Student health insurance and national health care reform: What does it mean for you?

National health reform, or the Affordable Care Act (ACA), is a law designed to improve access to health insurance for millions of people. This landmark law introduced some new ways for students to have greater access to affordable health insurance.

  • No-cost or low-cost insurance is available to more people than ever before through MassHealth, Massachusetts’ Medicaid program. Individuals who are 19 and older may also continue to qualify for MassHealth if they meet income and other eligibility requirements.
  • Tax credits help you pay for health insurance premiums if you buy a plan through the Health Connector. If you qualify for tax credits, you can have this credit paid directly to your insurance company every month so that your monthly premium is lower.
  • ConnectorCare plans have low monthly premiums, no deductibles, and lower out-of-pocket costs. If you qualify for a ConnectorCare plan, you can save on your monthly premium and pay less when you go to the doctor. For the first time, students will be able to access no-or low-cost ConnectorCare plans if they qualify.

Students can apply online through the Health Connector website to see if they qualify for MassHealth, tax credits, and ConnectorCare plans.

Better benefits for students

  • Students can stay on their parents’ health insurance until age 26
  • No annual and lifetime limits on the amount that a health plan will pay towards your health services
  • No limits on the amount that a health plan will pay towards your prescription drugs
  • All preventive care is covered at 100% and there are no co-pays, co-insurance, or deductibles for things like:
  • Immunizations
  • Contraceptives
  • Physicals
  • Screening and counseling for sexually transmitted infections, HIV, and tobacco use
  • Screenings for depression, obesity, and diabetes

Frequently Asked Questions

Under 956 CMR 8.00, institutions of higher education, referred to as Schools in this Frequently Asked Questions (FAQ) document, in Massachusetts are required to offer a Student Health Insurance Program (SHIP) to Students, and Students must either enroll in the SHIP or provide proof of comparable coverage. Due to the COVID-19 pandemic, some Schools are considering expanding remote coursework beginning in Academic Year (AY) 2020-2021, as well as arrangements to support graduating Students. These FAQs aim to help stakeholders understand options for Schools that are consistent with SHIP regulatory requirements as stakeholders consider the impact of a transition to remote learning or post-graduation arrangements on SHIP offerings and enrollment.

Yes; the transition to remote learning would not change a School’s requirement to make a SHIP available. See 956 CMR 8.03.

Yes; so long as those individuals otherwise meet the definition of a Full-time or Part-time Student under 956 CMR 8.01, they will be considered a “Student” under the regulations and would need to either enroll or waive out of the SHIP by demonstrating comparable coverage. Individuals who are in programs that are, by design, entirely remote and for whom COVID-19 is not the cause for their taking exclusively online courses, will continue to not be “Students” under the regulations, and therefore do not need to demonstrate enrollment in comparable coverage in order to waive the SHIP. The Health Connector encourages Schools to extend additional flexibility to Students who are attending class remotely due to COVID-19, as further detailed in Question 3.

The Health Connector strongly encourages Schools to provide flexibility for Students who are learning remotely due to COVID-19 by permitting waivers where Students have comparable coverage in the location where they are currently participating in remote classes, including other states or countries.

The regulations provide that a Health Benefit Plan submitted by a Student to waive the SHIP constitutes “comparable coverage” so long as it provides for: (1) “reasonably comprehensive coverage of health services, including preventive and primary care, Emergency Services, surgical services, hospitalization benefits, ambulatory patient services, mental health services, and prescription drugs”; and (2) access to those covered services is “reasonably accessible to the Student in the area where the Student attends School.” See 956 CMR 8.05(2)(a). The Health Connector notes that for the purposes of a Student

participating in classes remotely for any term of AY 2020-2021 due to COVID-19, the “area where the Student attends School” is the location where the Student is currently remotely attending classes for the relevant term. See 956 CMR 8.05 (2)(c)(3). In addition, the Health Connector reminds Schools that they may waive participation in SHIP if the Student is studying in a foreign country and the Student has coverage in that foreign location. See 956 CMR 8.05 (2)(c)(2).

In light of this interpretation, the Health Connector strongly encourages Schools to review their waiver processes to ensure that Students may waive SHIP coverage if they have comparable coverage such as out-of-state Medicaid, out-of-state Exchange Marketplace coverage (i.e., Qualified Health Plans), out-of-state employer sponsored insurance (e.g., HMO, PPO, POS), or foreign health coverage.

If a Student waives participation in SHIP for the fall term but returns to campus for the next term, the School must reevaluate the Student’s waiver. If the coverage with which the Student initially waived is no longer considered comparable coverage in the location of the School, the School must require the Student to enroll in the SHIP. If a Student returns to campus in the middle of a term, a School is encouraged to reevaluate the Student’s waiver mid-term and offer the Student the opportunity to enroll in the SHIP at a pro-rated premium.

The Health Connector strongly encourages Schools to work with their health insurance carriers and Third-Party Administrators to ensure they can timely disenroll individuals from the SHIP if Students have comparable coverage as defined in Question 3. To avoid undue operational complexity associated with disenrollment requests after SHIP coverage has begun for the academic year, the Health Connector urges Schools to offer an additional opportunity for Students to waive their SHIP.

The Health Connector’s regulations at 956 CMR 8.00 only describe the obligation for Schools to offer a SHIP, and for Students to either enroll in the SHIP or waive the SHIP by demonstrating they have comparable coverage. To the degree Schools have questions about who may validly be considered eligible to enroll in the SHIP, the Health Connector encourages Schools to work with their health insurance carriers, Third-Party Administrators, and the Division of Insurance (as applicable) to ensure that enrollment flexibility and extension of coverage modifications are permitted and, if so, are clearly explained in SHIP evidences of coverage, are available according to clear and consistently applied standards across all eligible newly graduated students, and remain consistent with applicable state law and federal requirements, including 45 CFR § 147.145.