Affordable Care Act brings changes and alternatives to student health insurance

As the Portland State health insurance waiver deadline approaches on Oct. 12, many students are busy comparing their health insurance options for the upcoming academic year. Students now have access to new and expanded health insurance options created by the Affordable Care Act, often called Obamacare.

For the 2014–15 year, PSU’s student health insurance costs $694 per term and $2,082 for the full year, including summer. This is mandatory for all students taking five credits or more, unless they submit a waiver proving they have outside insurance that the university deems comparable to the PSU plan.

Outside insurance with a deductible of $2,500 or less and a hospitalization coverage of at least 80 percent typically meets the waiver requirement.

“We’ve whittled these [requirements] down as much as we could to make the waiver as easy as possible,” said Nick Poublon, the student health advisor at PSU’s Center for Student Health and Counseling.

Oregon Health Plan

The Oregon Health Plan, Oregon’s no-cost Medicaid program for low-income individuals, also meets the waiver requirement.

Students may be eligible for the OHP if they are not listed as a dependent on their parents’ taxes and if they have an income of less than $16,100 for a single adult or $32,900 for a family of four.

More PSU students may find themselves eligible for OHP than in previous years, because Medicaid expansion under the Affordable Care Act increased the cutoff from 100 percent to 138 percent of the federal poverty line.

Sarah DeYoreo, a graduate student in English, opted out of the PSU plan this year with free Medicaid coverage through the OHP.

“I don’t know much about the student health insurance,” DeYoreo said. “But I know it is not cheap, and with a stipend that doesn’t even cover my monthly rent I have no idea how I’d pay for it.”

However, not all students who have tried the OHP have been satisfied. Many have later switched back to the PSU plan, which can be done at any time.

“While we would never discourage someone from taking OHP, there are some caveats to it,” Poublon said, “[including] longer wait times to see physicians and a lot of doctors not taking any more OHP patients.”

“Some of the students experience a particular health issue…whether it be chronic pain or some other kind of health issue that isn’t really ranked high on the list of priorities for OHP,” Poublon said. “And unfortunately, that’s the way it works with Medicaid; when you have so many people getting on the plan, there has to [be] some kind of prioritization.”

Student insurance costs rise

The price of the PSU student health insurance amounts to about $100 per term more than last year. After several years of experiencing dramatic price increases, many PSU students are confused about why the price continues to go up.

Angela Abel, the marketing and communications coordinator at SHAC, wants students to look past the sticker shock of the PSU health insurance because the increased cost has been matched by an expansion in what the insurance covers.

Abel explained that until 2012, PSU offered students a choice between a low-cost minimum health insurance plan and an optional, high-cost supplemental plan.

The minimum plan would only pay for the first $7,500 of medical bills, leaving many students with bills far beyond their ability to pay.

“You could break your leg on the last plan, and you would max out of the coverage,” Abel said.

“Our students said that if a high-cost [medical condition] happened to them, they wouldn’t be able to go to school because they couldn’t pay for both,” Abel said in reference to the former minimum health insurance plan. “Students were at risk of dropping out of school and leaving with a combination of medical bills, student loans and no degree.”

The supplemental insurance plan was unsustainable as well. Many of the students who opted for the supplemental plan were experiencing chronic health problems, and their high utilization of the plan drove the price higher each year. Poublon said the comprehensive plan has helped meet the needs of both under-insured and chronically ill students since its implementation in the fall of 2012.

The increases from 2013 to present, however, are distinct from the transition to the comprehensive health plan. Abel explained that the changes associated with the Affordable Care Act mandate that began in January 2014 are impacting the price of the PSU health insurance plan for the first time, as it renews for this academic year.

Costly changes mandated by the ACA include: paying ACA taxes, moving from a $500,000 medical maximum to a limitless plan, and ending preexisting condition exclusion.

Despite the increase in costs, Poublon thinks that many students are going to benefit from these changes, particularly with the coverage of preexisting conditions.

“Overall, the student is going to win because there’s going to be a lot of situations where the student is going to now have coverage,” Poublon said.

Health insurance marketplace

The ACA also created the Cover Oregon health insurance marketplace, where any individual can shop for standardized health insurance plans that are eligible for federal subsidy.

However, the timing might be impractical for students looking for insurance now to meet the PSU waiver deadline.
“Open enrollment [through the marketplace] begins Nov. 15 through Feb. 15, with new coverage beginning Jan. 1, 2015 at the earliest,” explained Dan Neils, a Cover Oregon-approved insurance broker.

The $2,082 annual cost of the PSU health insurance plan works out to be $173.50 per month, which is important to consider because monthly prices are given for the plans offered through the marketplace.

Poublon noted that he has worked with students who turned to the marketplace thinking that it would save them money, but actually ended up with health insurance more expensive than the PSU plan.

Additionally, students purchasing insurance should keep in mind that not all plans offered through the marketplace necessarily meet the PSU waiver standards.

Neils explained that since now Cover Oregon and the federal insurance marketplace exist, there might be less of a need for universities to be in the insurance business.

“I think a university would be wise to pull the plug on their group plans, [because] we have a robust marketplace here in Oregon,” Neils said.

Poublon took a different opinion.

“There is still a lot of uncertainty about the exchanges and the future costs of insurance plans offered [through the marketplace],” he said. “Because we pool all of our students together we are able to offer a robust plan created specifically for college-aged individuals that we feel is very competitive.”

Abel and Poublon both stressed that medical and counseling services at SHAC are available to students regardless of their insurance. “No matter what type of insurance they have, if they are taking five credits they can come to SHAC,” Abel said.

They also both expressed their interest in helping students find the right insurance options for them, regardless of whether it is the PSU plan or not.

“We take the education portion of what we do seriously,” Poublon said.