Student Health Insurance – Options for Coverage

There are many better choices for health insurance coverage than going without

If you're going off to college, you need health insurance. Going to college is one of the most important things you can do to secure your financial future. But what happens if you get sick or injured while you're there?

Don't be lulled into a false sense of security by your relative youth and apparent good health. Catastrophic accidents and sudden ailments can happen to anyone at any time, and big medical bills could derail all of your carefully laid plans. So it's important to make sure you have health insurance coverage.

College students in dorm
James Woodson / Getty Images

Here are some options:

Stay on Your Parent’s Health Insurance

If your parents carry you on their insurance, staying on it might be your best option.

As a result of the Patient Protection and Affordable Care Act (usually referred to as the ACA or Obamacare), children must be allowed to stay on a parent's health plan until they reach age 26. This is true regardless of whether they're still a tax dependent, in school, married, working for an employer that offers coverage, etc. If a parent's plan offers dependent coverage, it has to allow kids to stay on the plan until they turn 26. Even once you turn 26, you may have the option to temporarily continue your coverage under a parent's employer-sponsored plan using COBRA (access to COBRA depends on how many employees the employer has and whether the plan is sponsored by a private employer, church, state/local government or the federal government). And state continuation ("mini COBRA") laws in many states provide some level of coverage continuation options for health plans that aren't subject to COBRA.

But before you decide to stay on your parents' health plan, make sure you understand the all of the details and any other options you might have. If your parents' coverage is a health maintenance organization (HMO), full coverage may only be available in the area where they live. Some HMOs have reciprocal arrangements that allow for full coverage in areas outside their local base, however, and that's something that you should investigate before you select this option.

Similar problems can arise with parental insurance even if it's a preferred provider organization (PPO). It typically requires you to get treatment from a medical provider within a predetermined network to get the best rates, and you might not find one if your school is far from home. You might have to go home to get the lowest copayments and coinsurance.

In the case of a medical emergency, your parent’s health plan is required to cover services from any provider or facility (such as an emergency room) that provides immediate care, although if the hospital and/or doctors are out-of-network, they can still send a balance bill for the portion of their charges that the insurer doesn't pay.

See if Your School Offers Health Insurance

Many colleges and universities offer fairly low-cost health plans for their students through contracts with private health insurance companies, and many require their students to maintain comprehensive health insurance as a condition of enrollment. Check with your admissions office to see if your school offers student health insurance, and if so, what it will cost.

In most cases, student health insurance offered by colleges and universities is required to conform to the ACA's requirements for individual health insurance. So student health plans cover essential health benefits with no lifetime or annual limits, and cover pre-existing conditions. Note that if a school self-insures its student health plan (as opposed to buying coverage from an insurance company), it is not required to conform to the ACA's individual market regulations. So there are still some schools where the coverage is not ACA-compliant. But for the most part, the days of skimpy student health plans with low benefit caps are long gone, and the student health plans offered by most colleges are high-quality coverage.

Be wary, however, of plans marketed by outside companies that say they're designed for students. Some of these plans might be high-quality, but some are simply short-term health plans or fixed indemnity plans being marketed as coverage for students. These plans are not compliant with the ACA and are not the same thing as student health coverage offered by a college or university.

Buy Your Own Insurance

If your school does not offer a low-cost health plan and you don't have an option to remain on your parents' health plan (or if doing so would not provide good coverage where you're going to school), you may want to consider buying an individual health insurance policy, either in the health insurance exchange or directly through an insurance company.

If you apply through the health insurance exchange, you may be eligible for premium subsidies (and possibly cost-sharing reductions) based on income. But if your parents still claim you as a tax dependent, their income will be counted, along with yours, in determining whether you're eligible for subsidies.

Health Insurance Through Medicaid

If your family's income is low (or if your own income is low and you're no longer claimed as a dependent on your parents' tax return), you might be eligible for Medicaid.

The ACA expanded Medicaid to cover people with household income up to 138% of the poverty level (that's about $17,600 for a single individual in 2020, and about $42,338 for a family of five).

But a subsequent Supreme Court decision made this expansion optional, and more than a quarter of the states still have not expanded Medicaid. So your access to expanded Medicaid will vary depending on where you live. [Traditional Medicaid, which covers low-income children and low-income adults who are blind, disabled, pregnant, or elderly, continues to be available in every state; if you think you might be eligible based on one of those criteria, you can reach out to your state Medicaid office, even if your state hasn't expanded Medicaid under the ACA.]

Since Medicaid is run by the states (with funding from the state and federal government), coverage generally does not extend outside the state unless it's an emergency situation. If you're eligible for Medicaid in your home state and planning to move out of state to go to college, you'll want to talk with your home state's Medicaid office, as well as the Medicaid office in the state where you'll be going to school, to determine whether you should keep your existing Medicaid coverage or apply in the state where you're going to school.

Find a Community Health Center

If you currently have no insurance but need treatment, try looking for a federally-qualified community health center (FQHC) near your college. Community health centers can be found in most cities and many rural areas of the country. These healthcare facilities provide care to people without health insurance and have sliding fee scales based on income.

Community health centers provide checkups, treatment of illness, prenatal care, immunizations and care for your children, and treatment of mental health and substance abuse problems. Many health centers also have dental clinics and pharmacies in their buildings.

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