[Prepared by the GSU Healthcare Committee in Summer 2016. Updated in Fall 2020. If you have any specific questions, corrections, suggestions for improvement, or simply wish to chat about something related, please write to us at gsu@riseup.net.]

I: Who should use this guide?

II: Deadlines

III: Navigating Obamacare and healthcare.gov: how it works; how to apply; and how to select a plan

IV: Additional considerations for international students

V: Insuring spouses and children

I: WHO SHOULD USE THIS GUIDE?

This guide is for:

Students who do not receive U-SHIP for free from the university
Students who are on their last year of free U-SHIP coverage
Students who wish to insure their spouses and/or children

Students who do not receive U-SHIP for free may prefer not to purchase it for themselves or for their families: it is inordinately expensive, costing $4,566 per person per year.

Most graduate students are eligible for subsidized health insurance under the Affordable Care Act, commonly known as Obamacare, and can potentially secure comparable health insurance for a fraction of the cost of U-SHIP. Whether a particular plan will be better or worse than U-SHIP for you will depend on your individual medical needs. Note that legal non-citizens, including international students and their families, are eligible for Obamacare subsidies in much the same way as US citizens.

The university automatically enrolls all students in U-SHIP at the beginning of every academic year, and a student whose insurance is not paid for by the University must have already secured alternative insurance by this time in order to waive U-SHIP and avoid being charged the full price of premiums.

This guide will outline the alternatives to U-SHIP available via healthcare.gov, the Obamacare website.

II: DEADLINES

In order to waive U-SHIP coverage, a student must abide by two different sets of deadlines: the university’s deadlines and the federal government’s deadlines.

The university will not permit students to waive their U-SHIP coverage unless they have secured alternative coverage active the day they arrive on campus and/or by October 1. In order to secure this coverage, a student must complete their application on healthcare.gov by September 15. They will then need to submit a request to waive U-SHIP to the university by October 16th (though it’s advisable to submit the waiver as soon as possible). The waiver can be found here.

The open enrollment period for healthcare.gov is November 1st through December 15th. In order to secure insurance outside of this open enrollment period, students and their families will need to make use of a special enrollment period (unless they qualify for Medicaid, which does not have enrollment periods. See sections III and V). A student who successfully applies for insurance using a special enrollment period must apply again for insurance for the next calendar year during the November/December open enrollment period.

A special enrollment period is invoked by a significant life event. The most common such events for grad workerour purposes are:

The expiration of an existing health insurance plan (U-SHIP expires every year on August 31st)
Moving to a new city
Getting married or divorced
Having a child
Acquiring a new immigration status

Special enrollment periods generally last 60 days from the date of the qualifying life event. For instance, you have 60 days from the date your old coverage expires to apply for new coverage on healthcare.gov. Similarly, you have 60 days from moving to Chicago to apply for new coverage. You may submit a healthcare.gov application up to 60 days in advance of the date you anticipate losing insurance coverage or experiencing a major life event. More information on special enrollment periods can be found here.

Relevant dates for a new student who does not receive free U-SHIP coverage:

60 days from move to Chicago or end of previous insurance plan: Special enrollment period
September 15th: deadline to complete healthcare.gov application
October 16th: deadline to submit waiver application to university
November 1st -December 15th open enrollment period to secure coverage for 2020

Relevant dates for a student in their last year of free U-SHIP coverage:

July 3rd: earliest date to submit healthcare.gov application
August 15th: deadline to secure coverage starting September 1st
August 31st: U-SHIP expires
September 15th: final deadline to complete healthcare.gov application
October 16th: deadline to submit waiver application to university
November 1st-December 15th: open enrollment period to secure coverage for 2020

Relevant dates for spouses and children:

60 days from move to Chicago: special enrollment period (note that children will generally not require special enrollment periods. See section V.)
November 1st-December 15th: open enrollment period to secure coverage for 2020

III: NAVIGATING OBAMACARE AND HEALTHCARE.GOV

How it works

The Affordable Care Act consists of several interlocking programs, each with different eligibility criteria based on annual family income, family size, individual immigration status, and individual age, as well as state of residence. (All information in this guide pertains specifically to the state of Illinois.) The website for applying to all of these programs is healthcare.gov.

The most important eligibility criterion is the family’s annual income as a percentage of the federal poverty line. Obamacare benefits are more generous the closer an individual or a family is to the poverty line.

In addition, Obamacare benefits are influenced by which of the following groups an individual belongs to:

US citizen adult
Non-citizen adult
Child (under age 18), irrespective of citizenship
Pregnant woman, irrespective of citizenship or immigration status

Broadly speaking, there are three primary forms of assistance under the law:

Medicaid, a free public insurance plan, available to US citizen adults between 0-138% of the poverty line and to children between 0-318% of the poverty line
Heavily subsidized private insurance, available to US citizen adults between 138-200% of the poverty line and to non-citizen adults between 0-200% of the poverty line
Lightly subsidized or unsubsidized private insurance, available to all adults above 200% of the poverty line and to children above 318% of the poverty line

Pregnant women between 0-213% of the poverty line additionally qualify for perinatal Medicaid, which only covers expenses related to pregnancy and childbirth and which does not replace other forms of assistance. (The unborn child is counted as a member of the pregnant woman’s family only for the purpose of determining a woman’s eligibility for perinatal Medicaid. Her eligibility for other forms of assistance does not consider the unborn child. Pregnant women may qualify for perinatal Medicaid even if they have no legal immigration status – this is the only Obamacare benefit that can accrue to undocumented immigrants. (This is a particularity of Illinois law.) Pregnant women should apply to the Illinois Moms & Babies program directly here, even if they already have insurance (including U-SHIP).

