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- Despite being highly susceptible to illness, injury, and infection, college students are one of the most underinsured population groups.
- Students can often choose between several health insurance options, including Medicare, their parent's health insurance, and school-provided insurance.
- Students should take proactive measures to help minimize risk and save on medical spending.
Health insurance helps cover the cost of medical treatment, doctor's visits, prescriptions, and other health-related expenses. Colleges typically require students to either enroll in a student health insurance plan or prove that they are already insured through a different plan.
Although students may think they do not need insurance because they are in good health, they still face a high risk of injury and infection. Risky behaviors, participation in athletics, and auto accidents commonly lead to injuries that require medical attention.
Additionally, outbreaks of pathogens such as meningitis are relatively common on college campuses. Because of the exorbitant cost of medical care in the U.S., students without insurance are often left with high healthcare bills without the means to pay them off.
Students can choose from an array of health insurance options, including Medicaid, school-provided insurance, and their parents' insurance. This guide explores these options in more detail.
Why Do College Students Need Health Insurance?
Although access to health insurance in the U.S. has improved under the Affordable Care Act, 8.7% of students still lacked insurance in 2016, making college students one of the most underinsured population groups.
College students face a slew of health issues. Mental illnesses and related challenges often emerge during this time as a result of both stress and genetic predisposition. Students can also catch infections, such as mononucleosis, respiratory disease, and HPV. All of these illnesses require medical treatment.
- Stress and Mental Health
Nearly all college students complain about significant stress, and many experience mental health issues as a result. Common challenges include anxiety, depression, eating disorders, and substance abuse. Additionally, psychiatric disorders, such as bipolar disorder and schizophrenia, often emerge when patients are in their early 20s.
Students experiencing such problems should seek strategies to manage their stress and seek aid from mental health professionals.
- Sexual Health
According to the Centers for Disease Control, people aged 15-24 account for half of all new cases of STDs. One in four sexually active females aged 15-19 has an STD. Cases of gonorrhea, chlamydia, and syphilis reached an all-time high in 2015. Women and other students who were assigned female at birth may experience other reproductive issues, such as endometriosis, around this time. Students should get tested regularly and seek care from a primary care doctor and/or OB-GYN.
- Lifestyle Changes
Although the dreaded "freshman 15" is a myth, new college students do gain more weight than the general population. Stressed students, many of whom have recently left home for the first time, tend to go for easy comfort meals, such as fast food and microwave meals. This poor nutrition, combined with other changes like lack of sleep, can lead to negative health impacts.
College students share many things with their peers, including books, dorm rooms, computers, and illnesses. Because of cramped lecture halls, shared living, and social events, infections such as meningitis and the flu spread rapidly through college populations.
In 2020, colleges became hotspots for COVID-19. To protect against illness, students should follow guidance provided by healthcare experts and seek out preventive care like vaccines.
The Affordable Care Act (ACA)
Passed in 2010, the Affordable Care Act is a law designed to provide affordable health insurance to all Americans. Consumers receive tax credits based on their income, then apply these credits to help offset the costs of insurance. Individuals and families who earn too much to qualify for tax credits can still search for different insurance options through the ACA website.
The ACA sought to improve the quality of insurance by requiring insurance companies to meet a certain set of standards, including provisions for free birth control and coverage for preexisting conditions. The ACA also allowed young people to stay on their parents' insurance until they turn 26.
Experts say the quality of student health insurance improved drastically under the ACA. However, the ACA also included an "individual mandate" that required all taxpayers to have insurance. Students received a tax penalty if they did not enroll in a health insurance plan.
The individual mandate was repealed, but colleges still require their students to have health insurance and automatically enroll learners in a health insurance plan. Students at most schools can opt out if they have insurance through their workplace or parents.
The Future of the ACA
Since the ACA was passed, certain politicians have repeatedly tried to repeal it. While the ACA has had a positive impact on students and low-income families, critics argue that middle-class families have been left behind.
"Repeal and replace" has been a slogan shared by many Republicans, but at this point, it's uncertain what a potential replacement might look like. Additionally, about 62% of Americans support the ACA, and approximately 80% of Americans support protections for individuals who have preexisting conditions.
Regardless of any changes to the ACA, colleges will likely continue to require students to maintain health insurance and will offer a school-sponsored option.
To stay current on changes to healthcare in the U.S., visit healthcare.gov and follow news sites.
Student Coverage Basics: Where Do I Start?
When it comes to insurance, understanding its language and how it works goes a long way. At least half a dozen variables go into differentiating one policy from another, and each one carries its own financial implications.
