Terms like “premiums,” “deductibles,” and “out-of-network providers” can sound like they’re part of a complicated foreign language, especially if you’re in graduate school for something other than health education. Health insurance gets even more confusing for online students, considering some colleges, like the University of Southern Alabama, don’t require it for online students. Others, like the University of Nevada, Reno, mandate that all students must have a health insurance plan upon enrollment.
Fortunately, it is possible to understand your university’s healthcare requirements without taking an entire class on it. Plus, the University of Nevada and many other schools offer their own insurance plans.
In this guide, we’ll reveal how university-sponsored health insurance works, as well as if you’re better off with that, an employer-sponsored plan, or one through the marketplace. With an understanding of the basics, you’ll be well-prepared to choose your own plan. Read until the end for practical resources and answers to the most frequently asked questions about health insurance.
Preliminary Healthcare Considerations for Grad Students
Before you can enroll in a healthcare plan, you need to consider your current situation. Factors like your age, healthcare needs, school requirements, and available insurance options will inform you what healthcare plans are available to you. To get started, review the considerations outlined below.
Consideration 1: Your Age
According to the Council of Graduate Schools, today’s average grad student age is 33 years old. This statistic is important because grad students are only eligible to be covered under their parent’s healthcare plan until they turn 26. So if you are considered a younger graduate student and under 26, you can be covered by your parents’ plan; however, if you’re older, you’ve “aged out” of your parents’ plan.
When exactly you age out of your parents’ plan also differs, depending on the type of plan they have. If they have marketplace insurance (health insurance independent of their job), you can stay on their plan until Dec. 31 of the year you turn 26, even if your birthday is in January.
However, if your parents have health insurance through their job, you age out the month you turn 26. When this happens, you enter a special enrollment period, during which you have 60 days of additional coverage and 60 days after that to sign up for a new plan. For more on how aging out works, check out the U.S. Centers for Medicare & Medicaid Services’ guide to turning 26.
Consideration 2: Your School’s Health Insurance Requirements
As we’ve discussed, while there are some exceptions for online students, most schools require proof of health insurance for all graduate students.
When required, most schools offer a graduate student health insurance option. Some schools have an automatic enrollment policy, where all graduate students are enrolled in a plan, and students must submit a waiver to avoid the student insurance fee. The University of Maryland is an example of an automatic enrollment school.
The University of Iowa, on the other hand, offers students an open enrollment period instead of automatically enrolling them into a health insurance plan. During this open enrollment period, students must enroll in the university’s healthcare plan for graduate students or provide proof of an independent plan.
No matter what type of enrollment a school utilizes, students usually need insurance, either through the school or an independent plan that meets the institution’s standards. Inquire with your university to know what plans meet standards, as this can vary from school to school.
Consideration 3: Health Insurance Carriers
As you might have already guessed, there are multiple health insurance options for graduate students. All of them have pros and cons, and each will be the best option in different scenarios. If you’re ineligible for your parent’s health insurance, you have four main options from which to choose:
Employer-Based Healthcare Plans
If you’re balancing work, school, and life, your health insurance may already be covered by your employer. Coverage through a job usually means you don’t have to worry about an additional student health insurance fee, as long as you submit your insurance waiver on time. Be sure to research if your graduate program automatically enrolls students in a health insurance plan or has an open enrollment period so you know when to submit your employer-based insurance. If your employer-based health insurance covers less than your school requires, you may have to buy supplemental insurance.
Marketplace Healthcare Plans
The United States government regulates an open marketplace for citizens who don’t get health insurance through their employer. Under current law, these plans must offer a minimum level of coverage — and they must disclose what is offered before you enroll. If interested in this option, make sure you enroll during the set registration period (typically Nov. 15 through Jan. 15).
