Affordable Care Act (ACA)
What do I really need to know?

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

Aetna Student Health:
Insurance Exchanges vs. Student Health Plans

ACA 101
Required learning about
new requirements

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.

How to play by the new rules

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.

It won’t pay to procrastinate

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...

For 2014

$95 per adult
$47.50 per child

(up to a maximum of $285 for a family) or 1.0 percent of family income, whichever is greater.**

For 2015

$325 per adult
$162.50 per child

(up to a maximum of $975 for a family) or 2.0 percent of family income, whichever is greater.**

For 2016 and beyond

$695 per adult
$347.50 per child

(up to a maximum of $2,085 for a family) or 2.5 percent of family income, whichever is greater.**

How affordable are the new “Affordable Care Act” options?

  • As of this year, you can shop for an insurance plan in an online shopping center known as a marketplace or public exchange.
  • 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.
  • Student health plans typically have very low member cost-sharing, which delivers greater overall value to students.
  • Student insurance pricing factors in the needs of students, exclusively. But exchange plans must base prices on the general population — including what it costs to cover a much greater range of ages.

How does my student health plan compare to my individual coverage options?

Because they are geared to the unique needs of students rather than the general population, student plans provide many advantages for you:

Less pressure on your student budget:

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.

Coverage wherever you go:

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.

On-campus care:

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.

Avoid tax surprises:

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.

Better plan value:

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.

Additional support:

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.

Student health plans:

  • Satisfy the ACA’s individual coverage requirement
  • Provide equivalent essential health benefits***
  • Offer low deductibles
  • Give you a broader provider network, with over 1 million providers nationwide****
  • Cover visits to your student health center and generally require lower copays for these visits
  • Lower the premium you need to pay for plans with comparable benefits

Your student health plan keeps
you covered all year

Once enrolled in your school’s student health insurance plan, you are covered for the full academic year and throughout summer break, as long as you’re a student. Check with your school for specific enrollment dates and details.

*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.


ACA vocab
Talk the talk

It may seem like you’re studying yet another foreign language at first, but it’s important to get familiar with a few basic terms. This will help you assess which health plan is the right choice for you. Consider it the lightest reading you’ll have to do all semester.

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 vs.
nonpreferred care:

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 vs.
recognized charge:

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.

To learn more, visit our glossary.


My school’s philosophy
Minor cost, major benefits

Five reasons your student health plan may be the best formula for you:

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.

Extra credit
Review the finer points

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.