When colleges nationwide canceled in-person classes and closed dorms for the semester, thousands of college students like me moved away from our campuses. Like most full-time students with university-sponsored coverage, my health insurance is primarily intended to let me access care from on-campus providers during the academic year. So how will moving away from campus affect college students’ access to needed medical care during this pandemic?
In the context of a growing pandemic that affects people of all ages, the costs associated with limited health insurance coverage could discourage displaced students from accessing needed care, especially those from low-income and middle-income families. Many university-sponsored health insurance plans impose high out-of-network costs, meaning that accessing even vitally-necessary care could pose a serious financial burden for low-income students.
I’m no longer living in university housing, so my former primary care doctor is not in my insurance network. This means that I would pay 30% of the cost out of pocket for a visit to my primary care physician or an out-of-network hospital. That could easily cost thousands of dollars. Financial disincentives to access care like this, especially now, are a public health concern, but I can’t seem to find a single article discussing this potential disaster.
I’m not overly worried about paying for my own care. I come from a middle-class family (my parents are teachers), I’m young, and I’m fairly healthy. For lower-income students that don’t qualify for Medicaid, though, paying 30% of a hospital bill would likely prove impossible. It could lead to bankruptcy. Needing hospital care is not much of a choice, but low-income students in need of care could soon be forced to choose between receiving life-saving treatment or paying rent. Even as someone from a middle-class family, paying up to my yearly out-of-pocket maximum of $6,350 for a prolonged hospital stay could put my family into dire financial straits.
While COVID-19 disproportionately impacts older people, college students are not immune to the virus. According to the CDC’s most recent data, 20% of those hospitalized for COVID-19 were between 20 and 44 years old. College students can still be at high risk for severe complications from the virus if they have diabetes, severe asthma, or are otherwise immunocompromised. Even otherwise young and healthy people can become severely ill or die from COVID-19.
Under the newly-passed Families First Coronavirus Response Act, private health insurance plans are required to cover COVID-19 testing free of charge, which includes university-sponsored coverage. Although shortages of virus diagnostics in the United States severely limit the effects of this provision, making testing more affordable for some patients was certainly a step in the right direction.
Despite the current policymaking frenzy in Congress, federal legislators have not yet implemented any requirements for private insurance plans to waive out-of-pocket payments for COVID-19 treatment. Representatives from a health insurance industry group refuted President Trump’s statement that insurers would “waive all copayments for coronavirus treatments,” stating that major plans would cover copays for testing but not for treatment. Absent further legislation action, patients could be on the hook for a range of costly items like hospitalization or admission to an intensive care unit.
New Mexico and Massachusetts recently became the first states to waive out-of-pocket costs for COVID-19 treatment for some privately insured patients, filling the gap left by federal inaction. But the federal government’s deep pockets and heavy influence over health insurance regulation mean that states can only do so much without the help of Congress and the White House.
Displaced college students will need to access health care for a variety of other reasons during this crisis. Medical emergencies like anaphylaxis, car accidents, and life-threatening injuries haven’t magically stopped while we wait for the spread of the virus to subside. Out-of-network cost-sharing like copays and deductibles still apply. Displaced low-income students’ medical bills can threaten the livelihoods of their families, especially as unemployment surges. Surprise billing remains unaddressed, despite President Trump’s claim that insurance companies would prevent such charges.
High out-of-pocket costs lead patients to forgo necessary and unnecessary care indiscriminately. We can’t afford to let the prohibitive costs of out-of-network charges stop students from receiving the care they need.
Even as a student of health policy, I had trouble parsing what providers and benefits my health insurance covers while I’m not on campus. That information tends to be tucked away into a morass of lengthy and obscure documents on a poorly-designed insurance company website, full of hard-to-parse technical language. If you’re a college student with university-sponsored coverage inadvertently living away from campus, or a parent of one, it’s worth getting in the weeds of benefits, deductibles, provider networks, and copayments. (If you’re pressed for time, prioritize finding out which hospitals near you are in your insurance network.) You’ll thank yourself later.
Here are a few resources to help get started: