Here’s a fact that might surprise—and scare—you: 19- to 29-year-olds make up a third of uninsured Americans! High medical costs are a fact of life (at least for now), so it’s important to know what your health insurance options are. The Affordable Care Act (ACA), signed into law on March 23, 2010, is changing the healthcare game. Since most of us collegiettes won’t be flipping through the 906-page document anytime soon, we’re giving you the scoop on how it affects you.
How Much?!
Haven’t been sick in years? It’s still important to know your options. Minimum essential health insurance is a must, not only because it will be required of most individuals come 2014, but also because if something should happen (knock on wood), it’ll wreak havoc on your finances. Though our generation will be able to boast new records for longevity, we also have to deal with higher-than-ever healthcare costs. Healthcare includes everything from a simple check-up at the doctor’s office to a visit to the emergency room. It includes blood tests, x-rays, prescriptions… everything you need to make sure you’re healthy and get the care you need when you’re not.
But it doesn’t come cheap. At all. According to the Minnesota Council of Health Plans, something as simple as going into the doctor’s office with a cold (and being told to go home and drink fluids) could run you upwards of $80. What if you went to the emergency room instead? Now you’re looking at around $180! Still, that’s tame compared to the cost of dealing with something more serious, such as an allergic reaction to a bee sting ($1,050 for the ER visit and necessary drugs) or a broken arm ($2,523 for the ER visit, x-ray and cast). Keep in mind that these price tags can vary by state. New Choice Health found that the average cost of an x-ray ranges from $270 in Miami, FL, to $490 in Washington, D.C.!
You might be thinking, “This can’t be right! I’ve never paid that much for going to my doctor or the ER!” Well, that’s probably because you have health insurance. These companies are footing the bill in exchange for your monthly payments, and sometimes a small out-of-pocket “co-pay” at the doctor’s office or ER.
Are You Insured?
If you’re under the age of 26 and your job doesn’t provide you with health insurance coverage, you are eligible to be insured under your parents’ health insurance. It doesn’t matter if you’re financially independent, not living under your parents’ roof, at school, or even married—you can still be legally covered by your parents’ plan! You still need to be looking ahead, however. As Congressional staffer Hilary Fulp puts it, “I would tell students just because you may be able to stay on your parents’ plan doesn’t mean you don’t have a responsibility to be aware of what’s going on. Be proactive in your health care choices and pay attention. You will be making these choices soon enough.”
If your parents don’t have health insurance or if you’re over 26, starting in 2014 you will be able to buy your own health insurance with the use of a direct, state-based system known as the “Affordable Insurance Exchange.” All of the companies vying for your business will have to adhere to certain standards regarding what they offer and what they charge. Ideally, these Exchanges will allow you to select the best—as well as the most economical—plan for yourself. (D.C. and 14 states have already started to form their Exchanges!)[pagebreak]
For now, if you’re not under your parents’ health insurance and you don’t have a job-based health plan, you can buy it yourself from an insurance company. Websites like eHealthInsurance.com make it incredibly simple to shop for the best coverage. According to U.S. News, the top three health insurance providers nationwide are currently Unitedhealth Group, Wellpoint Inc. Group, and Kaiser Foundation Group. You can see what the top three companies are in your home state as well with their handy map.
Elizabeth Polster, an undergraduate at the College of William & Mary, describes her experience shopping for insurance as relatively simple: “I went online and got a quote based on my information (my health records). I also went to some different insurance companies and compared it to their rates. I picked one that seemed low and worked for me. They have different ones based on how much coverage you want, so I just picked one that fit my lifestyle (and how sick I’d been in the past).”
There are so many factors that determine how much health insurance will cost you. You need to look at both the premium, the face-value amount you pay (usually per month), as well as what costs you’ll have to pay out-of-pocket if and when you actually get sick and use medical services. In 2011, eHealth found that, nationwide, individuals are paying an average of $183 a month for their health insurance.
Though the Affordable Care Act now allows collegiettes to postpone worrying about health insurance, once you enter the workforce it becomes a major priority. Recent graduate Andrew Frantz says, “Now that I’m on the job market looking for something full-time . . . [healthcare] definitely has become something I think about. It’s just one of those things that becomes real after they hand you the diploma.” In other words, if you’re on the job hunt, knowing whether or not the company will offer you health insurance is a major pro or con to factor into your decision.
