A health insurance card, one would hope, says James C. Turner, president of the American College Health Assn. and executive director of student health at the University of Virginia. "College students typically see themselves as healthy and immortal, but I've seen students injured or become ill, and the medical costs without insurance can mean starting your life saddled with debt far higher than just tuition," he says.
Most college students -- 67%, according to a 2008 report from the U.S. Government Accountability Office -- have health coverage under a parent's employer-based plan.
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That may be changing. "I suspect that with the increase in premiums and the loss of jobs for some parents and the insurance that comes with it, that percentage could be lower for the 2009-2010 academic year," says Marian Mulkey, a senior program officer with the California Healthcare Foundation, an Oakland-based advocacy group.
But having insurance is sometimes non-negotiable. According to the GAO report, about 30% of colleges required students to have health insurance for the 2007-08 academic year.
Many colleges offer their own plan, typically costing about $1,000 to $2,000 per year. That can be well below the cost of continuing coverage under a parent's employment plan and below individual plans you might buy through insurance brokers such as ehealthinsurance.com. But Brenda Gleason, president of M2 Health Care Consulting in Washington, D.C., says you'll want to check to see how comprehensive the coverage is.
"Some college plans may exclude some pre-existing conditions, such as allergies or even cancer, which could mean you'd have to factor in how to pay for the care you need for a condition, such as drugs for asthma," she says.
According to the GAO report, annual premiums for plans offered by colleges range from $30 to $2,400, and maximum benefits range from $2,500 per illness or injury to unlimited lifetime coverage.
The American College Health Assn. offers guidelines for what a college health plan should contain, including coverage for prescription drugs and catastrophic coverage; find those recommendations at www.acha.org. (Click "Information and Resources," then select "Guidelines and Recommendations" and then "Standards for Student Health Insurance/Benefits Programs.") If your college's plan does not include one of the recommended provisions, compare costs for more comprehensive individual plans. Those plans can start as low as $70 per month, depending on where you live and your medical history, says Amir Mostafaie, a consumer insurance expert for ehealthinsurance.com.
Other factors college students should consider when selecting insurance:
COBRA: If a parent loses a job while a student is in college, he or she may be able to continue coverage for themselves and dependents under a program known as COBRA. It charges the employee the full cost of coverage, plus up to a 2% administrative fee, usually for 18 months after employment benefits end. Once COBRA is turned down, it's no longer an option, so parents who lose employment and coverage should compare the cost and specifics of a COBRA plan for themselves and all dependents, including college students. Keep in mind, though, that states have different rules about the age at which a student can still be insured under a parent's coverage, ranging from 23 in many states to 30 in New Jersey.
Self-insured plans can set their own limits on dependents' qualifying ages for health insurance.
Attendance: Many schools do not offer coverage to part-time students, with that being defined differently at every school. Counselors who advise a change in workload may not realize the insurance ramifications, so be sure to discuss any course-load change with the student health services and have that guidance clarified by an academic dean. One option may be to take a one-credit course or an incomplete for a course, which could keep you in good standing for insurance, with the option to make up the incomplete the next semester.
Ask for help: College insurance specialists know that many students may need advice and guidance, Turner says, so call ahead or visit the campus health center to ask questions. Students who can't afford a college plan may be eligible for some state assistance, such as Medicaid, and health center staff should be able to direct you to options or experts who can answer your questions. Pregnancy is usually not covered, and, although pregnancy at college is often unplanned, if you're considering becoming pregnant you may want to purchase supplemental coverage for about $1,000 rather than pay the full cost of having the baby, which can run up to $20,000 for a caesarean delivery.
Turner also advises asking about coverage during summer and other breaks and during a year abroad in a foreign country. Often, if those breaks in campus residence are not covered, the school can direct you to supplemental coverage. With the economy still in the doldrums, Turner advises students just now applying to college to ask about and factor in healthcare costs, so that they can build the amount into budgeting and financial aid.