EVERY ARTIST INSURED: NAVIGATING THE ACA Artists Health Insurance Resource Center A program of The Actors Fund Renata Marinaro, Eastern Region Health Svcs Director

What is The Actors Fund? The Actors Fund is a nationwide human services organization that helps all professionals in performing arts and entertainment. The Fund is a safety net, providing programs and services for those who are in need, crisis or transition.

Our services  Social Services  Housing  Employment and Training Services  Health Services

Words to know Co-pay Co-insurance Deductible Premium Out-of-pocket maximum HMO & POS/PPO Federal Poverty Level Marketplace/Exchange Advanced Premium Tax Credit (aka subsidy)

 Children under age 19 with pre-existing conditions can’t be denied coverage.  Young adults up to age 26 (in NY, through age 29) can stay on or enroll in their parents’ coverage. Note: special rules apply for coverage from age  Insurers can’t retroactively cancel the policies of people who get sick. What has health care reform done for me so far?

 All new plans must cover certain preventive services for free. These include: certain breast, colon and cervical cancer screenings; blood pressure, diabetes and cholesterol tests; vaccines, immunizations, and flu shots; and HIV & STD testing.  Insurers can’t impose annual or lifetime dollar limits on medical benefits. What has health care reform done for me so far?

 Insurers can’t refuse coverage to anyone, or exclude pre- existing conditions  Most people will be mandated to have coverage or pay a penalty. In 2014, the penalty is $95 or 1% of your income, whichever is greater.  Medicaid eligibility will be expanded to people with incomes up to 138% of FPL (approx $15,856/yr or $1,322 per month) What happens in 2014?

 New insurance marketplaces, called Exchanges or Marketplaces, will offer insurance to those who don’t get it through their employer or Medicare.  Subsidies will be available to people who buy insurance on the Marketplace with income less than 400% of the Federal Poverty Level. ($45,960 for single, $62,040 for couple)  Initial enrollment in Exchanges will begin Oct 1, 2013 and end March 31, Thereafter, open enrollment will be November 15-January 15 of every year. What happens in 2014?

The initial open enrollment period for plans on the Marketplace is October 1, March 31, In an open enrollment period, you’re free to sign up for a plan or switch plans. Only in limited circumstances will you be able to enroll in or switch plans outside of this period. Circumstances that would trigger a “special enrollment period” include: losing job-based insurance, losing Medicaid coverage because of an increase in income, marriage, divorce, and the birth or adoption of a child. When can I enroll?

 YES!! Penalty increases from $95 or 1% of income in 2014 to $695 or 2.5% of income in  Exceptions include: Native Americans, those w/religious objections, undocumented immigrants, those who don’t meet tax filing threshold ($9,750 single), people who’ve been uninsured for less than 3 months.  You will file proof of coverage with your taxes. Do I have to have insurance in 2014?

 Employers do not have to offer coverage. Starting in 2015, those with 50 or more employees will have to pay a penalty if they don’t.  Employees who are offered coverage and choose not to take it will not be eligible for subsidies to pay for coverage through the Marketplace, unless the employer’s plan fails to meet certain benefit guidelines.  Guidelines: must cover at least 60% of medical costs and be “affordable” (less than 9.5% of employee’s income) Will employers be required to offer me insurance, and if so, do I have to take it?

 If you don’t get it through your job or a public program, you can buy it on what’s called the New York State of Health Marketplace.  This is a competitive, private insurance marketplace. You can shop for plans and buy coverage online at or apply by mail. Only plans that meet certain quality and affordability guidelines will be allowed to sell on the Marketplace.  Marketplaces will also administer the new subsidies and help enroll people in Medicaid and the Child Health Insurance Program (CHIP). Where will I buy insurance?

 You can buy insurance as an individual on the Marketplace, without having to worry about being turned down for pre- existing conditions, or paying more because of your medical history or gender. This increases your options and will reduce premiums for those with lower to middle incomes.  You can no longer buy insurance as a small business.  You may qualify for Medicaid if your income is under $15,856 (single). I’m self-employed. How will this affect me?

Considerations when picking a plan Cost of Care Premium Deductible Out of Pocket Max PCP Specialist Hospitalization Access to Care Network Doctors Hospitals Benefits Consider your health status/needs! Quality of Care Independent ratings Opinions from family and friends Feedback from doctors/providers Personal experience %20Provider%20Networks.pdf

What benefits do plans on the Marketplace offer? Hospitalization Office visits (PCP & Specialist) Emergency Room Ambulance Mental Health treatment Substance Abuse treatment Medications Diagnostic and lab work Preventive Screenings (free) Maternity care Chiropraxis Gym reimbursement!

