After tuition, books and room and board, colleges’ rising health fees hit a nerve | News

Compare tuition. Updated campus housing costs. Even the milled prices of the student meal plan.

But have you ever thought about how much your son or daughter’s dream school will charge you for health care?

You may have a shock.

Hawley Montgomery-Downs was thrilled when daughter Bryn Tronco received a scholarship that pays half of her $63,000 annual tuition at the University of Southern California. But just as school started in August, she was surprised to receive a $3,000 loan from USC to pay for both student health insurance and money to allow students access to college clinics and other services. At home in West Virginia, she had paid nothing for her daughter’s health insurance, through the Children’s Health Insurance Program, which serves low- and middle-income families.

Montgomery-Downs, who lives in Morgantown, West Virginia, was upset that USC not only paid for her health insurance but also a $1,050 annual health fee. “It would be good for them to go to the student health center, but by buying insurance to go to the basic care providers, it feels like I’m paying twice,” she said.

Mandatory medical insurance and health service fees are common at colleges as a condition of enrollment, said Stephen Beckley, of Fort Collins, Colorado, a college health and benefits coordinator. Although health premiums can help reduce student insurance premiums, parents may feel they are paying twice. “That’s a big problem in our field,” he said.

For parents, these hefty fees can come as a surprise, making an affordable education seem less expensive. After all, students can save by choosing a fast food plan and cooking their own dinner or buying used books, but there is no way to pay for mandatory health insurance.

Costs vary by school but can typically run into several thousand dollars a year — costs that health care advocates say should be carefully reviewed by parents and students to make sure they understand their options while meeting university requirements.

Students can request waivers from university health insurance by showing that they have their own insurance or are covered by their parents’ insurance that meets certain university criteria. Schools usually want to see that the student’s insurance covers local doctors and hospitals with minimal out-of-pocket costs. Student health expenses, however, are generally not deductible.

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USC, a private college, charges $2,273 a year for its Aetna student health insurance plan. The average for public colleges is $2,712 and $3,540 for private universities, according to a 2022 study by Beckley’s firm, Hodgkins Beckley & Lyon.

Some elite colleges charge more, such as $6,768 at Stanford and $4,163 at Dartmouth College.

The University of Montana costs $4,700, and most services at its campus health clinic are fully covered by its health plan. The University of Colorado costs $3,976.

At Harvard, students who buy school insurance pay $4,080 a year and $1,304 in student health fees.

The easiest solution to avoid these costs would be for students to stay on their parents’ health policy – which the Affordable Care Act allows until they turn 26. But that only works if the student’s parent has a policy that meets the school’s full requirements and specials -In-network coverage where the college is located.

If not, parents may want to shop around for ACA marketplace plans to see if they can get a benefit. If their income is low enough, students can sometimes enroll in Medicaid or the CHIP program in the states where they study. But this strategy also has limitations. Students must meet the residency requirements of the state where they study, and parents cannot claim you as a dependent on a tax refund. CHIP coverage also expires when the student turns 19.

Schools that charge student health fees and require insurance coverage say the funding helps pay for services at campus health clinics, which would otherwise cost students hundreds of dollars a year or more.

USC’s student health fee — which includes primary and preventive health services — also helps the school pay for services that are typically not covered by insurance, such as monitoring outbreaks on campus.

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Dr. Sarah Van Orman, chief health officer of USC Student Health, noted that the student health fund provides funding for additional mental health providers on campus and a team focused on sexual harassment prevention and education – services available to students without any fees. He said these additions are important because even if they have insurance, students may face challenges in finding independent counselors to provide them with timely assistance and if they do, students will have to pay for the distribution of expenses.

“The student health fund supports the public health infrastructure on campus,” Van Orman said.

Because students can get basic health services on campus at the student health center, fewer of them seek insurance-paid care, he said, and that helps keep the monthly premium for Aetna’s student health insurance plan low. “These things are interactive and not repetitive at all,” Van Orman said.

USC’s student health insurance has an annual out-of-network deductible of $450 and a $20 copay for a doctor’s office visit. It also offers comprehensive services across the country, so students are covered at school and at home – even if that’s across the country. About half of USC students purchase Aetna student insurance, according to Van Orman.

Some colleges have a different strategy. For example, George Washington University’s mandatory health insurance covers campus health center services. Unless they get a waiver, undergraduates must enroll in the student health insurance plan — which costs $2,700 a year — unless they can prove they have another insurance plan that meets the school’s criteria. The health plan premium allows students to receive many free services at the student health center, including medical office visits, other prescriptions, and routine sexually transmitted disease screenings.

Beckley said college rules vary on whether they allow students to choose insurance plans other than those offered by the school.

USC allows students to purchase an alternative insurance policy through their parent’s plan or in the ACA marketplace as long as it meets the school’s requirements including comprehensive health coverage in the Los Angeles area and preventive care coverage without cost sharing. Out-of-state Medicaid or CHIP programs do not meet the university’s criteria because they do not have regular care provider networks in California.

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That was unwelcome news at Montgomery-Downs.

“This is not something we budgeted for,” he said of USC’s health care costs.

Montgomery-Downs, a former professor at West Virginia University who now works as a freelance editor, said she’s not sure what to do if she gets the USC health care bill. She thought Bryn, who turned 19 last week, would be covered initially because her CHIP plan provides medical care in emergency rooms and urgent care facilities outside the state. And Montgomery-Downs wanted to make sure her daughter received health care during the summer and holiday breaks when she was home.

Unsure of what coverage options in the marketplace would meet the school’s regulations and deadlines, she decided to go with the Aetna USC student plan offered.

A look at the marketplace options at Covered California shows the $2,200 USC Aetna student plan is a competitive rate. A comparably low-cost PPO plan offered by California Blue Cross that will provide Bryn with a national network of providers costs about $2,400 a year and includes federal subsidies based on their family’s income. PPOs provide out-of-network doctors and hospitals.

Montgomery-Downs gets her news from the market and says she will buy Bryn’s market plan for the next school year. He said he wished they knew about all the health costs at the time of admission rather than just before classes started.

“It’s all bad, even for someone who has the privilege of time and some understanding of these offices — higher education and medical insurance,” Montgomery-Downs said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major programs operating at the KFF (Kaiser Family Foundation). KFF is a non-profit organization dedicated to providing national health information.


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