Obamacare Open Enrollment: What You Need to Know

by Kelsey Butterworth, Policy Intern and Kevin Erickson, Communications & Outreach Manager

As of November 1, enrollment for the Affordable Care Act (better known as Obamacare) is once again open, which means it’s a counterintuitively exciting time to be an artist without medical insurance. The ACA does what its name implies, and for musicians lacking coverage, it can be a critical step in leading a long and productive life.

How many musicians lack coverage, you ask? Our 2013 survey (before ACA implementation) revealed that number to be a staggering 43%, much higher than the national average of 18% for the same 18-65 age range among the general population. This is likely because health insurance in America has been traditionally sourced through employers; this poses a unique and expansive problem for self-employed artists. The payment that artists do receive is often as contract, and though many musicians have day jobs, they’re often part-time gigs that don’t offer benefits. Of the 57% of artists who reported having insurance in our survey, 39% were paying for it themselves.

Luckily, the Affordable Care Act was designed to solve this problem and overall, it seems to be making an impact—the national uninsured rate is the lowest it’s ever been. But how effectively the law helps you may vary based on where you live, and decisions your state’s politicians may have made.  Here’s some practical advice:

1.  If you don’t have health insurance, you need to enroll or face a penalty.  That penalty will be bigger this year!

Like car insurance, health insurance is now essentially mandatory. If, according to your income, you could afford health insurance but choose to go without, you’ll have to pay a penalty. You also may have to pay a penalty if your spouse or tax dependents go without insurance too, and you get cumulatively charged for each insurance-less month when you file your federal tax return. There are a few ways to be penalized—you’ll either be charged a percentage of your income (2.5% of the household, capping out at however the Bronze plan’s yearly market premium is valued) OR per person ($695 for adults and $347.50 for children under 18, capping out at $2,085). As in Monopoly, whichever is higher is the one you pay. 

But all you need to avoid that is to either get insured, or get a waiver (if you qualify—more on that later). There are multiple ways to enroll in the health insurance marketplace: through the website at healthcare.gov, over the phone at 1 (800)-318-2596 or in person—you can find local organizations with trained “navigators” ready to help you at localhelp.healthcare.gov.

You can also get assistance from a private health insurance broker. Unlike “navigators,” they’re able to give you more extensive advice about which plan to choose on the exchange, though they’re not able to help you apply for Medicaid. The commission is paid by the insurance company whose plan you ultimately choose, so it won’t cost you anything extra.

Your eligibility for financial assistance is based on your annual adjusted gross income, as reported on your taxes. But accurately predicting your income can bevery difficult for musicians, whose income can fluctuate wildly from month to month and year to year. You can only estimate how your forthcoming album or tours are going to do. If you have no idea, use your income from last year’s taxes as a starting point. Your premium can be adjusted over the course of the year if your estimate was off the mark.

2.  If you have insurance now, you should still shop around on the marketplace anyway.

That’s true even if you’re happy with your current plan. Healthcare is changing almost as rapidly as the music industry; some premiums are going up while others are going down. Look around the ACA’s price-comparison marketplace to see if there’s a plan that better fits your needs. The devil’s in the geographical details, and you could get the same coverage by paying less. Be sure to watch out for stuff like out-of-network coverage, especially if you’re someone who spends lots of time on the road, away from your local health care providers.

3.  To the extent that you’re able, avoid falling into the Medicaid gap.

The Affordable Care Act helps make insurance more accessible in two main ways: Medicaid expansion (state-government-provided insurance) for the lowest-income folks, and subsidies to cover part of the cost of private insurance for folks making a little more. Your expected 2016 income and family size will determine your eligibility for either. Subsidized healthcare plans can be compared through the healthcare.gov website, which is working fine these days, and is much easier to navigate as well.  

Unfortunately some states have thus far chosen not to accept federal funding for medicaid expansion, since the Supreme Court ruled that they had that option. That’s bad news especially for low-income musicians in those states. (Watch John Oliver describe the Medicaid Gap). People who earn too much for medicaid but not enough to qualify for a subsidy end up being excluded from the benefits of the ACA.

These states that have chosen not to expand Medicaid:

  • Alabama, Alaska, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Michigan, Missouri, Mississippi, Montana, North Carolina, Nebraska, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming

States may add or remove themselves from that list, so you may want to call your governor and state representatives and tell them how you feel. Unfortunately, Kentucky musicians are now facing the news that their newly elected governor may roll back medicaid expansion.

If you’re a low earner in one of those states, one potential solution to get coverage is simply to do what you can to increase your income to the level where the subsidy kicks in ($11,770 for individuals). Enroll with that figure as your estimated income, and then do everything you can to get your income up to that level for your 2015 taxes to avoid any possibility of repayment penalties. Make sure you’re reporting all your income from house shows and t-shirt sales; whatever it takes to get up to that line.

4. Get a waiver if you need to, but get insured if you can.

If the plans available in your area aren’t actually affordable at your income level, there’s something called a hardship exemption that applies to people who’ve, you know, experienced a list of certain hardships. .This is especially important if you’re a low earner who would have qualified for medicaid if your state had expanded it because this automatically qualifies you for the HEIf you do qualify for a HE, be aware that it’s  only a temporary fix, as the month after the hardship ‘ends’ is the end of the exemption too. We’re all aiming for long-term solutions, so if you have to use it as a stopgap, by all means.

Now, you may look at the cost of available plans and determine that the only option you can afford is a high-deductible “Bronze” plan, or a bare-bones “catastrophic” plan and wonder whether it’s worth the extra hustle to pay that monthly premium, even with a subsidy. You really should sign up anyway, and not just to avoid that penalty. Here’s why: all the individual plans available through the marketplace have an out-of-pocket limit of $6,600 or less, which means you’re protected in the event of a worse-case scenario like an emergency surgery or chemotherapy. Your friends might have to throw you some benefit shows or launch a GoFundMe campaign to help you come up with that deductible, but it’s better than a career-ending bankruptcy.

5.  Don’t procrastinate.  

Open Enrollment for 2016 health insurance ends Jan 31, 2016, but if you wait that long, your new plan won’t take effect until March. If you want your insurance to start January 1, you want to have everything cleared up by December 15, 2015.

Signing up for health insurance may seem daunting and stressful, but imagine how good it’s going to feel to have the security of being covered. Don’t delay, get insured today—before Open Enrollment goes away.

Image via shutterstock.com

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