The Affordable Care Act (also known as Obamacare or the ACA) was signed into law in March 2010 and provides comprehensive health care reform in the United States. While much has been written about the ACA and its impact, there is still quite a bit of information that has yet to be determined. Harvard University Health Services (HUHS) continues to assess these changes and what they mean for Harvard students. Below is information on available health plan options.

The Student Health Insurance Plan and the ACA

Q. What are the current health insurance requirements for students at Harvard University? Will these be changing because of the ACA?
Massachusetts law requires that any full-time or part-time student enrolled in an institution of higher learning in Massachusetts participate in a qualifying student health insurance program or in a health plan of comparable coverage. Students are automatically enrolled in the Harvard Student Health Insurance Plan, but may choose to waive with comparable coverage.

At this time, the regulations governing student health plans in Massachusetts remain the same; however we expect changes will be made to reflect the ACA requirements.

Q. Will the Harvard Student Health Insurance Plan satisfy the individual mandate?
Yes. Beginning in 2014, the ACA requires individuals (unless excluded or exempt) to obtain “minimum essential health coverage” for themselves and their dependents or pay a penalty. The Harvard Student Health Insurance Plan meets the minimal essential coverage requirements.

The ACA Creates More Choice

In addition to the ACA extending coverage to children until age 26, as of January 1, 2014 it also introduces new Health Insurance Marketplaces in all fifty states, lower premiums through tax credits for certain low income individuals, and expands Medicaid for many others.

Q. If I don’t have access to comparable insurance coverage through a parent or spouse, what are my other options as a Harvard student?

1. Don’t do anything. Stay with the Student Health Insurance Plan.
Harvard students are automatically enrolled in and charged for the Student Health Insurance Plan. Tailored specifically with the student in mind, this coverage provides hospital/specialty care through Blue Cross Blue Shield (BCBS) of Massachusetts and prescription drug coverage.

Visit the Student Health Insurance Plan section of the HUSHP website for more information.

2. The Health Insurance Marketplace
The Marketplace is a new way to find insurance coverage. Beginning October 1, 2013 for plans effective as early as January 1, 2014, an individual may be eligible to purchase a qualified health plan through the newly created Health Insurance Marketplace. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage and its cost.

Massachusetts Health Connector Marketplaces in Other States
MAhealthconnector.org HealthCare.gov
Tax Credits
Depending on your income, family size, and other eligibility rules, you may also qualify for lower premiums through federal tax credits when enrolling in a qualified health plan through the Marketplace.
Can I use these credits towards the purchase of the Student Health Insurance Plan?
No. Students cannot use federal tax credits towards the purchase of the Student Health Insurance Plan. These credits are only available to individuals enrolling in the Health Insurance Marketplace.

 

3. Medicaid
Prior to January 1, 2014, eligibility in Medicaid was mostly restricted to the elderly, young children, and those with disabilities. The ACA expanded Medicaid eligibility to include adults age 19-65. Based on income, family size, and other eligibility rules, an individual may now qualify for a state-run Medicaid plan. Each state was able to determine whether or not it would expand Medicaid. Not all have elected to expand the offering. If you would like to determine whether you qualify for Medicaid in Massachusetts, you will need to apply for coverage online at the Massachusetts Health Connector.

For more information, visit healthcare.gov.

Choosing an Insurance Plan

Q. What types of questions should I consider when selecting a plan?
Choosing the right health insurance is an important decision. When deciding which type of plan to choose, some common questions to ask would be:

In addition to my premium cost, how much do I have to pay for care?

  • Are there deductibles, copayments, and/or a coinsurance percentage?
  • Can I afford the maximum out-of-pocket cost?
  • Does the plan work outside of Massachusetts (including outside of the United States) for non urgent or emergency care?
     

Some plans will look inexpensive but when you need care, you may have to pay much more.

Are there geographical concerns?

  • What is the extent of the health plan’s physician/hospital network in size and location?
  • Does the plan work in Massachusetts for non urgent or emergency care?
  • Does the plan work outside of Massachusetts (including outside of the United States) for non urgent or emergency care??
     

Most plans purchased outside of Massachusetts will have no network of physicians/hospitals inside Massachusetts for care other than for emergencies.

How do I obtain specialty care? Is a referral required from my primary care physician (PCP)?

A PCP outside of HUHS may be necessary if your plan requires that you receive a referral to see a specialist.

How will I find a PCP? When is the first available date I can make an appointment?

Will the plan allow you to fill prescriptions in the Boston/Cambridge area?

Does my plan include mental health coverage?

  • Does the plan network include access to mental health providers/hospitals in the Boston/Cambridge area?
  • Are these providers accepting new patients?
     

Q. If I elect to waive the Student Health Insurance Plan, what does this mean for me?
You are covered by the Student Health Fee, but not by the Student Health Insurance Plan. This means that your other insurance would be entirely responsible for some services at HUHS and all services outside of HUHS.

Depending on the type of plan you have, you may have to coordinate care with your primary care physician. If so, the physician/hospital you are seeking care with would have to participate in this plan’s network.

Additionally, claims issues would need to be resolved independently with your other insurance company.