Money Matters

Health care provider checking woman's blood pressure

Before psychology graduate student Sharon Smith left full-time work in a psychiatric hospital for Georgia State University, she figured she would find health insurance similar to the worry-free plans her job provided. But Smith found out that reality was much different: Her school offered only a catastrophic plan-one with a high deductible and meant for use mostly in an emergency. So Smith chose a private plan that fit her budget and was recommended by an insurance seller.

But when a kidney stone took her to the emergency room, she discovered the plan had an extremely high deductible and she faced thousands of dollars in hospital bills.

"It's easy for younger people to underestimate how much they're going to need insurance and to assume they're just going to be okay with the least expensive option," says Smith, who is in her seventh year. "But if you don't understand what you're buying and what it could mean to you in terms of costs, you really haven't protected yourself."

Some students are fresh out of college and can accept the risks of a bare bones plan, Smith says. But others, like Smith, expect better insurance coverage or need coverage for their families. However, they often find that schools don't offer graduate students good insurance plans and that private insurance, including continuing coverage from a previous job or from parental insurance-through the Consolidated Omnibus Budget Reconciliation Act or COBRA-can be expensive and complicated. For them, finding coverage may be difficult and, in a climate of generally skyrocketing health-care costs, prohibitively expensive.

Unfortunately, national student-advocacy groups and even large nationwide membership associations aren't able to find health insurance plans that cover members in all jurisdictions, says Alan Fox, APA Insurance Trust's marketing director.

In fact, during the last six years the American Society of Association Executives reports that the vast majority of nationwide membership associations have stopped offering health insurance to members. The reason? Health insurance is regulated by individual states, which have widely differing minimum mandates for coverage, such as varying number of days you can be in a hospital after a surgery, says Fox. That makes compliance for insurance companies both difficult and expensive, Fox says. Those same realities make it virtually impossible for an association like APA or APAGS to offer its members a health policy.

However, students may find good coverage either through their schools or through insurance agents who are familiar with the local environment, Fox says.


SCHOOLS' VARIED OFFERINGS

Students' first step is often finding out just what's available through their school, either to buy insurance outright as a student or as part of compensation for an academic assistantship. APAGS Chair and fifth-year Marquette University psychology student Michael Madson says there's a lot of variety in what schools offer.

"I've talked to some folks whose schools offer absolutely nothing," he says. "And then there's a place like Marquette where you're able to buy calamity insurance through the school. But there are also big state schools who cover teaching assistants and research assistants with full health plans like any other university employee."

Overall, less than 50 percent of schools provide health insurance for teaching assistants, graduate assistants and research fellows, according to a study conducted by Binghamton University in 2004. That study, "The Survey of First Year Graduate Students," which collected information from a representative sample of 73 graduate institutions, also shows that while 57 percent of teaching assistants at public institutions receive health insurance, only 8 percent of those at private institutions do.

Large public schools often have health plans that coordinate services with a university hospital, enabling them to provide coverage for a lower cost, experts say. They're also frequently home to organized student groups, such as those at the University of Wisconsin-Madison and Texas Tech University in Lubbock, Texas, which can successfully lobby the university for better coverage, says fifth-year psychology graduate student Margo Gardner of Temple University in Philadelphia. Graduate assistants there secured better health coverage and higher salaries after forming a union, Gardner says.


THE MARKETPLACE OF PLANS

When school-based health insurance isn't an option, students can turn to a wide variety of private plans, but it's important to be an informed consumer and to collect information from trustworthy sources, Smith says.

Try these outlets first:

  • Contact your state department of insurance by phone or through their Web site. There, you'll find information about what kinds of plans are available and how to track down a reputable company. You can locate your state department of health and state insurance office at www.naic.org/state_contacts/sid_websites.htm.

  • Contact local organizations such as churches, synagogues, women's centers and chambers of commerce for their recommendations on finding a plan. Some of these community-based organizations may endorse a plan or be able to put you in touch with a trusted local insurance agent.

  • Check out programs offered by any alumni associations you belong to.

  • Consult upperclassmen for their coverage methods.

Consider if you can afford the costs if you do get sick or need medication, not just how much you'll be paying as a premium every month.

After her early missteps, Smith found a reliable insurance broker who explains the details of plans and annually finds a Preferred Provider Organization plan that meets her needs. She currently uses a plan that costs about $260 per month; the university-recommended plan would have averaged about $330 a month and had a much higher deductible.

Smith encourages other students to similarly educate themselves before buying insurance and to take a close look at policy details, such as:

Lifetime maximum. The total amount the plan will pay out in an emergency. What would happen if your health-care costs went over your maximum? Could you pay it?

Covered services. Plans frequently exclude physical therapy, mental health, ambulance service and obstetrics. Will you need these services?

Deductible. The amount you must pay before insurance kicks in. Would a high deductible dissuade you from getting care when you need it?

Out-of-pocket expenses. Co-payments for doctor visits and prescription medicines can add up. How much routine care will you need?

-KAREN KERSTING gradPSYCH staff