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Student Health Insurance

Student Affordable Care Act FAQ

Q: Am I required to have health insurance?

Under the Affordable Care Act, starting January 1, 2014, most Americans will be required to have health insurance or pay a penalty. This is called the “individual mandate.” To avoid the penalty, you need insurance that qualifies as Minimum Essential Coverage.

Q: What is the penalty for not having Minimum Essential Coverage?

The penalties are as follows:

  • 2014: $95 per adult and $47.50 per child (up to $285 for a family) , or 1% of family income, whichever is greater
  • 2015: $325 per adult and $162.50 per child (up to $975 for a family), or 2% of family income, whichever is greater
  • 2016: $695 per adult and $347.50 per child (up to $2,085 for a family), or 2.5% of family income, whichever is greater

The important thing to remember is that if you do not get any health insurance coverage, you may be subject to pay the penalty and still be responsible for 100% of the cost of your medical care.

Q: Who is exempt from having to obtain health insurance?

Under certain circumstances, you may qualify for an exemption. You won’t have to make the individual responsibility payment if:

  • You are uninsured for less than 3 months of the year
  • Your income is below the threshold for having to file a tax return
  • The lowest-priced coverage available to you would cost more than 8% of your household income
  • You are a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
  • You’re a member of a recognized health care sharing ministry
  • You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
  • You’re incarcerated, and not awaiting the disposition of charges against you
  • You’re not lawfully present in the U.S.

Q: What options are available for students who wish to obtain health insurance?

Students may be eligible to obtain health insurance through one of the following options:

  • Coverage as a dependent on their parents’ health insurance plan (up to age 26)
  • Coverage through the State or Federal Exchange/Marketplace
  • Coverage through Medicaid
  • Coverage through an employer-sponsored health insurance plan

Q: What kinds of health insurance are available through the Exchange / Marketplace?

The Exchange / Marketplace offers a simple online tool to help you search for healthcare coverage. You can compare plans available in your area based on price, benefits and other features. To make comparing easier, the plans are presented in five categories:

  • Bronze
  • Silver
  • Gold
  • Platinum
  • Catastrophic (available to individuals up to the age of 30 years old)

The Marketplace will also tell you if you qualify for free or low-cost coverage through Medicaid (Washington Apple Health), or the Children’s Health Insurance Program (CHIP).

Q: How can I get lower costs on my health insurance through the Exchange / Marketplace?

Under the Affordable Care Act, many individuals will be eligible to get lower costs on their monthly premiums or out-of-pocket costs, or get free or low-cost coverage depending on where they live, family size and ages, tobacco use and their annual household income. Visit the Washington Health Benefit Exchange and use the interactive calculator to estimate your possible costs.

Q: Do I need to be a Washington State resident to apply for coverage through the Washington Exchange / Marketplace?

Yes. Residency means that you intend to live in Washington State on more than a temporary or transient basis. However, living in Washington during the school year qualifies ‘residency’ for Exchange eligibility purposes.

Q: Will I have access to the University of Washington medical facilities and providers (e.g., Hall Health) through the Exchange/Marketplace plans?

Maybe. Not all plans will have access to the University of Washington providers. It is very important to find and shop for a plan that includes your doctors, clinics, and hospitals in the network. The Hall Health website for information on exchange plans that include UW providers.

International Student Health Insurance Plan (ISHIP) for more information.

Q: How do I apply for coverage through the Exchange / Marketplace?

If you live in Washington during the school year, you’ll use the wahealthplanfinder.org website to apply for coverage, compare plans, and enroll. If you need help, you may call the Customer Support Center at 1-855-WAFINDER (1-855-932-4633). The Customer Support Center is open Monday-Friday, 7:30 a.m. to 8:00 p.m.

If you are not a Washington resident during the school year, you can visithealthcare.gov to learn more about your options. To contact the Federal Marketplace, call 1-800-318-2596, 24 hours a day, 7 days a week. (TTY: 1-855-889-4325).

Q: Are there deadlines for applying for coverage through the Exchange / Marketplace?

Yes, there are deadlines for open enrollment, but certain events entitle you to enroll outside the open enrollment period.

  • Losing insurance from another source, e.g., UW Student Health Insurance Plan (SHIP) termination for U.S. resident students, or a parents’ employer-based insurance will trigger a special enrollment period for the Exchange / Marketplace in which you may apply for coverage. You will need the letter from the insurer terminating coverage in order to prove your eligibility.