Health Insurance for Teens and Young Adults
I'm sharing our experience with our 21-yr old because I think there may be other families with this situation. Our soon-to-graduate daughter comes off our health insurance the day she graduates. She doesn't have a job that has health insurance, so we applied for an individual Kaiser policy. The questionnaire was lengthy but gave virtually no room to explain. Long story short, she was denied coverage. The decline cited ''serious medication'' and ''alcohol consumption'' as reasons. She was prescribed a small dose of Trazodone for temporary insomnia - at the time I was distressed to hear this because I know that it is more commonly prescribed for depression. Her alcohol consumption is probably below average for a student at a school with a party reputation, and with perfect attendance and a 3.65 GPA, and two internships I don't think she has a substance abuse problem. We will appeal the decision and can COBRA if needed - but I'm wondering whether other families have had a similar experience? In hindsight, we would get a note from the dr. re the reason for the prescription, and we would have attempted to come in under the established drinking limit, but a six-pack a week is not excessive in my opinion. Still hoping for health care reform - Concerned parent
The new health insurance laws recently passed by Congress will solve this problem. Children will be covered past college graduation. A few weeks ago the SF Chronicle Business section had an article about how these new laws will affect college graduates and you should search for this article on sfgate.com. You should also ask your company's HR department about when the new law is to be implemented for your work health insurance plan. What I remember from the article is that some companies were implementing it immediately (so your 21-year-old would immediately be covered in that case) whereas others were implementing it when the new health insurance contract came into effect yearly for each company (which might be October 2010 or January 2011, depending on the company). Your company must comply and cover your child but it may not start right away. Ask! Also, if your student had health coverage at the college attended, usually this runs through the summer after graduation (check on this).
It is highly annoying that health insurance companies refuse to offer coverage because of pre-existing conditions or behaviors that they see linked to increased use of health care services. I don't know if you can get around this on appeal since they may be allowed to rule out people based on these factors which may increase risk. If your child can stay on your health insurance plan for a few more years, this would be of great benefit. She can also reduce the behaviors that they used to judge her as ineligible, so a few years from now her background might pass their review. Good luck! And be thankful that Congress passed health care reform. Anonymous
assuming you still have health insurance coverage, your daughter might still be covered. i believe the new health care legislation mandates that children up to the age of 26, regardless of dependent or marital status, can receive coverage under their parents' insurance. not sure if it's employer dependent, by my employer just sent out a notice to all employees advising us that this is now in effect. good luck! Andrea
if your daughter had school sponsored health plan... that stinks! the day she graduates? If you have Kaiser now, Kaiser has generously implemented the 26 year age limit kids of family plans as of June 1, ahead of the new national standard (i don't work for Kaiser btw)
I'm wondering if there are any parents out there whose child has gone to UC Santa Cruz (or to any UC for that matter) and what you did about the health insurance question? My daughter is going to UCSC next year. I have health insurance through my job for both of us. We have good coverage including mental health benefits (which is a particular concern as she takes an anti-depressant medication), vision and dental. I am not going to take her off my insurance and substitute the UCSC insurance. I really want her to be able to get immediate care on-site and also have access to the mental health services on campus if she needs them. I was thinking of signing up for CruzCare (which they say is good for students who are already insured). Does anyone have experience with this? How has it worked out? Any other tips would be accepted gratefully! Thanks in advance! anon mom
You may have already done this, but have you checked with your current insurer to see if she can stay on your insurance and use doctors in Santa Cruz? I went through this kind of research a year ago, when my daughter went off to college, and found out that within CA my daughter could stay on our plan and just choose a different primary care doctor. I realize this varies from plan to plan. We have the Blue Cross HMO. What I also found out at the time was that Blue Cross has a little publicized agreement with Blue Cross providers in other states, so even though my daughter ended up going to school out of state, she was able to stay on our plan and switch to a ''guest membership'' in the state where her college is, but still use doctors here whenever she's home. anon
There is an option - read the website as well as the brochure. Do not hesitate to call Health Services and/or email them. We provided proof of insurance, and we have a modified coverage so our student can go to Campus Health but is covered for emergency treatment or local doctor's visit with our coverage. Your coverage is most likely better than the college's. If you drop your insurance there may be problems getting it back or a time gap. What are you going to do during breaks and summer? What if you student leaves in the middle of a quarter because of a serious illness? Serious illness is one of the main reasons one has health insurance. On the other hand if you loose your health coverage it is great to have the option to use the University Student Health Insuarance, and many people do not have family coverage. UCSC parent
When my son was at UCSC, even though he remained covered through my Healthnet and we could have switched his primary care physician to someone in Santa Cruz, we paid the extra so that he could have easy access to health care on campus. He used it a fair amount and we felt that it was money well spent. Parent of UCSC grad
