Medi-Cal Coverage For University Students: Who Qualifies?

University students in California have a few options for health insurance coverage. Firstly, they can remain on their parents' health insurance plan until the age of 26, regardless of their student status or whether they are a tax dependent. Secondly, they can opt for a student health plan offered by their university, which is typically different from the plans provided to faculty and staff. These plans are often more affordable, but students should check if they are ACA-compliant and confirm the extent of coverage, especially for out-of-network services. Thirdly, students can purchase their own health insurance policy through the California Marketplace. Income-based government assistance may be available to help with costs. Finally, university students may be eligible for Medi-Cal, California's Medicaid program, if their income is below 138% of the federal poverty line. This option provides free or low-cost health insurance, and enrollees are not eligible for premium assistance.

Income eligibility for Medi-Cal

Income is a key factor in determining eligibility for Medi-Cal, California's Medicaid health care program. This program provides free or low-cost health care to individuals and families with limited incomes and resources. The income threshold for eligibility varies depending on factors such as age, family size, and other factors.

For adults, eligibility for Medi-Cal is generally determined based on income relative to the Federal Poverty Level (FPL). As of 2019, individuals with an annual income of up to 138% of the FPL (approximately $16,395) may qualify for Medi-Cal. This equates to a monthly income of up to $954.72 for an individual or $1,598.14 for a couple. These figures are subject to change and may be higher for individuals who are blind.

For students, income eligibility for Medi-Cal can be assessed independently if they are financially independent from their parents. If students are still claimed as dependents on their parents' taxes, their eligibility for Medi-Cal is typically assessed based on their household income, including their parents' income. In this case, the higher income threshold for families may apply, with eligibility extending up to 266% of the FPL for children.

In addition to income, other factors can influence eligibility for Medi-Cal. These include being a resident in skilled nursing or intermediate care, having refugee status, being a parent or caretaker of disadvantaged children under 21, or having been diagnosed with certain types of cancer. Students applying for Medi-Cal should also consider whether they qualify for any exemptions, such as being below the tax-filing threshold.

Student health plans vs. Medi-Cal

University students in California have a few options for health insurance coverage. One option is to be covered under their parents' insurance plan. If a student is under 26 and their parent has health insurance through Covered California, they can remain under their parents' coverage. This is often the best option for students who attend college in their home state. However, if a student is moving to another state for college, their parents' insurance plan may not cover them, as the network of hospitals, doctors, and healthcare providers will likely be limited to California.

Another option for university students is to purchase a student health plan from their school. Many colleges and universities offer special health coverage plans for their enrolled students, which are typically different from the plans offered to faculty and staff. Student health plans count as health insurance under the Affordable Care Act, so students enrolled in these plans will not have to pay a penalty. Student health plans tend to be more affordable than plans on the national health insurance marketplace, and premiums can often be included in school expenses like tuition and room and board. However, it's important to note that some student health plans may only cover in-state networks, which can be inconvenient for students who return home for breaks or require medical care while travelling.

University students can also opt to purchase their own health insurance policy through the marketplace. This option allows students to choose a plan that best fits their budget and healthcare needs. Depending on their income, students may qualify for government assistance in the form of tax credits or lower premiums to help make a marketplace health insurance plan more affordable.

Finally, students may be able to get covered through Medi-Cal, California's Medicaid program. Medi-Cal provides free or low-cost health coverage to individuals with limited financial resources. To qualify for Medi-Cal, an individual's annual income must be 138% of the poverty level or less, which is currently $16,395 or less. Other factors such as pregnancies, children, or disabilities are also taken into account.

When deciding between student health plans and Medi-Cal, university students should consider their specific needs and circumstances. Student health plans may offer more convenience and accessibility, especially for those who live on or near campus. On the other hand, Medi-Cal may be a better option for those with limited financial resources who may struggle to afford the premiums and deductibles associated with student health plans or private insurance plans. It's important for students to carefully review the details of each option, including coverage, costs, and eligibility requirements, to determine which plan best suits their needs.

Medi-Cal for out-of-state students

Students in California have a few options when it comes to health insurance. Firstly, they can remain on their parent's insurance plan, as long as they are under 26 and their parents have coverage for dependents. This is often the most convenient option for students who attend college in their home state. However, for those studying out of state, this may not be ideal as their insurance company's preferred network won't travel with them. While emergency services will be covered at the in-network price, even out of state, routine appointments would require travelling home.

Another option is to purchase a student health plan from your school. These plans are designed with full-time college students in mind and are often more affordable than other plans on the national health insurance marketplace. The downside is that they may require paying premiums in one lump sum, and if the university is out-of-state, the plan may be limited to an in-state network.

Students can also purchase their own health insurance policy through the marketplace. If studying out-of-state, this would likely be done through that state's marketplace. Students with low incomes may qualify for government assistance to help with costs.

Finally, students may be able to get health insurance through Medicaid. California's Medicaid program is called Medi-Cal. To qualify, an individual must have an annual income of 138% of the poverty level or less, which is currently $16,395. Other factors, such as pregnancy, children, or disabilities are also taken into account.

