In 2010, Congress passed – and President Obama signed – the Affordable Care Act, a piece of legislation designed to overhaul the US health insurance system, and through a combination of incentives, Medicaid expansion, tax breaks and subsidies, provide more of the American public with access to affordable healthcare.
In October 2013, the federal government – and many state governments – opened up health care exchanges. These online marketplaces are designed to let uninsured adults see plan details – including prices – and either purchase individual coverage or see if they qualify for Medicaid. During this first enrollment period, which ended March 31, 2014, over 8 million Americans signed up through the exchanges.
We are currently in between enrollment periods, with the next window opening on November 15, 2014. While the exchanges are not currently accepting new applications, there are a number of "qualifying life events" that can make it possible for you to buy insurance at this time.
Frequently asked by artists
I heard that some people aren’t mandated to have insurance. Is that true?
Everyone is required to have insurance, with a few exceptions. Those exceptions are:
- Native Americans (who have their own healthcare system)
- People who have been uninsured for less than 3 months
- Those with religious objections
- Undocumented immigrants
- Those for whom the least expensive option would cost more than 8% 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).
I forgot about the enrollment deadline and I’m not eligible for an exemption. Can I still buy health insurance through the Marketplace this year?
No. Unless you’re Medicaid-eligible (more on that below), are buying insurance for a small business (2 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. If you don’t have a qualifying life event, you must wait for the next open enrollment period that begins on November 15, 2014 for coverage that starts January 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. To enroll in a Marketplace plan in states other than New York, go to www.healthcare.gov or call 800-318-2596. In New York, visit www.nystateofhealth.ny.gov or call 855-355-5777.
What is Medicaid, and how do I know if I qualify?
Medicaid is a joint federal-state program that provides comprehensive medical coverage at no cost to members. An individual who earns about $16,000 per year or less (about $33,000 for a family of 4) will be eligible for Medicaid if they live in a state that has expanded Medicaid guidelines (such as New York, New Jersey, and Connecticut).
Can I buy insurance off the Marketplace?
Some insurance companies are still selling plans off the Marketplace. However, you cannot receive premium subsidies, which reduce the cost of your coverage, for non-Marketplace plans. To find out more about non-Marketplace plans, contact the insurance company of your choice.
I'm currently paying for health insurance myself. Can I look at these exchanges and see if I can get a better price?
Absolutely! You can look at the full-cost plans on your state's Exchange website. Be sure to see if you qualify for the Advanced Premium
Tax Credit, which lowers the cost of your monthly premiums, as well. If you have a low household income, you may qualify for Medicaid.
I already have coverage via a union [like AFM or SAG or Equity]. How will things change for me?
You can stay on
your current coverage. Things won't change much for now. Most union plans will stay the same through 2014. If you lose coverage, you will be
eligible for COBRA or insurance through the Exchange. Talk to your union Pension and Health Department if you have any questions.
Am I better off getting a group plan through my band as a legal entity, or an individual plan?
As a small
business, you may be eligible for tax credits to offset the cost of buying insurance. As an individual, you may be eligible for tax credits
to lower the cost of your monthly premiums. Speak with a broker or Navigator and compare the two scenarios to see which one is better for you
and your band.
If I purchase coverage through an exchange, will it help me with health care needs while on tour?
concerned about being covered in other states, think about buying a PPO plan. Most PPO plans reimburse a percentage of your out-of-network
costs. HMO plans generally do not. However, all plans are required to cover emergency room costs outside their network in a life-threatening
emergency. Before you buy a plan, read the contract.
If band members are insured, under what circumstances do we have to insure our crew too?
Employers are not
required to insure their employees. In 2015, employers that have 50 more employees will have to insure them or a pay a penalty. Current
contracts usually limit coverage to "permanent" full-time employees and part-time employees who work more than a specified number of hours.
If you'd like to see what it would cost to insure your crew members, either contact your broker, or visit the SHOP Exchange, the small
business version of the individual Exchange, where you can review plans and see if you qualify for a tax credit of up to 50% on the premiums
I'm a smoker. Will coverage be more expensive for me)?
Yes. In most
states, smokers can be charged up to 50% more in premiums. However, the new law requires every plan offer a smoking cessation program and
smokers can avoid the surcharge if they enroll.
When do I need to have coverage in place in order to avoid fines?
You needed to have coverage by March 31, 2014, or
pay a tax penalty. The penalty in 2014 is 1% of your income, or $95, whichever is greater. It will go up to $325 or 2% of your income in
2015. If you don't have insurance now, plan to sign up during the next open enrollment period, which starts Novembre 15, 2014.
What If I don't file taxes?
If you don't file taxes because your income is below the tax filing threshold
(currently $9750 for a single person), you will not have to pay a penalty for being uninsured. However, at that income level you may qualify for
Medicaid and should apply.
What if I can't predict what my income is going to be?
You're in the same boat as a lot of people. The Exchange
application asks several questions about income. If your income this year is different from what it was on your last tax return, you can
indicate that. The exchange website will then calculate your potential subsidy based on what you project your total income to be this
year. Project carefully! If your income goes up or is actually higher, you'll have to pay some or all of that subsidy back the next time you
file taxes. Of course, if your income goes down or is lower, you'll get money back.
I’ve made very little money this year. Do I qualify for expanded Medicaid?
About half the states have expanded
Medicaid. This means that you can make up to $16,105 for a single person and $21,707 for a couple and qualify for free, comprehensive
coverage. Below is a list of states with expanded Medicaid coverage:
Arizona Arkansas California Colorado Connecticut Delaware DC Hawaii Illinois Iowa Kentucky Maryland Massachusetts Michigan Minnesota Nevada New Hampshire New Jersey New Mexico New York North Dakota Ohio Oregon Rhode Island Vermont Washington West Virginia
Where do I apply?
You can apply online at www.healthcare.gov.
I’m having trouble filling out the application. Can someone help me?
Sure! To get help, visit http://localhelp.healthcare.gov/ or call 1-800-318-2596.
Who should I go to if I have more questions?
This website lists a number of resources. The videos below provide both quick overviews and very detailed analyses of the Affordable Care Act and how to get coverage. The Washington Post recently hosted an online Q+A that answers many practical questions. And, there are a number of artist-friendly events and seminars happening. Check out the sidebar on the right.