How to apply

The healthcare.gov application process is long and complicated but largely self-explanatory. Here are a few things to keep in mind:

Estimate your income (or your family’s income, if you have a spouse) based on the calendar year, not the academic year
If you are unsure how much money you’ll make in a given calendar year (for instance: you’re not sure if you’ll get a teaching position in a given quarter, you’re not sure if you’ll receive a grant you applied for), do not list any of the income you’re not sure you’ll earn. You will be able to update your application later on with additional sources of income
You must file your taxes for the year you receive assistance. If you are married, you must file jointly with your spouse
You must include every member of your family in your application, even if you only intend to apply for insurance for yourself, unless they are non-citizens living abroad
The system may prove unable to verify your identity. If this happens, call thehealthcare.gov customer service hotline (1-800-318-2596) and kick up a fuss until someone acknowledges that you exist
If you say that you smoke, you will pay more for insurance

How to select a plan

If you make too much money to qualify for Medicaid, the next step will be to select one of the various private insurance plans available on healthcare.gov. Which plan is best for you will depend on your particular healthcare needs. Plans are divided into four metal tiers (bronze, silver, gold, and platinum), based on the estimated ratio of cost sharing between you and the insurance company. A few rules of thumb:

The University requires that you purchase coverage that is considered “comparable” to U-SHIP. There is a link that breaks down what is considered comparable coverage here.
If your annual family income is less than 200% of the poverty line ($24,120 for an individual plus $8,360 per additional family member), select a silver plan. Silver plans are, counterintuitively, comparable in quality to platinum plans at lower income levels. This is due to a poorly explained mechanism called Cost Sharing Reduction, an additional layer of subsidies that reduce deductibles and other out-of-pocket expenses
Do not select a bronze plan unless you have truly no expectation of going to the doctor ever (e.g.: you intend to spend almost the entire year outside of the country)
If your annual family income is over 200% of the poverty line, the decision will be between a silver plan and a gold plan. Generally speaking, the more care you anticipate requiring based on your individual health circumstances, the more sense it makes to buy a gold plan. For some individuals, especially those who anticipate having high medical expenses and who are at the upper end of the typical graduate student income range, it may make more sense to stick with USHIP, which is a platinum plan
If you have specific medical needs, check to make sure that your plan includes your specialist doctors and your medications. Also note that not all plans will have the University of Chicago Medical Center in-network, so you may have to receive treatment outside of Hyde Park. Trips to the emergency room for genuine medical emergencies are always in-network.

IV: ADDITIONAL CONSIDERATIONS FOR INTERNATIONAL STUDENTS

Non-citizen adults are eligible for Obamacare subsidies, but generally not for Medicaid, provided they have a legal immigration status. (Permanent residents, i.e., green card holders, who have lived in the US for five years or more are eligible for Medicaid.) Student visas (F-1, J-1) qualify for Obamacare subsidies, as do their spousal equivalents (F-2, J-2) and most other common graduate student immigration statuses. Tourist visas do not qualify.

International students should fill out their healthcare.gov applications well in advance of the deadlines, as there are several common glitches that may result in your application being delayed.

When filling out your healthcare.gov application, only list income you have earned in the United States and that you will report on your US taxes, unless you are a resident for tax purposes. Do not list your non-citizen spouse or children unless they reside in the United States, and only include income that your non-citizen spouse will earn in the United States.

You do not need a Social Security number to apply for insurance: your immigration numbers (Alien Registration Number, SEVIS ID, etc) will suffice. It is extremely likely that healthcare.gov will mistakenly deem you ineligible for assistance: this is almost always the result of an error. Call their customer service hotline (1-800-318-2596) and kick up a fuss.

A common error involves non-citizen adults who earn less than 138% of the poverty line. Healthcare.gov will think you’re eligible for Medicaid and forward you to Illinois Medicaid, which will then reject you on the grounds of your immigration status. At this point, you will have to go back through your application and find the question that asks if you have recently been denied Medicaid due to your immigration status. Tick that box and resubmit your application and the problem should be resolved.

V: INSURING SPOUSES AND CHILDREN

You can insure your spouse and/or children through healthcare.gov while remaining on U-SHIP yourself.

Children are eligible for Medicaid up to 318% of the poverty line, irrespective of citizenship. This equals $51,643 for a family of two plus $13,292 per additional family member. This is, needless to say, much higher than the typical graduate student salary, and so most graduate students with children should find them easy enough to insure. In addition, enrollment in Medicaid is open year-round, so there is no need to navigate the special enrollment period.

Spouses will generally need to either enroll during the open enrollment period (November 1st-December 15th) or avail themselves of a special enrollment period. Moving to Chicago from elsewhere in the country (or the world) constitutes a qualifying life event for a special enrollment period, and so you will have 60 days from the date of your spouse’s arrival in Chicago to get them insurance. Transitioning to a valid immigration status (e.g.: F-2, J-2, green card) is also a qualifying life event, and invokes its own 60-day special enrollment period.

The university will not automatically enroll spouses and children in U-SHIP, and so there is no need to abide by the university’s waiver deadlines for them.