While all registered students have access to Student Health Center medical services regardless of insurance status, students are encouraged to have health insurance. An unexpected serious injury or illness can interfere with your academic and personal plans, and in some cases, result in significant financial debt. If you do not have health insurance, there are several options for getting insurance:
- Parent’s Insurance—If you are less than 26 years old, you may be able to get coverage through your parent’s health insurance plan. Check with the insurance plan for eligibility, enrollment period and cost.
- Edusure Insurance Enrollment website – This is a website developed by Academic Health Plans specifically for college students. In this site, you can find and purchase health insurance available on the Health Insurance Marketplace (see details below). Licensed insurance advisors are available by phone or online chat with expert advice to help guide students. You can shop for plans based on the price or level of benefit. Shop online at edusure.com or call 1-800-EDU-EXCHANGE (1-800-338-3924) for more information.
- Health Insurance Marketplace—The Affordable Care Act created an insurance marketplace where health insurance plans with varying levels of coverage and cost are available. United States citizens may also be eligible for insurance subsidies (tax credits) from the federal government that help lower the cost of insurance. Even if you do not qualify for subsidies, you can still purchase health insurance through the federal insurance marketplace. For more information, visit healthcare.gov
- Health Insurance Plans—Health insurance may also be purchased directly from insurance companies through agents or online websites.
- Insurance Brokers—Offer health insurance plans from multiple insurance companies. Online insurance brokers such as eHealth (https://www.ehealthinsurance.com/ ) provide information on health insurance plans allowing you to compare features and prices. Then you can enroll online.
- Employer—You may be eligible for health insurance through an employer. If you work at least 30 hours per week for an employer with 50 or more employees, then the Affordable Care Act requires that the employer provide health insurance. As an alternative, employers may provide a defined contribution plan which allows an employer to pay you a monthly amount for insurance and you purchase a health insurance plan of your choice.
- Medicaid—Health care benefits are available for persons 18 years of age or younger whose family income meets Medicaid eligibility criteria, are U.S. citizens and Texas residents. Pregnant women with very limited income and adults caring for a child receiving Medicaid may also be eligible for Medicaid. Persons 18-20 years of age who were in the Texas foster care program and have no insurance may also be eligible for Medicaid. For more information, check http://yourtexasbenefits.hhsc.texas.gov/programs/health/ .
Tips on Selecting Health Insurance
- Cost: The cost of health insurance varies based on several factors including amount of deductible (amount you pay before insurance starts to pay), copays (amount you pay for doctor visits or medications), coinsurance (after deductible is met, percentage you pay for services) and maximum out of pocket (point at which the insurance will begin paying 100% of covered services). Health insurance plans that cost less to purchase will usually have higher out of pocket costs when the insurance is used. So, carefully consider the financial impact.
- Deductible: Pay particular attention to the deductible because this is the amount that you must pay out of pocket before the insurance begins to pay for a portion of the cost of services. Preventive care is usually covered at 100% even if you have not met the deductible amount. Some plans will also cover a certain number of visits to your primary care doctor at 100% even if you have not met the deductible. So, pay attention to the plan details!
- Coverage: The “Metal” (bronze, silver, gold, platinum) level of coverage determines the percentage you pay out of pocket after meeting the deductible. Generally, you will pay 40% in a bronze plan, 30% in silver, 20% in gold and 10% in platinum. The smaller the percentage you pay, the higher the cost of the insurance.
- Out of Pocket Maximum: Health plans may have different maximum amounts that you must pay out of pocket before the insurance will begin paying for 100% of covered services. So, you can determine the potential financial impact of a serious illness or injury on your personal and academic plans by paying attention to the maximum.
- Plan Type: Check the specific health plan you are considering to determine if the medical provider you want to see is part of their network. Some health plan networks are very limited and allow you only to see medical providers in their network (HMO, EPO) and others allow you to see medical providers outside the network too (PPO, POS)—but you have to pay a larger percentage of the cost. For more information about plan types, check https://www.healthcare.gov/choose-a-plan/plan-types/ .
- Total Cost of Care: The cost of healthcare will include the premiums that are charged every month and the out of pocket costs including deductibles, copays and coinsurance. So, carefully consider your health care needs, the combination of benefits that makes the most sense for your needs and what you can afford.
For a more complete list of health insurance terms and examples please click here.