A monthly premium is only the beginning of your out-of-pocket cost. If you cannot afford to pay the premium and the additional fees, you cannot afford the policy. Should you need medical treatment, understanding your obligations ahead of time can help you avoid a nasty surprise.
To make an informed decision, it's important to understand what you are being offered in exchange for your monthly premium. Before we examine your options in detail, take a moment to familiarize yourself with the basic terminology all insurers use.
What you pay, usually monthly, for your insurance plan. This is a bill, and is unrelated to other out-of-pocket expenses you are expected to pay.
A fixed amount that you are expected to pay in the earliest part of your policy year. After you meet the deductible, your insurance plan covers all or part of your expenses until year's end.
The percentage of costs you pay after you meet your deductible. Generally, this is a percentage that you and your insurance provider split. Many plans offer 80/20 splits, meaning that you are responsible for 20% of costs after the deductible.
Often confused with coinsurance, a copay is a fixed amount that you agree to pay toward specified expenses. A common example of a copay is the small flat fee you pay each time you visit a doctor or emergency room.
A group of providers that contractually partner with your insurance carrier. Your insurance plan will incentivize you to choose from this network by charging you less for treatment given by these providers.
- Preventive care
Preventive care refers to the treatment of illness before it starts. Vaccinations, certain screening exams, and annual checkups all fall under preventive care.
- Group plan
In any insurance plan, all policyholders form a group. Within this group there are likely to be a mix of healthy individuals (most young adults) and those who require more care (seniors or people with chronic illnesses). Insurance companies need to offset the costs of participants who need a higher level of care, and group plans that include healthy people allow them to mitigate this risk and keep overall costs lower.
What Are My Coverage Options?
Once forced to choose between expensive, high-deductible, single-payer insurance and whatever coverage a school wanted to offer, college students now have better choices for health insurance. College students generally have four options for health insurance:
- Remain on the family plan
- Purchase student insurance
- Purchase an individual plan on the open market
- Enroll in Medicaid
Parent's Health Insurance
Under the ACA, students can stay on their family's insurance plan until they turn 26. Students can stay on a parent's insurance, even if they file their taxes as financially independent from their parents. Learners who choose this option typically need to submit paperwork to their college opting out of the school insurance.
For many students, this is the best option, in terms of both ease and affordability. Depending on your age and circumstances, your family may continue to pay the same rate as before.
Who It's Good For
Students who attend college in the same state where their family lives benefit from this plan. Learners can continue to access the same network and health providers that they did before. Students under 26 often take advantage of this option.
Students who attend college out of state may face difficulties accessing their healthcare network. Many insurance companies do not operate in every state. Check with your family insurance provider to see exact details.
Students who are 26 and older cannot access this option. Students who do not wish to stay on their family's healthcare plan for various reasons may also decide this option does not suit their needs.
How to Apply
Your family must go through the same insurance application process they completed in previous years, keeping your information on file.
Student Health Insurance
Most colleges offer health insurance to their students, and many automatically enroll all new learners in a student health insurance plan (SHIP). Learners can use financial aid to help offset the cost of their SHIP.
Under the ACA, these plans typically must cover:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Prescription drugs
- Laboratory services
- Rehabilitative and habilitative services and devices
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
- Mental health and substance use disorder services, including behavioral health treatment
Who It's Good For
Many different students choose this option, including those from uninsured families, those who do not wish to stay on their family's plan, and those who attend an out-of-state school. Learners 26 and over — particularly those who earn too much to qualify for tax credits — can also save money through this option.
Prices vary widely by school, and students often do not consider SHIP costs when making their college decision. For instance, Stanford's plan costs about $6,000 per academic year. However, most schools feature more affordable options.
Additionally, these plans may only cover the academic year, leaving students uninsured over the summer or requiring learners to pay an additional premium during the summer months. Check with your school for more information about rates and coverage options.
How to Apply
Many schools automatically enroll all learners in a SHIP. Contact your chosen college for more information.
Individual Plan on the Open Market
Students can also use the ACA Marketplace to search for their own health insurance plan. Applicants who earn wages between 100% and 400% of the poverty line receive tax credits that help reduce the cost of insurance. However, not all schools accept this form of insurance; some may require a SHIP or a family plan.
Depending on the particular plan and each student's chosen school, ACA Marketplace plans may be more or less expensive than SHIPs.
Who It's Good For
Although unusual, some colleges do not offer school health insurance. The ACA Marketplace is a good option for these learners, as well as those who are 26 or older.
The ACA Marketplace can prove especially useful for students who earn very little money. Low-income students can pay extremely low rates of just a few dollars per month.
Although students who file as a dependent on their parents' taxes can seek out their own ACA plan, they will not receive tax credits. This can make the cost of insurance quite high. Students with extremely low income may qualify for Medicaid instead.
