As you plan for college, don’t forget about health insurance. Massachusetts requires that most students enrolled in an institution of higher education have school-sponsored health insurance or a comparable alternative.1 Here, we will explore the basics of what you need to know about student health insurance in Massachusetts so you can make an informed choice.
What You Need to Know
Massachusetts law requires students enrolled 75% to full-time to have comprehensive health insurance. This applies to both public and private schools.
You may be able to waive the student health plan if you have comparable coverage, but Massachusetts doesn’t require schools to offer this option.
You can remain on your parent’s health insurance until you turn 26, but you’ll need to make sure it covers care where you attend school.
Why Do Massachusetts Students Need Health Insurance?
Even if you don’t have ongoing health concerns, you may need to see a doctor for an unexpected illness or injury while attending college. Health insurance helps reduce your out-of-pocket costs for covered services. Without it, you or your parent(s) will have to pay your medical bills.
Student Health Plans
Student health plans in Massachusetts are regulated by the Affordable Care Act (ACA) and are designed to provide comprehensive coverage at a student-friendly cost.
What Should You Consider When Searching for Student Health Coverage in Massachusetts?
In Massachusetts, you may be automatically enrolled in your school’s student health insurance plan if you’re enrolled in a certificate-, diploma-, or degree-granting program as a full-time or part-time student who is not enrolled exclusively in online courses. (Part time in this case is equivalent to 75% of the academic requirements for full-time students.)2
However, most colleges and universities allow you to waive the student plan if you have comparable coverage, such as insurance through a parent. When deciding whether or not to waive coverage, be sure to consider:
- Provider networks: Does your existing plan include network providers where you attend school (especially if you will be coming from out of state), including any health services you receive on campus? If not, will out-of-network care be covered or will you be expected to pay 100% out of pocket?
- Affordability: Will your current plan premium and cost-sharing amounts (e.g. deductibles, coinsurance) be within your budget while you attend school?
Massachusetts requirements for comparable coverage include, but are not limited to, a health plan that provides reasonable comprehensive coverage of health services (e.g., preventive and primary care, emergency services, mental health services, prescription drugs) that are reasonably accessible to students in the area where they attend school.3
Health Insurance Requirement
Most Massachusetts residents over age 18 who can afford health insurance are required by state law to have minimum creditable coverage. If you are not exempt and don’t have coverage, you will pay a penalty through your state tax return.
What If You Get Covered Under a Parent’s Plan in Massachusetts?
Federal law allows you to remain on a parent’s health insurance plan until you turn 26, regardless of whether or not you’re in college, living at home, eligible for your own job-based coverage, financially dependent, or married.4
While maintaining coverage through a parent may seem like a convenient option, you’ll want to make sure it’s the right choice. Assuming you’re eligible to waive your school’s student health plan, cost and the provider network will probably be your main deciding factors (as mentioned above). Check with your college or university regarding waiver criteria and deadlines.
What If You Get Covered Under Your School Plan in Massachusetts?
Your school’s student health plan is designed to provide comprehensive coverage at a student-friendly cost. Unless a school self-insures, student health plans are regulated by the Affordable Care Act (ACA) and will be largely similar to the individual major medical plans available through the Massachusetts Health Insurance Exchange (called Massachusetts Health Connector).
Massachusetts law requires all student health insurance programs to provide benefits that are “substantially equal” to the state’s benchmark health insurance plan — the plan that sets the minimum standard for how ACA essential health benefits are covered within the state.5 Plans cannot have an annual or lifetime limit on required benefits.
Additionally, Massachusetts schools can designate their on-campus student health service as an in-network provider for certain services, may offer additional benefits beyond the minimum requirements, and can exclude certain charges and care if they are covered under another health insurance program with equal or greater coverage.
Not all colleges and universities have a campus health center, but if yours doesn’t, under the school’s plan you will have access to other providers in the community where you attend college.
What If You Get Covered Through the Affordable Care Act in Massachusetts?
Schools that permit students to waive coverage must approve waivers for those enrolled in a subsidized health insurance plan through the Massachusetts Health Connector, the state’s Health Insurance Exchange.6
Depending on your subsidy eligibility, an ACA plan may or may not be more affordable than your school’s plan. Subsidies, which include premium tax credits and cost-sharing reductions, are based on income. If you are a dependent, it will be based on your family’s tax return. If you are not, it will be based on yours. You can check your subsidy eligibility through Massachusetts Health Connector.
