Health Insurance vs. Rankings

[Algernon]

How much importance should one place on the quality of the health insurance programs offered when deciding between schools? Or perhaps a better question: how much importance are YOU placing on health insurance plans as you decide between funding offers? No matter your answer, do you consider yourself someone needing average health care services or above average?

I ask because I have Lupus, which requires daily medication, regular visits to a specialist, and, at minimum, yearly blood work. I have fully-funded PhD offers from two schools, one more highly ranked than the other by about 20 spots, both in the top 40 in my field. I like both programs pretty equally. However, in addition to a slightly better funding package overall, the lower ranked school offers significantly better health insurance (no deductible, 100% coverage of almost all services, prescription coverage etc.). The higher ranked school's health insurance has a $150 deductible, no prescription coverage, only 80% of charges covered after deductible, etc.

Given unique health needs, how would you weigh program prestige versus healthcare coverage, all else being equal? (I know the actual decision will have to consider many other factors, but set them aside briefly, if you will.)
 

Edited March 5, 2014 by Algernon

[bsharpe269]

For me, with my health history, I wouldn't factor in health care majorly. Lupus runs in my family majorly though so I am familiar with it and in your shoes and I would definitely take the school with better funding/insurance.

[ginagirl]

I don't have any serious health issues, but in your shoes I would probably opt for school with the better coverage as well (especially since you said you like them pretty equally). I think if it would cause you serious financial strain and worry, it may negatively affect your academic performance. With good health coverage, you would be able to focus more energy on your academics.

[TakeruK]

I would say I have average healthcare needs. My spouse has higher than average healthcare needs. When we moved to the US, we had a lot of issues with her not being able to get health insurance because of the whole not accepting pre-existing conditions thing. So, while my current school has excellent coverage, it is extremely expensive for dependents ($7000+ per year). We had no choice but to go that route until "Obamacare" happened. 

 

We did factor health care into our decision a little bit -- it's more convenient if you can get on the school's health care but ultimately, this is "just" a money issue. Not to trivialize the stress of finding healthcare, but even if the coverage is only 80%, that just means that you have to pay more out of pocket, not that your care will only be 80% as good. 

 

So, in your shoes, I would probably consider how much more money you would have to pay, out of pocket, in order to maintain your health at each school, and deduct that from the stipend offer. Is that still enough money to live on? Is there a huge difference in stipend after considering this cost (as well as others, such as cost of living etc.). For me, I would not worry about the difference in money if the lower paying school still pays enough to live the life you want. Maybe your situation is different, but in my case, the range in stipend spending value (i.e. after considering cost of living and health insurance) is almost within a few thousand dollars per year of each other. For me, something like $2000/year for 5 years might mean $10,000 over the course of your degree, but I think choosing a better fit school or a better fit location or whatever makes you happier is worth more than this money in the long run (**as long as you still have enough to pay all the bills). 

[Algernon]

Thank you all for the feedback! Hearing other opinions is very helpful. I really need to sit down and do some math to see where I'm at financially (though I tend to think I won't have the money for extra medical bills-- humanities stipends, even the more generous ones, are not great). I'm visiting both campuses soon, so I'll be sure to talk to students about their ability to afford health care on the available stipend. 

[phdcandidate022014]

Another consideration is timing.  You'll be in school for about four years +/-.  You will be in your career for 50+ (or whatever).  It would seem to be a very short-sighted decision to base your choice on what will amount to a handful of thousand of dollars over a four-year period (think about it: You're in school for about four years, you're in your career for 50+...a difference of 20 spots could have very substantial impact on your long-term career earnings).  I'll qualify this by saying I have no clue what the cost is to manage lupus, but based on your description my wild, uneducated guess would be that it would cost you a couple-few thousand dollars per year.

 

Another thought is to go back to the top school and convey your thoughts on the healthcare to see if there would be room to provide you with some sort of healthcare supplement.  There is no harm in asking for a better offer, especially when you have a very specific reason.     

[TakeruK]

Another thought is to go back to the top school and convey your thoughts on the healthcare to see if there would be room to provide you with some sort of healthcare supplement.  There is no harm in asking for a better offer, especially when you have a very specific reason.     

 

This might work if you have an external fellowship. I had one and although the stipend for everyone in my program is the same no matter your source of funding, because of the financial difficulty of a dependent with a $7000+/year health insurance premium, the school was able to help me out with a special healthcare supplement for one year only. This gave my spouse the time to find a job and now we are able to pay the premium cost (and starting April 1, she will be on a more affordable ACA care plan!). Finding work was difficult for my spouse because of the combination of the extra paperwork and approval to get work permission (we're Canadian), which took many months as well as the tough job market in our area. But it worked out in the end. 