For students moving to a new county in California, L.A. Care will cover emergency room and urgent care services in the new county. Routine and preventive care are also covered, but only in the county of residence, and the student must notify their MCP. For students enrolled in Medi-Cal who move to a different California county for their studies, there is no need to apply for Medi-Cal in that county. However, they must inform their eligibility worker at the Los Angeles County Department of Public Social Services (DPSS) of their new address.

For students who are leaving California temporarily to study in another state, it is possible to keep your Medi-Cal coverage. Emergency services and urgent care in another state will be covered, as well as emergency care requiring hospitalization in Canada and Mexico, as long as L.A. Care approves the service and the doctor and hospital meet Medi-Cal rules. Routine and preventive care services are not covered outside of California, and Medi-Cal does not cover any health care services outside of the US, except for Canada and Mexico.

Applying for Medi-Cal

Medi-Cal is California's Medicaid health care program. It provides health insurance coverage for students who are financially independent or those who come from low-income households. If you are a student in California, you may be eligible for Medi-Cal if you meet certain criteria. Here is a step-by-step guide to help you through the process of applying for Medi-Cal:

• Understand the Eligibility Criteria: To qualify for Medi-Cal, your income must be up to 138% of the Federal Poverty Level (FPL) for adults or up to 266% FPL for children. Other factors that are considered include foster care or adoption assistance, residency in skilled nursing homes, refugee status, being a parent or caretaker of disadvantaged children under 21, and certain medical conditions like breast or cervical cancer.
• Gather Required Information: Before starting your application, ensure you have all the necessary information and documents. This typically includes personal information such as your Social Security number, income details, tax filings, and information about any current health insurance coverage you may have.
• Apply for Medi-Cal: You can apply for Medi-Cal through Covered California, which is California's health insurance marketplace. You can apply online, over the phone, or in person. When applying, you will need to provide information about your income, household size, and other relevant factors.
• Determine Your Eligibility: Once you have submitted your application, Covered California will evaluate your information to determine your eligibility for Medi-Cal. They will consider your income, household size, and any other applicable factors mentioned earlier.
• Receive Notification: After processing your application, Covered California will notify you of your eligibility status. If you are eligible for Medi-Cal, they will inform you about the specific program details and the next steps in obtaining your health insurance coverage.
• Enroll in Medi-Cal: If you are deemed eligible, follow the instructions provided by Covered California to enrol in Medi-Cal. This may involve choosing a specific plan, providing additional documentation, or taking other necessary steps to finalise your enrolment.
• Maintain Your Coverage: To maintain your Medi-Cal coverage, remember to renew it annually on your original sign-up date. Additionally, report any household changes, such as income or address changes, to your local county social services office within 10 days. This helps ensure that your coverage remains up to date and reflects your current situation.

By following these steps, you can apply for and obtain Medi-Cal coverage as a student in California. Remember to carefully review the eligibility criteria and provide accurate information during the application process. If you need assistance, you can always reach out to a certified enrollment counselor, who can guide you through the process and answer any questions you may have.

Benefits and drawbacks of Medi-Cal

University students in California have a few options when it comes to health insurance, including their parents' insurance, a student health plan, a marketplace policy, or a Medi-Cal plan. Medi-Cal is California's Medicaid program, which provides health coverage for those with limited financial resources. Here are some benefits and drawbacks of choosing Medi-Cal:

Benefits of Medi-Cal:

• Affordable Coverage: Medi-Cal is designed to provide health insurance to individuals with limited financial resources. It offers a safety net for those who cannot afford private health insurance, ensuring they can access essential healthcare services.
• Comprehensive Benefits: Medi-Cal covers a wide range of health benefits, including doctor visits, hospital care, immunizations, pregnancy-related services, and nursing home care. It also includes "essential health benefits" mandated by the Affordable Care Act, such as outpatient services, mental health services, rehabilitative services, laboratory services, and children's services (including oral and vision care).
• No Premium Costs: Unlike private insurance or even some student health plans, Medi-Cal does not require the payment of monthly or annual premiums. This can be a significant financial relief for low-income individuals.

Drawbacks of Medi-Cal:

• Income and Eligibility Requirements: To qualify for Medi-Cal, individuals must meet specific income requirements, which are based on a percentage of the poverty level. This means that those who do not meet the income threshold may not be eligible, even if they struggle to afford private insurance.
• Limited Provider Network: Medi-Cal, like many other insurance plans, has a network of participating healthcare providers. While the network is extensive within California, students who attend college out of state may find that their access to in-network providers is limited or non-existent.
• Potential for Long Wait Times: Due to the high demand for Medi-Cal services, there may be longer wait times for certain specialty care or procedures. This can be a challenge for individuals who require timely access to specific medical services.
• Limited Out-of-State Coverage: While Medi-Cal covers emergency services out of state, non-emergency services received outside of California are generally not covered. This can be a significant drawback for students who attend college or travel frequently outside of the state.

Frequently asked questions