Insurance 4-1-1

The entertainment community has been reeling from the financial effects of COVID-19, and the pandemic is having a major impact on the finances of many health plans covering those working in the entertainment industry.
 
The health plans sponsored by representatives of the entertainment unions and contributing employers are “multiemployer plans,” which are designed to provide consistent health care coverage for workers with sporadic employment. These plans pool contributions from different employers made under collective bargaining agreements within the multiemployer plan, which provides health benefits for a specified period of time.
 
Since the onset of COVID-19, the production shutdown has led to a scarcity of employer contributions, which has put a serious financial burden on all plans, many of which have tried to ease the hardship on members while maintaining their own viability. Unfortunately, as the pandemic continues, it’s expected that more entertainers will be affected. Still, there are concrete steps you can take to secure coverage. 
 
Below is a series of FAQs about health insurance coverage, costs, rights and resources.

What is Open Enrollment?
Open Enrollment is one period of time when you can enroll in or switch your health insurance coverage, and it takes place annually. 

When is Open Enrollment?
In all the states that use the federal health care exchange/marketplace, enrollment annually takes place between Nov. 1 and Dec. 15. However, for California residents, this coverage is offered through the state and the enrollment deadline is Jan. 31. 

Can I get health insurance outside of open enrollment?
Yes. Those who lose coverage due to certain qualifying events will be eligible for a special enrollment period outside of open enrollment. Special enrollment periods last for 60 days from the date of loss of coverage related to important life changes, known as qualifying events, including:

• Loss of health coverage through employment (other than for failure to pay the premiums for that coverage)
• Losing coverage as a dependent due to age.
• Relocation to a different state or county.
• Getting married.
• Having or adopting a baby and, in some states, becoming pregnant.
• A change in immigration status.
• Divorce or legal separation.
• Termination of coverage under COBRA.

What are my options if I lose coverage?
There are four main options: 

• Enroll in COBRA continuation coverage through your health plan, if you are eligible. COBRA allows for continuity of coverage, but can be expensive. The SAG-AFTRA Health Plan offers generous COBRA assistance for those who qualify for temporary reduced premiums or Extended Career COBRA. 
• Buy insurance on your state’s marketplace, which may give you a discount (subsidy) based on your projected 2021 annual household income. In all states, if your income as a single person is less than $51,000 per year, you will receive a subsidy on your monthly premiums. However, some states are more generous; California, for example, has temporarily expanded its eligibility for premium subsidies, so residents in the Golden State can look forward to discounted coverage if they make up to 600% of the Federal Poverty Level (approximately $75,560 annually).
• Buy directly from an insurance company. You can skip the marketplace and buy insurance directly from an insurer. However, they won’t give you a discount based on your income. 
• Receive coverage through Medicaid (or MediCal). California is one of the 36 states that expanded Medicaid, meaning if your adjusted gross income is below $17,608 in 2021 — or below $1,468 this month — you will be eligible for Medicaid, which is comprehensive and free. There are no premiums or deductibles, and co-pays are low. Applications in most of these states can also be submitted through the healthcare.gov website.

Who can help me review my options?
The Artists Health Insurance Resource Center and The Motion Picture & Television Fund's Entertainment Health Insurance Solutions program can help you review your options and enroll in coverage.

Both programs offer online workshops on a weekly or biweekly basis. In addition, you can access short, animated educational videos on The Actors Fund YouTube channel. To request individual assistance, go to theactorsfund.submittable.com/submit and complete the form that pertains to your state.

I’m worried I won’t be able to afford health insurance.
It’s important to first check to see if you’re eligible for a state-based insurance program such as Medicaid or Medi-Cal. These programs have year-round open enrollment and will cover you at little to no cost. Medicaid can help save you lots of money on health insurance, and covers hospitalization, lab work, office visits, medication, surgery and many other benefits without monthly premiums and deductibles. Co-pays are low ($1 and $3) and generally apply to medications only. If eligible, you’ll receive coverage for 12 months, which helps ensure that you aren’t subject to a mountain of medical debt. 
 
