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I’m enrolled in student health coverage now, but now I think I can get a better deal in the Marketplace. Can I drop student health plan coverage and go to the Marketplace instead?

If you are currently enrolled in a student health plan, you can still qualify for Marketplace policies and subsidies if you apply during Open Enrollment. During Open Enrollment, you can sign up for a Marketplace plan and, if your income is between 100% and 400% of the poverty level you can also apply for premium tax credits. You will have to drop your student health coverage by December 31 in order to remain eligible for premium tax credits for the following year.

Outside of Open Enrollment, you cannot voluntarily drop your student health plan coverage in order to qualify for Marketplace coverage and premium tax credits. However, if you involuntarily lose eligibility for student health plan coverage mid-year – for example, if you drop out of school and so lose eligibility for the student health plan – you will qualify for a “coverage loss” special enrollment opportunity and be able to apply for Marketplace coverage and premium tax credits. The “coverage loss” special enrollment period (SEP) will last 60 days from the date your student health coverage ends.  If you know in advance when coverage will end, you can also apply for the SEP up to 60 days in advance.  If you apply in advance, you can elect to have new coverage begin the following day and avoid a gap in coverage.

If you live in a HealthCare.gov state, you will need to provide proof of coverage loss to qualify for this SEP — for example, a letter or notice from the school stating when coverage will end.

Log into your HealthCare.gov account to apply for the SEP and select a new health plan.  You will then have 30 days to provide documentation to the Marketplace  Once the Marketplace verifies your eligibility, you will be able to complete enrollment in the plan you selected.

It is very important to act quickly to complete this verification process.  If you do not submit the required documentation within 30 days, your plan selection will be cancelled and you will no longer be eligible for the SEP.  If you submit documentation on time but the Marketplace determines it to be insufficient, you can apply for an extension of the 30-day review period to submit additional documentation.  However, you cannot apply for an extension of your SEP.  If your eligibility is not verified by the end of your 60-day SEP, your plan selection will be cancelled and you will not be able to enroll until the next Open Enrollment Period.

If you have questions contact a Navigator or other Marketplace assister program for help.

I’m eligible for the student health plan but haven’t signed up yet. Do I have to take that or can I apply for coverage and subsidies in the Marketplace?

Eligibility for a student health plan does not make you ineligible for Marketplace coverage and subsidies. Even if you are eligible for student health coverage, you can get coverage through the Marketplace. In addition, if your income is between 100% and 400% of the federal poverty level  and you meet other requirements, you can qualify for premium tax credits; if you income is between 100% and 250% of the federal poverty level, you can also qualify for cost sharing reductions.

In addition, eligibility for a student health plan does not make you ineligible for Medicaid. Check with your state Marketplace to find out if you meet the income and other eligibility standards to enroll in Medicaid coverage.

Does my student health plan have to cover contraceptives?

Generally, yes it does, if it is a fully insured plan. A fully insured plan is one that your college or university purchases from a health insurance company. These plans are required to provide, without cost sharing, access to all FDA-approved contraceptive methods, sterilization procedures, patient education and counseling prescribed by a health care provider.

However, exceptions are made for institutions of higher education that have religious objections to providing contraceptive services. If you attend such a college or university, the college or university can opt to have the insurance company provide the contraceptive coverage directly to you, separate from the student health plan. Some universities have legally challenged this contraceptive coverage rule. While the litigation is ongoing, some universities may have excluded contraceptive coverage from their fully-insured health plan.

If your student health plan is a self-insured plan, it might not be required to cover contraceptive services. It’s up to states to regulate self-insured student health plans.  Check with your college or university to find out what type of student health plan they offer, or check with your state insurance regulator to find out what rules apply to your student health coverage.

You may have other options as well. If you are under 26, you should check if you are eligible as a dependent in your parent’s health plan. You can also consider buying coverage on your own through the Marketplace. If your income is between 100% and 400% of the federal poverty level and you meet other requirements, you can qualify for premium tax credits; if your income is between 100% and 250% of the federal poverty level you can also qualify for cost-sharing reductions. In addition, if your income is low you might be eligible for Medicaid. Check with your state Marketplace to see if you may be eligible for Marketplace subsidies or Medicaid.

Does a student health plan have to cover essential health benefits?

It does if it is a “fully insured” student health plan. A fully insured plan is one that your college or university purchases from a health insurance company. If your student health plan is fully insured, it must cover essential health benefits, which include

  • 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
  • Pediatric services including oral and vision care

However, if the student health plan is “self-insured,” it might not be required to cover essential health benefits. It’s up to states to regulate self-insured student health plans.  Check with your college or university to find out what type of student health plan they offer, or check with your state insurance regulator to find out what rules apply to your student health coverage.

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