Do Residents Typically Receive Subsidized Health Insurance?

[SooConfused]

If not, what does the coverage typically look like, and how bad are the premiums as compared to Obamacare Marketplace premiums, COBRA on a parent's policy, etc.?

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[Angus Avagadro]

They usually get crappy insurance and if they see docs within their system, they write off the difference in the bill. If they need to go elsewhere, lots of luck.

 

[SooConfused]

They usually get crappy insurance and if they see docs within their system, they write off the difference in the bill. If they need to go elsewhere, lots of luck.

This is what I was afraid of! When the time comes, I'm debating taking COBRA under my mom's plan. It's expensive, but it's very good coverage. OTOH, at some point it will run out (36 months), after which I'm going to be on my own anyway. I assume it gets better as an attending?

 

[SooConfused]

My program covers the full cost of the premium for residents and family for health, dental, and vision insurance, plus the hospital puts a big chunk of change in our HSA every year that is >50% of the deductible. I have had more healthcare costs than most and have easily been able to afford everything (albeit as a single person). However, it's not common for benefits to be that good. I would wait til you match and see what the benefits actually look like before making any big decisions.

I know. The reason I'm asking is because I'm going to turn 26 before I graduate, at which time I'm going to get kicked off my mom's plan and the COBRA ship is going to sail. So, I'm trying to get an idea of what residency health benefits look like so that I can make an informed decision regarding picking up COBRA or going on my school's student health plan, which kind of sucks and isn't really inexpensive, although it costs a lot less than COBRA because the coverage isn't nearly as good.

 

[Dr. Doctor MD]

The health insurance at my medical school and residency programs has been phenomenal. The premiums have been either free or greatly reduced and the plans themselves have been incredibly generous with very low deductibles and out of pocket expenses. Maybe these have been above average plans, but when I was interviewing I felt that most institutions provided free or heavily discounted health insurance. Also if they have group policies for hospital employees who tend to be young, educated, and healthy, they are often able to get much better rates and plans than anything you'd see on the marketplace.

I've looked on marketplace and other private areas for myself and family members, and have found nothing close to what is offered by my medical school/residencies, but given these have been at academic centers.

For you personally you could always continue cobra and then drop it once you're covered as a resident (with better and cheaper insurance) or keep Cobra if this somehow isn't the case.

For reference: medical school premiums were probably around ~$200-300 per month, residency probably between $0-200 per month. Most Cobra I've seen for people my age has been around $500-800 per month and the plans were not even that good.

 

[wysdoc]

The advantage of using your school's health plan is that you will know the local docs and hospitals will be "in network."
Stay on your parents plan until you turn 26.

 

[SooConfused]

The advantage of using your school's health plan is that you will know the local docs and hospitals will be "in network."
Stay on your parents plan until you turn 26.

Thanks! I'm definitely staying on my parent's plan as long as I can because it's very feature rich and heavily subsidized by my mom's employer.

The reason I started thinking about this is because once I turn 26, I have to make an irrevocable one-time decision within 60 days about COBRA, which will be before I graduate. I'll go on my school's plan if resident plans are decent and/or well subsidized.

Otherwise, I can't afford to blow the one-time opportunity to elect COBRA, which is a lot more expensive than my school's plan. This is why I'm asking.

 

[Med Ed]

If not, what does the coverage typically look like, and how bad are the premiums as compared to Obamacare Marketplace premiums, COBRA on a parent's policy, etc.?

The best insurance I ever had was in residency, and the premiums were almost nothing (part of the CMS funding for each residency slot is used for benefits). It was actually rather jarring to spit out into practice and suddenly be on a high deductible plan.

COBRA is almost invariably the most expensive option.

 

[throwaway123342]

My hospital is very generous with HSA contributions. Also we have low premium options. I think this is the best option for low income earners who are healthy.

 

[RangerBob]

All three programs I went to (internship, residency, fellowship) had phenomenal health insurance. Minimal copays. Having a baby coat like $200 for everything from prenatal care through post-natal, including a pump for my wife and whatever else was needed. Monthly premiums were super low/heavily subsidized.

I couldn’t have had better insurance unless everything was free.

 

[operaman]

Adding to others - my insurance in residency and fellowship was stellar. We’re talking 1998 level insurance here: $200 deductible, $1500 max out of pocket, plan pays 90% of costs, low copays for all visits, awesome drug coverage. They’re all PPO plans and there’s definitely benefit to staying in network, but in network usually means the big teaching hospital where your program is so presumably its a good place. The only better coverage I’ve found is now where there’s no deductible and a $1000 max out of pocket and great coverage across the board.

