4CollegeHealth tries to highlight the best thinking and insights on the subjects of student health. Sometimes articles appear to be so comprehensive that we choose not just to link to the articles but also to share a good portion of the article. With our thanks to the WSJ - (note we make no money from ads) but do want to recognize the authors of such an exceptional article.
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"On Thursday, the first big pieces of the new health-care
overhaul took effect. Among other things, the rules mandate that
insurance companies offer coverage to adult children until the age of 26
and devote at least 80% of their revenue to health-care costs.
But one major player was notably absent from these new rule changes:
colleges. They have managed to sidestep, at least for now, the
regulatory clampdown that has sent hospitals, insurers and corporations
scrambling.
How'd they pull it off? Since student plans for the 2010-11 school
year were negotiated before Sept. 23, they aren't subject to the
regulations this year."The White House denies that Ms. DeParle ever said that," says White
House spokesman Nick Papas. "The administration is still working on this
issue and is eager to hear from all parties."
The health-care overhaul has major implications for young adults and
their parents. For the first time, parents will have the choice of
keeping their graduate-student children on their corporate insurance
plans or opting for cheaper college plans.
They should think carefully.
There is broad consensus that, as a group, college health-insurance
plans rank among the worst in the nation for consumers. Many college
plans come with remarkably low benefit ceilings—in some cases as little
as $2,500. Others limit areas of coverage, such as preventative services
and chemotherapy.
The upshot: Students are often much less insured than they think they
are. In extreme cases high-school seniors with health issues might be
advised to consider a college's health plan before attending.
"These plans have not been thoroughly scrutinized," says Bryan A.
Liang, executive director of the Institute of Health Law Studies at
California Western School of Law in San Diego. "In some instances they
offer very paltry care."
The college health-care system is a hodgepodge of school plans and
private insurance. According to the Government Accountability Office,
more than half of the nation's colleges offer school-sponsored plans.
All told, about 80% of college students, nearly 7 million people, are
covered by private or public health insurance.
Most schools aim to provide the best care for the lowest cost.
Students tend to be healthier than the general population, so school
plans don't need the safety nets found in adult plans.
Yet these low-cost plans are a big business for insurance companies.
All of the major players are active in the college market, with Aetna
Inc. and United Healthcare leading the pack. According to a November
2009 study from the Massachusetts Division of Health Care Finance and
Policy, profit margins for student health programs in the state were
10%, compared with 2% for other insurance plans.
When colleges fall short, say health-care experts, it is often
because their administrators lack the savvy to negotiate with insurers
and arrange the best terms for their students.
"Not every podunk university is going to have a health plan official
who will look into these plans," says Elizabeth Ritzman, director of
Dominican University's student health center in River Forest, Ill.
The health-care overhaul deals with individual and group insurance
plans. In an Aug. 12 letter to the White House, the ACHA and other
groups argued that school plans shouldn't be considered group or
individual plans but rather "short-term limited-duration" insurance
policies. Such a designation would likely exempt them from many of the
new regulations, experts say.
The letter also warned that certain reforms "could make it impossible
for colleges and universities to continue to offer student health
plans."
The ACHA "is supporting regulatory clarification that would allow
student plans to preserve the grouplike status that is vital to
providing lower cost coverage to students," says Jake Baggott, ACHA's
advocacy coalition chair. Dr. Turner, ACHA's president until June, says
the spirit of his conversation with the White House was that "they would
be happy to include in the regulations the necessary language to assure
preservation of the plans."
Insurers seem to be confident they will get their way. According to
three people familiar with the matter, Aetna has told colleges that they
have nothing to worry about because their plans will be exempted.
Aetna says it never conveyed that message to its members. "We expect
that all student plans that wish to be credible will comply with minimum
coverage requirements as soon as possible," says Ethan Slavin, a
spokesman for the insurer.
Good insurance plans are marked by a few elements, among them benefit
ceilings of at least $250,000, generous prescription drug plans and
emergency room coverage. According to the GAO, more than half of all
school plans have ceilings of less than $30,000.
Some schools boast excellent health plans, says Dr. Liang. Take
Boston University's program, offered through Aetna. Students pay $1,676
for coverage that includes a $500,000 benefit ceiling and pays 80% of
any ambulance expenses.
Another indicator of a good plan is its "medical loss ratio," or the
percentage of the premium that the insurance provider pays out in
claims. The health-care overhaul limits loss ratios to 80%; a lower
ratio means students aren't getting as much for the cost. Brigham Young
University, which offers insurance through Deseret Mutual Benefit
Administrators, had a loss ratio of 93% last year, meaning that for
every $100 in premiums, students received $93 of care.
