- What health insurance options are available to today's college students?
- Since the passage of the Affordable Care Act, college students have several health insurance options:
- If available and you are eligible, you can purchase the school-sponsored student health insurance plan.
- If you're under the age of 26, you may be covered as a dependent on your parent's health insurance plan (if dependent coverage is available).
- You can purchase an individual health plan through a Marketplace.
- If you're under the age of 30 (or qualify for a hardship exemption), you can purchase a catastrophic health plan through a Marketplace.
- If you're employed you may be able to purchase your employee health plan.
- Depending on your state, you may qualify for Medicaid.
- Does the UHCSR student health insurance plan satisfy the "Individual Mandate" requirement of Minimum Essential
- Yes, the student injury and sickness health insurance plans from UHCSR meet the requirements for Minimum Essential Coverage.
- What is the penalty for not having Minimum Essential Coverage?
- For 2014, the penalty is $95 per person or 1% of individual's income, whichever is greater. The penalty for 2015 is $325 person or 2% of income. The penalty increases every year, with it going to $695 per person or 2.5% of income in 2016. This penalty is paid on your federal income tax return.
- Is anyone exempt from the Individual Mandate and subsequent penalty?
- You may qualify for an exemption from the penalty if:
- You're uninsured for less than three months of the year.
- The lowest-priced coverage you can get would cost you more than 8% of your household income.
- You don't have to file a tax return because your income is too low.
- You're a member of a federally-recognized tribe or eligible for services through an Indian Health Services provider.
- You're a member of a recognized health care sharing ministry.
- You're a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare.
- You're incarcerated and not being held pending disposition of charges.
- You're not lawfully in the United States.
- You qualify for a hardship exemption.
- What is a Health Insurance Marketplace?
- As part of the health care reform law, Health Insurance Marketplaces, also called Health Insurance Exchanges, were established to make it easy to sign up for health insurance plans that meet the requirements under the law. Individual states were to set up their own Marketplace, but for those that didn't do that, residents can purchase from the federal Marketplace. To purchase a plan from a state Marketplace, you must meet any residency requirements set by that state.
For more information on Health Insurance Market-places, go to www.HealthCare.gov or call them at 800-318-2596.
- Who manages the Marketplaces?
- That depends. Some states established their own state-based Marketplace, while others are using the federal Marketplace. The federal Marketplace is managed by the Centers for Medicare & Medicaid Service (CMS).
Regardless of who manages the Marketplace in your state, your can go to www.HealthCare.gov or call 800-318-2596 to be directed to the Marketplace applicable to you.
- When is open enrollment for plans offered through the Marketplaces, and when would they become effective?
- Go to www.HealthCare.gov to see when the next Marketplace open enrollment period begins. Plans purchased through a Marketplace run on a calendar year, not your academic year like the school-sponsored student health insurance plan.
You may be able to purchase coverage through a Marketplace outside of the open enrollment period, but only if you've had a Qualifying Life Event (QLE). These include things like losing insurance from another source, experiencing a change in your family size (marriage, divorce, a new child), moving to a new state, or changes in your income.
- What kinds of health insurance options are available through the Marketplaces?
- There are five categories of plans offered through Marketplaces. Plans in each category pay different amounts of the total costs of an average person's care. This takes into account the plan's monthly premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums. The actual percentage you'll pay in total or per service will depend on what you use during the year. The five categories are:
- Platinum: Your health plan pays 90% on average. You pay about 10%.
- Gold: Your health plan pays 80% on average. You pay about 20%.
- Silver: Your health plan pays 70% on average. You pay about 30%.
- Bronze: Your health plan pays 60% on average. You pay about 40%.
- Catastrophic: These plans pay less than 60% of the total average cost of care. These are only available to those under 30 years of age, or those with a hardship exemption.
Depending on your household size and income, you may qualify for a premium tax credit that lowers the monthly premium on a Marketplace plan. Sometimes referred to as a subsidy, these are only available on Marketplace plans (except for catastrophic plans).
Once you've enrolled in a Marketplace plan, you cannot change that plan unless you've experienced a Qualifying Life Event (QLE). These include things like losing insurance from another source, experiencing a change in your family size (marriage, divorce, a new child), moving to a new state, or changes in your income.
- What is the "Catastrophic Plan" offered through the Marketplaces?
- Catastrophic plans are only available to those up to 30 years of age or those who have qualified for a hardship exemption.
This type of plan tends to have lower premiums, but there is a trade-off. While it covers three primary care visits per year at no cost and some preventive services are free, everything else requires you meet your deductible before the plan helps cover costs. The deductible can be pretty high on these plans.
You cannot get a premium tax credit with a catastrophic plan. You must pay the standard price.
- Who is eligible for a premium tax credit, or subsidy, through the Marketplaces?
- According to the IRS, you may be eligible for a premium tax credit if you meet all of the following:
- You purchase health insurance through a Marketplace.
- You are not eligible for coverage through an employer or a government plan.
- You fall within certain income limits.
- You cannot be claimed as a dependent by another person.
- You don't file a Married Filing Separately tax return (unless you meet the criteria related to victims of domestic abuse and spousal abandonment).
- To determine your eligibility for a premium tax credit, go to www.HealthCare.gov or call 800-318-2596.
- Who is eligible for Medicaid under PPACA?
- This varies by state. To determine whether you qualify in your state, visit www.medicaid.gov and select your state.
