health Insurance Marketplace||The health insurance marketplace enables people to find and purchase health insurance coverage that meets their needs. All marketplace plans offer the same essential benefits as defined by the ACA.|
|Health Maintenance Organization||Health maintenance organizations (typically called HMOs) are insurance plans that specify patients must use in-network providers for healthcare and services, except for emergencies. If a patient chooses out-of-network providers, they may be liable for the full cost.|
|Health Savings Account||A health savings account (HSA) is a special tax-advantaged savings account designed to help accrue money to pay for noncovered expenses, such as deductibles, copays and drugs, and dental and vision care.|
|HIPAA||The Health Insurance Portability and Accountability Act (HIPAA) is a 1996 law requiring standardized protection of patients’ personal health information.|
|In-network||In-network healthcare providers and facilities are entities that have a negotiated discount with a health insurance plan.|
|Lifetime Limit||The lifetime limit is the maximum amount of benefits that your insurance plan will pay. After you reach the lifetime limit, the insurance company will not pay for covered services.|
|Medicare||Medicare is the federal health insurance program for seniors 65 or older, some younger people with disabilities, and those with end-stage renal disease. It consists of Part A (hospital insurance), Part B (medical insurance), and Part C (prescription drug coverage).|
|Minimum Essential Coverage||Minimum essential coverage is health insurance meeting the shared responsibility provision (individual mandate) of the Affordable Care Act. While there’s no individual mandate at the federal level, some states still have an individual mandate.|
|Network||A network is the group of doctors, facilities, and suppliers that your health insurance provider has contracted with to provide services.|
|Open Enrollment Period||The open enrollment period is the annual timeframe when people can enroll in health insurance plans for the following calendar year. For marketplace plans and most others, this is usually November 1 – January 15. Employer-based plans may use different dates.|
|Out of Network||Out of network means that a given healthcare provider, such as a doctor or hospital, is not contracted with your health insurance company. Out-of-network providers may be significantly more expensive for services than in-network providers, which operate under a negotiated discount fee structure.|
|Out-of-Pocket Maximum||The out-of-pocket maximum is the maximum amount you will pay for covered healthcare services in a plan year. When a patient spends this dollar amount in network (including deductibles, copays, and coinsurance), the health insurance plan pays all remaining covered benefits costs.|
|Preferred Provider Organization||A preferred provider organization (PPO) health insurance plan has a network of healthcare providers who give care to plan members at negotiated rates.|
|Premium||A health insurance premium is the amount you pay (monthly or yearly) to be covered by a health insurance plan.|
|Primary Care Physician||A primary care physician (PCP) is the first point of contact for you as a patient. They not only provide healthcare services, but they also coordinate other services such as referring patients to specialists.|
|Prior Authorization||Prior authorization is a decision health insurance companies or plans make about whether a medical service, treatment plan, or specific drug or piece of equipment is medically necessary. This can also be called precertification or prior approval.|
|Qualified Health Plan||A qualified health plan is a marketplace-certified plan that provides essential health benefits, conforms to established cost-sharing limits, and meets ACA requirements for minimum essential coverage.|
|Special Enrollment Period||The special enrollment period (SEP) is a period of time outside the annual open enrollment period when you can enroll in health insurance plans. People qualify for a SEP when life events, such as losing coverage, moving, getting married, having a baby, or adopting, occur.|