The ACA, or health care reform, has led to big changes in health benefits. More changes are coming in 2015 that will affect you and your college. The new rules may require you to make some new choices.See how our plans put your healthy in action
It’s essential to learn as much as possible about all of your health care options. As a student, you know just how important it is to make educated decisions. However, with all of the activity surrounding health care, we want you to focus on what really matters: your health and your studies. We’ll help you sort through the terminology and wade through the complexity, so that you can get a clear picture of what you’re looking for and what each option really means.
Starting in 2014, the ACA’s individual mandate* requires most people to have health insurance. If your college doesn’t provide insurance, you can buy it on your own through a broker, a public exchange or marketplace, or directly from an insurance company.
What happens if I don’t get coverage in time? If you miss the deadline, you may have to pay extra taxes. Here is general info about penalties...
(up to a maximum of $285 for a family) or 1.0 percent of family income, whichever is greater.**
(up to a maximum of $975 for a family) or 2.0 percent of family income, whichever is greater.**
(up to a maximum of $2,085 for a family) or 2.5 percent of family income, whichever is greater.**
Because they are geared to the unique needs of students rather than the general population, student plans provide many advantages for you:
Student health plans typically have very low member cost-sharing, which delivers greater overall value to students. By contrast, plans available on the exchange often have higher deductibles — even after a subsidy is applied. They may cover fewer services at a cost that is likely higher than that of a student health plan.
Many exchange plans have narrow provider networks. The providers you’re used to seeing may not be covered. And if you travel outside the region where your coverage is active, you may find that your spring break or study abroad doctor visit will not be covered at all.
Very few student health centers will be participating with plans on the exchange. With an exchange plan, you may have to leave campus for medical treatment. Even if your campus accepts your exchange plan, you may have to meet a high deductible before your student health visit is covered.
While you’re a student, your income may qualify you for a subsidy on the exchange. But once you graduate and are working, you should be prepared to claim more income on your 2014 tax return. When you do, you may have to pay back a portion of the subsidy.
If you purchase individual coverage on the public exchange, you’ll need to cover the entire cost of a plan on your own, without any contribution from your school. But your school has the advantage of covering a large number of students, so it can offer more efficiencies and better plan value for your health care dollar.
An individual plan purchased on the exchange won’t have the on campus support that your school’s Student Insurance Office can offer you. If you buy on a exchange, you will have to work with the exchange and insurer on your own with questions and concerns.
*Most U.S. citizens are subject to the individual mandate, as are most permanent residents. The mandate also applies to all foreign nationals who are in the United States long enough during a calendar year to qualify as resident aliens for tax purposes. U.S. citizens living abroad may be subject to the individual mandate, too. However, U.S. citizens who live abroad for a calendar year (or at least 330 days within a 12-month period) are treated as having minimum essential coverage for the year (or period). Please consult with your school’s benefits adviser to understand how this provision affects you or your family.
**“What if someone doesn't have health coverage in 2014?” Available at: https://www.healthcare.gov/what-if-someone-doesnt-have-health-coverage-in-2014/. Accessed November 2013.
*** The Affordable Care Act ensures health plans offered both in the individual and small-group markets offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
****Aetna Facts. December 31, 2012. Available at: www.aetna.com/about-aetna-insurance/aetna-corporate-profile/facts.html.ml.
Copay: The amount you may be asked to pay at the time of service (at the doctor’s office, when you fill a prescription, etc.). Not all health plans have copays.
Deductible: The amount you need to pay before your plan covers your costs.
Out-of-pocket: The amount your health plan does not pay and you are expected to pay.
Preferred Care: Doctors and facilities that are contracted by your health plan typically provide special discounted rates for plan members. To maximize your savings and reduce your out-of-pocket expenses, select a preferred provider or facility.
Non-Preferred Care: Non-Preferred doctors and facilities are not contracted by your health plan to provide services to you. You’ll pay more for Non-Preferred Care. Depending on your health plan, some Non-Preferred claims may not be covered at all.
Negotiated charge: A discounted amount that preferred care providers have agreed to accept for any service or supply, based on the terms of your coverage
Recognized charge: The full retail amount that your doctor charges, adjusted to reflect the average charge for similar services nationwide. Your health insurance will only recognize the average charge – even if that amount is lower than your doctor’s charges.
Built for the student lifestyle:
Generally, student health plans offer lower deductibles, access to your on-campus student health centers and flexible coverage that travels with you anywhere you go.
Designed for you:
Your university administrators select Aetna Student Health Plans and adjust benefits for life on your campus.
Strong network of doctors and hospitals:
Plans on the exchanges frequently offer limited networks. This means the providers you are used to seeing may not participate in the network. Or you may not have access to any providers when you travel outside the area where some plans are based. This can also restrict your access to your own student health center.
We give you on-the-go info:
We know you’re busy, so we use our website, mobile app and social media to give you answers that are accessible, convenient, and fit into your schedule.
Away from home and school?
Unlike exchange plans that may rely on regional networks, our plans protect you while traveling, visiting home for the summer, studying abroad, going on spring break and every stop in between.
Think understanding health care means doing even more homework? It doesn’t have to. Not when we do the math for you. Our interactive tools and resources are easy to ace. We walk you through, and break down your exact out-of-pocket costs, so you get the big picture.
Do the math: Use this tool to compare your family or individual plan to the student plan.
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