It's looking likely that my daughter will be going to college out-of-state next year. I just learned today that our medical insurance, through my employer, will cover her in California, only. It will cover her for emergencies outside of CA, but even that might be dicey, I suppose, if she's really living out of state full time. I'm sure some of you have been through this and can offer some advice. Do I take her off of my medical plan and sign her up for medical insurance through the university? It's expensive! Should I pay out of pocket for little things that might come up while she's away and keep her on my current plan (Blue Cross HMO) for emergencies? Thanks for any advice you can offer. Soon to be Mom of a college student
Check to see if your Blue Cross HMO has any providers (doctors, hospitals, etc.) under contract in the area where your child will be going to school. If the number is limited or nonexistent, then the coverage (your current coverage) will be of little value to your child while she is in school. Check the school's plan to see if it is a comprehensive plan. If it is, it might be better to have your child insured under that plan, but make sure that she will be covered outside of the school year and in her home area as well as the area where she goes to school. If you have additional questions, feel free to e-mail me directly. Robert
My son turned 23 and was taken off his health insurance. I contacted Jean Sturges, a health insurance agent I found through this web site. She recommended a Health Net plan that costs $51 per month and has a 25% deductible for each visit up to $1500 per year. He can get a physical for free, I think, according to her. The plan only covers a few generic medications and does not cover birth control or pregnancy for girls. He got the plan by answering no to every question-- I would have put a few minor things down but she encouraged us not to list them. He is on no medications, has no health problems, eats a healthy diet and exercizes regularly. anon
It really depends on how much of a gambler you are--will your child get sick at college or not? I don't think any of us can predict that, and I've heard lots of stories of students getting sick or injured at college. Plus, most students do not have cars or know how to look for a new doctor in a new town, especially if they're sick. I think it's important that children are insured so that they can immediately seek medical treatment if needed, in a convenient way. Your choices are to opt for the college insurance (that's the way I'd go) or to take out an individual policy for your child. Blue Cross, Atena, Blue Shield all offer individual policies; the problem is these policies often have high deductibles. I would think that the last thing to skimp on would be health insurance for your child. Anonymous
We have kept our daughter on our medical plan and, in addition, purchased the (in-state) university's student medical plan. If she used our plan at school, she would have to travel a substantial distance to see a doctor (and she doesn't have a car). The school has a clinic on-site. In almost two years (she is a sophomore) she has only gone to the clinic once. During winter quarter this year she got sick and couldn't shake a fever for a few days. Going to the on-campus clinic enabled her to get a doctor's slip which meant some of her assignment due dates could be delayed because she was so sick. susan
We have Kaiser and this is how we've handled it. Ours attends college in Chicago. We fly her home for occasional weekends when it makes sense to use the medical facilities we pay for here----she notifies her profs in advance of missing a Friday or a Monday because she's here for a 3 day weekend, using the weekday to see dentist, dermatology, lab work, primary physician, orthodontist (lost her retainer), whatever. For illnesses when she's back in Chicago, such as repeated strep throat last year, she went to the emergency room and unfortunately missed classes in order to sit there for several hours to be seen by a doctor. Just like your coverage, Kaiser only covers E.R. and Urgent Care outside their contract territories. Pharmacy: she mailed us her receipts and I forwarded them to Kaiser Claims.
Follow-up care after emergency room: she went to Urgent Care (sometimes called Immediate Care), which is covered, and got medical attention there--- follow-up and pharmacy. The biggest headache has been simply to get the kid to remember to fill out the Kaiser Claims address instead of our address (especially pharmacy, because there were so many items---in the end, Kaiser reimbursed us totally for all except the co-pay---I love Kaiser). I think we finally have it down, now---it takes awhile to work out the kinks/problems that arise in each situation. It would've gone a lot smoother initially if our student had kept a copy of the Claims address handy on her person at all times. I got sick of dealing with Kaiser Claims all the time--it takes 1/2 yr to get these things straightened out. Another note: she was hit by a car on her bicycle last year and there were a lot of expenses attached to that, including follow-up physical therapy. Of course, we couldn't fly her out here for that every week, so we had to pay for that ourselves---however, our insurance policy (hit by a car) covered her expenses generously, so we ended up making claims against our own policy for that major item. Good luck. It's not over when they go off to college.
Our 22 year is in college in the east and needs to buy private health insurance. Her permanent address is in CA. She wants a plan with a choice of doctors which also reimburses for medical care in other states. Does anyone have any suggestions, referrals?? Thanks. Jane
We've had some experience with medical insurance and coverage with kids in college. Our son was covered both through his college health insurance, which was HMO-style, pretty inexpensive and convenient with a clinic on campus, and through our family's policy. He was participating in a very strenuous sports program and had two episodes of difficulty breathing, blacking out, memory lapse. His coach urged him to seek medical care, which he did through the on-campus clinic. The clinic medical staff who saw him in a non-stress physical situation decided there was no problem, that he was likely just hyperventilating and getting too much oxygen; they told him to wear a mask during workouts to keep the blood oxygen level from getting too high. His coach said, ''See a real doctor.''
