Julie Martin, a second year law student at ASU bought the student healthcare plan through Aetna and later found out her prescription was not covered in the plan. Graduate students across the board are facing similar conflicts with the student healthcare plan and its coverage. (Photo by Hector Salas Almeida)ASU’s student health insurance has increased its deductible and premium costs and continues to provide limited coverage in areas not tailored for the majority of students.
After a year with Aetna, second-year law student Julie Martin said she is not satisfied with the company because of its lack of prescription coverage.
Martin, who has been diagnosed with hypertension and ADHD, said her insurance fails to meet her needs.
“I’m 41 years old," she said. "I have four kids, (and) I’m getting to the age now where I’m starting to have medical problems. (With) the insurance, I’m thinking, ‘Why am I paying all this money per month for an insurance that doesn't even cover prescriptions?’ That’s where the majority of my expenses comes from.”
According to the Arizona Board of Regents, the annual deductible at ASU rose $100 for a single student between the 2012-13 and 2013-14 school years, making the out-of-pocket cost $350 annually. For family coverage in the same years, the annual deductible increased from $500 to $2,000, according to Aetna.
A premium is the amount that the policyholder pays to purchase the health coverage from the provider, Aetna. A deductible is the out-of-pocket cost insured students must pay before their health care plan covers their medical expenses.
Aetna’s premiums for ASU have also increased from $1,612 in the 2012-13 school year to $1,956 for the 2013-14 school year.
Aetna spokeswoman Erica Iorillo said in an email that the company takes into account many different factors when deciding the premiums for each school year.
“Premiums were based primarily on the previous years' actual claims experience, medical trends and benefits selected (or) modified,” she said.
Iorillo said the premiums for this year had to consider required Affordable Care Act fees. The ACA, signed into law by President Barack Obama in 2010, aims to make preventive care more affordable and accessible.
The plan comes with many benefits to provide students with varied health care options, Iorillo added.
“The medical plan offered includes limited dental coverage, in case of injury to natural teeth,” she said. “It also includes contraceptives, which are 100 percent covered with deductibles waived ... diabetic medication and supplies, oral chemotherapy, hormone therapy medications, weight loss medication and tobacco cessation medications are 80 percent covered with deductible waived.”
To treat an illness or condition, the health insurance plan provides up to 30 days of coverage only for insulin, insulin needles and syringes, oral diabetic medications and supplies, smoking deterrents, oral chemotherapy medications and generic contraceptives.
Dr. Allan Markus, director of ASU Health Services, said the premiums increased this year because of the increase in last year’s high dollar claims, or claims that are significantly higher than the cost for annual checkups.
“We had more of those this year than we have in previous years," he said. "That’s the biggest part of the reason why the premiums went up this year.”
Health services looks out for students by checking claims ratios, Markus said.
“One of the things we always do is that we have a check where we look at a claims ratio,” he said. “The claims ratio is the amount of claims paid vs. the premiums paid, and that ratio we look at each year to make sure that they have not been overcharging for their premium."
ASU’s health insurance plan for students is a part of the Arizona Board of Regents Student Health Insurance Plan, which also includes NAU and UA. The University started its partnership with Aetna in 2007.
Second-year law student Joshua Faucher, who has a heart condition and needs annual checkups, said the relationship between the insurance provider and ABOR is full of constant negotiations.
“There’s always gonna be some tug-and-pull,” he said. “Aetna’s going to want to offer less coverage for the same price, and the Board of Regents is going to try to get more (coverage).”
Under ASU's health insurance plan, Faucher needs to get a referral for a different doctor instead of his usual physician.
"My cardiologist at Mayo is in-network, but if I go to him without getting a referral from ASU Health Services each year, he would be billed as out-of-network," he said. "This pre-approval requirement is usually referred to as a 'gatekeeper' function."
The National Center for Biotechnology Information defines gatekeeping strategies as "requiring a designated primary care provider to authorize referrals," and is used to control health care costs.
Faucher said the plan is focused on those who don’t need health insurance in the first place.
“When you look at the way the student plan is designed, it’s probably designed for young, healthy students who, the vast majority of them, don’t need prescriptions,” he said. “(They) wouldn't need to go to the doctor that often and wouldn't use the plan that often.”