Medicaid Plans
As the single largest healthcare provider in the country, Medicaid offers health insurance for over 72.5 million individuals. If you’re a low-income individual, you may be eligible for Medicaid, though the exact requirements vary by state. In all 50 states, pregnant women, children, low-income families, and those who receive Supplemental Security Income (SSI) are eligible for Medicaid. Beyond that, covered groups vary across state lines. To learn more about eligibility requirements, visit Medicaid’s website.
School-Based Healthcare Plans
Again, most universities offer their health insurance plans, which are governed by the Affordable Care Act (ACA). Coverage under your school’s health insurance plan means you don’t have to worry about meeting their requirements, providing proof of health insurance, or opting out of your school’s healthcare plan.
Choosing the Best Health Insurance Plan
When choosing the best healthcare plan, there is more to consider than your age, your school’s requirements, and the provider. Each healthcare insurer may offer multiple plans you qualify for. To add to this, there are a variety of different factors to consider — so how do you choose? Follow the steps below to better understand how to select the best plan for your needs.
Step 1: Understand Your Healthcare Plan Options
After you’ve considered your age, your university’s requirements, and different provider types, it’s time to understand the essential components of each plan you’re considering. For an easy side-by-side plan comparison, customize this worksheet with the specifics of each plan you’re considering.
Enrollment Period
The first detail to note is the enrollment period. For marketplace plans and many employers, the enrollment period is from Nov. 1 through Jan. 15. University-sponsored plans for graduate students sometimes have different enrollment periods. At the University of Kansas, there’s a different enrollment period depending on the start date of your semester.
You’ll also want to pay attention to schools with automatic enrollment, such as Rice University. At these institutions, you don’t need to actively enroll, but you will need to submit an insurance waiver if your plan is hosted through another organization.
Insurance Tier
Plans in the marketplace, as well as some other plans, are presented in four tiers: bronze, silver, gold, and platinum. Platinum has the highest premium, the set rate you pay each month, but the lowest out-of-pocket costs. Bronze has the lowest monthly premium, but the highest out-of-pocket costs and the least amount covered. The other two fall between bronze and platinum in terms of coverage and monthly cost.
At universities with Student Health Insurance Plans (SHIPs), there may only be one level, not many. That’s the case at Old Dominion University, though the plan they offer is ranked “gold” on the bronze to platinum scale.
Network
The U.S. government defines a network as the providers a specific insurance provider has a contract with to provide healthcare services to their insurees. For example, if your healthcare plan is through United Healthcare Student, you’d want to go to medical providers in United Healthcare’s network. When you go to an out-of-network provider, some or all costs won’t be covered. The exact amount covered out of network depends on the terms and conditions of your insurance plan.
Plan Type
There are a few different plan types that can affect your coverage options:
- A preferred provider organization (PPO) provides coverage to participants through a network of pre-selected healthcare providers, such as hospitals and physicians.
- An exclusive provider organization (EPO) only provides coverage when you see a PCP or specialist in your network, except in emergencies.
- A point of service (POS) plan charges you less when you use medical providers within your network. Going to an out-of-network provider costs more.
- A health maintenance organization (HMO) limits coverage to healthcare providers contracted by an HMO. If you see a provider who isn’t in your local HMO, these costs won’t be covered unless it’s an emergency.
The table below summarizes the primary differences between each type of healthcare plan.
| PPO | EPO | POS | HMO | |
|---|---|---|---|---|
| PCP required | No | No | Yes (usually) | Yes |
| Specialist referral required | No | No | Yes (usually) | Yes |
| Pre-authorization required | Yes (usually) | Yes (usually) | No | No |
| Out-of-network coverage included | Yes (usually) | No | Yes | No |
Step 2: Compare Healthcare Plan Coverage
Once you’ve looked at the different healthcare plans and understand the terms of each, it’s time to compare your options. While cost is an important concern, you’ll have other factors to consider, too.
Primary Care Provider (PCP)
Your primary care provider is a doctor (sometimes a nurse practitioner or physician’s assistant) who is your go-to person for all healthcare concerns. They treat common conditions, offer preventative care, and refer out to specialists as needed. Some insurance providers have a list you must choose from, while others let you choose anyone within your network. Make sure to research what each plan you’re considering allows, including if your current PCP is covered.
