What Does the Affordable Care Act Mean for Students?

Under the provisions of the Affordable Care Act, you have three options as a student:

  • You can be covered by your parents’ insurance (up to the age of 26)
  • If you parents are not covering you, your Marquette student health plan qualifies as sufficient health insurance, and you are not required to obtain additional coverage or pay a fine for not having coverage
  • You can choose to obtain more or different coverage through a private insurance provider, and with student status, you might have lower premiums and other costs

If you use the first or second option, those coverage plans won’t last forever. Your parents can’t keep you on their insurance past the age of 26, and your student health plan isn’t available to you after you graduate. The Affordable Care Act mandates that you have health insurance, whether it be through a private insurer, just a catastrophic insurance plan, or Medicaid. It’s important to learn about your options now, while you’re still covered, so when your current coverage ends, you can make an informed decision about what kind of insurance is best for you. While making that decision, these are some of the terms you might come across that you ought to know:

Premium: To have health insurance, each month you must pay a premium. A premium is the amount you pay on a monthly basis in order to have coverage for medication, hospital visits, and other approved expenses. Your premium must be paid every month, whether or not you are using any healthcare services.

Deductible: The deductible is the amount of money you need to pay before your insurance carrier will start to pay. For example, if you have a deductible of $500 and need a procedure that costs $800, you will have to pay the deductible of $500 before insurance will pay the remaining $300.

Co-pay: A co-pay is when you have a certain regular fee you are expected to pay for a medical service, with insurance covering the rest. For example, for a doctor you see regularly, you might have a co-payment of $20. You will need to pay that $20 every visit, and insurance will cover the rest.

Formulary: If a healthcare plan includes coverage of medication costs, the formulary is the list of prescription medications (both name brand and generic) that the insurance plan will pay for. Medications that are not part of the formulary will not be covered, so you’ll have to pay sticker price for them.

Cafeteria plan: In a cafeteria plan, the insured party can pick and choose a number of approved services that they would like to have covered by their insurance. Approved services include: chiropractors, ambulance services, orthodontia, regular doctor’s visits, laser eye surgery, acupuncture, and many more.

However, any service that is offered but not chosen as part of a cafeteria plan won’t be covered. So if you choose to have dentures covered but don’t choose orthopedic shoes, you might have to foot the bill for the shoes without help from insurance.

Health Management Organization (HMO): HMOs mean that you have one primary care physician who you see before you see a specialist (unless it’s an emergency). You need a referral from your primary care doctor to see a specialist in your network, and you will only be referred to a specialist if your primary care doctor is unable to help you with the problem.

Preferred Provider Organization (PPO): In a PPO, you can see any care provider in your network, with or without a referral. If you choose to see a physician outside of your network, those services might not be covered fully (or at all) by your insurance provider.

Originally published at mumoneymatters.tumblr.com.

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