Q&A: Navigating the health care maze

Volume 114, No. 5May, 2014

Jorge Elias flickrWe all need health care, but health insurance recently got more complicated – especially for freelance musicians. The Affordable Care Act (otherwise known as the ACA, or Obamacare) just ended its first open enrollment period, and with it one of the most publicized and tumultuous times in its four-year history. Below, Renata Marinaro, director of health services in the Eastern region at the Actors Fund, answers more of your questions about finding affordable health care.

I wasn’t paying attention to the ACA/Obamacare law. How can I get a basic understanding of what’s going on?

For an overview and frequently asked questions, start at Allegro has also covered this topic many times in the past few years. Go to and search the site for article topics that have to do with the ACA or Obamacare. Our most recent story can be found here:

Is it true that everyone is required to buy health insurance now?

Yes. Everyone is required to have insurance now, with a few exceptions. Those exceptions include: Native Americans (who have their own health care system), people who have been uninsured for less than three months, those with religious objections, undocumented immigrants, those for whom the least expensive option would cost more than 8 percent of their household income, and those who don’t meet the tax filing threshold (currently $10,150 for a single person, $20,300 for a couple). In order to be eligible for an exemption, you must complete an exemption application. For more information, see

What is the penalty for being uninsured?

The penalty for 2014 is $95 or 1 percent of your taxable income, whichever is greater. For example, if your taxable income was $30,000 in 2014, you will be assessed a penalty of $300 when you file your taxes in 2015.

I have coverage through Local 802. Do I need to do anything?

If you’re on Local 802’s Plan A+ or Plan A, you meet the minimum essential coverage and are considered covered. If you’re on Local 802’s Plan B, you do not meet the minimum coverage and will need to buy some kind of plan to avoid a penalty under the law, unless you’re exempt. (SPECIAL NOTE: Local 802’s health plans are changing, effective Oct. 1. See story on page 10.)

OK. I don’t have health insurance now, and I want to buy it. What do I do?

A major part of the ACA/Obamacare is the “Marketplace” system, where you shop for health plans online through a state or federal web site. New Yorkers should start at (or call 855-355-5777). Others should start at the federal site, which is (or call 800-318-2596). The advantage to using the Marketplace system is it includes free or subsidized health care for eligible people. That is how the ACA is bringing health insurance to millions of people who couldn’t afford it before. Local 802 took a test drive of the Marketplace system, and our most recent report was published in the March 2014 issue of Allegro, which you can read here: However, the deadline for signing up this year was March 31.

Oops! I forgot about the enrollment deadline. Can I still buy health insurance through the Marketplace system this year?

No. Unless you’re Medicaid-eligible (more on that below), are buying insurance for a small business (two or more employees), or are buying insurance for a child, you must have a major life-changing event (called a “qualifying life event”) to be eligible to buy insurance through the Marketplace this year. If you don’t have a qualifying life event, you must wait for the next open enrollment period, which begins on Nov. 15, 2014 for coverage that starts Jan. 1, 2015.

What are qualifying life events?

Qualifying life events are major changes in your situation that allow you to apply for health insurance after the enrollment deadline. The following are qualifying events:

  • Individual or dependent loses health insurance coverage due to: job loss, loss of union health insurance, employer no longer offers coverage
  • Marriage, divorce, or death of a spouse
  • Birth or adoption of a child
  • Becoming eligible for Medicaid or Child Health Plus
  • Expiration of COBRA coverage
  • Becoming a citizen or gaining a green card
  • Permanent move to an area that has different plan options (for example, moving from New York to New Jersey)
  • Voluntarily dropping your coverage or being terminated from your coverage because you didn’t pay premiums is not a qualifying event.

To qualify for a special enrollment period, you must tell your state Marketplace within 60 days of the event. New Yorkers should utilize (or call 855-355-5777). Others should start at the federal site, (or call 800-318-2596).

Can I opt out of my Local 802 coverage and get something on the Marketplace?

You can, but all restrictions discussed above apply, and don’t assume that you’ll be eligible for premium subsidies. For more information on this, call the Local 802 health department at (212) 245-4802.

I need health insurance now and I missed the deadline to buy it through the Marketplace this year. Can I still buy health insurance?

Yes. Insurance companies are still selling plans that have nothing to do with the Marketplace. For example, the Freelancers Union ( offers coverage to freelance musicians. However, you cannot receive premium subsidies (which reduce the cost of your coverage) for any plans not affiliated with the Marketplace. To find out more about health care insurance options, Local 802 members should start at the Musicians’ Assistance Program at (212) 397-4802, or the Actors’ Fund health resource center (which also serves Local 802 musicians) at (917) 281-5975 or

What is Medicaid, and how do I know if I qualify?

An individual who earns about $16,000 per year or less (about $33,000 for a family of four) will be eligible for Medicaid if they live in a state that has expanded Medicaid guidelines (such as New York, New Jersey and Connecticut). Medicaid is a joint federal-state program that provides comprehensive medical coverage at no cost to members. For help with Medicaid, Local 802 members can start at the Musicians’ Assistance Program at (212) 397-4802, or the Actors’ Fund health resource center (which also serves Local 802 musicians) at (917) 281-5975 or

Despite the ACA/Obamacare, I’m still uninsured or underinsured. Where can I go for care?

Local 802 members should first start at the Musicians’ Assistance Program at (212) 397-4802, or the Actors’ Fund health resource center (which also serves Local 802 musicians) at (917) 281-5975 or

For general primary care, musicians and all entertainers can go to the Al Hirschfield Free Health Clinic, a program of the Actors Fund. The clinic provides free health care to uninsured and underinsured entertainment industry professionals between the ages of 18 and 64. To make an appointment, call (212) 489-1939 or see You can also visit to find the community clinic closest to you. For hospital services, visit any of the public hospitals in New York City. All public hospitals in NYC participate in a program called HHC Options, which provides services at heavily discounted rates to the uninsured. For more information on HHC Options, visit

I’m still confused. Is there someone I can talk to about my situation?

  • For questions about your Local 802 health coverage, contact the Local 802 health department at (212) 245-4802.
  • For general questions about health insurance options for musicians, Local 802 members can start at the Musicians’ Assistance Program at (212) 397-4802, or the Actors’ Fund health resource center (which also serves Local 802 musicians) at (917) 281-5975 or
  • For specific questions about the ACA/Obamacare, you can call the Actors Fund, which is an approved ACA Navigator. The number for the Actors Fund’s health resource center is (917) 281-5975. Using that same phone number, you can also inquire about other health insurance options for musicians or ask about the Actors Fund’s free weekly seminar on getting health insurance.