It’s open enrollment time for Obamacare plans. But what does this mean – and how can you sign up?
The Affordable Care Act (otherwise known as Obamacare) has been in the news a lot recently, and with good reason: premiums for many plans are going up, and some big-name insurers have pulled out. Luckily, the markets in New York, New Jersey and Connecticut are more robust than most. Still, with open enrollment beginning Nov. 1, now is a good time to review a few key points about your insurance coverage.
The term “open enrollment” simply refers to the period once a year* when you can sign up for an Obamacare plan or switch your current plan. (*There are exceptions, such as if you lose your current coverage. See below for more on that.) Open enrollment runs from Nov. 1 to Jan. 31. During this time, everyone should review their coverage options.
Every year, health insurance plans make changes to their provider networks, co-pays, co-insurance and drug coverage. For example, the insurance company Oscar plans to significantly reduce the size of its network in 2017. 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. If you receive a letter from your ACA “marketplace” or “exchange” (in New York, it’s called the New York State of Health), open it. and read it carefully.
The Obamacare plans are designed to allow your premiums to fluctuate with your income. If you think your income will go up or down significantly in 2017, and you have coverage through one of the ACA plans, 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 mistakenly think they are not eligible for free health insurance. In New York, New Jersey and Connecticut, if your income is below $16,394 (single), you are eligible for free, comprehensive insurance through Medicaid. If your income is above the Medicaid limit but below $23,540 (single), you are eligible for the Essential Plan (NY only), which offers comprehensive coverage with no deductibles for $20 per month. If you don’t qualify for those programs you may still be eligible to receive subsidies to help lower the cost of your insurance if your income is below $47,080 (single). Confused? We can help you! See the end of this article for details.
UNION COVERAGE AND THE COBRA SUBSIDY
If you’re currently covered under your Local 802 plan, 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, 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 an ACA 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. (Again, if any of this is confusing to you, we can help!)
The penalty for not having insurance coverage in 2017 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 2016.
HELP NAVIGATING INSURANCE
The Actors Fund is a resource for all entertainment professionals, including members of Local 802. And the good news is that the Actors Fund has health insurance navigators who can help you review your health insurance options and help enroll you in coverage. To schedule a free appointment, call (917) 281-5975.
Besides the one-on-one appointments, the Actors Fund is also offering free 90-minute health insurance workshops each Tuesday at 6 p.m. and each Thursday at 12:30 p.m. from Nov. 1 to Jan. 31. Workshops take place at the Actors Fund, on the 10th floor of 729 Seventh Ave (between 48th and 49th). There’s no need to register, but space is limited. Call (917) 281-5975 for more info. Or start at www.ActorsFund.org and follow the links to Artists Health Insurance Resource Center.
If you can’t make it to one of the workshops, check out our online tutorials on the ACA (Obamacare), Medicaid, Medicare, “How to Read an Explanation of Benefits,” and more. Again, start at www.ActorsFund.org and follow the links to Artists Health Insurance Resource Center.
A NEW MEDICAL HOME
The Actors Fund and Mt. Sinai will be opening a new health center for the performing arts and entertainment community in New York City in early 2017 at the Actors Fund main offices at 729 Seventh Ave. The Samuel J. Friedman Health Center for the Performing Arts will provide a medical home for the creative community. It will offer primary and specialty care with extended hours that are sensitive to industry work schedules. It will accept all entertainment union insurance plans, commercial insurance, New York State of Health marketplace plans and Medicare. It will also offer a discounted fee for uninsured and underinsured patients. The Actors Fund Al Hirschfeld Free Health Clinic (at 57th Street at 10th Ave.) will continue to operate in its current location until the opening of the new health center. Stay tuned for more information in an upcoming issue of Allegro!
Renata Marinaro is the national director of health services for the Actors Fund. Reach her at firstname.lastname@example.org.