Aca And University Students: What's Covered And What's Not

The Affordable Care Act (ACA) has had a significant impact on college students' access to healthcare. Before the ACA, health coverage for students was often contingent on being enrolled full-time and under 22 years of age. Now, thanks to the ACA, young adults can remain on their parents' health plans until the age of 26, regardless of their enrolment status, tax dependency, or marital situation. This has led to a notable increase in health insurance coverage among students, with the uninsurance rate for 18-34-year-olds dropping from 29% in 2010 to 14% a decade later.

The ACA has also made individual insurance more accessible by removing exclusions for pre-existing conditions and providing subsidies for low and middle-income earners. Furthermore, the expansion of Medicaid has allowed more students from low-income families to access healthcare. The share of students enrolled in Medicaid has increased by five percentage points since the ACA's passage.

The ACA's provisions have contributed to significant increases in coverage, with health insurance coverage among students increasing by ten percentage points from 2010 to 2018, halving the national uninsurance rate for students.

The ACA's impact on college students

The Affordable Care Act (ACA) has had a significant impact on college students in the United States, particularly regarding their access to healthcare and health insurance coverage.

Improvements in Healthcare Coverage

Prior to the ACA, health coverage for college students was often inadequate and inconsistent. The ACA has improved this situation by allowing young adults to remain on their parents' health insurance plans until the age of 26, regardless of their student status, marital situation, or residence. This change alone has had a measurable impact on coverage rates for young people.

Expansion of Medicaid

The ACA also called for the expansion of Medicaid, a federal program that provides free or low-cost health coverage to low-income individuals and families. As of 2024, 40 states and the District of Columbia have expanded Medicaid coverage to adults with incomes up to 138% of the poverty level, providing another option for students with limited incomes.

Guaranteed Issue Coverage and Subsidy Eligibility

The ACA made individual insurance guaranteed issue, meaning that insurance companies cannot deny coverage based on medical history or pre-existing conditions. Additionally, it created subsidies (premium tax credits) to make insurance premiums more affordable for low and middle-income individuals, including students.

Impact on Students of Color

The ACA has been particularly beneficial for students of color, significantly narrowing the racial coverage gap. The coverage rate for Hispanic students, in particular, increased by 23% from 2010 to 2018.

Impact on Overall Student Coverage

Overall, the ACA has contributed to significant increases in health insurance coverage for college students. From 2010 to 2018, health insurance coverage among students increased by ten percentage points, cutting the national uninsurance rate for students in half.

Impact on Higher Education

The improvements in healthcare coverage for students may have a positive impact on their ability to pursue and succeed in higher education. Studies suggest that increased coverage and improved health and financial security can enhance students' educational outcomes, enabling them to make better decisions about their education and increasing their chances of completing their degrees.

Student health plans

The ACA has brought about several significant changes to student health plans:

• Extended coverage until age 26: One of the first ACA regulations, implemented in 2010, allows young adults to remain on their parents' health insurance plans until they turn 26, regardless of their enrolment status, tax dependency, marital status, or employment benefits.
• Guaranteed coverage and subsidy eligibility: The ACA ensures that individual insurance is guaranteed regardless of medical history, with no exclusions for pre-existing conditions. It also offers subsidies (premium tax credits) to make premiums more affordable for low and middle-income enrollees.
• Possible eligibility for Medicaid: The ACA called for the expansion of Medicaid, and many states have expanded coverage to adults with incomes up to 138% of the poverty level. This provides an additional option for students with limited incomes.
• Regulation of university health plans: Most university health plans are now regulated by the ACA, covering ten essential health benefits with no annual or lifetime benefit maximums. However, there are exceptions, such as self-insured plans offered by some colleges and universities, which are not subject to ACA regulations.
• Religious exemptions: Religious institutions of higher education may qualify for a one-year transition from the new contraceptive coverage requirement. Additionally, under the Trump administration, religious exemptions for universities with ACA-compliant plans became more widely available, though the Biden administration has proposed removing moral objections as a pathway for exemption.

