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Sharp Health News

Out-of-area care for young adults

Aug. 16, 2021

College students walking on campus

Many students will soon be heading to college campuses for in-person instruction. In addition to new courses, teachers, friends and living accommodations, it can also mean new health insurance needs.

If you have a child going to college in the fall, it's a good time to help them research their health insurance options to ensure they'll be able to access the care they need when away from home.

"Most students choose to stay on their parents' plan until they are 26 years old," explains Don Truong, director of sales at Sharp Health Plan. "However, it's worth comparing options to find the best fit."

Out-of-area care
If your child is enrolled as a dependent on your health plan and they need medical assistance while outside of your health plan's service area (the geographic area that your plan covers), they will need to access out-of-area care. Keep these tips in mind:
 

  • Most health plans will likely only cover emergency medical conditions from unexpected illnesses or injuries. Make sure your child tells their doctor about any care they may receive when away from home.
  • Most health plans will not cover routine health services (like primary care visits or lab work) outside of their service area. Some health plans may offer video or phone visits.
  • Always check with your health insurance carrier to find out what is covered and to ensure there are no gaps in coverage.
"If your child needs more coverage than your plan provides, they may want to consider adding supplemental health insurance like a student health plan through their university or enrolling in their own plan," adds Truong.

Student health plans
Most schools offer a student health plan that can be an easy and affordable way for your child to get basic coverage when they're away from home. In most cases, student health plans count as qualifying health coverage. This means they're considered covered under the health care law and won't have to pay the penalty for not having insurance. Be sure to verify this with your child's school.

Marketplace plans
If your child is attending school in another state, it may make sense for them to enroll in their own plan in the state where they're living. Even if they have access to a student health plan, they can apply for coverage through the health insurance marketplace.

Visit healthcare.gov to search for the state where your child will be located. From there, you can find out if the state participates in the federal exchange or has its own public exchange. When you complete your child's application, note:
 
  • They will still be included in your tax household, even though they're applying separately. When they fill out their application, have them state that you (the parent or guardian) do not need health coverage. Your income will still be counted because marketplace savings are based on expected income for all tax household members, not just the ones who need insurance.
  • The cost of your child's plan (and yours if you're enrolled in coverage through the health insurance marketplace) may be reduced with a premium tax credit and extra savings based on the whole household's income.
Knowing what coverage is right for your child
When making a decision, you should consider the health care services that your child uses regularly, such as prescription medication, lab work or behavioral health services.

"Research your current plan and see what services are covered out of your service area. Then you'll have a better sense of whether or not you need to look into alternative coverage for your child," Truong says.

When to enroll
A qualifying event is a change in circumstances that allows your child to update their health insurance policy. If your child moves out of your health plan's service area, that is considered a qualifying event.

"The deadline for this qualifying event is always on the 15th of the month, so be sure to enroll early to avoid any gaps in coverage," adds Truong.

Whether your child stays on your plan or enrolls elsewhere, you'll have the peace of mind knowing they'll be covered, no matter where life takes them.

For insurance advice from local experts, Sharp Health Plan's certified enrollment specialists are available to help. They can be reached by email or by phone at 858-499-8211.

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