Despite all the attempts this year to repeal and replace the Affordable Care Act (otherwise known as Obamacare), most things have remained the same. Open enrollment still begins Nov. 1. There’s still a penalty if you don’t enroll in health insurance. Premium assistance and cost sharing reductions are still in effect, just as they have been in years past. 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, 2018; if you live in New Jersey, it’s Dec. 15, 2017, and if you live in Connecticut, it’s Dec. 22, 2017. During open enrollment, everyone who is not enrolled in an employer- 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 2018. For example, both Affinity and Care Connect have left the New York market. 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 last section of this article about help navigating insurance.)
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 2018, 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 $16,643 (as a single person), you are eligible for free, comprehensive insurance through Medicaid. If your income is above the Medicaid limit but below $23,760 (again as a single person), you are eligible for the Essential Plan (NY 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 $47,520 (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 coverage in 2018 is $695 per person or 2.5 percent of your household income, whichever is greater. This will be assessed on your tax return. The same penalty applied in 2017.
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 Nov. 1 through Dec. 19, they will offer free workshops on understanding your current insurance options. Workshops take place at 729 Seventh Avenue, on Tuesdays at 6 p.m. and Thursdays at 12:30 p.m. There’s no need to register, but space is limited. If you can’t make it to one of the workshops, check out their online tutorials at www.actorsfund.org/services-and-programs/artists-health-insurance-resource-center.
HEALTHCARE FOR ENTERTAINERS
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, there is a new option. The Samuel J. 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 dermatology services with extended hours that are sensitive to industry work schedules. It accepts all entertainment union insurance plans, commercial insurance, four 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, visit www.actorsfund.org/services-and-programs/friedman-health-center-performing-arts or call (212) 489-1939.
Renata Marinaro is the national director of health services for the Actors Fund. E-mail her at email@example.com.