Millions of college students traveled home last week for Thanksgiving to share the holiday with family (and perhaps do some laundry). Many also peppered those of us who work on health care issues with questions about the Affordable Care Act and how it might affect them. Beyond the sales pitch that uses mom to prod young people to sign up for coverage, the ACA has important implications for young adults. As many as 7.8 million young adults were able to obtain or keep coverage on their parents’ plan because of the ACA’s requirement that plans cover dependents up to age 26. But the law also affects student health plans and provides new coverage options in the health insurance marketplaces.
With the support of the Robert Wood Johnson Foundation, CHIR recently released a Navigator Resource Guide that includes 237 FAQs addressing private insurance coverage.* Questions range from the individual mandate and premium tax credits for marketplace coverage to retiree health and high risk pools. One chapter is devoted to issues for young adults, including student health plans and coverage on parents’ health plans. Below we excerpt some of the FAQs from that chapter for those young adults who are considering their options (or who have mothers who are doing that for them).
- What is a student health plan? “Student health plan” refers to a special policy of health coverage that colleges and universities make available to their enrolled students. Typically the student health plan is different from the employer-sponsored group coverage that colleges and universities offer their faculty and staff.
- Does a student health plan count as minimum essential coverage? Yes.
- Does my student health plan have to cover contraceptives? Generally, yes it does, if it is a fully insured plan. A fully insured plan is one that your college or university purchases from a health insurance company. These plans are required to provide, without cost sharing, access to all FDA-approved contraceptive methods, sterilization procedures, patient education and counseling prescribed by a health care provider. Exceptions are made for religious institutions of higher education that have religious objections to providing contraceptive services. If you attend such a college or university, you will be able to seek contraceptive coverage at no cost directly from the health insurance company. If your student health plan is a self-insured plan, it might not be required to cover contraceptive services. It’s up to states to regulate self-insured student health plans. Check with your college or university to find out what type of student health plan they offer, or check with your state insurance regulator to find out what rules apply to your student health coverage.
- I’m enrolled in student health coverage now, but now I think I can get a better deal in the marketplace. Can I drop student health plan coverage and go to the marketplace instead? If you are currently enrolled in a student health plan, you can still qualify for marketplace policies and subsidies if you apply during open enrollment. During open enrollment, you can sign up for a marketplace plan and, if your income is between 100% and 400% of the poverty level you can also apply for premium tax credits. You will have to drop your student health coverage by December 31, 2013 in order to remain eligible for premium tax credits in 2014. Outside of open enrollment, you cannot voluntarily drop your student health plan coverage in order to qualify for coverage and premium tax credits. However, if you involuntarily lose eligibility for student health plan coverage mid-year – for example, if you drop out of school and so lose eligibility for the student health plan – you will qualify for a special enrollment opportunity and be able to apply for marketplace coverage and premium tax credits. The special enrollment opportunity will last 60 days, so be sure to contact the marketplace promptly to notify them of your qualifying event.
- I’m an American college student and I plan to study abroad next semester. Am I required to have U.S. health insurance while I’m living in another country? Yes, unless you qualify for another exception. In general, U.S. citizens with a tax home outside the U.S. and who are residents of a foreign country for the entire taxable year are exempt from the requirement to have health insurance in the U.S. But if you are a student temporarily living abroad for part of the year, and don’t qualify for any other exceptions, you would be required to have health insurance or else pay a penalty.
- I’m covered under my parent’s policy but I’m moving to another state. Can I remain covered as a dependent? Yes, you are eligible to be covered as a dependent up to age 26 regardless of where you actually live. However, your parent’s health plan probably has a network of participating providers and it may be difficult for you to find in-network care when you are living in another state. If you find that your parent’s plan doesn’t cover health providers in the state where you live, you can also explore the option of signing up for coverage on your own. Moving will qualify you for a special enrollment opportunity to enroll in other coverage. Check the marketplace web site in your state for more information about qualified health plan options and your eligibility for premium tax credits.
- My son goes to college in another state but we want him on our family plan in the health insurance marketplace. Can we do that? Yes. If your son or daughter is a member of your tax household, they can join your family plan on the health insurance marketplace, even if they live out of state. However, your child may need to return home in order to access care within your plan’s network. If he or she gets health care services in another state, the providers may be outside your plan’s network and you may have to pay high co-payments or coinsurance. Your son or daughter is also likely eligible to buy coverage in the state where they attend school. If they do so, they would have a greater choice of in-network providers.
These questions – and a couple hundred more – are addressed in our Navigator Resource Guide. In future blogs we’ll continue to answer commonly asked questions about private health insurance and marketplace topics.