Open Enrollment starts November 1 in New York and most other states, and many people are confused about the rules and options. That’s understandable. It’s hard to know what’s accurate and who to trust. Let me dispel a couple myths:
Myth #1: The Affordable Care Act (ACA) is dead.
The ACA is not dead; it was not repealed and is still the law of the land. In fact, all of the provisions in the ACA, including the prohibition against discrimination based on gender or pre-existing conditions, are still in place.
Myth #2: You have to enroll before December 15.
This isn’t really a myth—it’s true in many states. In all the states that use the federal exchange (www.healthcare.gov), the deadline to enroll is December 15. However, in California and New York, the deadline to enroll is January 31, 2020. To find the deadline in your state, visit this website.
Myth #3: You can’t get discounted insurance anymore.
Many people still mistakenly think they are not eligible for low-cost or free coverage. In New York, New Jersey, Connecticut, California, Illinois and 29 other states, if your income is below $17,237 (as a single person), you are eligible for free, comprehensive insurance through Medicaid. If your income is above the Medicaid limit but below $24,280 (as a single person), you are eligible for the Essential Plan (in New York only), which offers comprehensive coverage with no deductibles for $20/month. If you don’t qualify for those programs, you may still be eligible to receive premium assistance to help lower the cost of your insurance if your income is below $48,560 (as a single person). And California just expanded its eligibility for tax credits, so residents there can look forward to discounted coverage if they make up to 600% of the Federal Poverty Level (approx. $72,840).
Myth #4: You can’t get help enrolling.
Entertainment Health Insurance Solutions (EHIS), a program run in partnership with The Actors Fund and MPTF, helps California residents understand their options and enroll in insurance. To attend one of their seminars or get help enrolling, visit ehisca.com. The Actors Fund’s Artists Health Insurance Resource Center (AHIRC) provides the same services in New York. Visit The Actors Fund website for more information. The Fund’s AHIRC program also offers phone consultations to those who live in states other than California.
Now, let’s talk about a couple things that have changed:
#1: Some states have instituted penalties for being uninsured.
The federal penalty for not having insurance was discontinued in 2019. However, if you live in New Jersey, California, Washington, D.C. or Massachusetts, you will pay a state penalty for being uninsured. If you live in a non-penalty state and 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.
#2: Junk insurance is more prevalent.
Although this seems in direct contradiction to Myth #1, it’s not. Any plan sold on your state’s official Exchange/Marketplace still has to abide by ACA regulations. However, some states, like Georgia, Illinois and California, have made it legal to sell low-quality short-term insurance plans, association plans and religious cost-sharing plans that do not have to abide by these rules. (New York and New Jersey do not allow the sale of short-term plans). You may receive marketing materials about insurance plans that sound too good to be true: they usually are! They can exclude coverage of pre-existing conditions, exclude certain types of benefits such as drug and mental health coverage and cap how much they spend on certain services (such as inpatient hospital stays). If you are tempted to buy one of these plans, contact EHIS or AHIRC first.
The laws, regulations, programs and benefits discussed here are all a function of government action (or inaction!). As always, let your state and federal representatives know what’s working for you and what’s not, and contact us if you have any questions.
All the best during Open Enrollment!
Yours in good health,
Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Contact our regional office closest to you to speak to a counselor.
New York City
Don’t forget to use the resources section of our website. It contains tools to help you make decisions about your health insurance, including new online tutorials on how to choose providers and how to read an Explanation of Benefits. In addition, you’ll find an updated Stage Managers National Health Directory, our national online directory of health care providers recommended by industry professionals that can be used by theaters and touring companies. For these resources and more, visit actorsfund.org/HealthServices. You can also find out more about enrollment assistance and upcoming health insurance seminars near you!