Student Health Plan vs. Obamacare?

[Vulpix]

It seems like for full time graduate students, most schools require a student health insurance.  I noticed that for two of my possible schools, the fee is between $3,400-3,700 for a year of coverage, which seems like substantially more than Obamacare would cost each month.  Does anyone know if it's generally an option to enroll in state health insurance vs. student health insurance?  I saw that for Harvard, for example, it says:

 

Your coverage cannot be:

• Through the Health Safety Net, MassHealth Limited, or the Children's Medical Security Program

 

Does this mean you cannot get Obamacare as a student, and must pay the student insurance plan?

Edited March 6, 2016 by Heather1011

[TakeruK]

I can't speak for every case because I think a lot of this is case-by-case. But when my spouse signed up for Obamacare (ACA), they asked about me as well. The Marketplace clearly told me that because I have a student plan, I am not eligible for Obamacare/ACA. However, this was because my student plan is already subsidized (the full cost is $2700 per year but I only pay $450). Maybe if your student plan is more expensive than ACA, they will still let you use ACA.

However, I find that the student plan is often way better than the Obamacare plan. The copays are usually a lot lower and prescription drug coverage is often better. So, even though the premium might be higher, your total cost out of pocket might be lower overall. So, I would try to compare the two plans based on how often you use your health coverage! Some example numbers from my experience with my student plan (of course, your plan may vary) and the state ACA plans:

Prescriptions cost me about a few dollars per fill---we pay 20% of the negotiated cost of the drug. ACA plans usually have set prices for tiers: Tier 1 is $12, Tier 2 is $35, Tier 3 is $50. There has been prescriptions where I paid $5 but ACA plan holders pay $50.

My student plan deductible is $150 and out of pocket maximum is $1500. The Silver ACA plan deductible is $2000 and out of pocket max is $4000. 

My student plan is $2700 per year (if I were to pay full cost) and the Silver ACA plan is $3000 per year ($250/month in California). 

Copay for a doctor's visit is $15 on my plan; $45 on ACA.

Finally, my student plan is often customized to what students want/need. Our school works with students to figure out what the plan should cover. For example, mental health coverage is great at my school's plan. Each year, we get the first 25 visits to a mental health professional absolutely free (no copay even) and then every visit after that is $15 per visit. Other plans will have you pay the copay of something like $50 visit for all the visits.

[Vulpix]

1 hour ago, TakeruK said:

I can't speak for every case because I think a lot of this is case-by-case. But when my spouse signed up for Obamacare (ACA), they asked about me as well. The Marketplace clearly told me that because I have a student plan, I am not eligible for Obamacare/ACA. However, this was because my student plan is already subsidized (the full cost is $2700 per year but I only pay $450). Maybe if your student plan is more expensive than ACA, they will still let you use ACA.

However, I find that the student plan is often way better than the Obamacare plan. The copays are usually a lot lower and prescription drug coverage is often better. So, even though the premium might be higher, your total cost out of pocket might be lower overall. So, I would try to compare the two plans based on how often you use your health coverage! Some example numbers from my experience with my student plan (of course, your plan may vary) and the state ACA plans:

Prescriptions cost me about a few dollars per fill---we pay 20% of the negotiated cost of the drug. ACA plans usually have set prices for tiers: Tier 1 is $12, Tier 2 is $35, Tier 3 is $50. There has been prescriptions where I paid $5 but ACA plan holders pay $50.

My student plan deductible is $150 and out of pocket maximum is $1500. The Silver ACA plan deductible is $2000 and out of pocket max is $4000. 

My student plan is $2700 per year (if I were to pay full cost) and the Silver ACA plan is $3000 per year ($250/month in California). 

Copay for a doctor's visit is $15 on my plan; $45 on ACA.

Finally, my student plan is often customized to what students want/need. Our school works with students to figure out what the plan should cover. For example, mental health coverage is great at my school's plan. Each year, we get the first 25 visits to a mental health professional absolutely free (no copay even) and then every visit after that is $15 per visit. Other plans will have you pay the copay of something like $50 visit for all the visits.

Thank you so much for all this information!!  It's very valuable.  

Also, do student health plans ever include dental?  I feel like students just avoid dental visits entirely....