Premiums were all Subsidized for us. In residency I paid $80 a month for the coverage above and my program paid the other $700. In fellowship it was like $98 instead. Both remarkably cheaper than any marketplace plan and with coverage you can’t even find on any marketplace plan. Most big hospitals self insure which is why the terms are so good.

The only issue you might have is your school’s student health insurance. Sometimes student policies can suck a bit relative to big group plans. I’d get a copy of your schools coverage and see what it covers, what it costs. Then consider you need for care during those lost months and if it makes sense to do cobra or find a marketplace plan. Most student plans are geared toward young healthy people to keep costs low, but if you have more health care needs then other plans may work better.

Easy to calculate if you have the plan docs for each. Run the numbers and the decision should become very obvious.

 

[SooConfused]

Adding to others - my insurance in residency and fellowship was stellar. We’re talking 1998 level insurance here: $200 deductible, $1500 max out of pocket, plan pays 90% of costs, low copays for all visits, awesome drug coverage. They’re all PPO plans and there’s definitely benefit to staying in network, but in network usually means the big teaching hospital where your program is so presumably its a good place. The only better coverage I’ve found is now where there’s no deductible and a $1000 max out of pocket and great coverage across the board.

Premiums were all Subsidized for us. In residency I paid $80 a month for the coverage above and my program paid the other $700. In fellowship it was like $98 instead. Both remarkably cheaper than any marketplace plan and with coverage you can’t even find on any marketplace plan. Most big hospitals self insure which is why the terms are so good.

The only issue you might have is your school’s student health insurance. Sometimes student policies can suck a bit relative to big group plans. I’d get a copy of your schools coverage and see what it covers, what it costs. Then consider you need for care during those lost months and if it makes sense to do cobra or find a marketplace plan. Most student plans are geared toward young healthy people to keep costs low, but if you have more health care needs then other plans may work better.

Easy to calculate if you have the plan docs for each. Run the numbers and the decision should become very obvious.

Definitely. Many thanks for the detailed explanation. Yes, my school's student plan definitely sucks, and it's not cheap, since it isn't subsidized, which is the main reason I'm asking. I'm on my parent's plan now, and would be anyway since it is so good and so inexpensive.

The issue is once I become ineligible at age 26. My choice then will be to pick up very good, and very expensive, COBRA coverage or take the student plan until I am eligible for a residency plan. If the residency plan is good and/or inexpensive, the answer is obvious, which is why I made the post. OTOH, if it also sucks and isn't subsidized, then I'll probably have to go with COBRA.

It seems like most residencies do take care of residents, at least with respect to this, so I have my answer, and am very grateful to everyone who took the time to respond.

 

[guytakingboards]

Just throwing it out there...... (why) do you need the Cadillac health insurance? Paying for COBRA almost certainly isn't worth it if you're relatively healthy.

 

[SooConfused]

Just throwing it out there...... (why) do you need the Cadillac health insurance? Paying for COBRA almost certainly isn't worth it if you're relatively healthy.

Yeah, I don't "need" anything, but the Cadillac is what I happen to have now. I guess I'm just thinking that I won't "need" anything until I do, at which point it will be too late to go back if I let the COBRA ship sail.

If it's only for a few months before a good, heavily subsidized residency plan kicks in, that's one thing, and I'd be willing to take the chance and pick up the student insurance. OTOH, if residency plans suck, 3 years feels like a long time to me to hope nothing bad happens, since bad things seem to happen to people all the time.

 

[SooConfused]

I think there's a decent chance the plan your residency offers will be substantially more affordable, and if not, I don't think the price difference between a resident plan and the COBRA plan will be enormous. Even crappy plans have an out of pocket max, and if the premium is cheaper (which it probably will be on a crappier plan) you can put the money you would have been spending on COBRA premiums into an HSA or savings account to cover any out of pocket costs.

This is exactly the type of information I was looking for! It all depends on whether the plans are heavily subsidized, and it seems that most, if not all of them, are.

