When Dania Berjaoui graduated from Eastern Michigan University in the spring, she left behind not only the comfortable confines of a college environment, but also another important safety net: her student health insurance.

Now working as an administrative assistant in office of the University Health Service Director, Berjaoui is not eligible for University health benefits because she is a temporary employee. While some young adults can now be insured under their parents’ plan until age 26, Berjaoui’s father was laid off last year and now is enrolled in Medicaid, the program for low-income Americans that covers children until only age 18.

Berjaoui is one of roughly 48-million uninsured Americans who have the opportunity to learn more about their options starting Tuesday, when open enrollment for the Health Insurance Marketplace — one of the key components of the Affordable Care Act — begins.

Last week, the University Benefits Office, per ACA requirements, sent out a letter to all 67,000 of the faculty and staff it services to provide notice of the beginning of enrollment.

Roughly 46,000 employees are currently eligible to receive coverage through a University health plan, and are unlikely to participate in the new marketplace, according to Brian Vasher, director of operations for the Benefits Office. However, the remaining 21,000— most of whom are temporary employees like Berjaoui — may be inclined to use the marketplace.

Outside of temporary employees, it’s unclear how other University demographics, such as graduate and professional students, may benefit from the marketplace. The University’s GradCare plan currently covers 5,900 students, including graduate student instructors, graduate student staff assistants, graduate student research assistants, benefit-eligible fellowship holders and benefit-eligible medical students.

While enrollment data for the fall has yet to be released, combined graduate and professional student enrollment has exceeded 14,000 in each of the past three years, meaning that GradCare likely covers less than half of that.

For those outside the GradCare network, there are a variety of options: The University offers the Domestic Student Health Insurance Plan to graduate and doctoral students who are completing requirements. Graduate or professional students may be able to become insured through their parents if they are under age 26, or through a spouse. The deadline to enroll in DSHIP for the fall semester was September 23, and uninsured students were encouraged by University Health Services to enroll if they wanted insurance that could be used sooner than offerings on the marketplace.

Business graduate student Tiffani Bender decided that DSHIP’s $3,284-per-year premium was too expensive, instead opting to see if marketplace options would be cheaper.

Though exact costs have yet to be released, the marketplace will offer four plans: bronze, silver, gold and platinum.

A consumer who purchases the bronze plan would pay the cheapest monthly premium, but would also bear roughly 40 percent of out-of-pocket costs — the highest proportion of any plan. Someone on the platinum plan would pay the highest monthly premium rate, but would be responsible for only 10 percent of out-of-pocket costs.

Each plan provides the same set of essential benefits, including doctor visits, emergency services and prescriptions, but the more expensive options could include additional services.

UHS director Robert Winfield, the University’s chief health officer, said that the University’s health coverage most resembles the silver plan in terms of its proportion of covered to out-of-pocket costs — silver leaves patients responsible for 30 percent of out-of-pocket costs, while University policyholders pay roughly 28 percent.

Although the gold and platinum plans offered on the marketplace cover a greater proportion of costs, Winfield said the University health plan covers a broader range of pharmacy benefits and physical-therapy services.

“The University’s benefits for those non-essential covered items are for the most part going to be better than most of the insurances offered on the exchange,” Winfield said.

Despite all of the attention given to the marketplace, another component of the ACA may be more relevant for the uninsured University population: Medicaid expansion. This provision gives states the option of expanding Medicaid eligibility to 133 percent of the federal poverty level, all at the federal government’s expense.

Gov. Rick Snyder signed Medicaid expansion into law in September, but the Republican-led state Senate did not grant the bill immediate effect, meaning it won’t be implemented until late March or April. Temporary University employees and uninsured graduate or professional students may qualify for Medicaid because of the income eligibility expansion, which makes individuals with income of roughly $15,000 or a family of four with roughly $31,000 in income eligible.

Implementation aside, Winfield said one of the biggest challenges will be helping people figure out all of their options between the federally-run insurance marketplace and the state-run Medicaid program.

“I think it’s just a great example of the struggle between federalism and states’ rights,” Winfield said. “(There is) compromise after compromise which leads to more and more confusion.”

Consumers and health administrators share this confusion. For people like Bender, the Business graduate student who left a job in advertising at McCann Worldgroup to return to school, the insurance marketplace allows people to learn more about their options, but all that information can be hard to comprehend.

“When I got (insurance) through my employer, it was almost like a black box: You pay a premium every month, you know when you go to the doctor you may or may not have a certain copay, or if you needed prescriptions you’d know if it’s covered,” Bender said. “I’m 26; I’ve had health insurance my whole life, but now I feel like I’m just learning about it, because now it’s being put in my control.”

It is unclear how the government shutdown early Tuesday morning will affect the Marketplace, but it appears the program will open for enrollment as planned.

More information is available on HealthCare.gov, and organizations, such as the Kaiser Family Foundation, have already created a subsidy calculator which estimates insurance costs based on various demographic information. You can use the calculator below:

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