As recent high school graduates spend summer dreaming about the beginning of their college careers, it’s unlikely that many are thinking about how they are going to get their health insurance. But they should not throw caution to the wind; according to federal law, college students, like most other adults, are required to have health insurance.
They can satisfy the requirement posed by the Affordable Care Act’s (ACA’s) “insurance mandate” in a number of ways, including staying on their parents’ insurance until age 26, purchasing insurance in the health insurance marketplace, getting coverage from their college’s student health insurance plan, or enrolling in Medicaid if they meet the applicable enrollment criteria.
In addition to the ACA’s mandate, college students should remember to check state insurance laws in the state where they are going to college. Staying on their parents’ insurance may require some extra consideration. For example, since 1989, Massachusetts law has required all full- and part-time students in higher education to participate in a Student Health Program or in a health benefit plan with comparable coverage. A health plan that provides coverage through a closed network of providers and that is accessible only for emergency services where the student is studying is not comparable coverage. So if, for example, a student from Ohio is going to college in Massachusetts and is covered by his or her parents’ insurance, but the insurance company has a closed provider network and only emergency care is available outside the network, this does not satisfy the requirement and the student would be required to participate in a Student Health Program.
Many states have decided to expand Medicaid to individuals earning up to 138% of the federal poverty level ($16,105 for an individual). Regulations issued by the United States Department of Health and Human Services last fall made clear that Medicaid can pay the insurance premiums for Medicaid eligible individuals who purchase health plans sold in the individual market. In order for a state to take advantage of this arrangement, participation must be voluntary and the cost of the health plan must be comparable to the cost of providing coverage under the Medicaid program.
Currently, 27 states have decided to expand Medicaid. According to a recent NPR news story, colleges in some of those states are planning to use premium assistance to enroll Medicaid-eligible students in their school’s student health insurance plan. As required by the federal regulations, Medicaid will be secondary coverage. College students who qualify for Medicaid even without the expansion (i.e., those who meet their state’s “traditional” Medicaid eligibility criteria) can also participate in a premium assistance plan.
Historically, student health insurance plans often did not offer a robust package of benefits. But under the ACA, Medicaid plans and small group and individual plans (including student health plans) sold inside and outside of the health insurance marketplace must cover a package of 10 categories of items and services known as Essential Health Benefits. According to Stephen Beckley, a consultant on college health insurance, most student plans are comparable to gold or platinum level plans sold in the health insurance marketplace. (Plans sold in the health insurance marketplace come in four “metal levels” based on their actuarial value.)
So, college-bound students, even though you just graduated from high school and may have put your brain on autopilot for the summer, get a jumpstart on thinking about how you’re going to get health insurance when you’re in college. When you sprain your ankle playing intramural floor hockey, you’ll thank us.