Making plans for student health

Dr. Tracy Soska holds up an Enroll America T-Shirt. Courtesy of Alescia Teel

When making a back-to-school checklist for this fall, don’t forget to add health insurance.

This academic year, the U.S. Department of Health and Human Services is increasing outreach for Marketplace insurance enrollment through healthcare.gov, centering its efforts on a group that is more likely to be uninsured ––  healthy, young adults. To prepare for open enrollment in November, HHS is using email and Lyft to cater to their new audience.

According to HHS, young adults are two times more likely to enroll in response to email outreach than older individuals. New functionalities will allow HHS to send emails to consumers automatically.

For example, once a consumer creates an account, they will immediately receive an email about how to enroll. Other emails include information about financial assistance, which HHS found during 2016 open enrollment leads to more people actively renewing their coverage.

HHS will also begin partnering with Lyft to promote enrollment deadlines to drivers and to develop discounts for customers using the ride-sharing service to attend enrollment and informational events.

At Pitt, though, students wanting in-person help about the Health Insurance Marketplace don’t have to look further than the Cathedral of Learning.

Since 2013, Tracy Soska, a professor of social work at Pitt, has been collaborating with national non-profit Enroll America, an independent, nonprofit, nonpartisan organization based in Washington D.C., working to maximize the number of people with health coverage under the Affordable Care Act.

Soska and EA host information and enrollment sessions about the Health Insurance Marketplace and Medicaid on campus.  At these events, students, staff and members of the community can learn about their health insurance options and possibly enroll on-site.

According to the Center for Medicare and Medicaid Services, young adults age 19 to 25 have the highest rate of being uninsured — about 30 percent — and the lowest rate of access to employer-provided insurance of any age group.

The 2010 Affordable Care Act aims to lessen the financial burden of health insurance premiums by expanding Medicaid, providing subsidies to offset premium cost and offering low-premium plans through the Health Insurance Marketplace.

Pennsylvania didn’t implement the ACA’s mandated Medicaid expansion until last year, shortly after Gov. Tom Wolf took office.

To promote health insurance access, the ACA also made policy changes in 2010, such as allowing people to remain on a parent’s health insurance plan well into their 20s and outlawing the practice of denying coverage or inflating rates due to a pre-existing condition.

Soska aims to help students navigate their options for getting insured, because acknowledging the best choice is highly individual.

We believe in the importance of health care for people and making sure people are aware of resources that help them in their lives,” Soska said.

Since the enactment of the ACA, Marian Vanek, director of Student Health Service at Pitt, has observed an uptick in students staying on their parent’s insurance. She views this as a positive thing because she has seen the importance of stable health insurance firsthand.

Illness and injury can always occur, Vanek said, and health insurance coverage is vital.

SHS saw 32,286 students in the last school year, according to Joe Miksch, Pitt spokesperson.

SHS provides services from basic primary care to nutritional counseling and health and wellness services, to name a few. Students may also benefit from the full-service pharmacy and health education programs. SHS accepts most insurance plans and subsidizes the cost of office visits for uninsured students, although they may have to pay out-of-pocket for lab work.

Pitt students have come to the Wellness Center with anything from appendicitis and collapsed lungs to head injuries, Vanek said.

Unfortunately even young and healthy people can have illnesses and injuries which may require an emergency room evaluation with appropriate testing and even hospitalization,” Vanek said.

Young people are among the most likely to end up in the ER. The Centers for Disease Control and Prevention estimated 21 percent of people age 18 to 24 used the ER in 2014. That rate drops to 18 percent for those age 25 to 65.

According to a 2013 study by the National Institutes of Health, the median cost of an ER visit is $1,233. The Kaiser Family Foundation reports that each night spent in a hospital costs about $2,000, and surgery can cost more than 10 times that.

Only 33 percent of patients paying out-of-pocket successfully negotiated a discount with the hospital. For people without health insurance, 53 percent said they have trouble paying their medical bills and 45 percent said medical bills had a major impact on their families, KFF reported in January.

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EA started as a national initiative born from the ACA and targeted states who weren’t participating yet, Soska said.

According to Soska, the partnership between EA and Pitt is  natural because both share the goal of promoting health care and making sure people are aware of available resources.

Sean Murphy, regional organizing lead for EA, and Soska have been working to organize information sessions at the Cathedral since March 2014. With Medicaid being fully expanded by spring 2015, volunteers at the sessions are now able to help those that are eligible for Medicaid as well as the Marketplace.

At these information sessions, participants learn about health insurance coverage options, including Medicaid, state subsidies and various plans offered through the Health Insurance Marketplace. Participants can also enroll on-site. Health care navigators or certified application counselors are at the sessions for anyone needing guidance.

According to Murphy, he and Soska mostly steer attendees toward the Marketplace.

“Past events have been busy,” Murphy said. “Attendees have been students who are about to graduate and learning about their options or graduated students looking into their options now that they are without a health care plan.”

Recent and soon-to-be alums are not the only individuals attending these enrollment sessions — part-time students, graduate students, contract employees at Pitt and people in the community also turn up.

Soska said he markets the sessions within the University, and EA markets more generally to the people of Pittsburgh.

“We do events all over Pittsburgh and Allegheny county, but we can get people that live a half hour away to willingly drive to campus.” Murphy said. “The Cathedral of Learning is a rare, unique location that people want to go to because it’s a fun experience to be on campus.”