Medication
Before looking at plans, write down all medications you currently use. When reading the terms of each health insurance plan you’re considering, note if all your required medications are covered. It’s also important to determine if a provider covers generic or brand name medication. Since the FDA has determined generic drugs have the same active ingredient and effect as name-brand ones, health insurance providers are not required to cover both by law.
Pre-Existing Conditions
Pre-existing conditions, like pregnancy and asthma, are conditions that increase how much you might spend on healthcare. In the United States, no healthcare provider is allowed to deny coverage or charge more because of a pre-existing condition. The only exception to this is grandfathered plans, which means the plan was in existence before March 23, 2010, and hasn’t changed since; check with your university or employer to confirm if they have a grandfathered health insurance plan. Marketplace plans, however, are never grandfathered.
Specialist Visits (Therapy, Dermatologist, etc.)
Each health insurance plan has a different copayment amount and referral process for visiting a specialist. For a specialist visit to be covered, you usually must be referred by your PCP, though this might not be the case with all plans. In your plan’s terms, there should also be a stated amount you have to “copay” to see a specialist. For example, if you are referred to a back specialist, your plan could have a $40 copay for going to a specialist in your network and a $70 copay if you choose an out-of-network specialist.
Urgent Care/Emergencies
Unlike seeing a specialist, an insurance provider can’t charge you more if you see an out-of-network provider in an emergency. That means your copays and deductible payments will be the same no matter where you’re treated, and these appointments don’t need to be pre-approved by your provider. Your insurance provider is also responsible for paying all emergency care costs once you’ve met your deductible.
Step 3: Consider the Costs
No matter what health insurance plan you choose, you most likely will have to pay some money yourself. When looking at the costs, consider your monthly premium, but also look at other charges you may be responsible for.
Coinsurance
The Department of Health & Human Services defines coinsurance as the amount you pay after your deductible has been met. The number is usually stated in your plan as a percentage. For example, let’s say your coinsurance amount is 20%. If you’ve already met your deductible and you receive a medical bill for $200, your coinsurance would be $40. Your insurance provider would pay the rest.
Copayments
A copayment is a defined amount you pay for any medical service after you’ve met your deductible. Unlike a coinsurance, this number is set, not a percentage. The amount should be defined by medical service type. For example, one plan might charge a copayment (or copay) of $50 for a physical therapy appointment, while another could charge $30.
Deductibles
A deductible is the amount you have to pay before your insurance provider pays for healthcare services. For example, if your plan has a deductible of $1,000, you have to pay that amount yourself before a health insurance company covers any medical bills. There are often certain charges, such as a checkup with your PCP, that are covered before you meet your deductible. The exact terms and exceptions should be defined in a plan’s terms and conditions.
Out-of-Pocket Limit/Maximum
The maximum, often called the out-of-pocket limit, is the highest amount you might have to spend on health insurance costs in a single year. This covers your deductible, out-of-network costs, coinsurance, and copays. In 2024, the out-of-pocket limit on Marketplace plans is $9,450 for an individual and $18,900 for couples. For other plans, this amount could be lower.
Premiums
The premium is the amount you’re responsible for each month or year. For example, the University of Iowa has a $325 monthly premium for its student health insurance plan. If a student wants to cover their partner or children, that amount will increase. Each plan’s monthly and annual premiums will vary, so check with your insurance provider or all insurance providers you’re considering.
Health Insurance FAQs for Graduate Students
Am I required to have health insurance while enrolled in online college?
While it isn’t a federal or state law, almost all universities require health insurance for graduate students who attend school full time. At some schools, like the University of Nevada, Las Vegas, this only applies to those who are enrolled in 9 credit hours or more per semester. Even if health insurance isn’t a requirement by your university or if you’re a part-time student, you should be aware that there is a tax penalty in certain states for residents who don’t have health insurance. Not all states have this penalty, and there is no federal penalty.