How to Apply
To apply, students should visit the ACA Marketplace website at healthcare.gov. Applicants must submit proof of their income and other personal details. Some students may need to submit additional documentation.
Medicaid provides free and low-cost insurance to those who earn below 133% of the federal poverty level. Individuals with this form of insurance can access full, comprehensive healthcare services at little to no cost. As such, for those who qualify, Medicaid is the cheapest option.
Wider Medicaid coverage has helped increase the number of insured college students. However, not all states elected to expand Medicaid benefits when the ACA was passed. Students interested in this option need to check their state's requirements.
Who It's Good For
Medicaid is the best health insurance for college students with no income. Learners who are 26 and older (who cannot join their family's plan) often take advantage of this option. Pregnant people and people with a disability also have special eligibility for Medicaid.
Students with chronic health issues enjoy significant benefits from Medicaid — they only pay a very small amount (or nothing) each time they see the doctor or visit the hospital.
Not everyone qualifies for Medicaid. Students under 26 may not be able to access Medicaid, for example, if they file as a dependent on their family's taxes. Some states have not expanded Medicaid, making this option inaccessible to most students. Students and recent graduates also lose access to Medicaid once they start earning a higher income.
Additionally, you must be a resident of the state where you apply for Medicaid. This can impact learners attending an out-of-state college.
How to Apply
What Else Should I Consider When Choosing A Plan?
As you weigh your options, carefully consider your circumstances. Ask yourself the following questions, which apply to any individual in the process of choosing health insurance:
- Am I a healthy young adult or do I have a chronic illness or other condition that requires medical monitoring?
- What are the deductibles for each type of service?
- What coinsurance is offered after I meet my deductible?
- What copays can I expect for office visits or emergency room services?
- Do I want prescription coverage?
- Are there tweaks to my policy that can increase or decrease my deductibles?
- What is the maximum out-of-pocket expense where my plan begins to cover everything?
- How restricted is my provider network?
- Can I use on-campus health services for most medical needs or do I need to find a provider off campus?
Coverage for Recent Grads or Special-Status Students
Traditional undergraduates often have an easier time acquiring health insurance than their peers in less conventional circumstances. Depending on individual plan provisions, students who live off campus, attend classes part time, or are older than 25 may not qualify for the student healthcare plans discussed above. Fortunately, these students have other options.
The demands of work and family prohibit many students from pursuing a degree on a full-time basis. Fortunately, the educational system has made great strides to offer alternative means of learning to adult learners through distance education, evening and weekend classes, and extended programs designed for part-time students.
If you are a degree-seeking student taking a minimum of six credits, most schools will offer student health insurance to you. Depending on the school, you can meet this requirement in any learning format — sometimes even online.
Check with your prospective schools to find out their particular policies. Students who don't take at least six credits per semester may fall back on insurance plans offered independent of their school, whether by purchasing an individual plan or by using a family plan for as long as they can.
- Recent Graduates
Recent college graduates usually face some insurance uncertainty. Graduates may not immediately find employment that offers affordable health insurance. The job search can take time, and in today's job market, many recent graduates opt for unpaid internships or graduate school in lieu of a full-time job. These young adults must have health insurance during this gap period.
Students on family plans who complete a degree in their early 20s have more time to find alternative coverage. However, after turning 26, students need to find something else.
As of 2015, the ACA provides for a special enrollment period for recent college graduates. If you take advantage of this option, you may purchase a plan from the Marketplace whenever your student health insurance ends; any year thereafter, your Marketplace eligibility depends on the standard open enrollment period.
If you attend college with an individual health insurance plan, these benefits will remain in place until the end of the year, at which time you may choose whether to renew or discontinue your plan.
- Students with Disabilties
Students who have an intellectual or physical disability should never be prevented from learning or from having adequate healthcare coverage. However, navigating the rules can prove especially tricky. Adults who receive Social Security disability benefits are automatically enrolled in Medicare.
There is no rule that prevents these recipients from attending college; however, periodic case review is a standard part of the Social Security program. If a case manager feels that, by attending school, you are increasing your ability to work and support yourself independently, you may lose your benefits.
If you are unsure of your ability to work after graduation, think carefully about seeking a degree. There are no restrictions on taking classes for personal edification. Students who have disabilities that do not prohibit full-time employment after college are eligible for any of the comprehensive health plans available to non-disabled students.
- International Students
International students may purchase a healthcare plan from a vendor that specializes in international student insurance plans. These plans are ACA-compliant, which means they are comprehensive. Students of any age may enroll in coverage while studying in the U.S., although prices are often lower for younger students.
