As a newly married student in 2004, Hope VanBennekom went to the doctor for a routine physical exam, which she later found out her Michigan State University student insurance plan didn’t cover. She and her husband, Kurt, ended up paying out of pocket for the $80 visit.

A few months later she went back to the health center for a pregnancy test. When the test came back positive, the center tried to get her to take abortion and adoption lectures. It was only after she filled out surveys about her husband to convince the center that he would be a good dad that she was allowed to have additional prenatal care without attending the lectures.

Now the VanBennekom’s have a two-year-old daughter, Lillian. Kurt is a year and a half into Indiana University’s law school program, and Hope is a stay at home mom. They are uninsured. The university’s insurance plan would have cost them $1,360 per year to enroll Kurt and an additional $11,230 to cover Hope and Lillian. The high cost, combined with their previous experience, convinced them it wasn’t worth it. Both schools work with The Chickering Group.

“If they couldn’t pay for anything but a urine test and abortion lectures, we’re not going to mess with them,” Hope said.

Student families across the country grapple with the same decision the VanBennekom’s faced: with student loans piling up, little or no income and additional mouths to feed, where do they cut costs? Often, the answer is health insurance.

Some universities provide student families access to health insurance, but usually not at an affordable price. “NYU does not sponsor Health Care for dependents,” said Marc Fichtenberg, a student in New York University’s Stern School of Business and father of a newborn son. “The price they offer for dependents is a ‘public’ price.”

The public price can be upwards of $5,000 for a spouse and another $5,000 for a child, depending on the institution. At Cornell University, students pay $3,149 annually for dependent coverage, more than twice the rate of the student premium. In October graduate students at Cornell lobbied to encourage the university to provide a more affordable option.

Others schools don’t provide students an option to insure their families at all. Katie Moore, whose husband Dom is a medical student at SUNY Downstate in Brooklyn, New York, said that it would have cost them about $10,000 to insure Dom through the school, but the school didn’t offer coverage for her and their 13-month-old daughter.

At schools where dependent coverage is offered, the high cost drives many families away, leaving them uninsured. Stanford University found in a 2004 study that graduate students did not enroll in student health plans because they couldn’t afford it.

While the study said that the majority of Stanford’s student families are eligible for the state’s Healthy Kids or Healthy Families programs, there is “an alarming number of student families in which dependents have no health insurance at all.”

Although student families are often technically among the “working poor,” as the Stanford study revealed, they may have a difficult time finding and enrolling in insurance from government sponsored programs.

Even when student families qualify for government programs, getting signed up isn’t easy. Christian and Amy John spent a year and a half navigating the government-sponsored insurance bureaucracy before finding a plan that worked for their family. Christian is an undergraduate at New York City’s Parsons New School for Design, which doesn’t offer insurance plans for dependents of students.

Initially, the Johns were denied coverage because of their student loans, said Amy, a stay at home mother of two. The agency couldn’t figure out why they needed government health insurance when their bank account had so much money.

Even after proving that the money was a lump-sum loan they were to live off for the whole year, the Johns had to wait to be accepted. It was during that time that Amy found out that she was pregnant with their second daughter.

The pregnancy complicated their coverage needs, Amy said, and the plan they had signed up for wasn’t accepted by their doctor, so she went to a midwife. Then she found out her plan didn’t cover the baby. Six months into her pregnancy, she found Medicaid and signed up her unborn daughter for the plan.

In signing up the baby, the office also signed Amy up, effectively changing her insurance to a plan that the midwife didn’t accept. The Johns had already paid the midwife some expenses out of pocket, and it was too late to switch to a doctor that accepted Medicaid.

While the family is now insured, the two girls through Medicaid and Amy and Christian through New York’s Family Health Plus program, Amy still feels bad that because of all the confusion, the midwife didn’t get paid.

The John’s experience my not be typical, but it does provide an insight into why students in the Stanford study cited “Too much hassle” as the second most popular reason they chose to be uninsured rather than sign up for government sponsored insurance plans.

The VanBennekoms also searched out other options before resigning themselves to being uninsured. The only program they might have qualified for — and could afford — was Medicaid, Hope said.

The government would cover Lillian, but not her or her husband, Hope said. Their caseworker told them they were ineligible because although Kurt is a full-time law student, he isn’t working towards getting a job.

But the VanBennekoms know other student families who did qualify for Medicaid. Carla Tisdale’s husband is an optometry student at IU. Their case worker decided that going to school was putting forth effort to become employed and enrolled them in Medicaid.

“We’ve talked about it with our friends who didn’t qualify, and from what we can tell, the only difference is the caseworker,” Tisdale said.

The VanBennekom’s frustration at their limited and unaffordable options is echoed by many student families: “We pay $40,000 a year in tuition,” Hope said. “I think they can provide a way for us to have affordable health insurance.”