If you don’t get health insurance coverage through your employer, union or a government-funded health plan, like Medicaid or Medicare, chances are you’re uninsured or have encountered “sticker” shock, especially if you have a pre-existing condition.
For artists, the challenges of obtaining and maintaining health insurance often are exasperated by their relatively low incomes, episodic work and high rates of self- and part-time employment. A majority of those who currently lack health insurance want coverage but say cost is the biggest barrier. Those without coverage are about twice as likely as their insured counterparts to say they worry about affording both routine and catastrophic medical costs. The insured also worry about looming risks like employers, professional organizations or insurers dropping their plans (a temporay fix will allow insurures to reinstate cancelled policies) or about uninsured friends and family members who will need help paying astronomical hospital bills.
Now every artist can obtain health insurance with full benefits at a reasonable cost. And you can't be denied coverage because of a pre-existing condition. GET COVERED
St. Louis Volunteer Lawyers and Accountants for the Arts knows that many individual artists are wondering how the Affordable Care Act (ACA), also known as Obamacare, affects them. Many are still largely unaware of the “individual mandate” that requires most Americans to be insured or pay a penalty or the new Health Insurance Marketplace.
This grassroots Every Artist Insured campaign is about navigating the changing health insurance landscape. Our goal is to educate every St. Louis artist — working in every discipline — about the basic provisions of the ACA, including the law’s financial incentives and disincentives, and options for securing coverage by 2014 (and beyond).
Every Artist Insured will rely on our network of new and established partners. Our first priority is to ensure that our region’s artists understand their options and know how to sign up for coverage. We will co-host free informational sessions with the Missouri Foundation for Health, provide access to easy-to-understand online information, send email blasts and distribute printed materials. And we’ll be updating our Artist as Bookkeeper publication to explain the law’s tax implications. Every Artist Insured is made possible by grant support from the Regional Arts Commission.
The Affordable Care Act (ACA) was signed into law in 2010 and upheld by a Supreme Court ruling in 2012. It contains numerous provisions that will increase the quality and affordability of health insurance and control health care costs.
The healthcare act:
• Creates the Health Insurance Marketplaces, also called exchanges, a new way for individuals, families and small businesses to get health coverage.
• Requires insurance companies to cover people with pre-existing health conditions.
• Helps you understand the coverage you’re getting.
• Holds insurance companies accountable for rate increases.
• Makes it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick.
• Protects your choice of doctors.
• Covers most young adults under 26 under their parents’ plans.
• Provides free preventive care.
• Ends lifetime and yearly dollar limits on coverage of essential health benefits.
• Requires employers, including nonprofits, with 50 or more FTE (defined as a person who works, on average, 30 hours a week or more) or an equivalent combination of full-time and part-time employees to offer “adequate” coverage to their full-time employees or pay a fine. This provision begins in 2015.
The Individual Mandate
The ACA includes a mandate for most individuals to have health insurance or pay a penalty, also known as a shared responsibility payment, for noncompliance. Beginning in 2014, most individuals will be required to maintain minimum essential coverage for themselves and their dependents. Some people will be exempt from the mandate (examples include the religious conscience exemption, those whose household incomes are below the minimum threshold for filing a tax return, and short term — under 3 months — gaps in coverage.)
Health coverage provided through your job, public programs such as Medicare or Medicaid, and most policies purchased on your own for yourself and your family will satisfy the mandate. It’s important to note that unless you’re under age 30, catastrophic high deductible insurance plans, often purchased by individuals directly or through their professional organizations, will not meet the ACA’s minimum essential benefits requirement.
The 2014 enrollment deadline is March 31. If you do not have the minimum level of coverage and do not qualify for an exemption, you’ll pay a penalty to the IRS at the end of the tax year. In 2014 the penalty is 1% of annual income or $95 per person (whichever is higher); the penalty increases to 2.5% of income or $695 per person in 2016.
If you are going to require people to have insurance, it should be affordable. Many low- and middle-income individuals who enroll through the government-operated Health Insurance Marketplace are expected to qualify for tax credits and subsidies. Eligibility will be based on adjusted household income. It does not include the value of a house, bank accounts or other assets.
Subsidies are available if your household income is between 100% and 400% of the federal poverty level. So, if your annual income is less than $45,960 for an individual and $94,200 for a family of four, the subsidy will cap the amount you spend on premiums in relation to your total income. The subsidy will also cap your annual out-of-pocket medical costs. The formulas are complicated. You can get a sense of what the subsidy might mean for you by using Kaiser Family Foundation's health insurance subsidy calculator.
Starting in 2014, all health insurance newly sold to individuals and small businesses must be classified as one of the four levels of coverage – bronze, silver, gold or platinum. Each plan level must cover the same set of essential benefits, including:
• Doctor/Emergency Room Visits
• Maternity and Newborn Care
• Laboratory Services
• Substance Abuse Treatment
• Mental Health Coverage
• Prescription Medicine
• Pediatric Services, including Dental Visits and Eye Exams
While the scope of benefits will be the same among the plans, the value of those benefits will vary across the bronze, silver, gold and platinum levels. Bronze plans have the least generous coverage with higher out-of-pocket costs, and platinum plans have the most generous benefits. Prices will vary based on age, region, family size and tobacco use. The older you are, the more it's going to cost. But your gender or health history will not affect the cost of coverage. Catastrophic plans with lower premiums are available to those who are under 30 years old, who are vulnverable to serious accidents and life-threatening infections.