Residents in states that expanded Medicaid who are under 65 must show that household income in the prior month was below a certain threshold in order to qualify. For a single person, the prior month’s income, including unemployment and other income sources, must be below approximately $1,468 gross. For two people, it must be below $1,983 gross. If you are under 65, Medicaid does not take assets, such as savings accounts, into account. (Rules are different for those age 65 and older). To apply, visit healthcare.gov or your state’s Marketplace/Exchange.

If you’re not eligible for one of these programs, there are other options. Community health centers are a great place to get your preventive screenings, such as mammograms and colonoscopies, and charge sliding scale fees based on your income. NeedyMeds, a nonprofit that connects people to programs that help them afford their medications and other healthcare costs, has a nationwide list of community health centers. It’s also a great resource for finding out if you’re eligible for a pharmaceutical assistance program, which will cover the cost of your medications. 
 
A third option is visiting a public hospital. Unlike private facilities, public hospitals are mandated to help the uninsured and offer discounted rates based on your income. They are your best option for containing in-patient medical costs. A helpful tip: Before visiting a hospital emergency room, it’s best to determine if your issue might better be treated at an urgent care center. Many urgent care centers can handle stitches, uncomplicated fractures and other non-life-threatening medical needs, and are much cheaper than a visit to the ER.

My income has changed dramatically. Does that have an effect on my premiums?
If you’re covered by an Affordable Care Act Marketplace/Exchange plan, you can go back to your online account and change your income to reflect your current reality. For example, if you are now collecting unemployment, you should change your income estimate to reflect your gross unemployment benefits for 2021. This may result in an income estimate that is much lower than before, making you eligible for much higher tax credits, and lower premiums. 

If you are typically self-employed and/or work on 1099 forms but have no current income, you should change your estimate to reflect that. In most states you can submit an affidavit stating that you have no current sources of income and are living off savings or credit cards. The Marketplace/Exchange can access your IRS and Department of Labor records, so make sure you haven’t forgotten any ongoing sources of income before you do this. This will greatly reduce your premiums, and may even make you eligible for Medicaid, depending on the state you live in. 

Should I sign up for insurance outside the Marketplace?
A word of caution for those who are tempted to buy insurance policies that are not regulated by the state: Don’t do it! There are many “junk insurance” policies out there that do not cover what you think they cover. One common feature of these plans is that they only cover hospitalizations on certain days of the week! In addition, they exclude those with pre-existing conditions, often have some kind of “initiation fee,” and may not cover certain basic benefits, like prescriptions or mental health services. If you’re unsure about a plan, contact AHIRC or EHIS for their evaluation. For individual assistance, go to theactorsfund.submittable.com/submit and complete the appropriate form.

Is there a penalty for being uninsured?
The federal penalty for not having insurance was discontinued in 2019; however, those who live in California, New Jersey, and a couple other states have to pay a state penalty for being uninsured. If you are considering remaining uninsured or dropping your coverage, think twice: A simple preventive screening, such as a colonoscopy, can cost anywhere from $2,300-$5,000; room and board in a hospital (excluding all procedures, diagnostic tests and doctors charges) can cost anywhere from $2,000-$5,000 per day.

What are some things that I can do to lower my drug costs?

• Have a conversation with your doctor so you can find an alternative that works for you. Ask if a generic drug would be appropriate. Generics are chemically identical to, and often have exactly the same dosage, intended use, strengths, effects, risks and side effects, as the original drug. 
• If you’re uninsured, NeedyMeds can direct you to a pharmaceutical assistance program that will allow you to get your medications for free if you meet certain eligibility requirements. They also offer a discount card. 
• If you pay out of pocket, shop around and compare prices. One great resource is goodrx.com. Accessing the site allows you to see how prices vary for the same medication, and you’ll probably be quite surprised at the range.
• If your co-pays or medications are too expensive, check out Rx Outreach, a non-profit pharmacy. If you meet income eligibility requirements, you can get a 90-day supply of many medications for $20.

By the Actors Fund National Director of Health Services Renata Marinaro for the Los Angeles Local newsletter.