Health insurance subsidy?
March 30, 2013 9:56 AM   Subscribe

My wife and I are both graduate students living on about $30k a year in southeastern Pennsylvania. We're about to turn 26 and will be losing our health insurance coverage through our parents. Does the state of Pennsylvania or the government offer any sort of subsidies or vouchers to help us purchase our own insurance?

My wife and I are turning 26 and so will have to buy our own health insurance soon. Fortunately I'm covered through my Ph.D. program, but my wife in the humanities isn't so lucky. We'd like to keep our costs down as low as possible, so we're looking for any governmental assistance we could get. Does anyone know of a program that could help us pay for our health insurance? Thanks guys!
posted by Aanidaani to Health & Fitness (13 answers total) 2 users marked this as a favorite
Long story short, if you are looking for a full-service health insurance plan like you have under your parents, you're outta luck unless you want to pay out the butt. Or unless your school is wonderful and offers low-cost plans to students. However, you can cobble things together through the various programs and clinics aimed towards low-income people.

The SelectPlan for women provides basic women's healthcare and free birth control. Some clinics may also be able to finagle things so it covers checkups and stuff, but that will really depend on the clinic and its willingness to type in different insurance codes (my school clinic did). However your income may be too high, check the chart in the link. Planned Parenthood will also provide basic healthcare services, though if I were her I'd try to go to a clinic outside the city limits because inside the city they're incredibly overcrowded.

She can also get additional basic healthcare assistance through Philadelphia's Community Health Clinics. Quality is really hit or miss. My experience is in the West Philly area. Health Center #3 is a hellhole, I've heard good things about Health Center #4 and Sayre, and the Health Annex is an amazing wonderland of caring doctors and administrative people, at least compared to what a low-income person with no health insurance is used to.

Another option is high-deductible emergency plans. These can run about $100/month (less for dudes) and will cover catastrophes (though do your research!). The tradeoff is you'll have to pay thousands out of pocket before they do. I never did one of these because the cost of the deductible alone would bankrupt me so I didn't see the point.

Worst comes to worst, if she has to go to the ER make sure you start the process of applying for financial assistance through there immediately. If you have the luxury to do so do, before going to one hospital or the other search its web page for information on financial assistance. Insist on applying even if intake people say you won't qualify, because they might not know what they're talking about (as I found at the Hospital at UPenn). Whenever a bill comes, call up the biller and as about financial assistance. The process is onerous no matter what, but some are worse than others. Applying for assistance at Mercy Hospital was a week long process of calling one number, being given another number, calling that, being given another number, calling that, ad infinitum. But once I actually sent the paperwork in approval was relatively simple and quick. Meanwhile Penn made it easier to apply, but getting approved was another story.

Keep in mind all of my experiences come from doing this as a single person, but with an income significantly less than yours. However most of these things are sliding scale so you could still qualify. You just might have to pay a little more.
posted by schroedinger at 10:23 AM on March 30, 2013 [1 favorite]

Can she get coverage through your plan? It might still be pretty expensive, but that's the first thing I would look into while you're looking at options - what would it cost to add her to your plan.
posted by LobsterMitten at 10:28 AM on March 30, 2013

Have you ascertained what the situation with health insurance through the university is? It's not clear to me if you're looking for insurance for your wife only or for both of you. Your program's health insurance is probably a good deal (graduate students are a pretty cheap demographic to insure, after all). You may be able to add your wife to your plan (assuming you're married in the eyes of the state, etc).
posted by hoyland at 10:30 AM on March 30, 2013

Check to see if you can add her to your plan, that might be the cheapest option.

Grad health plans are usually kind of shitty, though, especially if she has any specific medical needs. If you know that she needs certain prescriptions, or has any chronic health conditions, start looking into prescription assistance or supplementary insurance.

The families I know on the grad plans generally tend to cobble several things together, in order to get better coverage.
posted by vivid postcard at 10:50 AM on March 30, 2013

Wait, are you sure? I cannot think of a US university of any significance where every enrolled and registered PhD student (irrespective of fellowship status, humanities vs science, whatever) would not be eligible for group coverage under the same plan for all students (or sometimes all graduate students and the undergrads are handled differently). A fellowship may pay some or all of the cost of this coverage, but buying into the group plan should be possible without respect to financial aid/fellowship.

