By Paul Shafer, The Conversation
As colleges and universities decide whether or not to reopen their campuses this fall, much of the discussion has focused on the ethics behind the decision and the associated health risks of in-person instruction.
As a researcher who studies health insurance policy, I see two important gaps in this discussion: 1) Who should pay the cost of treating the inevitable COVID-19 cases that will occur; and 2) What do college students need to know about their coverage?
Here are four things I think every college student – and those who care about them – should know about health insurance coverage when it comes to COVID-19.
1. Weigh coverage options
If you’re covered under a student health insurance plan through your school, it may be worth considering whether that is still your best option. The Affordable Care Act allows, but does not require, dependents to stay on their parents’ plan until age 26. Many students already take advantage of this, but if you don’t, it may be worth a second look, particularly if your parents are insured and you are staying home this fall. The catch is that your parents’ premiums might increase if they are switching from single or spousal coverage to family coverage.
Students can also qualify for a special enrollment period on HealthCare.gov – or their state-specific health insurance marketplace – if their county or state of residence is changing. This is likely a good option only if students earn some income. That’s because the financial subsidies for marketplace coverage kick in only if you are making at least 100% of the federal poverty level, which is US$12,760 a year for a single person in the lower 48 states.
If you don’t earn any income or work only part-time, health insurance coverage through Medicaid may be an option, depending on where you live. If you live in a state that expanded Medicaid under the Affordable Care Act, or attend a college or university in a state that did, you have a better chance of being eligible. Childless adults can qualify for free or nearly free coverage in states that expanded Medicaid with incomes up to 133% of the federal poverty level, which is $16,971 in the lower 48.
2. Ask how COVID-19 is covered
All universities planning to reopen their residential campus are developing detailed plans with protocols that include measures like social distancing, daily symptom reporting and regular testing. In these plans, a positive test will likely result in isolation, retesting, contact tracing and other measures to protect the student and their campus. However, treating complications of COVID-19 is a different story. Students will certainly be connected with treatment, but these plans don’t often address who pays for it.
Several major health insurance companies have committed to waiving out-of-pocket costs for COVID-19 treatment, but some already have plans to end this benefit. There is certainly a question of how this will work out given the potential length of the pandemic and cost of treatment for severe cases. Many of these national insurers are the companies behind student health insurance plans, so these policies may ultimately affect students, but not always.
At Boston University, where I teach health policy, our Student Health Insurance Plan through Aetna is covering COVID-19 treatment just like any other illness, subject to the usual deductibles, coinsurance and copayments. Given that COVID-19 treatment can cost into the tens of thousands of dollars or more for cases requiring hospitalization, a student could be responsible for their full annual out-of-pocket maximum of either $3,000 or $5,500 when those bills come due. The risk of severe complications is thought to be low among young adults, but hospitalization rates are on the rise among all age groups.
3. Use telehealth
Students may have other health care needs to be addressed during this pandemic but may not be able to or feel comfortable going to their student health or neighborhood clinic in person. Telehealth has been around for years, but the onset of COVID-19 has seen a dramatic shift in some health systems of moving nonemergency care online. Routine visits for chronic disease management and mental health care, a particular concern right now, are obviously critical to good health.
Many insurers and student health plans have waived copayments for telehealth visits. But some are already looking to scale back this benefit as states continue to reopen. Things don’t always work as planned. Patients still get billed sometimes for “free” telehealth, so double-check before you pay any bills.
4. Out-of-network care
For students who decide to stay home this fall, or have to because their college or university is offering courses online only, an important consideration is whether and how generously their student health insurance plan covers out-of-network care. A student may be in a different city, state or even country from their school, which means that the network associated with the student plan might not be accessible.
Certainly, telehealth services can help work around this problem, but students may have care needs, unrelated to COVID-19, that require in-person care. Out-of-network coverage generally comes with a higher deductible and greater financial responsibility for the patient. For example, at the University of North Carolina, their StudentBlue plan comes with a $4,000 out-of-pocket maximum for in-network care, which doubles to $8,000 for out-of-network care.
These higher costs can make a big difference in access to care. Poorer families will be at greater risk of delayed or foregone care that can lead to negative health consequences down the road.
Also, research has shown that when people don’t understand their health insurance plans – as many college students may not due to their limited experience with it – it can lead people to avoid care due to worries about cost. College students who want to learn more about the basics of health insurance can check out this BestColleges guide.
Students and their parents really need to understand their health insurance coverage heading into the fall semester, whether or not they go back to campus. Being informed is the best defense during this pandemic. Minimizing risks is critical, but it’s also important to understand what a positive test could mean financially. Students should reach out to their student health office and health insurance company to get the facts about their coverage and what their financial responsibility would be if they were to get COVID-19 and need treatment.