Congratulations on your child’s acceptance to college!! March is an exciting time for high school seniors as many are finding out which colleges they have been accepted to and thinking about where they will be attending in the fall. Parents across the US are wondering about costs, logistics, and how to get our baby birds safely out of the nest.
Health insurance for your college bound kid is a topic that all parents must grapple with. Imagine, if you will, your darling baby, away at college and sick or injured. They go to student health, which is usually paid for by their student fees (so there is no charge to them or you beyond those fees) and the provider is concerned enough to order some blood work or a radiographic study. The results come back, your child is cared for, and the symptoms resolve. Phew! You think no more about it UNTIL…
You get a bill for hundreds or even thousands of dollars for services that are not covered because your employer’s health insurance plan, which has been all your family has needed til now, may not cover your child in the same way at college. Referrals to hospital services, lab work, radiology or providers may be considered out of network or not emergent and therefore not covered.
With the adoption of the Affordable Care Act (Obamacare) in 2010, your young adult child is allowed to continue to be covered under your health insurance until age 26. This is an important and excellent thing for most families, BUT there can be significant unpleasant surprises for many families if their child goes to school out of state.
Making sure that both you AND YOUR COLLEGE BOUND CHILD understand what your health insurance plan does and does not cover is very important BEFORE they access healthcare while away at college so they do not break the bank any further with medical bills that are higher than the already astronomical costs of college.
When you pay your fall tuition bill, all colleges require you to prove that your child has health insurance.
If not, you can buy insurance for them through the school as part of tuition payments (administered through a third party). This is a costly add-on to an already hefty bill.
Many parents think that if their child is already covered under their employer-sponsored health insurance plan, it makes sense to decline that special student health insurance. Right? Not so fast. Health insurance for your college bound kid is not that simple.
The answer to that question really lies in both you and your child having a firm understanding of exactly what your employer-offered health insurance will and will not cover for your child when they are out of state or out of network while at college. Health insurance for your college bound kid can be quite confusing.
Below are two common points of confusion that you may have about health insurance for your college bound kid:
1. Emergency-only coverage out of network/state
This is a common iteration of a problematic policy for out-of-state college students. Their health insurance coverage while at home and in-network is fine, but as soon as they are out of network, the policy ONLY COVERS CARE DURING AN EMERGENCY.
That means that all testing done on your child will only be covered if it is ordered out of an emergency department (regardless of whether the problem is actually an emergency or not).
For example, your child twists their ankle and goes to a provider at student health, who sends them to an outpatient radiology site for an x-ray of the ankle. The x-ray ends up being negative and your student is diagnosed with a sprained ankle. That x-ray will not be covered because it was ordered from an outpatient facility and therefore was not an emergency.
If the student had gone to the emergency department, waited for hours upon hours to be seen for their non-emergent problem (the twisted ankle), and gotten an x-ray, it would have been covered.
Going to the emergency department for this problem is poor utilization of resources in an already overburdened emergency department system, BUT, if your student needs an x-ray, and your coverage only pays for emergency services, it forces your hand to utilize the emergency department inappropriately to get insurance to pay for care.
If you have an out-of-network emergency-only policy, it might be worth paying for additional student health insurance.
If you choose not to do that, YOUR CHILD NEEDS TO KNOW that whatever gets ordered through outpatient care WILL NOT BE COVERED by health insurance. This may influence where they access care if any testing at all is needed, including simple bloodwork.
2. Reduced coverage out of network
Perhaps you have a policy that is not an emergency-only policy but covers health care expenses well in-network and significantly less well out-of-network. You may also have a large out-of-pocket deductible to meet before coverage for some limited percent of the bill kicks in.
This may be true even in emergency settings where out-of-network providers or emergency departments are not covered until a certain deductible is met.
In situations like the ankle twist above, the emergency department is THE WRONG place to go if you have reduced coverage while out of network since emergency care is far costlier than outpatient care. This is another situation where it may make sense to buy student health insurance coverage through your college.
Regardless of what you decide to do for health insurance for your college bound kid, the important thing is that both you AND YOUR CHILD understand what is and is not covered under your policy while they are away at college.
Expensive tests such as CT scans and MRIs require prior authorizations, so unexpected bills are less likely, but blood work, simple radiography, ultrasound, STD testing, and other medical services do not usually require prior authorization and may easily create some unpleasant financial surprises for many students and their families.
The medical provider your child sees makes medical decisions and requests testing based on their medical judgment. They do not take insurance company coverage into account when making medical decisions about what tests to order. Your child must understand what their health insurance covers and how to best use it. Families need to decide what health insurance plan works for them in their particular coverage circumstances.
Health insurance for your college bound kid is somewhat complex but it is much better to put in the time now to understand how it works than to be hit with a giant bill on top of the other giant bills you may receive.
*Want to review what every college bound kid needs to have in their college medical kit? We’ve got you covered!
*Wondering how to say goodbye to your new college kid? Look no further!
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