Q. Next year, I start college and I’m trying to decide whether I would be better off enrolling in the plan my college offers, buying my own insurance in the exchange (where I may get a subsidy) or hitching a ride on my mother’s plan.
A. You will have to compare benefits and costs, as there’s no one-size-fits-all answer in this circumstance. Here are a few things to keep in mind:
Student health insurance
- Student health plans offered by colleges and universities are nearly fully-compliant with the ACA. The exceptions are that they don’t have to be merged with the carrier’s other plan in the state for risk pool purposes, and they’re not required to fit into the narrow actuarial value (AV) ranges that apply to other individual market plans. For all intents and purposes however – particularly from the enrollee’s perspective – the plans are fully compliant with the Affordable Care Act. So they cover pre-existing conditions, provide preventive care with no cost-sharing, include coverage for the essential health benefits, and do not have annual or lifetime benefit caps.
- There are no subsidies to offset the cost of student health insurance offered by your college or university. Whatever the premium is, you’ll have to pay it in full in order to have coverage in place.
Staying on your parents’ plan
- You’ve got an option to remain on your parents’ health plan until you turn 26, regardless of whether your parents claim you as a dependent for tax purposes. That might work out well for you and your family, but it’s important to note that the plan’s network might not include hospitals and doctors in the area where you’re going to school, and also that health plans are not required to cover maternity care for dependents.
- If there’s any chance that you might need maternity care, or if you’re concerned about the adequacy of your parents’ plan’s network in the area you’re going to school, you may want to consider getting your own plan instead. Regardless of whether you purchase a plan in the individual market – on or off-exchange – or enroll in the student health plan offered by your college, you’ll have maternity coverage and your plan will have a local provider network in the area where you purchase it.
- If you’re in a state that has expanded Medicaid, you might qualify for Medicaid, depending on your income. If your parents claim you as a dependent on their tax returns, their income will be factored into your eligibility. But if you file your own tax returns and your household income is under 138 percent of the federal poverty level ($16,394 for a single individual in 2016), consider Medicaid as an option if your state has expanded the eligibility guidelines as called for in the ACA.
Getting your own individual market plan
- You can also get your own plan in the exchange (or off-exchange if you’re certain that you’re not eligible for premium subsidies and won’t be eligible for them for the remainder of the year). Moving to a new location – which includes moving to college – is a qualifying event that will allow you to purchase an individual market health insurance plan outside of the annual open enrollment period.
- Your eligibility for subsidies will depend on your household income and the cost of plans in your area. If your parents claim you on their tax return, your total household income will include their income. If you file your own return, your subsidy eligibility will be based on your own income. (Note that household size is also part of the equation – if your parents income is counted, they’re also counted as members of the household when the household’s total income is compared with the federal poverty level guidelines.)