Will college students use Affordable Care Act insurance?

• Although many young students say they think health insurance is important%2C nearly 80%25 know little about the Affordable Care Act%27s new insurance marketplace.
• Students will benefit in many ways from the online marketplace%2C one health-organization official says.

Unlike most college students, Tara Carey chose her own health insurance plan.

Three years ago, Carey's father passed away from a chronic blood disorder after being laid off and losing his health insurance, rendering him temporarily unable to afford chemotherapy treatments. With her mother unemployed and uninsured, the Emory University junior was required by her school to get insured, but opted out of Emory's Student Aetna plan because it didn't offer reasonable coverage.

"The insurance that I have now actually is fine — it has great coverage with low co-pays, but the premium costs too much of my monthly income," says Carey, 20. "When I had the Aetna plan as a freshman and sophomore, the amounts I paid out of pocket were ridiculous. I had to have a minor surgery that cost roughly $4,000, and I had to pay $2,500 — doesn't exactly sound like good coverage for a college student."

Still working to pay for the procedure, Carey plans to utilize the open enrollment period — Oct. 1 to March 31 — of the health insurance marketplace under the Affordable Care Act to find a plan that better suits her needs.

While she admits she doesn't entirely understand how the marketplace will work, she thinks the impact on college students will depend on their family income.

"Yes, Emory is a wealthy school, but many people have a health plan that doesn't meet their needs, so people need to know," Carey says.

Yale senior Christina Chandra, 21, found herself in a similar position when the restaurant where her parents worked closed and they lost their health insurance. As a result, Chandra opted into Yale's default student plan only to find it expensive and lacking coverage for services such as dental care.

Come Oct. 1, Chandra hopes to use the marketplace to find a suitable plan — not only for herself but for her entire family.

"[My parents] feel as though they don't understand the health insurance marketplace at all, so at the moment they are depending on me and the Affordable Care Act to get them a plan at a reasonable rate that will cover essential health services," she says.

According to a recent Kaiser Family Foundation Health Tracking Poll, around three quarters of those ages 18 to 25 believe it is important for them to personally get insurance and that insurance is worth the cost. However, nearly 80% of those under 30 had heard little to nothing about the marketplace.

One organization trying to change that is Young Invincibles.

Currently in the midst of a nationwide education campaign called Healthy Young America, Young Invincibles has reached more than 1,000 youth-serving organizations and health partners with information about the ACA and new options through the exchanges.

Jennifer Mishory, deputy director at Young Invincibles, says students will be affected by the online marketplace in three significant ways:

1. Students can enroll in plans without the threat of being denied coverage because of a pre-existing condition.
2. Students who earn less than about $46,000 or families that earn less than $94,000 annually may be able to access free coverage through Medicaid or discounted coverage through monthly tax credits depending on the state and their exact income level.
3. New plans will provide free preventive services, annual checkups, prescriptions and substance use disorder services.

"We need to make sure that young people understand their new options and know where to go to see if they can get monthly tax credits," Mishory says. "We also need to make sure that young people are armed with information about how insurance works so they can make good choices for themselves."

With national road maps to coverage and health care finder apps, Young Invincibles hopes to ease this process.

However, the option itself for college students to optin has been nothing short of a contentious debate.

The National Center for Public Policy Research's David Hogberg recently found that more than 3.7 million young adults will be at least $500 better off if they forgo insurance and pay the opt-out penalty.

Josh Archambault, a senior fellow in health care at the Pioneer Institute in Massachusetts, says it is important to remember this claim is from an economic standpoint. He says only 1,913 of 6 million residents under 30 are on Massachusetts' Young Adult Plan (YAP) because most remain on their parents' insurance until they turn 26.

"I think college students should visit the federal website to look at the possible costs and options that are available to them, but I think a lot of them will find that it makes more sense for them to remain uninsured, remain on their parents' plan or seek out a more catastrophic plan Archambault says.

After using the Yale health plan freshman year without knowing she could opt out, Yale senior Rachel Kubi has been under her parents' insurance for the past three years and plans to stick with it.

"It just seems easier than researching and purchasing insurance on my own, especially since I can stay on my parents' plan until I'm 26," says Kubi, 21. "After graduation, hopefully my employer will cover insurance, but if not, I would decide between staying on my parents' insurance and using the health insurance marketplace."

Emory junior Audrey Zeis will also be staying on her parents' plan and thinks others will do the same until they absolutely have to find their own plan.

"It's really hard to get people our age involved with this kind of issue because there's the mentality 'I'm not going to get sick, so I don't need to worry about it,'" she says.

However, by volunteering in free clinics at local hospitals in Texas — which has the largest uninsured population —Zeis has seen reason for concern firsthand.

"It was really disheartening to see people sit there for seven hours then tell them they couldn't be seen that day, knowing the only reason they came into the free clinic is because it's their only option," Zeis says. "If any of those people had insurance, it'd be so much easier for them to get the basic care they needed."

Carey echoes this sentiment.

"People think that health disparities are only problems of developing countries across the globe, when in fact, it is a huge problem right here in the U.S.," she says. "That is something I believe Obamacare will change significantly. People just need to be educated about the marketplace and their options — the word needs to spread."