I talk to a lot of students who don’t really know if they should feel good, bad or indifferent about the mandatory PSU health insurance. If you are carrying this insurance, you have a “Cadillac” plan, whether you know it or not. It has tons of benefits and it’s super cheap. It’s time you learned what you’re sitting on.
The PSU mandatory student health plan is a major medical plan, covering all doctors visits, specialists’ care, labs, x-rays, tests, hospital care, surgery, ambulance and prescription drugs, up to $500,000 per year. The old basic insurance plan at PSU was more minimal and covered up to $7,500 per year.
The new plan also covers chiropractic care, acupuncture, maternity care, mental health counseling and treatment, substance abuse treatment, physical therapy, contraceptives, diabetic testing and testing for learning disabilities. Many plans do not cover these, or they charge much higher monthly premiums to do so. Unlike an HMO plan, there is no requirement for a referral from a primary care physician to see a specialist. Preventative care is paid at 100 percent, so you can go get an annual checkup, a physical or even vaccines without worrying about paying for it, all before illness strikes and it gets expensive.
Arguably most important of all, the plan has no deductibles, which are common to most medical plans and require you to pay the first $250, $500, $1,000 or even $2,500 of your medical expenses before the plan will cover much of anything. A lower deductible means paying a higher monthly premium. But the PSU plan has no deductible. Zip. You will have some copays of $15 to $30 for some types of provider visits, but you don’t have to pay off a deductible first.
After your copay, the plan pays 80 percent of the remaining cost if you use a provider in Aetna’s extensive Preferred Provider network. But if you need to see a certain out-of-network doctor, the plan still covers 60 percent of the remaining cost.
Also, if you have a pre-existing illness or injury, the plan will cover you from the start, provided you have been continuously covered on another plan or on the old student insurance.
Now consider the price for all this. The school charges you $594 per term, not per month, for this plan. The plan throws in the summer term for free! (The school wants you covered whether or not you take summer classes, graduate or even travel to Europe to “broaden your horizons,” then break your leg.) This works out to $148.50 per month over a twelve-month period.
Is that a good price? Most major insurance companies will charge at least $250-$300 per month for an individual. If you work for a smaller company or buy your own insurance, expect to pay about $300 per month if you’re young and $500-$600 per month if you’re middle-aged. If you are a family of two or more, expect to pay $800 to $1400 per month.
Also compare this to the price PSU students with health problems, even the youngest ones, paid under the old plan. Those who carried the supplemental plan and basic plan under the old system paid around $980 per term if they were in their twenties and roughly $1800 per term if they were over 50. For even the youngest students with disease or injury, the new plan is a much better deal.
Yet many students have howled about the new plan, especially over the waiver.
Students can waive or opt out of the insurance and avoid the $594 insurance fee if they can show they are covered on a different health plan that has comparable benefits and meets certain criteria. A big consideration: the alternative plan must carry a deductible of $2,500 or less (as opposed to PSU’s $0 deductible). The vast majority of the waiver requests that are denied are because a student’s alternative health plan carries a deductible higher than $2,500.
Some students wonder what business it is of the university to keep track of their insurance and deductibles. The waiver requirements anticipate the new requirements coming in the Affordable Care Act, or Obamacare, which will be fully implemented on Jan. 1. Similar to PSU’s requirements, Obamacare will require all plans everywhere to carry certain minimum benefits that will be much greater than the insurance business’ average plans in the individual market in the past.
Some students want to be left to their own devices; they are healthy and can afford the risk, they say. Yet many chronic diseases, athletic injuries and other health problems can manifest in your twenties. And you don’t have to look far around campus to find students with major health problems.
One student I talked to came to PSU last year with pre-existing health problems. She paid $6,000 herself in medical care the year before attending PSU. Her temporary insurance plan chipped in only $75. Prior to that, she had an employer plan that charged as much as PSU’s old supplemental plan, but with about half the coverage.
Until now, I would’ve always argued that you wouldn’t find a plan this generous and also this cheap after you leave school if you have to buy your own insurance. But with the Obamacare state exchanges opening now and coverage beginning on Jan. 1, the individual insurance market in the “real world” may start catching up to the current PSU student health insurance.
So many people will be eligible for subsidies under Obamacare that it may well bring their plans’ prices close to the PSU plan. For example, my sister estimates her family of six will pay $2,100 per year in premiums, with the government paying the rest, to buy their insurance—only slightly more than the PSU plan. Even so, the plan she will be able to buy may not be quite as generous as the PSU student plan.
So appreciate what you have, Vikings. Use the benefits. Get around to those doctor visits before you graduate. You don’t know what you got until you lose it.
Theo Burke hosts The Raging Moderate, a news and talk show, Thursdays at noon at KPSU. org.