Other plans, however, are less generous.
Paula Villescaz, a senior at the University of California at
Berkeley, says she never looked closely at the Anthem Blue Cross
insurance policy she got through her college. The plan has a $400,000
ceiling, but also has some important limitations, as Ms. Villescaz found
out recently.
The political-science major had always been healthy—until March, when
doctors discovered she had Ewing's Sarcoma, a rare form of cancer.
Berkeley's plan didn't cover her first MRI, her PET scan or many blood
tests her doctors required, she says.
In between chemotherapy treatments, Ms. Villescaz says she had to
battle the insurance company, which refused to cover her last round of
chemotherapy, declaring it medically unnecessary. Her chemotherapy has
since concluded, but she is now undergoing radiation treatment.
Ms. Villescaz says she owes about $80,000 all told. Before she got
sick, she worked two jobs to support herself and help out her single
mother. "I'm going to be paying off these bills for the rest of my
life," she says.
Both Berkeley and Anthem declined to comment.
Students who don't study the details of a plan before signing up can
end up with nasty surprises, as Nia Heard-Garris, a 24-year-old medical
student at Howard University Medical School, learned firsthand.
Ms. Heard-Garris in 2007 signed up for Howard's standard health plan,
administered by Summit America Corp. The plan, which now costs $476 a
year and is mandatory for all students, came with a $5,000 limit per
injury and sickness, and didn't cover radiation and chemotherapy—though
the plan now offers more coverage. (Howard also offers an enhanced plan
that costs $699 a year and has a limit of $200,000 per injury or
sickness.)
Last year, Ms. Heard-Garris went to the emergency room complaining of
neck pain. She got a CT scan—then found out that her insurance wouldn't
cover the $1,600 bill. "I have absolutely no idea how I can pay this,"
she says. "I think it's kind of ironic that here I am learning how to
help people, and I can't even get care covered." She says she is
negotiating with Summit to cover her bill.
Howard doesn't comment on specific cases. A spokeswoman says students
receive a booklet detailing medical-care protocols, and "the student
health center staff will take the appropriate steps to provide
[students] with appropriate care." A Summit spokeswoman says, "We're
always willing to work with any student to provide clarity."
Some school plans limit their coverage of certain categories, such as
mental health. Franklin College in Indiana offers a plan through Markel
Insurance Corp. that covers $50 for every mental-health counseling
visit—up to $250 per year.
"There's admittedly very little coverage for mental health," says
Terri Nigh, coordinator of student health services at Franklin. While
negotiating benefits and evaluating the plan each year, school
administrators try to meet the needs of the majority of students, she
says. "It's a difficult process."
That's been a problem for Katie Todd, a sophomore at Franklin. A
pre-med major, Ms. Todd says she has battled depression since she was
12. She says most private insurers considered her depression a
pre-existing condition, and that the best quote she has gotten would
cost a steep $310 a month.
With no alternative, she signed up for the Franklin plan, but is
frustrated by its limitations. "It's really vital for me to get this
coverage, and the plan just mostly ignores it," she says.
"The plan's design is based on the specifications of the college, not
the insurer," says Mark Nichols, a managing director at Markel.
Parents and students can get the most for their money by carefully
examining school plans before signing up. Health-care planning should
come long before enrollment, says James A. Boyle, president of the
College Parents of America, a Virginia-based nonprofit.
Anyone considering a school plan should ask a number of questions, say experts:
• What is the maximum benefit for the policy?
• Are prescriptions and mental health services included?
• What happens to coverage if you leave school, go abroad or graduate?
• What is the loss ratio?
• Do any on-campus services, such as checkups or flu shots, overlap with existing coverage?
Parents who are considering keeping their child on their personal
insurance should ask their benefits representative or insurer about how
coverage will be carried over on campus and off—especially at schools
far from home. (This also applies to graduate students and to adult
children under age 26.) They should also be ready to sign a waiver with
the school so they're not charged for automatic enrollment in a campus
policy.
If, after getting all these answers, both the employer and school
insurance options seem unappealing, parents should consider using a site
like eHealthInsurance.com, which allows for comparison browsing among
10,000 plans from 180 carriers. The prices and coverage can vary widely
depending on the state, but the site offers free access to licensed
agents who don't work on a commission basis and can answer specific
questions about plans, says Carrie McLean, a consumer specialist at the
company.
The key is to do the legwork now to avoid surprises later. Otherwise,
says Aaron Smith, a founder of Young Invincibles, a nonprofit student
group that seeks better care for college students, you could wind up "in
a dangerous place, with insurance plans that don't cover any real
health-care costs."