Unfortunately since the college medical plan was HMO style he needed a referral in order to see someone more skilled in sports medicine, and they felt they had diagnosed and dealt with his problem adequately. We would have had to personally intervene from a distance to navigate through the bureaucracy and appeal to get further up the chain of expertise.
Instead we decided to use our family's health insurance and were able to get him seen quickly by the renowned sports medicine staff which, ironically, is affiliated with the university our son attends. Our sense of urgency was spurred by the fact that our son was still participating in his sport and they were in midseason, and we felt the cause of his collapses needed to be addressed immediately for his own safety.
The sports medicine facility was great and were able to quickly determine the cause of his problem, which turned out to be a heart defect, and referred him to a cardiologist. Had we not had our own more flexible insurance we would have had to go through a cumbersome and time-consuming negotiation with the HMO structure and wouldn't have known the cause of the problem until after the sports season ended.
Our conclusion is that the college coverage was convenient and cheap, but maintaining our son on our family coverage was very worthwhile. And we would never have him go without health insurance of some kind in any event; it's way too risky. sb
I'm curious about how families deal with the medical insurance issue for college-aged students when their children have chronic health issues. My daughter has diabetes and if I understand it correctly, our options are not great. I would love to hear from others if I'm wrong about this. The way it seems to me is:
1)If I keep her on my plan and she chooses to go to school out of the area, she will not have convenient access to her regular doctors, and most university health clinics are not set up to deal with the specialized care diabetics require.
(2)If we select the university health insurance, it is viewed as the primary, in which case my health coverage wouldn't be utilized to its full advantage.
I also wonder if she switches to the school's plan, if she (1) would be covered during the summers and (2) would she be barred from being reinsured under my plan if the school plan doesn't work out? I've been told that if they're dropped from the parent's plan that they can't get back on. I've also been told that if she is unable to find a job immediately following graduation and loses health coverage that her diabetes becomes a pre-existing condition that insurance companies can discriminate against, thus the importance of Cobra and/or HIPPA.
I would love to hear words of advice from other parents who've dealt with this already. Thanks. anonymous
My daughter will be graduating from college in June 2007. Because she took a year off prior to college, she will be 23 when she graduates - just the age where she ceases to be covered by our health insurance (Health Net). She is not certain what she'll be doing after graduation, but as she is planning to take some time off prior to going to grad school, I am not assuming that she will have a job which immediately insures her. Our insurance provides a kind of interim coverage (Cobra) for 18-36 months after you go off the family policy, but it costs over $300/month. Before my daughter and I start researching other health insurance possibilities, I wanted to ask if anyone else had suggestions to guide us. Thanks much! Kathy
My son turned 23 last November, just before he was graduating college. He then came back to the Bay Area to do an internship which is basically unpaid, without health insurance of course. The Cobra would have cost in excess of $300/mo, as you found. We have HealthNet. I went to the Kaiser website and found a policy where we pay $110/month plus a $50 copayment on each visit. It covers health, dental, and vision. There's a yearly total deductable, which is fairly high but not as high as a couple days in the hospital. So we picked that. He has been to the doc once in the last year for a checkup, which cost around $200 plus the co-payment. He was happy with the experience and I'm happy he's insured and I'm not paying $300 month! By the way, you only have a small window of time to sign up for a new policy once they turn 23, so you need to stay on top of that. Otherwise they are considered uninsured and it costs more and is more of a hassle Ginger
We've had the same questions for our 19 yr. old son who is currently choosing not to continue in college after his 1st yr, and does not yet have a job (and many low-paying jobs he may be able to get would not provide health insurance in any case). If he is not a full time student our insurance does not cover him. I called Kaiser & Blue Cross. Both have plans in the $150 per month range (for a 19 yr old male). The one recommended did NOT cover pregnancy, so that may be a question to ask (just in case). I was told that he would NOT be required to get a health exam...just needed to sign up. Good luck in the same boat
There are so many options and information for your 23 year old. Be sure to look at Short Term as an option if your pretty sure she will get a job with coverage. Or look at a more standard plan which can cover her at a very reasonalbe cost if she/he does not have any heatlh issues. I do not recommend letting your COBRA go until you are sure she is eligible (which is based on the persons heatlh, what and how many medications and weight) for the individual plan. I have been an insurance field for 30+ years and help a lot of people learn the facts of their options to decide which overage best meets their needs financially and by plan design. I would be happy to help. Call me at 800- 222-BLUE or 510 881-4900 for help. There is never any added cost going through an agent and we can help with rates and claims and any renewals. Good luck. Also watch out for plans with no maternity. They are lower in cost but you always need to be sure of the risk when we deal with young ladies Sharon