That's the rub, because what I discovered with the student plan is that the coverage kind of sucks, the co-pays are kind of high, and, while the premium is definitely less expensive than COBRA, the difference isn't as large as I would have thought, due to the lack of a subsidy. This is what got me thinking, because, if residency plans are similar, I'd pay the extra for the peace of mind and superior coverage with COBRA. If it's a lot less expensive, and/or it offers comparable coverage (and, what I'm hearing is that both apply in many cases), then it's a no-brainer to not mess with COBRA.

 

[butidontwantto]

Also check to see if you’ll qualify for Medicaid in your state for the time you’ll be over 26, but still a student and not making anything. All nonprofit hospital systems are required to offer financial assistance to people making under a certain amount (which as a student at least you will qualify for). It’s not always easy information to find, and you may have to make some phone calls/ fill out a bunch of paperwork, but it beats having to take out a loan to cover whatever $$$ bill for an unexpected event (car accident, appendicitis, etc)

 

[SooConfused]

Also check to see if you’ll qualify for Medicaid in your state for the time you’ll be over 26, but still a student and not making anything. All nonprofit hospital systems are required to offer financial assistance to people making under a certain amount (which as a student at least you will qualify for). It’s not always easy information to find, and you may have to make some phone calls/ fill out a bunch of paperwork, but it beats having to take out a loan to cover whatever $$$ bill for an unexpected event (car accident, appendicitis, etc)

Thanks! I will definitely look into it when the time comes, but it seems kind of counterintuitive that full time students who have an ability to pick up a plan sponsored by the school, and have the premium fully covered by a loan that just about everyone is automatically eligible for, would qualify for free insurance.

My sense is that whatever people are getting now might be made possible by whatever emergency pandemic declaration we are under, with expanded Medicaid eligibility, so I'm not counting on it going forward, since that has to end at some point. That said, it is definitely worth checking out, and it would be great if I could actually get it.

Going without insurance and seeking charity care is not an option, since the school requires us to have insurance, and automatically signs us up for the school plan and adds the cost to our loans unless we get a waiver (meaning that we show that we have other insurance). I'm sure that's how it works at most med schools.

 

[Wolvvs]

Thanks! I will definitely look into it when the time comes, but it seems kind of counterintuitive that full time students who have an ability to pick up a plan sponsored by the school, and have the premium fully covered by a loan that just about everyone is automatically eligible for, would qualify for free insurance.

My sense is that whatever people are getting now might be made possible by whatever emergency pandemic declaration we are under, with expanded Medicaid eligibility, so I'm not counting on it going forward, since that has to end at some point. That said, it is definitely worth checking out, and it would be great if I could actually get it.

Going without insurance and seeking charity care is not an option, since the school requires us to have insurance, and automatically signs us up for the school plan and adds the cost to our loans unless we get a waiver (meaning that we show that we have other insurance). I'm sure that's how it works at most med schools.

Loans are not income. Generally speaking you should qualify for medicaid if you're not eligible to be on your parents plan, you're not married, and you have no other income. This could depend on the state though.

COBRA is almost always the worst option. It's sort of a holdover from the pre-ACA days when insurers could reject you or mess with your rates for having pre-existing conditions, and was a way to ensure employees who lost their jobs would still have some access to insurance. You can often find a similar plan for cheaper on your state's insurance marketplace. That's something you can do now actually, just go to the marketplace website (make sure you're on the official state/federal website and not a broker's website), put in a bit of information, and see the rates available for different plans. You can then compare those plans to the COBRA option and decide what the best option for you is.

 

[SooConfused]

Loans are not income. Generally speaking you should qualify for medicaid if you're not eligible to be on your parents plan, you're not married, and you have no other income. This could depend on the state though.

COBRA is almost always the worst option. It's sort of a holdover from the pre-ACA days when insurers could reject you or mess with your rates for having pre-existing conditions, and was a way to ensure employees who lost their jobs would still have some access to insurance. You can often find a similar plan for cheaper on your state's insurance marketplace. That's something you can do now actually, just go to the marketplace website (make sure you're on the official state/federal website and not a broker's website), put in a bit of information, and see the rates available for different plans. You can then compare those plans to the COBRA option and decide what the best option for you is.

Since Medicaid sounds like the obvious answer, any idea why schools don't push it, or even default us to it rather than making us buy their plan? This is what is making me think there must be a catch, such as maybe full time grad students are only eligible now due to some relaxing of the rules due to the pandemic. It just doesn't make sense that full time students who have access to school sponsored plans, and federal loans to pay for them, would have free government insurance as an alternative, but I am definitely going to look into it.

