Major-college athletes aren’t the only ones who get injured.

But the debate about medical insurance largely ignores athletes at lower levels – such as those at the University of Southern Maine, an NCAA Division III school that cannot offer sports scholarships.

Does an absence of sports revenue remove small-college athletes from the medical care discussion?

“At the Division III level, you’ve got a really good argument (to not provide insurance), which is nobody’s making any money off of you,” said Paul Haagen, co-director of the Center for Sports Law and Policy at Duke University. “The fairness argument is that there is something that could be shared (among all schools). Should it be shared?”

The NCAA reported revenue of $913 million in 2012-13, largely from its lucrative Division I men’s basketball tournament. That money doesn’t find its way to places such as USM.

The university spent $245,578 last year to care for its athletes. It has three athletic trainers, led by Matthew Gerken, who work 10 months a year providing many of the same services available at the University of Maine. USM also pays $4,800 a year for a secondary insurance policy to help seriously injured athletes, which kicks in after $10,000 in medical expenses.

Director of Athletics Al Bean, who oversees teams competing in 23 sports, said it’s a far cry from what existed when he started working at USM 31 years ago.

“When I got here, the training room was a hallway, pretty much. There was no point in being hurt or sick because there wasn’t much that was going to be done. You went and got your physical and then you started playing,” he said.

“Now, we’re not doing every testing in the world, but we’re doing the responsible things. I feel very good about the level of care we can provide for people. I’m sure there are (schools that) have more resources than we do.”

As the university has been able to provide more professional care for its athletes, Gerken has noticed a change in attitudes.

“I think now athletes are more concerned about their long-term,” he said. “(They) are becoming more savvy, more conscious of risk factors and wanting to protect themselves. They’re going online and looking up problems. And I think they expect more from us, which is a good thing.”

Athletes at USM are required to have medical insurance before stepping onto the field, just as their Division I counterparts are. The financial repercussions of an injury are just as real.

Hana McNally came from New Jersey to play soccer for the Huskies last year. She had completed her freshman season when a teammate set up a scrimmage against a local U-17 team in March.

McNally emerged from one scrum with her foot tingling and her shin numb. At an urgent-care clinic, she was told the swelling would subside in a few hours. But Gerken told her to get X-rays, which revealed a torn anterior cruciate ligament and meniscus in her knee.

McNally had surgery April 3 and likely will have to sit out this fall as a medical red shirt.

She started her physical therapy at a clinic in Gorham but has since returned to New Jersey, where the 19-year-old got a lesson about insurance. She was planning to continue the therapy three days a week, but discovered she will be charged a $15 co-pay for each visit. Instead, she’ll probably cut back to twice a week.

“It adds up quickly,” McNally said.

To add to the uncertainty, her mother is losing her insurance at the end of this month after not being rehired as a public school teacher.

“It’s a little bit scary,” McNally said. “Because insurance doesn’t cover 100 percent, maybe the school should be held responsible for part of that. Plus, if I was at a bigger school, I wouldn’t have to go off-campus for physical therapy.

“I’ve been an athlete my whole life and injuries are part of the game,” she said. “Was this my greatest fear, tearing my ACL? Definitely.”

Mike Poulin had a couple of tough breaks while playing basketball at USM. The Maranacook High graduate fractured his left forearm during a practice session a week before his sophomore season was to begin. Then the point guard tore an ACL during the fourth game of his senior year.

He was determined to see his college basketball career through, so he endured a second year of rehab, both on and off campus. He was fortunate that his father, a teacher, had good insurance with minimal co-pays.

“I could tell that it was kind of time to wrap it up in terms of college basketball,” he said of the tail end of his final year. “I was more of a slasher and defender, and it didn’t do well for my knees at all. I was putting a good beating on them.”

Poulin now works in an insurance office in Portland, and said he’ll always feel lingering effects from his injuries.

“I get soreness in my knee a lot. If I sit for too long, the knee stiffens up,” he said.

Poulin is not sure universities should be compelled to provide insurance for athletes, although he can see the merits.

“I think it would allow them to focus on their academics and athletics without having to worry about having to pay for surgery,” he said. “That never crossed my mind because I knew there wasn’t a doubt that I was going to have surgery and be able to rehab.

“I kind of looked at basketball as something I love to do, and USM gave me the opportunity to do that.”