The Breakdown: Health Insurance

As a student there are decisions you need to make concerning your health care. Learn about health insurance options in college and find the right student plan for your needs!

By SAGE Scholars — November 21, 2022


The Breakdown: Health Insurance

As a student there are four essential things you need to decide on concerning your health care:

1. Make sure you have health insurance.

2. Know where to go if you get sick.

3. Choose a primary care physician.

4. Choose a pharmacy.

If your school offers a student health plan, it can be an easy and affordable way to get basic insurance coverage. If enrolled in a student health plan, in most cases, it qualifies as health coverage under the Affordable Care Act (ACA).

Even if you have access to a student health plan, you can still apply for coverage through the Health Insurance Marketplace. If you're a dependent under 26, you can remain on your parent or legal guardian's plan.

You can also opt for coverage under the Affordable Care Act. If you decide to pick a health plan for next year, Open Enrollment begins on November 01, 2022, and ends on January 15, 2023, the federal Marketplace. To get started, log in to HealthCare.gov, fill out an application, and enroll in a 2023 Marketplace health plan. Enroll by December 15, 2022, for coverage that starts January 01, 2023.

It's crucial to keep that timeline in mind if you are interested in getting your healthcare from the open Marketplace. If you miss the deadline, you'll have to wait until next year to apply unless you qualify for a special enrollment period. Special enrollment applies to significant life events like pregnancy, getting married, or losing health coverage.

Coverage is aimed at people who can't get health insurance through their employer or if their parent's plan is not an option. This group usually includes part-time workers, independent contractors, the unemployed, early retirees under 65, and college students. It is not intended for those covered by government programs such as Medicaid or Medicare.

Signing up for ACA Health Insurance is as easy as going to HealthCare.gov. You can enroll in coverage for the first time from the home page and view your existing or compare plans. Several states operate their exchanges. You must apply through your state if you live in one of them. These states include CA, CO, CN, ID, MD, MA, MN, NV, NJ, NY, PA, RI, VT, WA, and DC.

If you already have coverage under the ACA, it will renew automatically. Visit the website anyway to update your information and compare plans. You might be eligible for a better plan.

Plans that comply with the ACA cannot discriminate against people with pre-existing conditions. They must also cover birth control, breastfeeding equipment, counseling, and ten essential services. These services include:

  1. Outpatient Care
  2. Emergency Services
  3. Hospitalization
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance abuse services
  6. Prescription drugs
  7. Mental and physical rehabilitation for people with injuries, disabilities, or chronic conditions
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric treatment, including dental and vision care

Plans come in four categories: Bronze (lowest premiums), Silver, Gold, and Platinum. You'll want to make sure your healthcare providers are in the plan network and that your prescription medications are covered.

Premiums and out-of-pocket costs differ depending on the plan you choose. Most of those enrolled in insurance through the Marketplace receive subsidies to help lower their premiums. There is no income cap to qualify for a subsidy. However, the lower your income, the higher the premium tax credit you're eligible for.

The subsidies break down as follows:

  • If you earn up to 150% of the federal poverty level, you can get an ACA plan with no monthly premium.
  • If you earn up to 400% of the federal poverty level, you qualify for a sliding-scale subsidy.
  • If you earn over 400% of the federal poverty level, you won't pay more than 8.5% of your household income towards premiums.

Finally, if someone claims you as a dependent on their tax return, you can buy a plan through the Marketplace but won't qualify for savings based on your income. Once you enroll in a plan, you will pay your premiums directly to the insurance company, not Health Insurance Marketplace. Your coverage won't begin until you pay your first premium.

Bottom line: if you are a college student, you have options. Higher-education institutions often offer student health plans at affordable prices. If you are under 26, you may qualify for coverage on your parent's health plan. Depending on your income and household, coverage through the ACA may be right for you.

SAGE Scholars

SAGE Scholars

At SAGE Scholars, we deeply believe in the value and quality of private higher education. Our mission is to provide access to affordable college opportunities while bringing together families, colleges & universities, and benefit providers to create college funding solutions. Since 1995, SAGE Scholars has bridged the gap between students who want a quality private college education and colleges that will work closely with member families to ensure affordability — all at no cost to the families.
Six Keys to Studying Abroad as a Student - Athlete
Six Keys to Studying Abroad as a Student - Athlete
November 22, 2022
As a student-athlete, it may require more discipline to experience a new culture while maintaining fitness. However, the work is worth the sights, lessons, friends, and personal growth you will experience while away from home.
Building a Mental Toolbox
Building a Mental Toolbox
November 21, 2022
Most students come to college with a few tools already developed in high school, but probably not enough to breeze through their university career. Students should be conscious of their current toolbox and always look to expand, refine, and improve it.
Saving in College
Saving in College
November 21, 2022
Managing finances in college can be challenging. This article is here to ease that stress and give you a few helpful tips to maximize your savings in college.