What International Students Should Know About Health Insurance in the U.S.

Before applying to and enrolling at a U.S. university, prospective international students may want to start thinking about medical insurance. Many U.S. universities require students enrolled at their school, including international students, to have health insurance.

Health insurance policies and costs can vary from campus to campus, and some institutions offer their own plans in which students must enroll. Here are things prospective international students should know when determining whether they need health insurance in the U.S.:

-- Requirements may depend on the visa category.

-- The U.S. does not have universal health care.

-- Some universities have their own health insurance plans.

-- Lack of insurance may affect studies.

-- There are other ways to obtain health insurance.

Requirements May Depend on the Visa Category

The U.S. Department of State requires exchange visitors on a J-1 visa and their dependents on a J-2 visa to be covered by medical insurance for the length of their program. But the State Department has no specific insurance requirements for international students and their dependents on an F visa.

"F-1 visa holders do not have to meet government-mandated standards, so some colleges, like those in the City University of New York CUNY system, do not mandate health insurance for F-1 students," says Mandee Heller Adler, president and CEO of International College Counselors.

But even if a college does not require medical insurance, Adler says all students in the U.S. should have it because not having insurance could be costly. Some international students may mistakenly think that medical care without health insurance is affordable.

"One of the mostly likely reasons for bankruptcy in the U.S. is unpaid medical bills," says Julia Matthews, interim director of the student health center at Bentley University in Massachusetts. "Without health insurance, people in the U.S. can face financial disaster due to unforeseen or uncovered health problems."

[Read: How Prospective International Students Can Demonstrate Financial Ability.]

Adler says while there are some community health clinics that offer specific services at very low costs, medical emergencies can happen at any time and be financially devastating for international students without insurance, given how expensive U.S. health care is. In the U.S., access to low-cost or public health care is very limited, and international students typically are not eligible for most programs.

Experts say students should contact universities about their specific policies, which can vary widely.

Despite not requiring it, CUNY, for example, does highly recommend F-1 international students and their dependents purchase international student health insurance, according to the school's website.

Other schools require all international students to purchase health insurance. The Board of Regents of the University of Texas System, for instance, requires all international students holding F-1, F-2, J-1 or J-2 nonimmigrant visas to have approved health insurance while enrolled at any institution in the system.

Similarly, "at UCR, the coverage is the same for all students regardless of visa type," says Kelly Eldridge Hinosawa, associate director of the International Students and Scholars Office at the University of California--Riverside. That means the health insurance requirements are the same for J and F visa holders, adds Magid Shirzadegan, former director of the office who is now retired.

The U.S. Does Not Have Universal Health Care

Some prospective international students may mistakenly believe that health insurance is the same as in their home country, without realizing there is no national or free medical care in the U.S. While in many countries the government covers the cost of health care for its citizens, in the U.S. students and their families are responsible for these costs themselves.

"Medical insurance and health care in the United States is complicated and will often work differently than medical insurance and the health care system in your home country," Hinosawa says.

She says it's important for prospective international students to have an idea of how the health care system works in the U.S., particularly for those who come from a country with universal health care.

Jim Deleppo, director of International Student and Scholar Services at The New School in New York, says international students often come from countries with much simpler medical systems, "and when faced with complex concepts and processes like copays, claims, bills, explanation of benefits, in-network, out of network, it can be overwhelming."

Hinosawa says a student from Japan, for example, may be accustomed to walking into any local hospital to get covered treatment as needed. She says in the U.S., students will need to think about where they can go to get treatment depending on their insurance coverage. Different medical providers accept different types of insurance, she notes, so students need to make sure to get medical care at a provider that accepts their specific insurance.

Some Universities Have Their Own Health Insurance Plans

When researching U.S. universities, international applicants may find that many require a mandatory school-sponsored group insurance plan. Universities that don't offer a school-sponsored insurance plan require international students to select their own coverage.

"Universities provide international students with their health insurance policies and programs prior to arrival," Deleppo says. "In many cases, schools require international students to be on the institution's plan or allow them to waive if they can show proof of their own health insurance."

[Read: Ways to Save Money as an International Student.]

At the University of California--Berkeley, all international students are required to have health insurance coverage while registered at the institution and will automatically be enrolled in the Student Health Insurance Plan, or SHIP, and charged a health insurance fee. The plan, which provides medical, counseling, prescription, vision and dental services, costs $1,768 per semester for undergraduates in 2020-2021 and $2,841 per semester for graduate students, per the school's website.

Similarly, Margaret Fitzgerald, former associate director of the health center at Bentley University, says the school automatically enrolls all international students in the student health insurance plan offered through the university.

Lack of Insurance May Affect Studies

New international students who think a lack of health insurance will not affect their studies in the U.S. may be in for a surprise.

Schools within the California State University system require health insurance to be obtained before registering for classes. For example, San Jose State University, which is part of the CSU system, states on its website that international students cannot register for classes without first purchasing SJSU health insurance.

"Many universities require students to have insurance," Adler says. "It is best to check with your university registrar or university health center prior to your first semester for specific requirements for enrollment to ensure you will be able to register and begin classes on time."

Fitzgerald says Bentley does "not accept insurance policies from other countries or policies purchased from a third party," due to the Massachusetts Universal Health Care Act requiring that all students enrolled at least three-quarter time -- 6.75 credits for graduate programs and nine credits for undergraduate programs -- participate in a qualified U.S. domestic insurance program headquartered in the U.S.

"Health insurance plans marketed solely to international students are often not filed in the U.S., have limited benefits and/or coverage periods that do not comply with the Massachusetts student health plan regulations and the Bentley University waiver requirements," Fitzgerald says.

At the University of South Carolina, international students are automatically enrolled in the school's Blue Cross Blue Shield insurance plan, but they have the option to buy their own health insurance, according to the school's website. Students waiving USC's insurance must fill out a waiver every fall and spring semester.

Beyond the potential impact on registering for classes, which depends on each school's policy, Deleppo says a lack of proper health coverage can affect international students in other ways.

"I have seen many cases where a student has high medical bills and is not able to continue studies because they cannot cover tuition costs," Deleppo says. "This is why it is important that a student understands his or her health plan so that it can meet their needs should medical expenses arise."

[Read: 4 Hidden Costs for International Students While Studying in the U.S.]

There Are Other Ways to Obtain Health Insurance

A university is not the only place international students can buy health insurance, which is another misconception some may have.

"Health insurance can be purchased through an outside agent," Adler says.

Ball State University in Indiana recommends that students purchasing health insurance through outside sources, such as via the internet, contact the school's international office first so that staff can verify the insurance policy meets the school's minimum requirements.

"There are many different plans for international students in the marketplace, and sometimes students will look for the most inexpensive plan to save costs," Deleppo says. "It is important that students understand what their health plan will cover as medical costs can escalate if a student doesn't have a comprehensive plan."

Adler says a school's group plan, however, is likely to be a more convenient and possibly more affordable option for international students.

"I would highly advise checking what your school is offering before purchasing anything outside of your school's plan," Adler says.

At most U.S. universities, Deleppo says, health insurance specialists are usually available to advise students about their options, and students can contact the international student office with any questions about how medicine and health care work in the U.S.

"For new international students, health insurance can be complicated, and proper education is important," he says.

Searching for a college? Get our complete rankings of Best Colleges.