Either way, I believe it is the law that if you are entitled to coverage in your phd program, that you can add your spouse and dependents. You need to talk to the benefits people at your school. I am almost certain you are wrong to think she has no options through the school.
posted by spitbull at 11:28 AM on March 30, 2013 [2 favorites]

Guessing from your profile location that you guys are at Penn (or Temple, which ought to be similar, because there aren't that many places in Philadelphia where you could be doing a science and a humanities PhD together) -- if so, look here:

A Penn PhD student can cover dependents, any Penn student can be on the plan (and if you are not ABD, you have to pay a fee for not being on the plan, actually). It's Aetna, which is not off-brand coverage at all, although the limits are pretty modest.
posted by spitbull at 11:35 AM on March 30, 2013

I spent nine years in grad school at two different universities and tried to find better deals than the school insurance but never did. It's generally pretty reasonably priced and much better coverage than anything I could find on the private market. The only one that I found that was marginally cheaper didn't have prescription coverage, which was fine until I actually needed prescriptions.

You should also look into your on-campus health center. At most college and universities in the US, all students, including grad students, pay health fees and can receive basic healthcare free or relatively cheaply at Student Health even without health insurance. You definitely should both still have health insurance, but the on-campus student health centers usually save students a lot of out of pocket money in co-pays and lab fees and frequently have discounted prescriptions as well.

The only exception might be if you're at a Catholic school that refuses to properly cover reproductive health care for your wife. In that case, she really might be better off going with private coverage and seeing doctors not affiliated with the college.
posted by hydropsyche at 12:56 PM on March 30, 2013

200% of the federal poverty level for 2 people is $31k. I think most programs cut off below 200%, but not all (that's why the tables tend to go up to 200%). Pennsylvania has a website about health insurance. This is the page about Medical Assistance, which you probably aren't eligible for, but links to Pennsylvania's other programs.

Your algorithm should probably be:
1) Figure out how much it costs to insure you through the university. (Quite possibly less than your parents were paying to insure you, unless their plan was structured so any number of dependents costs the same.)
2) Figure out how much it costs to insure your wife as your dependent on the university plan.
3) Figure out how much it would cost your wife to buy into some university plan. (Where I am, your wife's option through the university would be the "undergrad" plan, which isn't as good and costs more than the plan TAs/RAs/people with fellowships are on.)
4) Figure out which option is better for your wife
5) Find non-university insurance options for both of you.
6) Make a choice.
posted by hoyland at 1:12 PM on March 30, 2013

Response by poster: Hi everyone. Thanks for the suggestions. I'm definitely going to get my insurance through my school (Drexel), but my wife will look into getting hers through her school (West Chester). It's really expensive to add a spouse to my Drexel insurance, but we may consider that if we can't find a deal through West Chester or private insurance.
posted by Aanidaani at 2:04 PM on March 30, 2013

You could always give Medicaid a shot... but generally it's very difficult to qualify. Although a classmate of mine managed to get his wife and child on Medicaid while he was in grad school, different states have different qualifying parameters so you never know until you try.
posted by hobo gitano de queretaro at 5:24 PM on March 30, 2013

Of interest: a new report on the tax credits available to insurance purchasers in Pennsylvania as the ACA is implemented. Though Pennsylvania declined to start its own insurance exchange, it will be part of the federal exchange program, which is expected to be up and running later this year for coverage beginning Jan. 1.

Unlike Medicaid, these tax credits and/or subsidies will be open to individuals and married persons without children.
posted by dhartung at 6:36 PM on March 30, 2013

If PA has accepted the federal Medicaid expansion funds, you may qualify for that if your income is at less than 138% of the federal poverty line. It sounds to me like you will definitely qualify for tax rebates based on your income, and you may qualify for other programs offered by PA.

Not sure what your timeline is but it may work for you to get a short term policy that would cover you during any gap period between when your current insurance runs out and Jan 1, 2014. I would check with a broker who has a sense of what the ACA is going to mean for someone your age and map out your plan from there.
posted by deliciae at 12:45 PM on March 31, 2013

Adding your wife to your insurance will almost always be cheaper than a woman trying to independently purchase insurance. You should be comparing the costs of adding her to your insurance against whatever she can get from her health services office here.
posted by WeekendJen at 1:15 PM on March 31, 2013

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