Monday, November 4, 2013
Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours here.
The Question: Is the fee I pay to use my university health center enough to satisfy the Affordable Care Act's individual mandate?
Laura Rengstorf lives in a small Ocean Beach cottage with her husband and dachshund. They just moved to San Diego from Washington state for school. She's getting a master's degree and teaching credential from the University of San Diego. He's at Point Loma Nazarene.
A graduate student can get most of her health needs taken care of on campus for a small fee. Does that count as health coverage under the Affordable Care Act?
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Rengstorf says her student fees cover quite a bit of in-office medical care at USD's health center – check-ups, treatment for minor injuries, medication and immunizations. Rengstorf wants to know whether that's enough to comply with the Affordable Care Act or if she'll need more coverage.
Here's her question:
"As a 30-year-old grad student, I go to a school that requires me to pay a health fee that covers me seeing the doctor at the school. I'm curious if that fee that I'm paying for my university also covers me under the Affordable Care Act."
The Takeaway: It's probably enough if it gets you care at a hospital.
Most Americans are required to have a health insurance policy next year – but not just any old policy. It has to include a minimum level of care called essential health benefits. Those include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
The USD health center doesn't offer emergency care, hospitalizations or the full range of specialists needed to offer every essential benefit. Dr. Kimberly Woodruff, USD's lead physician, said students will need to take out a traditional insurance policy to avoid paying a fine next year.
For students at other universities, the key is to make sure they're not just paying a fee to use the campus health facility, as they would to use the student union. They should have insurance that extends beyond the campus. That can be a policy through any of the large providers (just make sure they cover doctors in your new town if you go away to college) or through a special group plan insurance companies often put together for college students.
The Orders: Pick a plan, get on Medi-Cal or take the fine.
If Rengstorf were an undergrad, I'd tell her to stay on the family plan. Under the Affordable Care Act, kids can keep their parents' coverage until age 26.
But Rengstorf is 30. She'll have to go for the add-on group plan advertised by her school or sign up for Medi-Cal. Her unpaid gig as a student teacher and her husband's part-time job mean the couple qualifies for the public plan, which puts them out of the running for subsidies on the health insurance exchange.
Since we're talking colleges, I should point out that residency doesn't mean the same thing to Medi-Cal as it does to universities collecting out-of-state tuition. All Rengstorf needs to do for Medi-Cal is prove she's physically present in the state and intends to stay a while, according to a California Department of Health Care Services spokesman. In other words – her apartment lease agreement will do.
Of course, Rengstorf has one other option: Pay the fine. Some folks have found paying the government 1 percent of their income in lieu of getting covered makes financial sense. (The fine goes up to 2.5 percent in 2016.)
Check out last week's Second Opinion: What if my income increases after I sign up for Obamacare?