My husband recently lost his job so we have to buy health insurance off of the healthcare.gov exchange. The only insurance available has in-network providers only in our state. Our son (college freshman) goes to college out of state. I know that the law is that health insurance must cover emergency room visits no matter in network or not, but I am concerned about unforseen “gaps”. What if he got into a car accident at school and had to be hospitalized? Would that be covered? If not, is there some sort of supplemental coverage we could purchase? I am not concerned about routine doctor visits as he’d still do those when he’s home from school.
Thanks for any advice. I couldn’t find any real answers on this topic.
Does his school have an option? I bought that for my daughter, mostly because she was an athlete and I was afraid she’d break her arm or something. It was about $1200/yr (I know some is a lot more expensive). She ended up using it for a few strep tests and some prescriptions and overall it was truly insurance - paying for something she never used but was there in case of an emergency.
When she came home the summer after senior year, it was still in effect until Aug 1. She got the birth control implant and we thought it would be covered under my insurance, but they billed it back to her college policy so that company ended up paying about $3000
Sometimes the college policies are cheaper and better than the exchange policies (unless you need a family policy to cover other kids). For example it’s about half the price my D was paying for her prior policy with lower copays. And it still covers her in our state when she is at home.
A loss of insurance should be a triggering event allowing you to purchase a college policy even for this academic year.
Not on the exchange, but our insurance company issued my son a “guest policy” still under ours. He got his own card and own number with his out of state address with local providers near his OOS school. Callyour insurance company and see if the might have something similar.
We don’t have an exchange policy. But we live in WA with a daughter in college in AR and use Kaiser Permanente which has no clinics or operations in AR. Check with the insurance company but this is an extremely common thing and they have procedures to deal with it.
In our case, the insurance covers any emergency services she needs while she is in college but routine care they want her to do in WA at a Kaiser facility. So we basically just schedule her annual checkups and such for when she is home on breaks. She also has the option of doing virtual video visits with her doctor which she has done a couple of times for minor things.
The biggest hassle is with prescription meds. She has a couple. Kaiser has an online pharmacy that does mail order but they won’t mail to Arkansas because they aren’t licensed to operate in that state so we have to have her prescriptions sent to our house and then I re-mail them to Arkansas.
We have a high-deductible plan and have just paid cash for a few minor things she had to deal with in AR but had them run through the insurance card anyway just to get the charges credited against our deductible which they did. So, for example, she went to a dermatologist in AR who swiped her Kaiser card. Kaiser denied payment because it fell within our deductible and we just paid the bill out of pocket. But Kaiser did credit the bill against our deductible. We didn’t reach the deductible that year anyway so it didn’t really make a difference.
You may have to call the insurance company and ask if you can’t find the details on their web site. But since they are required to cover children up to age 26 this is going to be a routine thing for which they have procedures in place.
I kept my son in Kaiser Permanente (private co-payment plan without dental plan) because his planned to live in a college dorm only for 8 months (which ended up only 6 months due to campus closer) and his college town has a Kaiser hospital close enough to his college. However, his college has an university student health plan with a clinic in campus which was about $800 / year cheaper than his current Kaiser plan in this academic year. I didn’t research in depth about coverage compare with his current co-payment plan. I am now considering to switch to his university student health plan for next academic year (from Mid-August 2020 to mid-August 2021) in case of Coronavirus outbreak / cluster in campus. College must have a protocol before opening a campus. It may be simpler if he becomes ill or close contact with the virus in campus.
You can only buy off the exchange if you are a resident of the state. If OP’s son is still a dependent, it won’t be possible to buy off the exchange. If he’s not a dependent, he could become a state resident. However, his income may become an issue. In my state, he’d have to make about $20k to qualify. Below that, he’d be on medicaid.
Yes, we still qualify for COBRA but that is $1100 more per month than a pretty OK plan that we can buy from our exchange. Our new plan includes all of our current doctors and isn’t bad with overall coverage in spite of high deductibles and having a network that is only in our state. With the current pandemic we don’t know when we might get another job (energy sector) so saving money is a big priority.
I think my main concern is with Covid and how that might affect my son. Even though he’s healthy if he did get sick at college and had to be hospitalized our insurance would not cover that, and there would be no way for us to get him back to our state to be in network.
Since he is still a dependent he wouldn’t qualify for an exchange plan in his college state and we really don’t want that since he goes for regular appointments in our own state when he’s home for breaks.
It’s amazing how hard it is to find this information but I discovered a couple of options. One is a supplemental indemnity plan that runs about $70 a month. Since my son would be on our regular plan this satisfies ACA rules. This plan would pay so much for emergency room visits, surgeries, and hospital stays. It’s not subject to an enrollment window either so we could just buy coverage for the 9 months of the school year. For around $600 a year this is a much better deal than for us to pay $1100 a month extra for our COBRA plan. And even though my son most likely will never use it, it would keep us from a catastrophic financial loss should something major happen.
I would suggest people look at their insurance plans to see about out of state coverage as I was surprised how many plans have strong limitations.
Yes, the kids on college plans who are forced to live back at home really need to have a good look, I suspect there are more than a few retired parents whose kids are in this situation.
Usually getting sick with the flu or covid19 (although we don’t know) is considered an emergency OOS and is covered, especially if you need to go into the hospital. Illness is an emergency while going to the doctor or getting therapy is not.
My daughter was in Florida and went to the ER for what it turned out was a bladder (or kidney?) infection. EIGHTEEN THOUSAND dollars later, our insurance did cover it as an emergency. All it really took was an antibiotic and some fluids, and they billed her $18k. And that didn’t even include the antibiotic.
I am curious about this because our new insurance only has networks in our state and nowhere else. It specifically says out of network providers are “not covered”. Does your policy say the same thing? Because most job-provided insurance I think is more generous in that way than policies bought on the exchange. You might have to pay more than an in-network copay but you are at least covered.