College students have several options for obtaining health insurance. They may obtain private health insurance through group market plans offered by employers, colleges, and other groups or through individual market plans. In addition, some college students may obtain coverage through public health insurance programs, such as Medicaid or the State Children’s Health Insurance Program (SCHIP). College students may obtain health insurance through employer- sponsored group market plans, which are plans employers offer to their employees and their dependents. Under these plans, employers typically subsidize a share of employees’ premiums for health insurance, and premiums are calculated based on the risk characteristics of the entire group. To offer health insurance, employers either purchase coverage from an insurance carrier or fund their own plans. All plans purchased from insurance carriers must meet state requirements, which vary by state. For example, some states require employer-sponsored plans purchased from insurance carriers to offer coverage to dependents. Although requirements for dependent coverage vary by state, plans have traditionally offered health insurance coverage for dependents through age 18, and have generally continued coverage for dependents through age 22 only if they attend college full-time. Under federal law, college students who have lost eligibility for dependent coverage under a parent’s employer-sponsored insurance plan may be able to use provisions in COBRA to continue their health insurance for a limited period of time. Specifically, COBRA allows individuals such as college students who have lost eligibility for dependent coverage the option of purchasing up to 36 months of continuation coverage under the employer-sponsored plan. COBRA does not require employers to pay for or subsidize this continuation coverage, which can appear expensive in contrast to the subsidized premiums that employees and their dependents may be accustomed to paying for employer-sponsored coverage. COBRA permits employers to charge 100 percent of the premium, plus an additional 2 percent administrative fee. College students may obtain health insurance through health insurance plans offered by other groups such as their college. Colleges offer health insurance plans to students because they have an interest in maintaining the health of their students and helping them achieve their educational objectives. These plans also can help students avoid high medical bills. To offer a health insurance plan, colleges either contract with an insurance carrier or fund their own plans. Unlike enrollees of employer-sponsored plans, those enrolled in student insurance plans typically pay the full premium for coverage. To make decisions about the plan’s eligibility criteria, benefits, and premiums, colleges typically convene a student health insurance committee, which generally includes college administrators, student health center administrators, and student representatives. These committees decide how the student insurance plan will coordinate with a college’s student health center, if one exists. College student health centers vary greatly in the services they provide—some offer limited services from one nurse, and others offer extensive services from multiple specialists. The committees may also consider college student insurance program standards issued by ACHA. Among other things, these standards suggest that colleges require students to have health insurance as a condition of enrollment, and that student insurance plans provide an appropriate level of benefits, including coverage of preventive services and mental health services and coverage for catastrophic illnesses or injuries. College students may also obtain health insurance through individual market plans, which are plans sold by insurance carriers to individuals who do not receive coverage through an employer, college, or other group. Because these plans are offered by insurance carriers, the plans must meet state requirements, including those regarding eligibility for dependent coverage. Individuals purchasing a health insurance plan in the individual market typically pay the full cost of their health care premium. Insurance carriers who sell plans in the individual market are typically allowed to review the health status of each individual applying for insurance. Unlike the employer-sponsored group market where premiums are based on the risk characteristics of the entire group, premiums for individual market coverage are based on factors associated with differences in each applicant’s expected health care costs, such as health status, age, and gender. Furthermore, applicants for individual market coverage may be rejected. Some college students may be able to obtain health insurance in the individual market as a result of protections established by HIPAA. Specifically, HIPAA protects eligible individuals, including college students who have exhausted COBRA continuation coverage, by requiring insurance carriers to offer individual market plans without a waiting period for coverage of preexisting conditions. HIPAA also protects eligible college students who were previously and continuously covered by a group market plan and are seeking coverage under a different group market plan. For these individuals, HIPAA requires insurance carriers to limit the use of waiting periods for coverage of preexisting conditions to no more than 12 months. In addition to private sources of health insurance, college students may obtain health insurance coverage through