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Volume CXXXII, Number 20 |
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Graduate insurance
JEFF BENSON, M.D.
Dear Dr. Jeff: Did you happen to see that piece in Newsweek in January, about students needing health insurance after graduation? Any suggestions? T.W.
Dear T.W.: As Commencement draws near, that Newsweek article does seem
timely. As the author, Linda Stern, pointed out, most family plans no
longer cover children after they turn 18, if they're not full-time students.
And most plans then drop them altogether at age 21 or 22, whether they've
finished school or not. This leaves very large numbers of young adults
without health insurance coverage. In fact, roughly one in three Americans
aged 19 to 29 have no health insurance. Most have finished school, are
too old to be covered by their parents' policy, and haven't yet found
a job that offers health insurance benefits.
Men and women in this age group have very definite preventive health care
needs, as well as unforeseen, unpredictable, and often very costly acute
care needs.
Here at Bowdoin, all students have very comprehensive health care coverage, which assures them access to all of the preventive and acute care services they might need. Unfortunately, for graduating seniors, that coverage ends September 1st, 2003.
If you're not covered by your parents' plan, if you're not going to graduate school or starting a job with health insurance benefits, what are your options?
The Newsweek piece mentioned COBRA, the federal program which allows up to three years of continuing coverage. COBRA coverage is quite expensive, though, and filled with rules and restrictions. If the coverage you're extending is HMO-based, for instance, you'll have to follow all of the HMO rules and procedures and then some. This can become very problematic if you've moved away from your HMO "home base."
Various commercial short-term policies are available, and offer a variety of plans, with different deductibles, coinsurance limits, HMO restrictions, and of course, costs. Anthem (Blue Cross-Blue Shield) offers a range of plans, renewable monthly. Your premium is based on your deductible (the amount you'll pay up front before the coverage kicks in), your coinsurance (basically co-payment), your maximum out-of-pocket limit (basically deductible + coinsurance beyond which you're covered 100 percent, up to some lifetime limit), and breadth of coverage (e.g. HMO versus "whatever you like," low coinsurance for preventive care versus low deductible for emergency care, or low cost generic drug prices versus low deductible on all medications.) Anthem plan deductibles start at $250 and go up to $1,500. Coinsurance rates range from 20 percent to 40 percent of covered expenses, and lifetime limits are $1 to 2 million.
It's confusing!! Take a look at Anthem's website (http://www.anthem.com/), click on "Consumers" and then "Maine," and then play with some of the options on the "Get a rate quote" page.
Another insurance company, Fortis (http://www.studentresources.net/), offers temporary health insurance coverage that seems easier to figure out and certainly seems less expensive. All you have to do is choose a deductible (from $250 - $2,500) and either monthly premiums or a one-time, up-front payment (much cheaper, of course). Then for 30 to 185 days, after you meet your deductible, they'll cover 80 percent of the costs of medical expenses up to $5,000, and after that, 100 percent of expenses up to $2 million. The catch is that these policies are limited to six months coverage, and are essentially unrenewable after that.
Both Anthem and Fortis, as well as many other companies, also offer "catastrophic coverage". This type of policy is usually quite inexpensive, and as the name suggests, covers medical expenses when something very bad-or at least very costly-happens to you. Deductibles are very high, so you'll have to cover all of the regular small and medium expenses yourselves.
So: lots of possibilities, lots of choices. If you'd like to discuss options with any of us at the Health Center, please give a call or send an email.
Be well!
Jeff Benson, M.D.
Dudley Coe Health Center
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