Considerations for choosing a student health plan:

When deciding on a student health plan, there are several factors to consider:

• Cost comparison: Compare the costs of a student health plan with the costs of remaining on a parent's plan or purchasing an individual plan through the Marketplace. The affordability of each option will depend on factors such as income, family size, and location.
• Studying out of state: If studying in a different state from their parents, students should consider the network restrictions of their family plan, as this may result in limited access to healthcare in their new state. In such cases, obtaining a new health plan through the university or the Marketplace may be more suitable.
• Eligibility for exchange subsidies: If claimed as a dependent on their parents' taxes, students' eligibility for premium subsidies or Medicaid will be determined by their parents' income. However, students who file their own taxes may qualify for subsidies based on their income.
• Maternity and contraceptive coverage: While the ACA allows young adults to remain on their parents' plans until age 26, these plans may not cover maternity care for dependents. Additionally, students attending religiously affiliated schools may find that their student health plans have limited contraceptive coverage due to religious exemptions.
• Foreign travel: Most health insurance plans, including student health plans, do not cover foreign travel. Therefore, students planning to study abroad will need to explore additional travel health insurance options.

The ACA has significantly improved student health coverage options by providing access to more comprehensive and affordable plans. Students can now take advantage of extended coverage under their parents' plans, enhanced protections and benefits under university health plans, and the possibility of obtaining individual coverage through the Marketplace or Medicaid. However, it is important to carefully review and compare the available options, considering factors such as cost, location, eligibility, and specific coverage needs.

Marketplace coverage

The Affordable Care Act (ACA) offers a range of options for university students to obtain healthcare coverage, including through the Health Insurance Marketplace. The Marketplace is a platform where individuals can shop for and enroll in affordable, quality health insurance plans. This is particularly beneficial for students who may not be covered under their parents' plans or those who are seeking more comprehensive or affordable options.

Under the ACA, students can enroll in a Marketplace plan during the open enrollment period, which typically occurs in the fall each year. Some students may even qualify for a special enrollment period if they experience certain life events, such as losing other health coverage or getting married. This flexibility ensures that students can secure healthcare coverage when they need it.

Marketplace plans offer a range of benefits that are particularly relevant to university students. These plans must cover essential health benefits, including ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, and preventive and wellness services. This comprehensive approach ensures that students have access to the care they need to maintain their health and well-being during their academic journey.

Additionally, the ACA provides financial assistance to make Marketplace coverage more affordable for students. Depending on their income and family size, students may qualify for premium tax credits and cost-sharing reductions, which lower the overall cost of their health insurance. This financial support can be crucial in making healthcare accessible and affordable for students who may be facing financial constraints during their studies.

Medicaid expansion

The Affordable Care Act (ACA) has had a significant impact on the health insurance coverage of college students. The law's dependent coverage provision, which allowed young adults to remain on their parents' insurance until they were 26, had a measurable impact on coverage rates for young people.

The ACA also called for the expansion of Medicaid, and this has been taken up by 40 states plus the District of Columbia, with 10 states not adopting the expansion. The expansion provides Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level (around $20,783 for an individual in 2024). This has been critical in increasing coverage for students, especially those from low-income families.

The share of students enrolled in Medicaid has increased by five percentage points since the ACA's passage, from 8% to 13%. This is particularly important as young people have historically been the most uninsured age group. The expansion of Medicaid in states that have not yet implemented it would provide significant new protections for currently uninsured students.

The ACA's impact on college students has been far-reaching, improving access to coverage and reducing the uninsurance rate for this demographic. The expansion of Medicaid has been a key component of this, and its continued expansion could further enhance these positive effects.

Subsidy eligibility

The Affordable Care Act (ACA) has improved health insurance coverage for college students, with health insurance coverage among students increasing by ten percentage points from 2010 to 2018, and cutting the national uninsurance rate for students by half. The ACA's dependent coverage provision, which allows young adults to remain on their parents' insurance until they turn 26, has been particularly impactful.

The ACA also made individual insurance guaranteed-issue, regardless of medical history, and created subsidies (premium tax credits) to make premiums affordable for low and middle-income enrollees. These subsidies are available to students who qualify based on income, although if a student is claimed as a dependent on a parent's tax return, the parent's income is included in the total household income when applying for a subsidy.

The ACA called for the expansion of Medicaid, and as of 2024, 40 states plus the District of Columbia have expanded Medicaid coverage to adults with incomes up to 138% of the poverty level. This means that some students with limited incomes may be eligible for Medicaid, depending on their state.

If a student is a dependent on their parents' tax return, their parents' income is included when determining eligibility for premium subsidies or Medicaid. However, students who file their own taxes may qualify for significant subsidies if they have a limited income.

It's important to note that the premium subsidies provided by the ACA cannot be used to offset the cost of student health insurance offered by a college or university. The cost of student health plans has increased due to the improved benefits and coverage required by the ACA. As a result, students may need to consider their options, including staying on their parents' plan, enrolling in a Marketplace plan, or purchasing a separate individual market plan.

Frequently asked questions