You’ll have many choices when it comes to purchasing healthcare coverage:
Insurance agents/brokers and private online exchanges, such as eHealthInsurance.com and Gohealth.com, offer a broad range of health insurance plans, including supplemental benefits that may not be available on the government marketplace, such as vision, dental, accident and short-term “gap” plans.
The public Health Insurance Marketplace is a new way to find quality health coverage. When the technical glitches are fixed, the portal will help if you don’t have coverage now or if you have coverage but want to look at other options. When you visit the website you'll be able to:
• Compare and evaluate health insurance plans.
• Calculate the cost of the plans.
• Buy a plan for yourself, your family or your small business.
• Find out if you qualify for a tax credit or cost sharing reductions.
• Learn if you qualify for Medicaid (Illinois expanded coverage to people making up to 138 percent of the poverty line; Missouri has not) or the Children’s Health Insurance Program (CHIP) program.
• Receive enrollment support.
When comparing plans, be sure to look closely at networks of doctors and hospitals. They are expected to be narrower than the networks usually found in insurance that is purchased on the private market. Medications may also be covered differently.
• Learn about different types of health coverage. Through the Health Insurance Marketplace, you'll be able to choose a health plan that balances costs and coverage.
• Make sure you understand how coverage works, including premiums, deductibles, out-of-pocket maximums, co-payments and coinsurance. Common health care terms
• Gather basic information about your household income. Most people using the Health Insurance Marketplace will qualify tax credits and/or subsidies. To find out how much savings you're eligible for, you'll need income information, like the kind you get on your W-2, current pay stubs, or your tax return.
• Make a list of your doctors and your prescription medications.
• Think about your budget. You'll need to determine out how much you’re willing to spend on premiums each month. For guidance, see Managing Your Money, key questions and worksheets prepared by the University of Missouri Extension.
• Explore other options. You may be able to get coverage by staying on your parents’ plan until you turn 26, through your union, from a private insurance agent, broker or and online exchange, such as eHealthcare.com or Gohealth.com.
For your coverage to start on January 1, you must buy a plan by December 23. The enrollment period for 2014 closes on March 31, 2014. After that deadline, you’ll be able to enroll only if you have a major life event, such as losing your job, marriage or divorce.
The federal government will operate the Marketplace in Missouri. The state of Illinois will participate in a partnership with the federal government for the first year and will launch its state-based Health Insurance Marketplace for the second year of operation.
• Call 1- 800/318-2596, twenty-four hours a day, seven days a week.
• Chat online
• Talk to someone in person. Trained Navigators and Certified Application Counselors can answer questions and help you fill out your application. Find help near you.
The Affordable Care Act also provides benefits and opportunities to small businesses that will increase access to affordable coverage options. The SHOP Marketplace is open to employers with 50 or fewer full-time-equivalent employees (FTEs). It gives businesses the same purchasing clout as big corporations, and the small business tax credit (calculator here) is helping small businesses afford the cost of healthcare coverage for their employees. If you have employees (workers whose income you report on W-2s) you’re considered an employer. Then you will able to get coverage for yourself and your employees through the SHOP Marketplace. The online SHOP Marketplace will be open in November 2014. Meanwhile, small employers can take advantage of SHOP coverage through an agent, broker or insurer (Antheum in the St. Louis area) that offers a certified SHOP plan. If you run an income-generating business with no employees, then you're considered self-employed (not an employer even if you hire independent contractors to do some work). You can purchase insurance coverage through the individual marketplace.
If your nonprofit employs fewer than 25 employees, pays premiums for health insurance for its employees, and average wages for all employees is less than $50,000 annually, the nonprofit may be eligible for the Small Employer Health Credit to help pay for the cost of health insurance for your staff. Since tax-exempt organizations do not pay income tax to the IRS, the "credit" is in the form of a refund on employee income tax withholdings. Tax-exempt organizations will claim the tax credit on a revised IRS Form 990-T.
Get More Info
Affordable Care Act Tax Provisions
The IRS site is designed to educate individuals and businesses on how the health care law may affect them. The site provides information about tax provisions that are in effect now and those that will go into effect in 2014 and beyond.
Arists and the Affordable Care Act
This site was created by a task force of musician and artist advocacy organizations to help creatives learn more and take action on health care. Info about upcoming artist-friendly seminars and an artist-friendly hotline number are included on this site.
Artists' Health Insurance Resource Center
The center is operated by the Actors Fund. Check out the e-Learning Center's multimedia tutorials and Every Artist Insured: Understanding Health Care Reform.
Here's where you can learn about the new Health Insurance Marketplace. Spearheaded by the Missouri Foundation for Health, the information is neutral and based on facts and will help you find quality, affordable health insurance.
This national nonprofit organization for health care consumers advocates for high-quality, affordable health care for all Americans.
Future of Music Coalition
The organization's excellent Health Insurance Navigation Tool (HINT) provides artist-friendly advice, lots of links and the results of a 2013 study. It found that 43 pecent of artists of all disciplines and 53 percent of musicians have no health insurance. That compares to 18 percent of the general population.
Get Covered Illinois
The state's official site covers the basics. Check out the glossary.
This is the federal government's site where you can shop for insurance. It also explains health care reform and helps consumers understand how the law will affect them in the coming years.
Health Care Reform in Illinois
This is the state government’s site. It includes information on the ACA and healthcare related initiatives.
Small Business Majority
This advocacy organization the No. 1 authority on educating small business owners about the Affordable Care Act and the new health exchanges. Check out the organization's Misssouri Health Coverage Guide site. Contact the Missouri office here.
The Henry J. Kaiser Family Foundation
The foundation is a leader in health policy analysis, health journalism and communication