International Students and Navigating the U.S. Health Care System

Navigating the complex U.S. health insurance and delivery system can be difficult, even for a native student. International students may have additional difficulties, as the U.S. system may be very different from the one in their country of origin. Some of the important factors to include in a health system educational program for international students include:

  • health insurance basics and why it’s needed
  • patient privacy
  • TB screening

Health Insurance: the Basics and Why It’s Needed in the U.S.

The cost of health care per person in the U.S. is higher than anywhere else in the world, and international students should be made aware of these costs so that they can better understand the importance of having a health insurance plan. Using examples of common outpatient and inpatient health issues experienced by students, presenting average cost information will demonstrate the need for health insurance to defray these costs. Basic information should be provided regarding local health resources (local outpatient clinics, urgent care, emergency room) and examples of when to use those services instead or in addition to using student health services.

Institutional Mechanisms to Monitor Requirement for Health Insurance

Most colleges require international students to demonstrate adequate health insurance coverage as a requirement for enrollment. Many require a policy with a comparable level of coverage to the college-sponsored insurance plan. Standards for student health insurance benefits can be found in the ACHA Standards for Student Health Insurance/Benefits Coverage [pdf].

Generally a “hard waiver” process is in place, automatically enrolling the student in the college-sponsored plan unless proof of comparable insurance is shown. The student health insurance vendor often has a process in place to assist the college with the evaluation of policy content for the hard waiver process and the monitoring of international student health insurance enrollment.

Essential Health Insurance Terms/Concepts

Orientations for international students to help them understand the language commonly used in health insurance policies are often conducted upon entrance. These one-time events may be inadequate for some. On-line orientations can be constructed for student convenience and ease of use. The college health insurance vendor can often provide the orientation or help with content and frequently asked questions. Some of the more common terms needing definition and explanation regarding policy benefits/limitations include:

Deductible: the amount paid by the policyholder (student) before the insurance company pays any benefits.


Copay: a fixed amount that the insured must pay for a particular service each time it is accessed.


Coinsurance: a percentage of the cost to be paid by the policyholder, after the deductible is paid, usually applied until an out-of-pocket maximum is reached.


Out-of-pocket maximum: The maximum the policyholder will have to pay in any policy year, including coinsurance, copays and deductibles.


Preferred provider/hospital network: A list of providers and facilities that the policyholder must use to minimize the policyholder’s copays and coinsurance and other out-of-pocket expenses.


Medical benefits (outpatient/inpatient): schedule of benefits paid for each type of medical service provided to policy holder.


Mental health benefits (outpatient/inpatient): schedule of benefits paid for each type of mental health service provided to policyholder


Pharmacy benefits/formulary and tiered copay-coinsurance: The amount of copay or coinsurance that the policyholder must pay each time a prescription is filled will depend on the tier classification of the drug and its placement on an approved formulary. Pharmacy benefits are often administered by a PBM (Pharmacy Benefits Manager); prescriptions must be filled at participating pharmacies and a specified mail-order process may be encouraged.


Policy exclusions: those services excluded from coverage. Often, elective, ineffective, or experimental services are excluded, as well as some vision and hearing correction services.

Patient Health Information Privacy: FERPA and HIPAA

International students may be less likely to seek care, especially mental health care, due to stigma and fears that seeking care could be noted on their transcript or affect their visa status. These fears are unfounded, and it is important to educate international students on U.S. privacy protection. The protections afforded those using the health care system in the U.S. are significant. A basic understanding of a student’s <a href=”/for-students/patient-conf/” rights to privacy may reassure students who fear seeking care because of confidentiality issues.

TB Screening

Depending on the country of origin, international students may need TB screening. For more information, see the ACHA Guidelines: Tuberculosis Screening and Targeted Testing of College and University Students and FAQs, both available here.