Tier% of costs covered by insurer DeductibleConsumer’s max out of pockets costs Bronze60%$3,000$6,350 Silver70%$2,000$5,500 Gold80%$600$4,000 Platinum90%$0$2,000 What will the plans look like in NY?

Will there be dental coverage? Only for children. For discounted dental services visit:  NYU & Columbia dental schools  New York City Technical College  Dental hygiene clinic: Provides cleaning, fluoride treatment, and x-rays;  Negotiate with your dentist!

 If a company offers coverage to an employee, the company must also offer coverage to children (but not spouses).  The employer must make insurance affordable to the employee (less than 9.5% of the employee’s income) but does not have to offer affordable family coverage.  If the employee’s coverage is “affordable”, then no matter what the employer charges to cover the employee’s dependents, those dependents will not be eligible for government-subsidized coverage on the Marketplace. What about family coverage?

 Dependents (incl. spouses) who decline employer-provided coverage that they cannot afford will not be penalized under the Individual Mandate if the cost of the family coverage exceeds 8% of modified adjusted gross income.  All children in New York are eligible for the Children's Health Insurance Program (CHIP). What about family coverage?

If they were married in New York or a state that recognizes same-sex marriage, they will be eligible for Medicaid and subsidies based on household income, not single income. As far as we know, there will be no changes to ADAP/AHIP/APIC in New York What about same-sex married couples?

 Under age 30: high-deductible plan option. Deductible is $6,350. Prevention benefits and 3 primary care visits are exempt from deductible.  Under age 26: can stay on/enroll in parents’ plan, regardless of living situation, marital status, student status, whether you’re offered insurance through an employer, or financial dependence. In NY, adults age can stay on their parents coverage, but special rules apply: you must be unmarried, live or work in NY, and have a policy that was issued in NY. Are there special programs for people under 30?

 If your income is $15,856 (single), you will be eligible for Medicaid.  Medicaid is a joint federal-state program that provides comprehensive health insurance at no cost to patients. There are no premiums or deductibles, and very small co-pays. I’m broke. How Will I Afford Insurance? Household SizeIncome Limit 1$15,856 2$21,404 3$26,951 4$32,499

 People who have low to moderate incomes will receive subsidies (APTC) which will lower the cost of premiums. Some people will also qualify for cost-sharing reductions (CSR).  The amount of the subsidy depends on your household size and income. If your household income is below 400% of the FPL, you’ll receive a premium subsidy. 400% of the FPL = $45,960/yr (single), $62,040/yr (couple), and $78,120 (family of 3).  You must pay your premiums by January 10 for coverage starting January 1, What will it cost to buy coverage on the Marketplace?

 You are ESTIMATING YOUR 2014 INCOME  Use your HOUSEHOLD modified adjusted gross income:  Adjusted Gross Income (guideline: line 37 of Form 1040)  +  Non-taxable social security benefits  Tax Exempt Interest  Foreign Earned income For Medicaid eligibility, you can exclude from your income: scholarships, awards and grants (for education only), and certain lump sum one-time payments How do I calculate my income?

Subsidies  You can take the credit in advance, or when you file your taxes.  Advance payments are made directly to the insurer.  If you choose to wait until you file taxes, the credit will be applied to what you owe, or refunded to you.  If the advance subsidy payments exceed the amount of credit for which you’re eligible, a portion of the overpayment must be repaid.

Income as % of Federal Poverty Level Income range for 1 person at this level Max % of your income you will spend on premiums Up to 133%$15,2822% %$15,282-$17,2353-4% %$17,235-$22, % %$22,980-$28, % %$28,725-$34, % %$34,470-$45,9609.5% Subsidy Chart

 Example: Susan is single and makes $22,000/yr. She will have her premiums capped at 6.3% of her income (approx $130/mo) and her annual out-of-pocket medical costs will be limited to under $4000/yr (excluding premiums).  Calculate your potential subsidy here:  ator ator Example

More info:  Navigating the ACA for Small Businesses  First Tuesday of every month  5:30-7pm  th Avenue, 11 th floor  Rsvp:  Navigating the ACA for Individuals  Every Thursday  12:30-1:30pm  th Avenue, 10 th floor  Rsvp: Small Business Seminar - monthlyIndividual seminar - weekly