I will also be moving to a new state, so am not sure if I would be eligible to enroll in another state's ACA plan until I have actually moved, and at that point it would likely be past the date by which I need to get the student health insurance  .  But your information makes it seem like perhaps that is overall the cheaper option.  I generally have limited use of my health plan (and as a teacher right now, I have an amazing plan that costs me $0 each month and very low copays).  As for prescriptions, I have gotten used to $0 for birth control, which I know the ACA also covers completely in many cases, but I'm not sure if that is also on a plan-by-plan basis.

Edited March 6, 2016 by Heather1011

[Cheshire_Cat]

My student health plan cost almost the same as a comparable plan at my old job, which was a LOT cheaper than any of my friends were getting on the exchange. 

[rising_star]

Few student health plans include dental. If there's a dental school in your area, you can often get low-cost cleanings and exams, which helps a lot with the cost of dental. That said, I paid out of pocket for cleanings and x-rays in grad school and it was typically about $120/visit.

[MarineBluePsy]

In regards to dental insurance, be on the look out for coupons in the local papers because often you'll find pretty steep discounts for first time patients.  Just double check their reviews online and such and it should be fine.  I did this regularly when I went without dental insurance and even though it meant always going to a new dentist the money I saved was worth it.

As for free birth control it looks like the ACA requires that whether your insurance plan is through your employer/school, private purchase, or discounted through the marketplace.  I found some info about that here.

[Vulpix]

Thanks once again everyone for the info!

[ashiepoo72]

Whether the plan has dental depends on the university. The UCs have medical, dental and vision coverage for graduate students. If you can get your exams done at the university health center, student insurance usually covers even more and copays are low.

[Vulpix]

I saw that one of my schools allows you to add dental for an additional $294 a year.  Considering I'd likely only go for one cleaning or so, it's probably not worth it (either skip the cleaning or find a place that's cheaper out of pocket).

[TakeruK]

19 hours ago, Heather1011 said:

Thank you so much for all this information!!  It's very valuable.  

Also, do student health plans ever include dental?  I feel like students just avoid dental visits entirely....

I will also be moving to a new state, so am not sure if I would be eligible to enroll in another state's ACA plan until I have actually moved, and at that point it would likely be past the date by which I need to get the student health insurance  .  But your information makes it seem like perhaps that is overall the cheaper option.  I generally have limited use of my health plan (and as a teacher right now, I have an amazing plan that costs me $0 each month and very low copays).  As for prescriptions, I have gotten used to $0 for birth control, which I know the ACA also covers completely in many cases, but I'm not sure if that is also on a plan-by-plan basis.

My school has a dental plan that is optional (the health plan isn't "optional"---you must either take the school plan or provide proof that you are covered by another plan, e.g. your partner's or parent's plan). We can choose to pay $120 or so per year for pretty good dental coverage (I pay about $4 for cleanings, $6 for x-rays and if I need something done on a tooth, it's $50 deductible and the plan covers about 80% of the cost). So, I am definitely on this plan and I love it.

All plans, whether it's ACA or private or school plans, are required to follow ACA guidelines because it's national law. So, birth control must be $0 on every plan in the United States, as far as I know. As part of our student government, we actually recently had to fight our healthcare provider to cover the Nuvaring (at $0). They argued that Nuvaring is a brand name version of the oral contraceptive because they are both "hormonal methods" (despite that any sane person will tell you that they are applied very differently!) and thus they would meet ACA guidelines by covering oral contraceptives and not Nuvaring. We pushed back on this and eventually we won and they agreed to cover the Nuvaring (it's not clear if ACA by itself would have compelled them to do this, we had also used previous agreements/contracts to demonstrate they are required to cover this).

ACA open enrollment is only November through February, but you can always enroll when you have a "life changing event" like starting a new school/job! Here's one suggestion/idea: if your school allows you to drop out of their student plan partway through the year, then consider starting with the school plan and then switching to ACA if you find the ACA plan is better. Sometimes, they make you stay for a whole year though and unfortunately, the ACA enrollment season of Nov-Feb compared to the school year starting Aug-Sep might mean that you won't be able to switch without a gap in coverage. (Plus, you have to be sure you are actually eligible for ACA if you have a student plan option).