public health insurance programs, such as Medicaid or SCHIP. Some college students may have coverage through Medicaid, a joint federal-state program that finances health care coverage for certain low-income families, children, pregnant women, and individuals who are aged or disabled. Federal law requires states to extend Medicaid eligibility to children aged 6 through 18 in families with incomes at or below the federal poverty level. Some college students may have coverage through SCHIP, which provides health care coverage to low-income children through age 18 who live in families whose incomes exceed their state’s eligibility threshold for Medicaid and who do not have insurance through another source. This estimate is within plus or minus 133,000 of the population value at a 95 percent confidence level. Compared with college students aged 18 through 23, young adults not enrolled in college were more than twice as likely to be uninsured. Specifically, about 42 percent of nonstudents aged 18 through 23 were uninsured in 2006. Of the 1.7 million college students aged 18 through 23 who were uninsured in 2006, certain groups of students were more likely than others to be uninsured; and uninsured students incurred from $120 million to $255 million in uncompensated care for non-injury-related medical events in 2005. In particular, we found that part-time students, older students, and students from families with lower incomes were more likely than other groups of students to be uninsured in 2006. Of the 1.7 million college students aged 18 through 23 who were uninsured in 2006, certain groups of students—including part-time students, older students, and students from families with lower incomes—were more likely than others to be uninsured. According to our analysis of CPS data for 2006, we found that part-time students were more likely to be uninsured than were full-time students. Specifically, 31 percent of part- time students aged 18 through 23 were uninsured in 2006, compared with 18 percent of full-time students of the same age. In addition, CPS data show that older college students—those aged 22 and 23—were more likely to be uninsured in 2006 than younger students aged 18 through 21. Specifically, about 35 percent of college students aged 23 and 25 percent of college students aged 22 were uninsured in 2006, in comparison with 16 to 19 percent of college students aged 18 through 21 who were uninsured in 2006. (See fig. 2.) College students of certain racial and ethnic backgrounds—specifically, Hispanic, black, and Asian students—were more likely to be uninsured than white students in 2006, according to our analysis of CPS data. Specifically, we found that 38 percent of Hispanic, 29 percent of black, and 26 percent of Asian college students aged 18 through 23 were uninsured in 2006—in contrast with 15 percent of white college students of this age group who were uninsured in 2006. (See fig. 3.) These differences among uninsured college students from different racial and ethnic backgrounds are consistent with characteristics of the uninsured found in the general U.S. population. According to the U.S. Census Bureau, Hispanic, black, and Asian individuals were more likely to be uninsured in 2006 than were whites. In 2006, college students reporting lower family incomes were more likely to be uninsured than college students reporting higher incomes that year. Specifically, according to our analysis of CPS data, the average family income for uninsured college students aged 18 through 23 was about $52,000 in 2006, whereas the average family income for insured college students was significantly higher—about $95,000. This difference in income among uninsured college students is consistent with characteristics of the uninsured found in the general U.S. population. According to the U.S. Census Bureau, the likelihood of having health insurance rises with income. Based on our analysis of CPS data we also found that college students aged 18 through 23 from states in the West and South of the country were more likely to be uninsured in 2006 than students from states in the Northeast and the Midwest. Specifically, about 22 percent of college students aged 18 through 23 from states in the West and about 23 percent of students from states in the South were uninsured in 2006, whereas about 15 percent of college students from states in the Midwest and 18 percent of students from states in the Northeast were uninsured that year, according to our analysis of CPS data for 2006. These differences among uninsured college students from different regions are consistent with characteristics of the uninsured found in the general U.S. population. According to the U.S. Census Bureau, individuals from states in the South and West were more likely to be uninsured in 2006 than were individuals from states in the Midwest and Northeast. According to our analysis of MEPS data, uninsured college students incurred from $120 million to $255 million in uncompensated care for non-injury-related medical events during 2005. About 18 percent of uninsured college students aged 18 through 23 incurred uncompensated care in 2005, according to our analysis of MEPS data. Most of the charges for non-injury-related uncompensated care incurred in 2005 by uninsured college students were through visits to office-based providers and hospital emergency rooms. Uninsured college students may also incur uncompensated care for medical events related to injuries that our estimate does not reflect because we could not reliably determine the cost of this care.