If you are a dependent coming from another state to attend school in Massachusetts, you and your parent(s) will need to fill out separate applications for ACA coverage and provide financial information for everyone included in the tax household. Your parent(s) will indicate that they don’t need coverage and that the policy is for you; however, their income will still play a role in determining your eligibility.
If you have a subsidized ACA plan, either through a parent or on your own, compare coverage details with your school’s plan to see which is your most affordable option. Also be sure your ACA plan allows you to access care where you attend school — whether on campus or in the community.
What If You Get Covered Through Medicaid or CHIP in Massachusetts?
Schools that allow waivers must also approve them for most participants in most MassHealth programs — MassHealth is the state’s umbrella program for Medicaid and the Children’s Health Insurance Program (CHIP).7 That means you can continue your coverage if you so choose.
What Are Other Options for Coverage in Massachusetts?
If for some reason a school, ACA or parent’s plan won’t work for you, you may want to consider catastrophic health insurance. Catastrophic plans are designed as worst-case-scenario coverage for adults under the age of 30 and others with hardship or affordability exemptions.
Catastrophic plans are sold through Massachusetts Health Connector. They have low monthly premiums, but their deductibles are much higher than traditional ACA plans. Before you meet your deductible, however, you will have access to certain no-cost preventive services and at least three primary care visits per year.
What If You Skip Health Insurance in Massachusetts?
While the federal tax penalty for going without health insurance no longer applies, Massachusetts imposes its own state mandate and penalty.8 Massachusetts state law requires minimum creditable coverage for most residents over age 18 who can afford health insurance coverage. Those who are not exempt and go without coverage will pay a penalty through their state tax return.
The student health insurance plans offered by Massachusetts colleges and universities meet state criteria for minimum creditable coverage, as do plans purchased through the Massachusetts Health Connector and enrollment in a MassHealth program.9 Other coverage may also qualify if it meets standards set by the state, as mentioned above.
What Are State-Specific Rules for Massachusetts Students?
Massachusetts law requires most college students, including full-time, three-quarter-time, and international students who attend public and private institutions, to have health insurance that meets state standards for minimum creditable coverage.10
What Are School Requirements in Massachusetts?
Beyond the state requirements, schools may establish their own rules for eligibility, benefits and waivers. Here are examples from two of Massachusetts’ largest independent and public institutions of higher education:
Boston University
Under state law, students will be automatically enrolled in Boston University’s Student Health Insurance Plan (SHIP).11 The plan is also available to part-time students, regardless of how many credits they take, and dependents, including spouse and dependent children up to age 26. Online-only students are not eligible for the SHIP.
Students who have ACA-compliant coverage and want to waive the SHIP must do so by the fall and spring semester deadlines.
University of Massachusetts Amherst
The University of Massachusetts Amherst automatically enrolls students taking five or more credits into its Student Health Benefit Plan (SHBP).12 The school allows the following populations to waive the SHBP13:
- U.S students with comparable coverage under another major medical insurance plan.
- Veterans with benefits that provide access to Veterans’ Administration healthcare facilities and those with benefits through the U.S. Family Health Plan.
- International students who study remotely or online outside of the U.S., or who are enrolled in an employer- or embassy-based health insurance plan within the U.S.
The school doesn’t allow students with closed network plans or out-of-state Medicaid coverage, or international students who don’t meet the criteria listed above, to waive the SHBP.
What Are Resources for Massachusetts Students?
As you decide which coverage is right for you and use your benefits, here are a few useful resources:
College and university websites: Many school websites provide information about the institution’s student health plan, waivers, campus health services, and other health topics. As you decide between a SHIP and other coverage, this can be a place to start gathering information.
The Commonwealth of Massachusetts — MassHealth: Go here to learn more about MassHealth, the state’s combined program for Medicaid and the CHIP, including application criteria.
Massachusetts Health Connector: This is the state’s Health Insurance Exchange, where you can buy an individual ACA plan and apply for subsidies, including premium tax credits and cost-sharing reductions.
Next Steps
If you attend college in Massachusetts, it’s likely you’ll keep dependent coverage through a parent or enroll in your school’s student health plan. Even if you think your decision is clear, it can be worth your time to compare your options — you may be surprised. Contact your school with any questions you have about its student health plan or about waiving coverage.
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