Do you need health insurance, but don’t have enough union health contributions to get on one of Local 802’s health plans? If so, we’d like to remind you that the Affordable Care Act (Obamacare) is still active and can be a great way to get insurance. But you have to act now.
Despite attempts to weaken the individual insurance market, most things in New York and New Jersey have remained the same. Open enrollment still begins Nov. 1. Premium assistance is still in effect, just as it has been in years past – and rate increases have been modest for most plans. And the Essential Plan is still going strong! However, a few key things have changed – and now is a good time to review your insurance coverage.
Pay attention to the open enrollment period in your state! Open enrollment begins Nov. 1 across the country and has been shortened to end on Dec. 15 in most states. However, if you live in New York, the deadline is Jan. 31, 2019; if you live in New Jersey or Connecticut, it’s Dec. 15, 2018. During open enrollment, everyone who is not enrolled in an employer-based plan (or union-based plan) should review their coverage options. It is the only time during the year when you can enroll in coverage or switch plans (a few exceptions apply).
Check to make sure your health insurance carrier will still be offering plans in 2019. Plans can also make changes to their provider networks, co-pays, co-insurance and drug coverage every year. So check to make sure that any providers (including hospitals) that you use are still in your network, and that the drugs you need are still covered under what’s called a “formulary.” If you receive a letter from your health insurance plan, open it and read it! And don’t be afraid to shop around. At renewal time, you should be armed with alternatives in case you need to switch to a different health insurance. (Are you already feeling overwhelmed at all of this? Don’t panic! See the HELP NAVIGATING INSURANCE section below.)
The health insurance plans offered through the ACA (also called Marketplace or Exchange plans) are designed to allow your premiums to fluctuate with your income. If you think your income will go up or down significantly in 2019, and you have coverage through the Marketplace/Exchange, it’s a good idea to re-estimate your income to see if you are either paying too much, or possibly not enough for your insurance coverage. You may be eligible for lower-cost coverage.
FREE AND LOWER COST COVERAGE
Many people still mistakenly think they are not eligible for free coverage. In New York, New Jersey and Connecticut, if your income is below $16,754 (as a single person), you are eligible for free, comprehensive insurance through Medicaid. If your income is above the Medicaid limit but below $24,120 (again as a single person), you are eligible for the Essential Plan (New York only), which offers comprehensive coverage with no deductibles for $20/month. If you don’t qualify for those programs, you may still be eligible to receive premium assistance to help lower the cost of your insurance if your income is below $48,240 (as a single person).
UNION COVERAGE AND THE COBRA SUBSIDY
If you’re currently covered under one of Local 802’s health plans, congratulations! You don’t have to worry about buying another plan. Should you lose your coverage, you will be eligible for a 60-day “Special Enrollment Period” outside of open enrollment, which starts the day after your last day of coverage. If you’re eligible for COBRA, you should compare the cost of COBRA coverage with the cost of a Marketplace plan. Don’t forget, you may be eligible for a subsidy to pay for 50 percent of your COBRA premiums if you’re covered through an entertainment union and are a New York resident. For more information, visit www.dfs.ny.gov/consumer/cobra_entertainment.htm.
The penalty for not having insurance has been discontinued for 2019. In 2019, you will not pay a penalty for being uninsured. (If you were uninsured for more than two months in 2018, you will still have to pay a penalty). If you are considering remaining uninsured or dropping your coverage, think twice. A simple preventive screening, such as a colonoscopy, can cost anywhere from $2,300 to $5,000. Room and board in a hospital (excluding all procedures, diagnostic tests, and doctors charges) can cost anywhere from $2,000 to $5,000 per day.
Although New York and New Jersey do not allow the sale of short-term insurance plans, other states do. You may receive marketing materials about insurance plans that sound too good to be true. They usually are! Short-term insurance plans do not have to play by the rules set up by the Affordable Care Act. They can exclude coverage of pre-existing conditions, exclude certain types of benefits such as drug and mental health coverage, and cap how much they spend on certain services (such as inpatient hospital stays). If you are tempted to buy one of these plans, contact the Artists Health Insurance Resource Center first (see below).
HELP NAVIGATING INSURANCE
The Actors Fund’s Artists Health Insurance Resource Center has trained “Navigators” who can help you review your options and enroll in coverage. To schedule a free appointment, call (917) 281-5975. In addition, from now through Dec. 18, they will offer free workshops on understanding your insurance options. Workshops take place at 729 Seventh Avenue, between 48th and 49th Streets, on the 10th floor, on Tuesdays (from 6 p.m. to 7 p.m.) and Thursdays (from 12:30 p.m. to 1:30 p.m.). There’s no need to register, but space is limited, so it’s best to arrive early.
OTHER HEALTHCARE OPTIONS
Local 802 members who have questions about getting on one of the union’s health plans can start at www.local802afm.org/health-benefits.
For members looking for doctors who understand the needs of musicians, the Friedman Health Center for the Performing Arts, a program of the Actors Fund and Mount Sinai, has been designed with industry insurance needs in mind. The Friedman offers personalized primary care and specialty services, including physical therapy, dermatology, and podiatry, with extended hours that are sensitive to industry work schedules. It accepts all entertainment union insurance plans, commercial insurance, several New York Marketplace plans, workers’ comp and Medicare. Entertainment professionals – including musicians – who are uninsured or underinsured may be eligible for a reduced rate. For more information, call (212) 489-1939 or make an appointment at www.actorsfund.org/services-and-programs/friedman-health-center-performing-arts.
Renata Marinaro is the national director of health services for the Actors Fund. E-mail her at Rmarinaro@ActorsFund.org.