Understanding Health Insurance in College: A Guide for Students

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 2024?

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?

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:

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.

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.

Step 1

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.

Step 2

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.

Step 3

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.

Step 4

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.

Step 5

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.

Step 6

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!

Step 7

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.

Misconception

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.

Misconception

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.

Misconception

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.

Misconception

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.

Misconception

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.

Misconception

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.

Misconception

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

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.