Christopher Phipps didn't think much about health insurance when he applied to graduate school at the University at Buffalo in New York in 1998. A doctoral student in linguistics, Phipps had never been in a hospital. He didn't even bother reading his $717-a-year student insurance policy. Then one day last year, he felt a numbness in his fingers that later developed into severe pains in his hand. He was eventually diagnosed with an aneurysm in an artery in his neck, requiring two bypass operations and five hospital stays. "I never dreamed I'd have this kind of problem," said Phipps, whose student insurance policy paid just $25,000 of the $90,000 bill. With a yearly income from part-time teaching jobs of only $20,000, Phipps says there's no way he can pay off his debt. "I'm currently preparing a bankruptcy filing."

When choosing a graduate school, most students, like Phipps, rank health insurance somewhere between proximity to a good all-night diner and access to cheap on-campus housing. Accustomed to relying on their parents' insurance, many don't read the fine print on the policies offered by schools they're considering or even purchase insurance once they've enrolled. (In fact, most young adults get kicked off their parents' policies between the ages of 23 and 25.) And unaccustomed to severe health problems, many graduate students still harbor youthful illusions of invulnerability. "Graduate students are all broke and struggling," says Doris Dirks, president of the National Association of Graduate-Professional Students. "They consider health insurance a luxury. You're gambling that you're not gonna get sick."

Of course, many students win the wager. They either don't get sick or don't get so sick that the school's health center can't care for them. Many schools include in their tuition a health services fee that ranges typically between $100 and $250 per year. The fee entitles students to free or reduced-cost access to the campus health center for primary healthcare such as treatment for routine illnesses like strep throat. But each year many other students lose the gamble and find themselves underinsured, facing mountainous medical bills.

The University at Buffalo offered graduate students Erin Murphy and Christopher Phipps very different health plans. (Kevin Horan for USN&WR) Good, bad, and ugly. Two years ago, the American College Health Association, an organization of more than 900 colleges and universities that promotes healthcare on campus, issued guidelines recommending that schools make insurance a mandatory condition of enrollment. But while 90 percent of private universities now meet the recommendation, 3 out of 4 public universities still do not. Moreover, even schools that require students to get insurance don't necessarily offer decent policies. "It's a huge spectrum," says Stephen Beckley, who handles student benefits at the University of Idaho in Moscow and who helped draw up the ACHA guidelines. Some provide policies that are "outstanding," he says, while others offer plans that are "wholly inadequate, coverage you wouldn't want to rely on."

How can students distinguish the good from the bad and the plain ugly plans? Generally, private universities offer better insurance policies, as do many of the major public universities. Harvard University in Cambridge, Mass., for instance, has no dollar limit on medical expenses covered by its student policy and doesn't require copayments except for the purchase of prescription drugs. The University of Minnesota system has a basic student insurance plan that caps students' yearly out-of-pocket payments at just $2,000 and has no limit on preventive care received through the student health service, like routine checkups.

However, not all big schools have great plans. The vast University of Texas system provides a student plan, at an annual cost of $535, with a lifetime cap of just $250,000. It covers only $300 worth of prescriptions a year and includes a clause limiting coverage of catastrophic injury or illness suffered by a student prior to enrolling in the plan.

By contrast, the tiny Colorado School of Mines in Golden, an engineering school with just 3,000 students, has an $810-a-year student plan that corporate workers might envy. It has no exclusions for pre-existing conditions, no copayments for visits to physicians within the plan's network of specialists, and a $2 million lifetime cap on reimbursements for medical expenses.

To further complicate matters, some schools offer different plans to different categories of student. At the University at Buffalo, where the limits of the $717-a-year basic student insurance plan drove Phipps to file for bankruptcy, a blue-ribbon, university-subsidized policy is available to grad students with research and teaching assistantships at a cost of about $125 a year. Erin Murphy, 26, a research assistant and Ph.D. student in microbiology, had a total hysterectomy last summer after being diagnosed with endometrial cancer. "My insurance was exceptional," she says. "The surgery and hospitalization ended up costing me $1,000."

Because university health centers provide many basic services, it is especially important that students review the level of coverage for major injuries or illnesses when picking a plan. With hospitalization costs and doctors' fees rising, many experts believe that $500,000 of lifetime coverage should be the minimum. "Bare-bones plans are not doing a service to anyone," says Edward Ehlinger, director and chief health officer for the student health center at the University of Minnesota.

Drug-lite. Prescription drug coverage is particularly important for those with chronic conditions like asthma, although even students with a clean bill of health can suddenly find themselves needing drug benefits. Alicia Gardner, 25, a doctoral student in pharmacology at the University of Cincinnati College of Medicine, was diagnosed with multiple sclerosis last year. "My MS medication is $1,100 a month," she says. "The cap on prescription drugs is $500 a year, so I use that up in the first month."

Another student, Daryl Arkwright-Keeler, 41, who is pursuing a doctorate in biological sciences at Western Michigan University in Kalamazoo, came down with Crohn's disease, an autoimmune disorder, while in graduate school. Her $646-a-year insurance policy has a $500 yearly cap on prescription drugs, so she moved up her marriage date from next year to this past January to get on her new husband's insurance plan, which will cover the $9,000-a-year drug regimen her doctor has recommended.

Another important consideration is whether a policy includes mental health benefits. Graduate school, with its heavy workload and competitive environment, can be a time of considerable stress for students. While some plans don't cover psychotherapy, others, like the Colorado School of Mines, have free on-campus counseling centers for short-term therapy and generous benefits for long-term therapy off campus. Students also should check whether a policy excludes pre-existing medical conditions and find out the size of the annual deductible (which can range from nothing to several hundred dollars).

For university administrators charged with formulating student insurance plans, the ongoing dilemma has been how to offer comprehensive benefits while keeping down the cost of premiums. "[We] could certainly cover more drugs," says John Andrews, director of university health services at the University of Cincinnati, "but then everyone's premium would go up. [We're] trying to give something that's affordable for the healthy 18-year-old," yet is still useful to the older student.

Indeed, a top-notch insurance plan, like Harvard's, doesn't come cheap: Students there pay $1,484 a year for their insurance plan ($805 of that is included in their tuition). University of Minnesota students pay $996 for the basic plan, in addition to the $178 annual health services fee in their tuition. Coverage for spouses and children further inflates the bill. Half of grad students are married and a third have kids, and at most schools adding just a spouse to the policy more than doubles the premium.

Still, some university administrators are improving their health plans, viewing a good policy as a recruiting tool. Many schools, like Western Michigan, now subsidize insurance for grad students who have jobs as teaching or research assistants. "It was one way we could make ourselves more competitive," says Kevin Vichcales, who administers the plan. If two universities offer similar programs at about the same cost but one of them provides a good health package, "it's pretty easy to figure out where you'll go," he says.

For some students, though, health insurance will become important only in hindsight. "I hadn't even considered it," says London Silas Shavers, 23, a teaching assistant at Western Michigan's school of music, who was uninsured last year when he got a kidney stone and had to foot $600 of medical bills. "Now it's a priority."