Graduate Student Health Insurance: What's Covered By Universities?

Health insurance is a necessity for graduate students. While some may be covered by their parents' health insurance plans, others may need to purchase their own. Many universities offer student health insurance plans, which can be an easy and affordable way to get basic insurance coverage. These plans typically comply with the Affordable Care Act (ACA) and cover essential health benefits, including pre-existing conditions and preventive care. Graduate students can also explore other options such as employer-based healthcare plans, marketplace plans, or government-provided insurance. Understanding the different types of plans and their costs is essential for graduate students to make an informed decision about their healthcare coverage.

Student health insurance plans

Coverage Options:

• Stay on your parent's plan: If you are under 26 years old, you may be able to remain on your parent's health insurance plan. This is a good option if you have a pre-existing medical condition or if you will be attending school in the same state as your parents. It is important to note that your parent's plan may not provide adequate coverage if you are studying out-of-state. Additionally, your parents will be handling the bills, and their plan might be more expensive than other options.
• School-sponsored plan: Some colleges and universities offer their own health plans for students. These plans typically cover on-campus services, but may not provide off-campus coverage. Eligibility for these plans might also be restricted to full-time students only.
• Student Health Plan: These plans are designed specifically for full-time students aged 17-29. The major advantage is that the coverage travels with you across the US. However, it may require a lump-sum premium payment and is not available in all states.
• Individual and Family Plans: You can purchase an individual or family health plan on your own. These plans offer a range of coverage benefits depending on the specific plan selected.

Important Considerations:

• Minimum coverage and deductibles: Ensure that your plan offers minimum coverage per year (e.g., $500,000) and includes an annual deductible, which is a fixed amount you pay each year before your insurance plan takes over.
• Inpatient and outpatient services: Your plan should cover inpatient and outpatient services across the US, including mental health services, physical therapy, and prescription drugs.
• Eligibility and limitations: Be aware of any limitations or restrictions on your coverage, such as eligibility requirements or limitations on doctors and locations. Check if your coverage will lapse during breaks or if you withdraw/graduate, and if there is a grace period.
• International students: If you are an international student, holding an F-1 or J-1 US visa, you are generally required to purchase health insurance. Contact your campus international student and student health office for more information.

Examples of Student Health Plans:

AcademicBlueSM: Offered by Blue Cross and Blue Shield of Illinois (BCBSIL) and Blue Cross and Blue Shield of Texas, these plans are designed specifically for university students and provide quality, affordable health insurance. Benefits include preventive care, low deductibles, access to PPO networks, 24/7 nurseline and virtual visits, and a mobile app for accessing services.

Staying on a parent's plan

As a graduate student, you have several options for health insurance. One option is to stay on your parent's health insurance plan. Here are some things to consider if you're thinking about staying on your parent's plan:

• Age requirements: If you are under 26 years old, you may be able to stay on your parent's health insurance plan, regardless of your student status, tax-dependent status, marital status, or employment status.
• Location: If you live in a different state from your parents, carefully review the plan's coverage documents and provider network to understand what is covered in the state where you attend school.
• Network limitations: The plan's network might not include hospitals and doctors in the area where you're studying.
• Maternity coverage: Dependent coverage on a parent's plan might not include maternity coverage.
• Privacy: If privacy is a concern, staying on your parent's plan may not be ideal, as the health plan will likely send the explanation of benefits (EOB) to your parents.
• Cost: Depending on the structure of your parent's health plan, being included as a dependent may or may not affect the amount they pay in premiums.
• Pre-existing conditions: Staying on your parent's plan can be beneficial if you have a pre-existing medical condition, as you may not need to worry about being declined coverage.
• Open Enrollment Period: If you are enrolling in a Marketplace plan with your parents, note the Open Enrollment Period of November 1 to January 15 each year.

Remember that staying on your parent's health insurance plan is just one option. You can also explore student health insurance plans offered by your university, or purchase an individual or group health insurance plan on your own. It's important to carefully consider your priorities, budget, and unique situation when deciding on the best health insurance option for you.

Buying an individual plan

If you're a graduate student, you can purchase an individual or group health insurance plan on your own. Your options will vary from state to state, and you may have some affordable options, especially if you are young and healthy. Check with a local insurance agent to explore your choices.

There are some individually purchased health plans designed specifically for students, which can provide good benefits and flexibility. This may be useful if you are travelling between two states.

Keep in mind that you could be declined coverage based on any pre-existing medical conditions you have. You may also be able to purchase an individual plan through the Affordable Care Act (ACA) marketplace.