What happens if I can't afford health insurance?
If you can’t afford health insurance, you may be eligible through Medicaid. While it’s important to check Medicaid’s eligibility requirements in your state, it’s generally available to those on Supplemental Security Income (SSI). Each state also has a certain percentage below the poverty line to qualify. If your income level is too high for Medicaid but paying for insurance is difficult, you may be eligible for a lower-cost plan through the Marketplace.
What happens if I age out of my parent’s health insurance in the middle of grad school?
As we’ve discussed, if you’re covered through your parents’ plan, you have 60 days to enroll in a new plan. If they receive insurance through the Marketplace, you’re covered on their plan until the end of the year and may choose a new plan in the open enrollment period (Nov. 1 through Jan. 15). To learn if you can switch over to your university’s graduate student health insurance plan, reach out to your individual institution.
How does health insurance work for international students?
If a university requires graduate students to have health insurance, that same policy applies to international students. That means international students in the United States will need to get a healthcare plan, often through their university. For example, Lehigh University requires international students to enroll in their student health insurance policy.
If you’re an online student taking classes at a U.S. college while in another country, you may be able to apply for a health insurance waiver with the health insurance plan in your home country, though this varies from school to school.
How do I opt out of graduate student insurance?
If you want to opt out of your university’s health insurance, you typically have to submit a waiver. The exact information you must submit and when your waiver is due depends on the university. For example, at the University of Maryland, the waiver is due between June 15 and Sept 30. It results in a refund for the automatically charged student health insurance.
Health Insurance Resources for Graduate Students
Ready to perform an even deeper dive into the world of graduate student health insurance — or perhaps you’re looking for insights into how to choose a plan? Review the 15 resources below for more information.
- 6 Tips to Help You Pick the Right Health Insurance Plan – read or listen to this NPR report that offers tips on choosing the best plan for you.
- Choosing a Health Insurance Plan – this guide from Washington University in St. Louis outlines what graduate students should consider when choosing healthcare insurance.
- Demystify Health Insurance for Graduate Students – Penn State University created this helpful FAQ and guide about the biggest misconceptions about graduate student health insurance.
- Graduate Students with Disabilities – if you’re a graduate student with a disability, you may have additional health and insurance concerns. Some of these might be covered in our guide for graduate students with disabilities.
- Healthcare.gov’s Guide for Students – Healthcare.gov, the governing body of health insurance in the United States, offers a short but useful guide to health insurance for full-time students.
- Health Insurance Glossary – as you review health insurance options, you might come across unfamiliar terms. This health insurance glossary from the U.S. Department of Health & Human Services is here to help.
- Health Insurance for International Students – if you’re an international student and still confused about your healthcare options, check out this helpful YouTube video.
- How Graduate Student Health Insurance Works – Boston University created a series of videos for graduate students about how student health insurance works and other healthcare considerations.
- The Marketplace – if you aren’t happy with your university’s healthcare plan, the government-facilitated Marketplace is the place to go to explore other options.
- Medicaid Eligibility – if you’re a low-income student, your health insurance may be covered by Medicaid. Check out this guide to Medicaid eligibility to see if this is an option for you.
- Mental Health Resources – whether your plan covers mental health costs or not, our guide to mental health resources for graduate students is here to help.
- Seeing a Specialist – still confused about how seeing a specialist works under your plan? Explore this guide from the U.S. Centers for Medicare & Medicaid Service.
- Student Health Insurance Podcast – this episode from the University of California, Irvine answers important questions about insurance for college students.
- Subsidized Health Insurance – some universities subsidize part of their graduate student’s healthcare costs. George Mason University explains how this works in greater detail.
- When Insurance Isn’t Needed as an Online Student – at some universities, fully online students are not required to provide proof of insurance or eligible for graduate student health insurance. This page on the University of Central Florida website is an example of how schools with this exception word their online student insurance policy.