Hawley Montgomery-Downs was thrilled when her daughter earned a scholarship to cowl half the schooling at USC.

But simply as Bryn Tronco was beginning college in August, the West Virginia mom was shocked to get a invoice for almost $3,000 from USC to cowl a scholar medical health insurance premium and a payment that enables college students to entry on-campus clinics and different companies.

The charges appeared duplicative to Montgomery-Downs.

“It would be nice for her to go to the student health center, but with buying insurance to go to a primary care provider, it feels like I am paying twice,” she stated.

Mandatory medical insurance coverage and well being service charges are widespread at schools as a situation of enrollment. But the large invoice may come as a shock, making a barely inexpensive training really feel even much less so. The prices range by college however typically can quantity to a number of thousand {dollars} a yr — prices that healthcare advocates say needs to be rigorously reviewed by dad and mom and college students to make sure they perceive their choices whereas additionally assembly college necessities.

Stephen Beckley, a Fort Collins, Colo., well being and advantages guide to schools, stated the well being payment may help cut back college students’ insurance coverage premiums. But he can perceive how dad and mom might really feel as if they’re paying double. “That’s a big conundrum for our field,” he stated.

Students can search a waiver to college medical health insurance by exhibiting they’ve their very own insurance coverage or are lined by their dad and mom’ insurance coverage that meets particular college standards. Schools sometimes wish to see {that a} scholar’s personal insurance coverage covers native docs and hospitals for little out-of-pocket value. Student well being charges, nonetheless, typically can’t be waived.

USC, a non-public college, charges $2,273 a year for its Aetna scholar medical health insurance plan. The common for public schools is $2,712 and $3,540 at personal universities, based on a 2022 survey by Beckley’s agency, Hodgkins Beckley & Lyon.

Other distinguished schools cost rather more, resembling $6,768 at Stanford and $4,163 at Dartmouth College. The University of Colorado expenses $3,976.

The best answer to keep away from these expenses could be for college students to remain on a dad or mum’s well being coverage — which the Affordable Care Act permits till they flip 26. But that works provided that the scholar’s dad or mum has a coverage that meets the varsity’s complete necessities and provides in-network protection the place the school is positioned.

Otherwise, dad and mom might wish to store amongst ACA market plans to see if they’ll discover a cut price. If their incomes are low sufficient, college students can generally enroll in Medicaid or a Children’s Health Insurance Program (CHIP) in states the place they go to high school. But this technique has limitations as nicely. Students should meet state residency necessities the place they go to high school and fogeys can not declare them as a depending on tax returns. CHIP protection additionally expires as soon as a scholar turns 19.

Schools that cost a scholar well being payment and require insurance coverage protection say the funding helps cowl companies at campus well being clinics, which in any other case would value college students tons of of {dollars} a yr or extra.

The USC student health fee — which covers main and preventive well being companies — additionally helps the varsity pay for companies not sometimes lined by insurance coverage, resembling monitoring illness outbreaks on campus.

Dr. Sarah Van Orman, chief well being officer of USC Student Health, famous that the scholar well being payment gives funding for extra psychological well being suppliers on campus and a crew targeted on sexual assault prevention and training — companies out there to college students with none copayments. She stated these additions are important as a result of, even with insurance coverage, college students might face challenges discovering personal counselors to offer well timed assist and, in the event that they do, college students would have cost-sharing bills.

“The student health fee supports our public health infrastructure on campus,” Van Orman stated.

Because college students can get main well being companies on campus on the scholar well being middle, fewer of them search care outdoors it paid for by insurance coverage, she stated, and that helps preserve the month-to-month premium on the Aetna scholar medical health insurance plan decrease. “These things are working together and are not at all duplicative,” Van Orman stated.

USC’s scholar medical health insurance has an in-network annual deductible of $450 and a $20 copay for doctor workplace visits. It additionally gives complete companies nationwide, so college students are lined when in school and again at dwelling — even when that’s throughout the nation. About half the USC college students purchase the Aetna scholar insurance coverage, Van Orman stated.

Other schools have a distinct technique. For occasion, George Washington University’s necessary medical health insurance covers well being middle companies on campus. Unless they get a waiver, undergraduates should enroll within the scholar medical health insurance plan — costing $2,700 a yr. The well being plan premium permits college students to get many free companies on the scholar well being middle, together with medical workplace visits, some prescriptions and routine screenings for sexually transmitted infections.

Beckley stated faculty guidelines range on whether or not they enable college students to decide on insurance policy aside from what the varsity provides.

USC permits college students to purchase an alternate insurance coverage coverage by way of their dad and mom’ plan or on the ACA market so long as it meets the varsity’s necessities that embody complete well being protection within the Los Angeles space and protecting preventive care with zero value sharing. Out-of-state Medicaid or CHIP plans don’t meet the college’s standards as a result of they don’t have supplier networks for routine care in California.

That was unwelcome information to Montgomery-Downs.

“This is not something we budgeted for,” she stated of USC’s well being prices.

Montgomery-Downs, a former affiliate professor at West Virginia University who now works as a contract editor, stated she wasn’t positive what to do when she received the USC well being invoice. She had thought Bryn, who turned 19 in December, could be lined initially as a result of her CHIP plan gives protection for therapy at emergency rooms and pressing care facilities out of state. And Montgomery-Downs needed to ensure her daughter had well being protection on summer time and vacation breaks when dwelling.

Unsure of which market protection choices would meet the varsity’s guidelines and deadlines, she determined to go along with the Aetna scholar plan USC provided.

A have a look at market choices on Covered California exhibits the $2,200 for the USC Aetna scholar plan is a aggressive price. The lowest-priced comparable PPO plan provided by California Blue Cross that would offer Bryn a nationwide community of suppliers prices about $2,400 a yr factoring in a authorities subsidy based on their family income. PPOs present some protection for out-of-network docs and hospitals.

Montgomery-Downs will get her protection on {the marketplace} and stated she is going to store for a market plan for Bryn for the following college yr. She stated she needs that they had been conscious of all of the well being prices on the time of admission slightly than simply earlier than lessons started.

“It’s all nightmarish, even for someone with the privilege of time and some understanding of these bureaucracies — higher education and medical insurance,” Montgomery-Downs stated.

This report was produced by Kaiser Health News, one of many three main working packages at Kaiser Family Foundation.