[Algernon]

A PhD in English takes, at bare minimum, 5 years after the BA, and often as many as 8, so the health care plan would affect me a bit longer than you suggest, but you do make a good point-- it's still just a short time compared to the length of a career. 

Given both schools have comparable placement rates at institutions I would be fine working for, I'm actually not convinced (yet) that the ~20 points ranking difference really is *that* significant in terms of job prospects. I need to ask around more about it. I'm not worried about prestige for the sake of prestige, so someone would have to prove WHY the higher ranked school ranks where it does (is it anything more tangible than reputation?) and how their program is a better bet for my future despite the shitty health care. 
 

Whenever I do decide, or am about to decide, I definitely will bring up the health care issue with the higher ranked school. I'm very skeptical that they will be able to offer anything more than what they already have considering their inability to even cover the costs of me flying out to visit, but you're right-- it doesn't hurt to ask. 

Thank you for your input!!
 

[themmases]

I have average to low healthcare needs I think. My main issue is anxiety/depression, and in my previous experience as a student there were other ways to monitor that without using health insurance (e.g. the 6 free sessions from the school/semester or letting trainees practice on you), so that's usually what I did and what I plan to do as a grad student. If I had a different health issue where I would need to use insurance to handle it, I would definitely be like you in weighing it carefully.

 

However, I should point out that even the "worse" coverage you're considering actually sounds pretty good. Most of my working friends would consider a $500 deductible amazing, and 80% coverage after that still pretty good. As a person with a job, I couldn't even buy no-deductible coverage, and my employer's coverage is considered good. Also, you should look into what the deal is with prescriptions. Just because your insurance doesn't pay for something, doesn't mean you won't get discounts on your out of pocket cost for being a plan member.

 

Some other things to think about: how often has your school changed its student health coverage? My work coverage is good, but it's gotten a little worse every year, so not only does it make me mad every fall it makes it hard to budget. I'd go with slightly more expensive coverage that is unlikely to change over great coverage from a place with a history of hopping between providers every year, or that may decide they can no longer afford to offer that level or service at all. You should also find out what the network is and what the penalty is for going out of it.

 

I can't know exactly what your health needs will cost you, but from my perspective these plans are both good enough to base the decision on other factors.

[sweetpearl16]

The other thing you need to consider is how the Affordable Care Act impacts student health insurance policies. Prescription benefits are considered one of the 10 essential benefits health insurance plans must provide. I believe that starting in Fall 2014, most college insurance plans are required to have prescription benefits. 

[juilletmercredi]

Given both schools have comparable placement rates at institutions I would be fine working for, I'm actually not convinced (yet) that the ~20 points ranking difference really is *that* significant in terms of job prospects. I need to ask around more about it. I'm not worried about prestige for the sake of prestige, so someone would have to prove WHY the higher ranked school ranks where it does (is it anything more tangible than reputation?) and how their program is a better bet for my future despite the shitty health care.

 

To be frank, the "why" doesn't matter at all on the back end.  Let field A be a heavily impacted academic field, where approximately 20% of PhD holders actually get tenure-track positions. If professors in field A believe that School X is significantly better than School Y, and they would rather hire people from School X, it doesn't matter whether School Y is objectively better than School X, right?  The students from School X are still getting the jobs regardless.  For that reason, I do mostly agree with Algernon's assessment - spending a few extra thousand dollars in the ~6-8 years you're hopefully in the English PhD program may end up being financially and professionally worth it.  (Of course, it depends on how much "a few extra thousand") is.

 

However, if you've already asked about placement rates and the two universities/programs have similar placement rates in your field (and subfield), then it shouldn't matter and you should go where you feel more comfortable.

[crysby]

It seems the real issue here is the lack of prescription coverage at the higher ranked school. If you have medications that you take regularly, I would check the websites of the drug manufacturer's to see if you qualify for their patient assistance programs. Many non-generic drugs have them, and your medicine would cost significantly less or may even be free.

[Algernon]

Great idea, Crysby-- thanks!

[sweetpearl16]

I am part of the health care working group of my university's graduate employee union. My school does not offer prescription benefits. I have severe asthma and must take two prescriptions. I am lucky that I am under 26, since these two medications together cost about $500 a month without insurance coverage. I have spent most of this year working to get get prescription benefits for graduate students. I was told at a meeting today that as of Fall 2014, all college insurance plans must be compliant with the Affordable Care Act, which means they must include prescriptions.