Estudiantes

La mayoría de los estudiantes, a menos que califiquen para una exención, tendrán que contratar un seguro de salud o estarán sujetos a una multa de impuestos.

A student may be eligible for an exemption, for example, if a student does not file taxes because they are below the tax filing threshold.

Planes de salud para estudiantes y la Ley del Cuidado de Salud a Bajo Precio

A “student health plan” refers to a special policy of health insurance that colleges and universities make available to their enrolled students. Typically, the student health plan is different from the plans that colleges and universities offer their faculty and staff.

Student health plans count as health insurance under the Affordable Care Act. Therefore, for the months consumers are enrolled in student health insurance, they will not have to pay a penalty.

If students have a “fully insured” student health plan, that plan does have to cover all 10 essential benefits (the services that all health insurance plans through Covered California cover), including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and services for children, including dental and vision care. Generally, fully insured plans must also offer contraceptives without cost-sharing (meaning no copays, etc.). A fully insured plan is one that your college or university purchases from a health insurance company.

Sin embargo, si el plan de salud para estudiantes es “autoasegurado”, es posible que no sea necesario que cubra los beneficios esenciales de salud. Los consumidores deben consultar a su universidad y averiguar qué tipo de plan de salud para estudiantes ofrece.

Covered California for Students

Students can opt out of their student health plans and purchase health insurance through Covered California. Depending on income, students may receive tax credits to help pay for a private health plan through Covered California or receive low- or no-cost insurance through Medi-Cal.

If, however, students accept and enroll in the school’s health insurance plan, they will not be eligible for financial help through Covered California while they are covered by their school’s plan. When students are considering whether to enroll in their school’s health insurance plan or a health plan through Covered California, they should consider the location of clinics and doctors and the costs of accessing services.

Planes de cobertura mínima

If students are under 30, they may be able to buy an additional health insurance plan option called a minimum coverage plan (also known as a catastrophic plan). These minimum coverage plans usually have lower monthly premiums and mostly protect consumers from worst-case scenarios. Catastrophic plans through Covered California cover three doctor visits or urgent care visits, including outpatient mental health and substance use visits, with no out-of-pocket costs, and free preventive care. All other services will be full price but at the negotiated in-network price, until an individual spends $9,450, after which all in-network services are covered at 100 percent.

Planes de salud para estudiantes y planes de salud para padres

For a Covered California health plan, as long as students are a tax dependent of their parent(s) or under the age of 26, their eligibility for student health coverage does not make them ineligible to be covered on their parent’s family health insurance plan.

Al tomar esta decisión, los estudiantes deben considerar la red de cobertura de seguro de sus padres. Si los estudiantes asisten a una escuela que está lejos de la casa de sus padres, es posible que su seguro médico no cubra los servicios médicos que se les brindan mientras están fuera de la escuela. Los estudiantes deben hablar con el plan de seguro médico de sus padres para obtener más información. Si un estudiante va a estudiar fuera del estado de California, solo podrían cubrirse los servicios de urgencia mediante un plan de seguro de salud de Covered California. No se cubrirán los servicios que no sean de emergencia recibidos fuera del estado de California.

If students are claimed as a dependent on their parent’s taxes and choose to opt out of their student health insurance, their parent’s Covered California family plan would still be eligible for tax credits. Additionally, if students choose to stay or accept their student health plan, their parents would still be eligible for tax credits through Covered California, if otherwise eligible. However, parents must correctly state on their application that although their child (the student) is a tax dependent, they are not seeking health coverage through their (the parents’) Covered California health plan.

Sin embargo, un estudiante que esté considerando renunciar a su plan de salud estudiantil para acceder a un plan familiar a través de Covered California debe tener en cuenta la red de cobertura. Si la escuela a la que asiste está lejos de la casa de los padres, es posible que el seguro de salud de los padres no cubra los servicios médicos mientras el estudiante está en la escuela. Los estudiantes que estén considerando esta opción deben hablar con el plan de seguro de salud de sus padres para obtener más información.

Si los estudiantes son dependientes fiscales, pueden estar cubiertos por el plan de salud de Covered California de sus padres, independientemente de dónde vivan. Sin embargo, Covered California no ofrece en este momento ningún producto de plan de salud que cuente con una red de médicos, hospitales u otros proveedores de atención de salud fuera de California. Por lo tanto, si la escuela a la que asiste el estudiante está fuera del estado, el seguro de salud de los padres no cubrirá la mayoría de los servicios médicos mientras el estudiante esté fuera en la escuela. La excepción es que todos los servicios de urgencia deben estar cubiertos al precio dentro de la red, aunque el servicio se haya recibido fuera del estado. Los estudiantes que consideren esta opción deben hablar con los planes de seguro de salud de sus padres para obtener más información.