Health insurance is an investment in your physical, mental, and sexual health. If you get sick, need to treat an injury, or fill a prescription, your health insurance company is there to help with the costs. If that isn’t a good enough reason to get insured, you have another: Almost every college and university requires its students to have health insurance. When deciding how to get the best deal for your health status and financial situation, you have options.

Health insurance is a plan that helps you pay medical expenses should you get a checkup, fall ill, or need surgery. To receive health coverage, you or your family must pay a premium, or fixed amount, to an insurance company every month. Typically, the higher the monthly premium, the less you will have to pay when you actually seek medical attention.

Many people receive health insurance as a benefit through their full-time employers. If you’re a busy student, it’s unlikely that you work full-time, but you can still meet your school’s health insurance requirements. In fact, it’s easier than ever for some students to get health care coverage, but your options for health insurance depend on your immigration status. If you are ready to get covered for college, refer to the section below that describes your residency status.

For U.S. citizens and permanent legal residents:

In March 2010, the Affordable Care Act (ACA), commonly known as Obamacare, was signed into U.S. law with the intent of helping more people get quality, affordable health care coverage. Public and private insurance options expanded, and their standards went up.

Shortly after the federal government passed the ACA, it began requiring U.S. citizens, permanent legal residents, and holders of immigrant visas to take advantage of their new health care options. Called the individual mandate, it requires every citizen and legal resident to have basic health insurance coverage, also called minimum essential coverage (MEC). Failure to meet this standard resulted in tax penalties, even for students.

In December 2017, however, President Trump signed off on a tax reform bill that addressed, among other things, the individual mandate. Beginning in 2019, the individual mandate no longer exists at the federal level, meaning that individuals may choose whether they want to purchase health insurance coverage. Keep in mind that some states, including Massachusetts, New Jersey, and the District of Columbia, have their own individual mandates; if you live in one of these locations and decide to go without insurance, you may owe a fee to the state when it comes time to file your taxes.

Because schools want their students be healthy enough to concentrate on their academic work, accredited colleges may request proof that you have MEC. Even in states without individual mandates, it’s likely that colleges will continue to require their students to maintain coverage. Eventually, the repealing of the individual mandate may lead to increased health insurance premiums, but currently there are several quality, low-cost options for students.

• Stay on your parent’s plan until you turn 26. Under the ACA, children can remain on a parent or legal guardian’s health insurance plan until their 26th birthday (or December 31 of the year they turn 26) even if they are married, financially independent, or have insurance options through school or an employer. If you are 25 or younger, talk to your parents about this option. Your parents may be willing to pay or help you pay to stay covered on their plan until you graduate or turn 26. This would mean that you don’t have to take responsibility for premiums or shop for insurance just yet. That said, if you plan to attend college in a different state, you will need to check to see which providers in that state are part of your health insurance network. You can usually do so by accessing provider directories on your insurance company’s website.
• Participate in your school’s group insurance plan. Many colleges and universities offer health insurance plans for students. These plans are similar in concept to insurance plans offered by employers. The school may pay a chunk of the total cost, effectively lowering the premium for students. A student health plan will qualify as MEC. School health plans are often more affordable and better quality options than the ones you could find at private companies or in the federal health insurance marketplace. Furthermore, if you fail to provide proof of MEC before the start of the school year, your school may automatically enroll you in its group insurance plan and add the cost to your tuition bill.
• Buy coverage through the state or federal health insurance marketplace. Your school wants you covered, and so does the government. To make it easier for you to shop for MEC insurance plans, the government opened a federal health insurance marketplace, also called the health insurance exchange. Some states have their own exchanges. Through the exchange, you can compare and contrast the plans for which you qualify based on your state, age, and income. The government may also pay part of your monthly premium if you are eligible for financial assistance. If you want to purchase coverage from your state or federal marketplace, you may do so during the open enrollment period, which falls between early November and mid-December each year. You may also be eligible to purchase a policy during a special enrollment period if you move states, turn 26, or experience another qualifying life event. If you are looking for coverage, it is a good idea to check the cost of your school health plan against the cost of a similar plan from federal or private sources to ensure you’re getting the best deal.
• Enroll in Medicaid. Medicaid is a federal-state program that provides health care coverage to low-income citizens and legal residents of the United States. The ACA aimed to expand Medicaid nationwide, but a 2012 ruling by the Supreme Court made program expansion optional, up to the discretion of each state. Currently, 36 states and the District of Columbia participate. To qualify for Medicaid, your income must be no higher than 133% of the federal poverty level, but your state’s guidelines could be stricter. In 2019, the poverty level for a single person is between $12,490 and $15,600, depending on your state. If you think you may qualify for Medicaid, check your eligibility with the federal health exchange; it may redirect you to your state marketplace, where you can apply for Medicaid.
• Buy coverage through a private insurance company. Compare as many prices as you can when looking for health insurance. Individual plans through private insurance companies are often more costly, but it’s worth looking into it anyway. Present them with your school or marketplace health plan and ask if they can provide better coverage at a better cost.