How ASU stacks up
While the increase in ASU’s student health care insurance plan may seem extreme, it's moderate when compared to other public universities like Pennsylvania State University or the University of Texas at Austin.With an enrollment of approximately 53,000 in the fall of 2013, UT- Austin is similar in size to ASU and uses Blue Cross Blue Shield, according to the UT- Austin website.
The annual deductible for their student insurance is $300 per person, per academic year for both students and family members, according to the 2013-14 Student Health Insurance Plan.
UT- Austin's premium is $1,432 for students and $7,734 for a student, their spouse and children, according to the school's website.
Penn State has approximately 96,000 students as of October 2012, and it receives its health insurance through Aetna, according to the University website.
For the 2013-14 school year, Penn State has a $2,348 premium for students, but is $3,825 for their spouse and $3,507 for children, according to the Penn State Student Health Insurance Plan.
Penn State has a $75 deductible for individuals and $225 deductible for families, according to Penn State's summary of its insurance plans.
Faucher said he was concerned for this coming summer and if he would be able to get his premium refunded after he graduates.
"The spring charge includes the summer session even if a student doesn't enroll in it,” he said.
ASU opts to include summer with spring, because they do not offer year-long coverage.
Prescription coverage
Martin said that although she is not satisfied with Aetna's insurance coverage, ASU Health Services is a different story.“I’ve been going to Health Services, and they’ve been great," she said. "They’re very helpful, a little hard to get a hold of on the phone, but other than that, their service has been great."
Martin said her Aetna insurance lacks significant prescription drug coverage, which causes her to pay the difference.
“Right now, I’m taking five medications, and it's a huge burden," she said. "Some of them are very pricey, especially those that don’t have generics.”
Aetna is not covering five prescription drugs Martin uses.
She said Aetna had once accidentally paid for one of her prescriptions. When she went to refill it, she found out that the insurance not covering it and had to pay $180 for her 30-day prescription.
"I almost had a heart attack in the middle of this pharmacy," she said. "I was like, ‘Oh my gosh, how in the world am I going to pay for this?’”
While the Health Services pharmacy does offer a 10 percent discount for prescriptions with Aetna, Martin said she would end up paying more than she does paying full price for her prescriptions at CVS Pharmacy, where she gets her medication.
Martin said she felt misled by the information she received about Aetna's prescription drug coverage.
“I was told they do not cover anything except birth control and insulin,” she said. “I didn't know that when I was first on the program. Their website said that (they covered) prescriptions including insulin and birth control, but it should have said only those things.”
She added that the information she received from Health Services physicians led her to believe they did not know her medications would not be covered.
“It’s funny, because the doctors were under the impression that it covered prescriptions, too,” she said. “These are the Health Services doctors that should know, and every time I’d go to the pharmacy they’d say, ‘No, it's not covered.’”
Family coverage
Another difficulty Martin had with Aetna was the difference in the plan's prices. She said she could never afford the family health insurance for her and her four children because the rates are so expensive. The annual deductible for family coverage is $2,000.“My oldest child is in the army, so he has Tricare now,” she said. “My daughter, though, she’s uncovered."
Her oldest daughter, who is 19, is unemployed and not in school, so she doesn't have health care. Her two youngest children are still using their father's coverage.
Martin said her inability to afford the family coverage for her daughter leaves them both with an air of unease as they wait for government health care.
"Come January, when the Medicaid expansion comes online she'll qualify for that, but until then she has nothing and if she gets hurt or gets sick then she's stuck," she said. "We'll be stuck paying a bunch of money out-of-pocket that neither one of us really have."
Martin said that if Aetna reformed its insurance to include a plan for a smaller family unit and charge per person, she would consider it for her daughter and herself.
“They don’t have single-parent plans," she said. "That sort of thing when they only cover one other child or two other children, because usually that’s cheaper if you have a single parent plan vs. everything else.”
Markus said students have requested some of these benefits in the past, and that they were able to incorporate a $1 million per year maximum as opposed to a standard $1 million life maximum.
Sustainability graduate student Arijit Guha, who died in March after battling colon cancer since 2011, managed to negotiate with the University to establish the new plan.
Markus said Health Services facilities are equipped and staffed to provide all primary care and some specialty care.
Martin said that while she feels she chose Aetna based on a misunderstanding of their coverage, looking for another insurer would prove to be a daunting task in itself.
"You just can't find anything that's affordable for a student in school and has limited ability to work outside the home," she said. "That's been a real challenge for me."
Reach the reporter at jcushma1@asu.edu or on Twiter @jcushma1