 

[butidontwantto]

Since Medicaid sounds like the obvious answer, any idea why schools don't push it, or even default us to it rather than making us buy their plan? This is what is making me think there must be a catch, such as maybe full time grad students are only eligible now due to some relaxing of the rules due to the pandemic. It just doesn't make sense that full time students who have access to school sponsored plans, and federal loans to pay for them, would have free government insurance as an alternative, but I am definitely going to look into it.

I'm guessing there aren't many students who end up needing it (e.g. the traditional path means you're done with school before 26)? I got the student insurance, and then also got medicaid as co-insurance to cover the gaps in our not great school insurance. Also you can apply for charity care from the hospital system to cover out of pocket costs whatever your insurance status is. When I had to have surgery after my first semester, I hadn't applied for Medicaid yet. My school insurance covered 80% of the cost, but that was still going to be several thousands of dollars out of pocket. The hospital forgave that, and then when I was approved for Medicaid, Medicaid retroactively covered the out of pocket cost so the hospital ended up being able to get that money back. ¯\_(ツ)_/¯ I was just grateful I didn't have to pay more than a year's worth of rent for an emergency medical costs.

 

[NotAProgDirector]

No school wants to advertise that their students get Medicaid for health insurance.

 

[SooConfused]

No school wants to advertise that their students get Medicaid for health insurance.

Why not, if they are eligible? And who says they have to advertise it? If it's a federal or state benefit, or entitlement, why would medical schools, of all institutions, stigmatize people who avail themselves of it?

Maybe they should focus less on that and more on how they improverish, even if only temporarily, their students through insanely high tuition. NYU solved the problem by raising an endowment to eliminate tuition.

Where are all the other schools? Worrying about people signing up for Medicaid? Really?

 

[cj_cregg]

Just going to toss out there as a physician who takes care of a lot of Medicaid patients - Medicaid can have a lot of issues of its own. Obviously varies from state to state, but many physicians do not take Medicaid at all or only take a limited number of Medicaid patients, and in particular I have a lot of challenges getting my patients in to see specialists. Certainly issues with getting certain meds covered (although I don't think any more frequently than private payors necessarily? I just see a lot more Medicaid patients so it probably feels like more), and it seems like the preferred brands are changing constantly. If you go to med school out of state and you have to seek care in your home state/elsewhere for whatever reason (want to keep your regular PCP, emergency while traveling, etc.) your Medicaid will almost certainly not cover it. Your coverage is also at the whim of state and federal politics and so Medicaid can be a bit less of a stable insurance source than insurance through your school/employer if eligibility criteria change.

 

[Isoval]

I have a pretty solid PPO and it is 100% paid by my program.

It also includes free dental

 

[collegestud2013]

If not, what does the coverage typically look like, and how bad are the premiums as compared to Obamacare Marketplace premiums, COBRA on a parent's policy, etc.?

If not, what does the coverage typically look like, and how bad are the premiums as compared to Obamacare Marketplace premiums, COBRA on a parent's policy, etc.

Very program dependent, but typically it's at least comparable to the insurance offered to other clinical staff in the same health system. Will probably be cheaper per month than paying for COBRA to continue your previous plan and offer better coverage than most Obamacare Marketplace plans. Might be still be somewhat expensive at some institutions, while at others it's completely covered with no monthly premium. Obviously less of an issue if you're pretty health and have no medical issues requiring long-term treatment.

 

[Wolvvs]

Just going to toss out there as a physician who takes care of a lot of Medicaid patients - Medicaid can have a lot of issues of its own. Obviously varies from state to state, but many physicians do not take Medicaid at all or only take a limited number of Medicaid patients, and in particular I have a lot of challenges getting my patients in to see specialists. Certainly issues with getting certain meds covered (although I don't think any more frequently than private payors necessarily? I just see a lot more Medicaid patients so it probably feels like more), and it seems like the preferred brands are changing constantly. If you go to med school out of state and you have to seek care in your home state/elsewhere for whatever reason (want to keep your regular PCP, emergency while traveling, etc.) your Medicaid will almost certainly not cover it. Your coverage is also at the whim of state and federal politics and so Medicaid can be a bit less of a stable insurance source than insurance through your school/employer if eligibility criteria change.

Yes I definitely agree with this, although I will throw it out there that this is extremely state-dependent. There are some states where Medicaid is some of the best insurance you can get!