Usually the only options for this situation are COBRA or an individual policy with a high deductible (e.g. catastrophic coverage). Once in a while there is an organization that provides group coverage to members, but usually these policies don't last very long. Claudia
We signed our daughter up for a Blue Cross individual policy. It's $75 a month, has a copay for office visits, etc but since she is relatively healthy we think it'll be fine until she gets her own insurance. karen
My daughter is going to college on the east coast next fall. The college offers a health insurance plan for $2500 that covers everything. She now has Kaiser which will only cover emergency room visits when the student is out of the plan area. The college has a mandetory health service fee of $275 that provides doc visits but no drug coverage, lab work or xrays. There may be other kinds of independent student health insurance that would also work,but it likely has a high deducitble, like $2500. Any experience out there with this question? Your info will be greatly appreciated. Thank you. janet
for the parent asking about health insurance in college...as a 19 year old university of chicago student, i learned this year that whenever you go into the health center, they pressure you to get the school insurance and make it seem like you'd be charged less if you had it. however, it's vastly overpriced, and hopefully your kid won't be spending too much time in the clinic. don't give in! you're paying the school more than enough already not-too-sick college student
Our daughter's new school (Sarah Lawrence) offers a $1400 plan. The school says that the plan covers all local docs, including mental health -- and that without the plan, student must sometimes return home for medical care if they are injured or need extra mental health help. We've heard that my husband's company (Home Depot) offers a low-cost plan that works out of state, but have yet to check it out. I'll be interested in hearing more about what you learn MS
Health insurance is such a thorny issue. Neither of my kids went very far from home so I know our experience doesn't fit exactly. However, for the record...
My son attended UCSC and was covered by our HealthNet plan. However, we did go ahead and pay for the student health insurance plan for him. He was our first and we thought it would be easier for him to navigate the system if he just knew he was covered. For approximately $55 a month he got: ''worldwide, year-round coverage, hospitalization, off-campus care with specialists and other services (e.g.; physical therapy, chiropractic and acupuncture), pharmacy, x-rays and lab services, up to $250,000 per calendar year, 85% coverage for in-network charges, $3000 out of pocket maximum, $200 deductible.''
What did he use? I probably don't know all of his visits but I remember that he had a bad cold/sore throat that I think he went for in his freshman year. He also injured his shoulder and saw someone about that. In his soph or junior year he decided to get accutane for acne that had bothered him for several years and the plan covered that drug and the accompanying visits and bloodwork.
My daughter is finishing her second year at UCD. We applied for the waiver for her (the plan at Davis costs about $250/quarter). The UCD health center is open to all students (whether or not they are enrolled in the student health insurance plan) and charges small ''deductibles'' for all services. She has used the women's health care services but has filled prescriptions through our HealthNet at the Walgreens in Davis.
$2500 does seem a bit steep. You can probably safely assume that all she'll need is the occasional drs. visit and perhaps birth control ;-) . It sounds like the $275 will cover the visits, generic drugs are relatively cheap (and that's usually all the plans will cover anyway!), and sounds like Kaiser would cover a trip to the emergency room where she would probably end up for x-rays. The beauty of a plan that covers everything is that it allows them to be totally independent of you in managing their own health care. Sally
Both my kids are at school back east (college and grad school) and have full health insurance at their institutions. One was diagnosed with a chronic illness several months ago and required emergency surgery, plus a follow-up surgery and several hospitalizations. The total cost of that episode was approximately $75,000. We paid more for plane tickets back and forth than out-of-pocket for the medical care. The other was taken by ambulance to the emergency room in the fall. Thanks to the comprehensive coverage, we were spared additional anxiety and expense.
One hopes that young people will be spared health problems but there are unforeseen events. Insurance is a gamble and finances are certainly a consideration but in our case, choosing the more expensive option turned out to be a wise move Anonymous
My daughter is 23 and on an expensive Cobra health policy. Since she has a pre-existing condition (asthma), I'm concerned that she might be uninsurable. She just graduated from college and will be job hunting. I suspect she wont be looking for jobs that provide health coverage. I could really use some advice on how to approach this. Any suggestions on specific health policies that might work? Thanks. Concerned Parent
I was in a similar position years ago (except for the asthma). I was paying for a Cobra plan, and when I called the insurance company about a personal policy, it turned out to be about 1/3 as expensive. So I switched as soon as I could.
Have your daughter check with the insurance company she has now through Cobra about an individual policy. Since they should know about her pre-existing condition already, they might not make a big deal about swithing her to a personal plan.
It that doesn't work, there is HIPAA. State law says every insurance company has to offer a plan that basically anyone can sign up for. Of course it's going to be pricy, maybe more than the Cobra coverage.