Know The Tricks of the Trade
There are still a few new elements of the Affordable Care Act that you should keep in mind. For example, insurance companies are no longer allowed to deny coverage to anyone under 19 because of current or pre-existing health conditions. In fact, if you have a pre-existing health condition (such as heart disease, cancer, asthma, or even being a smoker), there are new systems in place to make sure you are not discriminated against when selecting health insurance plans. One of these is the “Pre-Existing Condition Insurance Plan,” which you can be eligible for if you’ve been uninsured for at least six months. Once 2014 hits, job-based and individual policies will not be able to refuse coverage to or charge higher premiums to any individuals with pre-existing conditions!
Additionally, it will no longer be legal for health insurance providers to discriminate based on gender. Before, a woman could be paying 50% more on her premium than a man of the same age! Health insurance companies could even go so far as to deny individual policies to women. This was based on the idea that some pre-existing conditions—such as past pregnancies or even simply the potential to become pregnant—made women riskier, and thus more expensive, to insure. But fear not, ladies—these inequalities will be illegal come 2014.
Another consideration is that adults under age 65 making less than $15,000 a year (for a single person) may be able to obtain health coverage through Medicaid in any state. Medicaid is a state-operated program providing health insurance for lower-income people, as well as the elderly and people with disabilities. If you’re working but your income is less than $43,000 (for a single person), you may be eligible for tax credits to help cover insurance costs.
Health insurance companies are no longer allowed to set lifetime limits on essential healthcare services. A lifetime limit is simply a ceiling put on the amount of money that your insurance company can spend on you in your lifetime. There are also annual dollar limits which are gradually being phased out: by September 23, 2012, no individual health insurance plans can set an annual limit below $2 million, and by 2014, no annual dollar limits will be allowed. All good news!
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Know What You’re Paying For
You can choose any primary care doctor you want, as long as they’re part of your insurance company’s list of “participating” or affiliated companies. You can also choose your own OB-GYN without requiring a referral—basically a permission slip—from your primary care doctor. You don’t have to worry about referrals when choosing emergency care either, and this even goes for emergency care outside of your provider network—the “pre-approved” doctors and medical facilities which your insurance company affiliates with. Just keep in mind that the pre-approved ones are often the cheaper options.
Secondly, the ACA requires new healthcare plans to cover so-called “preventive services”—this means things like blood pressure screenings, alcohol misuse and depression screenings, diet counseling, and immunization vaccines—without any additional out-of-pocket costs. For sexually active women, this also includes HPV, HIV, and cervical cancer testing, as well as STI counseling and, with a few exceptions, birth control and other forms of contraceptives. Considering how relevant these tests and services are for college girls, it’s a huge relief to know a healthcare plan includes these costs. However, testing for other STIs is not included, so you may have to pay out of pocket for those.
Keep In Mind…
As you may have heard, the Affordable Care Act is set up to unfurl slowly, with many of the more dramatic changes not occurring until January 1, 2014. Even then, this law will still have strings attached! One of the big ones is that “grandfathered” plans, or plans that were purchased prior to the issuing of the ACA, don’t have to abide by the new laws against annual limits—kind of a bummer for those of us in that boat.
Another type of exemption is given to “small companies”—those with 50 or fewer employees. These businesses will not be required to provide their employees with insurance, and may opt for a relatively small penalty fee instead. As Legislative Assistant Hilary Fulp says, “If you compare a several hundred dollar penalty to the thousands of dollars it costs to insure an employee for a year, in a struggling economy, businesses may just do the math. Students should be aware of this when looking for employment.”
The central component of the ACA that reduces insurance costs is the individual mandate, which—you’ve probably noticed if you’ve been keeping up with the news—has undergone intense scrutiny within the Supreme Court recently. The Supreme Court upheld it as a tax, and that’s what it is: it requires uninsured individuals to pay a penalty, which grows steadily over the years (it starts at $95 in 2014, and by 2016 is $750). So even if you have Superman’s immune system, if you’re uninsured your cost-free joyride is only going to last another couple years. You’ll be paying up no matter what, so you might as well get the reassurance of being insured. As University of Michigan undergraduate Chris points out, “Health insurance is a necessary evil. In a perfect world, humans wouldn’t get sick and we wouldn’t have a need for medical care. Unfortunately, we all will need medical care at some point in our lives, and the easiest way for the most people to afford that care is through insurance. It’d be a nice thing to live without, but it’s not possible to have a 21st-century standard of living without it.”
If you want more information about the Affordable Care Act or healthcare in general, www.healthcare.gov is the site to check out! Have you gone through the process of getting healthcare? Let us know how it went and what tips you have for other collegiettes below!