For this calendar year, failure to have minimum essential coverage will not result in any fees unless you live in Massachusetts, New Jersey, or the District of Columbia. If you do need to see a medical professional for any reason and decline health care coverage, you will be responsible for all costs. On top of that, without health insurance, you may be barred from enrolling in your college.

You should talk to your school about its policies regarding student health insurance. Oftentimes, an insurance form will be sent to your home with your admissions offer or first tuition bill. You may use to form to opt in to student insurance or waive the right. To waive your offer of student insurance, you will probably have to submit proof of the health insurance you receive through your parents, the exchange, Medicaid, or a private company.

For international students:

The Affordable Care Act encourages all U.S. citizens, permanent legal residents, and holders of immigrant visas obtain health insurance. Prior to 2019, international students who held F, J, M, and Q visas, all nonimmigrant visas, were exempt from the individual mandate requiring MEC for their first five years in the United States. Now, regardless of time spent in the United States, individuals do not have to purchase or maintain continuous health care coverage.

That said, if you are an international student, it is likely that your school will require that you obtain health insurance for yourself and any F-2, J-2, or M-2 dependents (e.g., spouse or children who accompanied you to the United States). If you hold a valid F, J, M, or Q visa to study in the United States, there are a few ways that you can get covered.

• Participate in your school’s mandatory or optional group insurance plan. Most U.S. colleges and universities offer group health insurance to their full-time students. Because so many students enroll on the group plan, premiums are typically lower for everyone. Some colleges may require international students to opt in to the school’s health insurance. Other larger universities may have two student health insurance plans: one for U.S. citizens and permanent residents, the other for international students.
• Purchase a policy through the state or federal health insurance marketplace. The federal government opened a health insurance marketplace, also called an exchange, under the Affordable Care Act. Some states have decided to create their own exchange instead of using the federal one. These exchanges help to connect U.S. citizens and residents with health insurance coverage. International students who hold F, J, M, and Q visas are eligible to buy insurance through state and federal marketplaces, but they are not eligible for Medicaid or financial assistance. Check out the federal marketplace to get started and to get redirected to your state’s exchange.
• Buy a policy through a private health insurance company. There are dozens of private insurance companies that offer policies to international students enrolled at U.S. colleges and universities. These policies may be more expensive than your other options, but they may cover medical evacuation to your home country in addition to your regular health care benefits.

Your school will have its own requirements, and the International Student Office can give you a list of your specific options. Health insurance is often required for all students, international students included. If it isn’t required, it is still a good idea to buy it. Your stay in the United States may be a semester or it may be five years, but anything can happen. The U.S. health care system is probably different from the one in your home country, and it will be difficult to find adequate, affordable care in the event that you do not have insurance.

For undocumented students:

If you are an undocumented student, your access to U.S. health care is limited. While the Affordable Care Act expanded health care options for many other students, it prohibited undocumented immigrants—even those who can legally work under deferred action or DACA—from obtaining health insurance through any federally funded means. Though DACA beneficiaries have documentation to work in the United States, they are still barred from accessing coverage through Medicaid, the federal health exchange, and most state health exchanges. In this regard, DACA beneficiaries (undocumented students who hold EADs and social security numbers) have the same limited health care options as other undocumented immigrants who do not have permission to work.

Undocumented immigrants often receive care at community and nonprofit health clinics, which offer free or low-fee health care services. These clinics are often staffed by medical students or volunteer physicians, nurses, and interpreters, and many of their medications and pieces of equipment were donated. At these clinics, it is not necessary to provide information about immigration status to receive care.

Colleges and universities often require their students, regardless of immigration status, to have health insurance. In high school, you may have received your medical care at a community clinic or participated in a state insurance program for undocumented children under age 19, but these usually aren’t viable options to pursue as an adult enrolled in school.

• Participate in your school’s optional or mandatory student health plan. If your school has accepted you despite your immigration status, you may be eligible for a student health plan. Your university might work with you to help you cover the costs. Note that usually only full-time students qualify. Part-time study, independent study, or opting to take online classes may affect your eligibility for the school’s health insurance plan. Check with your school for more information.
• Purchase a policy through a private company. Not all private insurance companies offer health care coverage to immigrants who do not hold authorized immigration documents, but policies are out there. They are usually expensive, so be sure to consider them along with your school’s insurance plan.

It is important to get health insurance so that you have coverage during emergencies, but your school may also require it. If it is not offered by your school and you cannot afford to purchase private insurance, you may be interested in visiting community health clinics. It is also important to note that by law, hospitals must provide some emergency care to everyone, regardless of immigration status or ability to pay. These services include emergency screenings, treatment until stabilization (including treatment for an unborn baby), and transfer to a different health care facility, if necessary. Learn more about emergency services for immigrants without documents here.

If you are looking for more information about enrolling in college as an undocumented student, refer to this section of Student Caffé.

Page last updated: 03/2019