Upcoming information sessions will occur Nov. 15, Dec. 7 and Jan. 17, in room 2017 of the Cathedral, from noon to 6 p.m.

In addition to the Cathedral, enrollment sessions are held at the Downtown YWCA, Consumer Health Coalition on the North Side and East Liberty Family Health Care Center.

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Young people choose plans that fit their needs. Typically they will have the option of lower cost plans because they do not have pre-existing health conditions. Younger students who do have pre-existing conditions may also have the option to participate in state health insurance targeting juveniles.

Given the childish-sounding name, first-years may not realize they qualify for the State Children’s Health Insurance Program, which offers sliding-scale premiums — based solely on household size and income — to individuals 19 years and younger.

Another option students may not be aware of is to remain on a parent’s plan throughout college and beyond.

Under the ACA, children are allowed to remain on a parent’s plan until age 26. For Pennsylvania-based employers, that cutoff is extended until age 30, as long as the child remains unmarried, has no dependents and either lives in Pennsylvania or is enrolled as a full-time student. Those studying in another state can still participate, but may be out of network for PA-based plans.

In addition to the options ACA provides, full-time undergraduates and graduate students are eligible to purchase coverage from Pitt, and the University gives graduate students with an academic appointment — such as teaching assistants and graduate student researchers — free health insurance. Students can enroll through my.pitt.edu.

Currently, 4,500 Pitt students hold University-sponsored health insurance, Miksch said. That’s about 16 percent of the student body.

The monthly premium for the UPMC General Student Medical Plan — geared toward undergraduates and graduate students without an academic appointment — costs $205.80 for an individual and $1,726.17 for a family. The UPMC Graduate Student Medical Plan costs $344.32 for an individual and $730.27 for a family.

Both plans offer 100 percent coverage for participating providers with zero deductible and co-pays ranging from $0 for preventative care to $75 for ER visits. Coverage is similar for the General Student and Graduate Student plans. The key difference is eligibility.  

In contrast, Marketplace plans with premiums comparable to the General Student Plan can have either higher co-pays — up to $600 for an ER visit on a $0 deductible plan — or higher deductibles — up to $6,500 for a plan with low co-pays. The deductible is the amount paid out-of-pocket before insurance kicks in.

According to Pitt’s benefit office, regardless of when the student graduates he or she could maintain coverage through August when the new billing cycle starts.

Predoctoral fellows have the chance to extend insurance coverage after graduation through the Consolidated Omnibus Budget Reconciliation Act of 1985, a general federal program that allows employees to pay for continuing coverage through an employer after leaving their job.

According to Alescia Teel, Pennsylvania deputy state director with EA, students should be aware of circumstances that allow immediate enrollment.

Anyone can enroll with Medicaid or through the Health Insurance Marketplace during the open enrollment period Nov. 1, 2016 to Jan. 31, 2017, Teel said. Special circumstances — change of employment or marital status, birth of a child, graduating or moving to a new state — allow a person to enroll immediately at any time of the year.

Like the Marketplace, Pitt also offers special enrollment year-round for students who qualify to make a change in their plan outside of open enrollment in August, according to the benefits office.

“It’s a life-changing opportunity to have health care,” Teel said. “For people who are leaving with a graduate degree, have a family or a sick child, you have access to quality health care. There’s no price [tag] on that.”

According to Teel, that price tag may not be as high as people assume.

“The great news is that in Pennsylvania, four out of five residents are receiving financial help to pay for the cost of their premiums,” Teel said. “Most people are receiving financial help which is putting health care within reach for most people.”

Under Pennsylvania’s Medicaid expansion program, those earning below 138 percent of the federal poverty level — which currently equates to about $16,000 per year for a single person or about $34,000 for a family of four  — qualify for subsidized health insurance, Teel said.

Stipends, fellowships and scholarships are not counted as income under Pennsylvania tax law, so graduate students who do not receive health insurance through Pitt are likely to qualify for Medicaid. Undergraduates whose parents don’t receive employer-provided health insurance may also qualify.

When deciding where to apply, it’s important to consider tax-filing status. According to the Marketplace website, subsidies are paid out as tax credits, so a person must file their own tax return in order to claim the rebate.

Although the cost of insurance can be extremely affordable, Vanek said, all students should research health insurance very carefully because plans with cheap premiums may end up costing more in the long run.

“In my experience,” Vanek said, “if a plan seems like a great deal, it probably will not cover much, leaving you to pay out-of-pocket.”

Not only is the ACA aimed at getting more people insured by lowering cost, but it also imposes a penalty for being uninsured.  

In 2016 the annual fine is $695 per uninsured adult and $347.50 per uninsured child, or 2.5 percent of household income — whichever is greater. What the ACA does is to make health insurance required under law, Teel said, and in many cases the fine is more costly than getting covered.

“The cost of the fine might not be your only worries,” Teel said. “The average emergency room bill for something as small as a sprained ankle is $1,018 — or 156 Chipotle chicken burritos — and a broken arm, on average, costs $7,500.”

According to Soska, despite the ACA’s fine for not being covered and the act’s provisions for expanded access, people are still falling through the cracks of health care coverage.

“There’s always people in that gap,” Soska said. ”From the social work school we make these resources available to meet people’s needs.”

To apply for Medicaid directly, go to the state website www.compass.state.pa.us. For a person who does not meet the Medicaid income criteria it is best to use the Marketplace, www.health care.gov

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