Usually, international student plans are PPOs that carry deductibles and coinsurance amounts. In addition to standard medical coverage, these plans cover the costs of emergency evacuation and repatriation.
For U.S. students spending time studying abroad, similar health insurance plans are available for purchase. Some school plans or family plan providers may extend coverage overseas, but this is not required.
Strategies for Managing Health Expenses
The passage of the ACA has helped reduce insurers' methods of extracting money from your wallet. Many industry standards, such as charging higher premiums for policyholders with preexisting conditions, are no longer legal. Still, insurance carriers are for-profit corporations, and you need to approach your policy options as carefully as you would any other major purchase.
Make a Wise Policy Choice
First-time policy buyers can follow a few rules of thumb to avoid overpaying for their coverage:
- Be wary of add-ons or riders that come with extra fees. Make sure you need the extra layers of protection they offer you. If you do not, try to negotiate a plan with a lower premium and forego extra coverage.
- Resist the urge to choose a plan with a low monthly premium and a high deductible. Even if you are in perfect health, an accident can happen in a second. A very high deductible could haunt you for years.
- Be a conscientious consumer. File claims accurately and promptly and read your statements and records of service. Ask questions when you are confused. Many insurance companies will reward you for spotting a billing error.
Minimize Medical Expenses
Once you have found a policy that matches your needs, the best way to save on costs is to avoid using your policy more than necessary. You cannot prevent every illness or injury, but there are proactive measures that can minimize your risk and maximize your spending dollars.
Smart, preventive steps can impact your body and your bank account. Avoid a copay at the student health center by practicing healthy living.
If you need to access your health plan benefits, do so wisely. Start with your primary care provider or student health center before you see an expensive specialist. Request generic medication whenever possible. Follow your medical professional's instructions so that you are back on the road to health as soon as possible.
Many dorm residents will attest that eating well is challenging, but a little planning and creative shopping goes a long way. Simple choices, such as avoiding added sugar and eating fruits and vegetables, can effectively boost your immune system.
When you drink enough water, your organs work better, your muscles are energized, your skin is clearer, and your stomach functions best. When your body is operating at peak conditions, you are better able to resist illness.
Hit the Gym
The long-term cardiovascular benefits of regular exercise are well documented. Additionally, maintaining strength and flexibility can help a typical college student avoid an injury during active recreational pursuits.
Sleep accomplishes more than preparing you to tackle your studies. Adequate sleep is directly related to immune system function, and a lack of sleep makes you more susceptible to colds and the flu. In the long term, inadequate sleep is also linked to heart disease, obesity, and diabetes.
Consider vaccinations against the flu, viral pneumonia, and meningitis — particularly if you live in a dorm or other form of group housing. Many schools offer free flu shots at the beginning of flu season, so check with student health services for more information.
Regular hand-washing is also a powerful tool against communicable disease. Wash your hands whenever you have gone out in public.
Proactively Manage Your Health
If you have a diagnosis like a chronic illness or even something as simple as allergies, take care of yourself. Refill your medications on time and take them as directed.
Selecting a health insurance plan can be daunting. Educating yourself about the ins and outs of coverage plans takes time, but the more time you spend doing research, the better the chance you have of staying safe, healthy, and financially secure.
HHS.gov is the home site for the Affordable Care Act and its implementation. Visit this site to learn more about health insurance terminology and current events in our evolving healthcare system.
On this site, you can access the health insurance Marketplace, explore the plans available to you, get insurance price quotes, and identify important deadlines.
This extensive site offers quizzes and other interactive tools to help you learn to manage your health. Detailed articles on various health-related topics are also available.
On this site, you can find out if you can apply for Medicaid as a student and learn more about what Medicaid offers in your state.
This site offers information specific to the healthcare needs of students. In addition to insurance-related concerns, eHealth offers informational articles on staying healthy in a collegiate environment.
This site provides detailed information about the ACA and its effect on your options.
This is the ACA's official resource for college graduates. You can learn about your health plan coverage options and places to find low-cost healthcare services in your area.
Frequently Asked Questions
- What is the best health insurance for students in college?
The best health insurance for college students depends on each learner's unique circumstances. Low-income students may benefit from Medicaid, while other learners may save money by enrolling in the school-provided plan.
- How much does health insurance cost for a college student?
On average, student health insurance plans cost $1,500-$2,500 per year. However, this figure varies significantly by school.
- What is the cheapest health insurance for college students?
It depends on each student's finances and individual circumstances. Oftentimes, students can stay on their parents' insurance plan for free. Low-income learners may qualify for Medicaid.
- How long can college students stay on a parent's insurance?
Thanks to the Affordable Care Act, students can stay on a parent's insurance until they turn 26. Students can stay on a parent's plan even if they do not file as a dependent.