What to Consider

When deciding whether to buy an individual plan, here are some things to consider:

• Cost: If your parents have a group health insurance plan that includes additional children, the premium is likely the "family" rate, and it won't go down if one child is removed from the plan. In that case, staying on your parents' plan might be more affordable.
• Location: If you are studying out of state, network restrictions on your parents' plan could result in little or no access to healthcare in your school's location. In that case, it makes more sense to get a new health plan—either in the exchange or through your university—that includes providers in the area where you will be living.
• Eligibility for Exchange Subsidies: If you are a dependent on your parents' tax return, their income is included when determining eligibility for premium subsidies or Medicaid. But if you file your own taxes, you may qualify for significant subsidies if you're on a limited income.
• Maternity and Contraceptive Coverage: Group plans with at least 15 workers have covered maternity care since the 1970s, but there is no requirement that those plans cover maternity care for dependents. HHS clarified in 2015 that dependents must have access to preventive prenatal care with no cost-sharing, but young adults who remain on a parent's plan may not have coverage for labour and delivery. If this is a concern, you can purchase individual coverage (on or off the exchange) or obtain student insurance through your university, as both of those options include maternity benefits.
• Contraceptive Coverage at Religiously Affiliated Schools: For students who attend religiously affiliated schools, contraceptive coverage could be limited under the student health plan offered by the school. The Trump administration allowed colleges and universities to avoid offering various types of contraceptive coverage if they had religious or moral objections. This was upheld by the Supreme Court in 2020, but the Biden administration has proposed a rule change that would allow access to zero-cost contraception for women enrolled in health plans that have religious exemptions.
• Foreign Travel: Most health insurance plans do not cover foreign travel. If you're planning to spend a semester abroad, your school will be able to point you toward the health plans that they recommend for coverage outside the US. There are also many travel health insurance plans available, many of which cater specifically to students.

Student Health Plans

Student health plans are often purchased when family coverage is not available, and an estimated 3 million students are covered through such plans. However, not all student health plans are the same, and some offer limited benefits that can put students at risk for high medical bills. These plans are also treated differently depending on how and where they're offered, creating a confusing patchwork of regulations that can make it difficult for students to understand their coverage and rights.

The Department of Health and Human Services (HHS) has issued a proposed regulation to ensure that students enrolled in these plans benefit from important consumer protections created by the ACA. The proposed regulations clarify that these plans would be defined as "individual health insurance coverage."

Getting coverage from an employer

However, obtaining employer-sponsored health insurance may not be possible immediately after graduation, or even in the near future. It is worth noting that the Affordable Care Act (ACA) has made it easier for young adults to have health insurance coverage, even if the benefits they assumed they would receive from employers take longer than expected to materialize.

If you are employed and your employer offers health insurance, you won't qualify for savings on a Marketplace plan if the job-based plan is considered "affordable". In 2024, a job-based health plan is deemed "affordable" if your share of the monthly premium for the lowest-cost plan offered by your employer is less than 8.39% of your household income. If your employer's plan meets this standard and is considered "affordable", you won't be eligible for a premium tax credit if you opt for a Marketplace insurance plan.

If you have a Marketplace plan and receive an offer of health insurance from an employer, you may no longer qualify for savings on your Marketplace plan, even if you don't accept the job-based coverage offer. If you already accept the offer of job-based insurance, you will likely want to cancel your Marketplace plan and enroll in your employer's plan.

It is important to carefully consider your options when deciding between Marketplace and job-based insurance. While employer-sponsored health insurance is a desirable option, it may not always be available immediately after graduation, so it is essential to explore other alternatives to ensure continuous coverage.

Government programs

The US government offers a range of health insurance programs for graduate students. Here are some of the options available:

Marketplace Plans

The US government regulates an open marketplace for citizens who don't have health insurance through their employer. These plans must offer a minimum level of coverage, and they must disclose what is offered before enrolment. The registration period for these plans is typically between November 15 and January 15.

Marketplace plans are offered at four tiers: bronze, silver, gold, and platinum. Platinum has the highest premium, which is a set rate paid monthly, but the lowest out-of-pocket costs. Bronze has the lowest monthly premium but the highest out-of-pocket costs and the least amount of coverage.

Medicaid

Medicaid is a government-provided health insurance program for over 72.5 million low-income individuals. In all 50 states, pregnant women, children, low-income families, and those who receive Supplemental Security Income (SSI) are eligible for Medicaid. Additionally, 38 states and the District of Columbia have expanded Medicaid eligibility to adults with incomes up to 138% of the federal poverty level (higher in DC). You can check your eligibility using the federal poverty level (FPL) calculator.

Children's Health Insurance Program (CHIP)

CHIP is an insurance program that provides low-cost health coverage to children in families that earn too much to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP also covers pregnant women.

Frequently asked questions