- How can I calculate the premium tax credit I'll get?
- The Henry J. Kaiser Family Foundation has created a Subsidy Calculator, available on their website: http://kff.org/interactive/subsidy-calculator/
You may also go to www.HealthCare.gov, select your state, and complete the application process to determine whether you qualify and what impact it will have on premiums.
- How are premium tax credits managed and reconciled?
- If you're eligible for a premium tax credit, you have two choices:
- You can have some or all the estimated credit paid in advance to the insurance company, thus lowering your monthly premiums.
- You can wait and get the full credit when you file your tax return.
If you experience any changes in income or family size, report them to the Marketplace when they happen. This will help ensure you're getting the proper amount of financial assistance, and help avoid a surprise at the end of the year when you file your taxes. If the estimated amount of credit was too high, you'll have to pay the difference back to the IRS.
- If my college/university offers a school-sponsored student health insurance plan, can I still opt to purchase a plan
through a Marketplace?
- Yes, even if a school-sponsored plan is available, you can purchase a plan through a Marketplace. However, before doing that, be sure to do a thorough comparison of the plans. Odds are the school-sponsored plan is a better option. Here are some things to consider:
- If your school has a Student Health Center, is it treated like a preferred provider? That's typically the case with UHCSR student injury and sickness health insurance plans.
- If it's a Marketplace plan, will it cover medical care beyond emergency services (e.g., doctor's office visits, diagnostic testing, x-rays, prescription drugs, mental health, etc.) in the geographic region of your campus?
- Are there in-network providers available across the nation (so you're covered at school, at home, and even when you're travelling)?
- Does it offer Global Emergency Services when you're abroad?
- Does the plan have pre-certification or pre-authorization requirements, or does it require a referral from your Primary Care Physician?
- To complete your comparison, make sure you compare more than just the monthly premium. Look at the deductibles, copays, and total out-of-pocket cost, too.
- Can a school require students to carry health insurance?
- Yes, colleges and universities can require students to have health insurance as a condition of attendance. Typically, this requirement can be met by enrolling in the school-sponsored student health insurance plan, or completing a waiver form showing proof of comparable coverage.
- If I go to an out-of-state school, can I purchase a plan on that state's Marketplace instead of my home state?
- No, you can only purchase plans from the Marketplace that services your state of residence. Each state has its own residency requirements that must be met in order to purchase from their Marketplace.
- Can international students purchase a plan through a Marketplace? If so, are they eligible for a premium tax credit, or
- International students who are legally in the United States may purchase a plan through a Marketplace, but they aren't eligible for a premium tax credit.
- Are plans purchased outside of the Marketplaces eligible for a premium tax credit, or subsidy?
- No, plans purchased outside of a Marketplace, including a student health insurance plan, are not eligible for any federal premium tax credit.
- What is "Community Rating"? How does this apply to Marketplaces and student health insurance plans?
- As defined by www.HealthCare.gov, Community Rating is a rule that prevents health insurers from varying premiums within a geographic area based on age, gender, health status, or other factors. With the health care reform law, insurers must consider the claims experience of all individual health plan enrollees in a particular state, combining them into a single risk pool. This means any risk factors are spread across the whole group, versus a single person. However, PPACA does allow for some reasons to vary the premium amount; for instance, there can be as much as a 3:1 ratio in premium ranges of the highest to lowest risk. That means a healthy young adult's premium can be no lower than a third of that for someone with serious health issues.
The Department of Health and Human Services (HHS) recognized the unique nature of the school student health insurance market (mostly young healthy adults who will only be on the plan for a few years). PPACA allows school-sponsored student health insurance plans an exemption from the single risk pool or community rating. That means premium costs for student health insurance plans are typically lower.
- Why is the school-sponsored student health insurance plan a good alternative to a Marketplace plan?
- There may be several reasons why the school-sponsored plan is a better option. It starts with the fact that student plans don't have to follow Community Rating, and instead benefit from the fact that schools typically have younger, healthier adults and the plan is only needed for a few years. This typically means the premiums will be lower than a comparable plan on the Marketplace. On top of that, school-sponsored student health insurance plans from UHCSR typically offer the following:
- If the school has a Student Health Center, it may be treated as a preferred provider with a plan from UHCSR.
- Our student plans have a national network of preferred providers backed by UnitedHealthcare. That means whether you're at school, at home, or enjoying spring break, we've got you covered.
- Most UHCSR student plans include global emergency services from UnitedHealthcare Global; great for when you're traveling or studying abroad.
- Our plans typically offer lower deductibles, copayments, out-of-pocket maximums, and premiums than the lower cost options (Bronze, Silver, and Catastrophic) offered through the Marketplaces.
- Your school-sponsored plan from UHCSR meets the Individual Mandate requirement of Minimum Essential Coverage.
- With the school-sponsored student health insurance plan, the plan period is based on the school's academic year, not the calendar year like Marketplace plans. This means you can have coverage from the first day of school in the fall instead of waiting until a January 1 effective date.
- Whether you're attending an in-state or an out-of-state school, you can purchase the school-sponsored plan. With the Marketplace, you can only purchase plans on your state's Marketplace. For students attending an out-of-state school, those on a Marketplace plan may only be able to get non-emergency care within their Preferred Provider Network, which is often regional.
- Depending on the school, you may be able to use financial aid to purchase the school-sponsored student health insurance plan.