Dennis G. Shea, Ph.D. Associate Dean for Undergraduate Programs and Outreach Professor of Health Policy and Administration College of Health and

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1 Dennis G. Shea, Ph.D. Associate Dean for Undergraduate Programs and Outreach Professor of Health Policy and Administration College of Health and Human Development

2 Summary of before 2010 Overview What is the Affordable Care Act and How it Impacts and Student Health Insurance Future issues

3 Before 2010 Patient Protection and Affordable Care Act (PPACA, also called ACA, also called Obamacare ) passed March 2010 Led to major changes in U.S. health insurance system What was in place before 2010? Penn State contracted with private health insurer to offer a health insurance plan to students Graduate assistants and other students with support received a subsidy to help pay for health insurance International students were required by U.S. government to purchase health insurance plan Plan offered through Penn State met all requirements for international students Students could purchase other plans, as long as they met requirements Other students had option of purchasing the health insurance plan through Penn State, getting health insurance through another source, or going uninsured

4 PPACA Changes All individuals in U.S. required to have health insurance or pay a penalty Can be from group plan (usually through employer) or individual plan Expansion of health insurance options Dependent coverage to age 26 Expansion of Medicaid (state program for low-income population) Creation of Health Insurance Marketplaces Online market of standardized health insurance plans Enables comparison shopping Subsidies for individuals and families below 400% of poverty line 400% of poverty = $47,000 for individual, $97,000 for family of 4

5 How are graduate students affected by the ACA? Under the new law, most people over age 18 (this includes nearly all college students) must purchase health insurance or pay a penalty. The ACA provides affordable ways for some students to get health insurance coverage Are there any exceptions to the ACA s individual mandate that students have health insurance? Students with household income so low they do not have to file federal income tax; Students who qualify for a hardship or affordability exception when they apply for coverage; Students who are members of a recognized Indian tribe, health care cost-sharing ministry, or religious group that objects to health insurance; or Students who are in the U.S. illegally

6 What are my options for getting insurance if I am covered by ACA s individual mandate? 1) Purchasing coverage through the Penn State student health insurance plan; 2) If you are age 26 or younger, you may be able to continue to be covered as a dependent by a plan from a parent; 3) Purchasing ACA coverage as an individual or under a family plan, if you are a dependent, through one of the ACA exchanges/marketplace, where you may be eligible for a premium tax credit, or subsidy, if requirements are met; 4) If your income or your family s income is low enough, you may qualify for Medicaid 5) A catastrophic or young invincible plan offered through the Exchange/Marketplace 6) Purchasing an Individual Health Plan offered outside of the Exchange/ Marketplace Key Issues: Costs, Benefits, Provider Coverage

7 What kinds of health insurance options are available through the Exchange/ Marketplace? Health insurance plans offered through the Marketplace are standardized by metallic tiers Platinum: estimated to pay 88-92% of your health care costs Gold: estimated to pay 78-82% of your health care costs Silver: estimated to pay 68-72% of your health care costs Bronze: estimated to pay 58-62% of your health care costs Plans can achieve those percentages in many different ways The Penn State student health insurance plan is a nonexchange plan that has Platinum level coverage

8 Who is eligible for a premium tax credit or subsidy? Individuals with low and moderate incomes may be eligible for an upfront premium tax credit (subsidy) only when purchasing insurance through the Marketplace Premium tax credits (subsidies) are based on the lowest cost Silver Plan in the state Since Penn State plan is not a Marketplace plan, it does not qualify for subsidies, BUT Marketplace plans can still be more expensive or may cover less of your costs or may not allow you to see as many doctors in the State College area

9 How are international students affected by the ACA? In 2016, international students can continue to enroll in Penn State s Student Health Insurance Plan International students can still demonstrate comparable insurance coverage and be granted a waiver out of the Penn State plan. The ACA exchanges may provide an option Discuss with someone familiar with immigration and tax law. Make sure the plan meets the Penn State waiver requirements and any requirements from their visa.

10 I m a U.S. citizen from another state. What if I am not a Pennsylvania resident? If you choose coverage from an ACA Marketplace plan, parent plan or Medicaid plan in your home state, make sure you compare or ask about the following: Coverage for providers in the State College area Coverage for University Health Services providers Penn State plan covers State College and UHS providers very well. Since Aetna is a national health insurer, they may also provide coverage for some of your providers at home

11 What is the penalty if I do not enroll in a health insurance plan? In 2016 the penalty is the greater of the following two amounts (capped at a maximum of $2,085) 2.5% of your total household adjusted gross income, or $695 per adult and $ per child These are, of course, on top of any health care costs you will have to pay on your own

12 What are Young Invincible Plans? Young Invincible Plans are catastrophic plans available to people under age 30 Designed for healthy young people who do not anticipate needing many health services. Typically have very low premiums With the exception of the three annual primary care visits, you will be responsible for the full cost of all health services up to the deductible amount There are no subsidies or tax credits available for Young Invincible Plans

13 Where can I get more information? For more info on the exchanges and subsidies, go to For more info on the Penn State student health insurance plan go to The Young Invincibles web site provides some good information for students and they also provided a guide for students: Toolkit_Helping-Students-Understand-Health-Care-Reform-and-Enrollin-Health-Insurance.pdf NAFSA, an association of international educators, provides resources for international students and scholars: The American College Health Association provides resources on how ACA is impacting student health insurance: The U.S. Government also issued a toolkit for colleges and universities that has helpful information for students:

14 PPACA, Penn State and Future Issues PPACA will continue to impact health insurance for graduate students. Penn State will try to address in several ways: Beginning in 2017, Penn State will have a universal health insurance coverage requirement with a hard waiver for all full-time domestic and international graduate students Hard waiver requires students to provide proof of insurance coverage that matches what the Penn State student plan provides Advantages of this approach include: Ability to negotiate best price with insurers Protection for students from insurers who misrepresent coverage Encourages students to investigate and discuss options early Minimize catastrophic losses that jeopardize students

15 PPACA and Future Issues PPACA will continue to impact health insurance for graduate students. Some universities have decided to stop offering student health insurance at all. Some universities have created multiple student plans. For example, one for graduate assistants, one for international students, one for other graduate students. Some universities self-fund their student health insurance. This could give Penn State and its graduate students greater flexibility, but it is not allowed by Pennsylvania law. Some benefits consultants have questioned whether university subsidies for graduate assistant health insurance coverage violates PPACA rules. Penn State is studying the issues and solutions. Students have a voice in these issues through the Student Insurance Advisory Board and GPSA Get involved.