Health Insurance HQ: An Update on the Health Care Landscape | Actors Fund

Health Insurance HQ: An Update on the Health Care Landscape

Welcome to Health Insurance HQ—coming to you from the experts at The Actors Fund's Artists Health Insurance Resource Center and special guests!

Dear Friends,

This letter is meant to answer some basic questions about health care and health insurance since the appearance of COVID19 in the United States. 

If You’re Uninsured

Some states are opening their Affordable Care Act Marketplaces/Exchanges in the wake of the public health crisis, so you can buy insurance for yourself and your family based on your current income (or lack thereof). The following states have opened their Marketplaces for a COVID19 Special Enrollment Period (SEP):

  • Washington State You can enroll until April 8. Coverage takes effect April 1. 
  • Massachusetts You can enroll until April 25. Enrollments completed by March 23 will have coverage effective April 1. 
  • Maryland You can enroll until April 15. Coverage takes effect April 1. 
  • Rhode Island You can enroll until April 15. 
  • New York You can enroll until May 15; coverage takes effect April 1. 
  • Nevada You can enroll until April 15. 
  • Connecticut You can enroll until April 2. 
  • Colorado You can enroll until April 3. All plans take effect April 1. 
  • Minnesota SEP starts March 23, ends April 21. All plans take effect April 1.  
  • California You can enroll until June 30. 
  • Vermont SEP continues for one month, according to details the exchange posted on March 20.

Source: https://www.healthinsurance.org/special-enrollment-guide/exceptional-circumstances-for-special-enrollment/

*Check state websites for updates!

Thirty-two states, including Florida and Georgia, rely on the Federal Government website to run their exchanges and have decided not to reopen for enrollment. This primarily affects those who are uninsured. If you are going to lose or have lost your insurance coverage in the last 60 days, you're eligible for a "regular" special enrollment period. Special enrollment periods apply to those who have had certain life changes, like losing job-based insurance, moving to another county or state, getting married, etc. For more information on special enrollment periods, visit this website.

If You’re Insured

If you’re insured through your job or union but will be losing that coverage, you have 60 days to choose COBRA or enroll in other insurance. COBRA as a law lets you keep your employer or union-based coverage for 18 months and sometimes longer. However, you’re paying the full cost of your health insurance, and it’s often very expensive.  Contact your employer or union’s HR or Pension and Health Department for more information on your costs. 

If you’re covered by an Affordable Care Act Marketplace/Exchange plan, you can go back into your online account and change your income to reflect your current reality. For example, if you were laid off from your job and are now collecting unemployment, you should change your income estimate to reflect your gross income through the last day you were paid, and then add up to 39 weeks of gross unemployment benefits to the estimate (through 12/31/2020). This may result in an income estimate for 2020 that is much lower than before, making you eligible for much higher tax credits and lower premiums. 

If you are self-employed and/or work on 1099 forms and 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, credit cards, etc. (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. 

Please note that the one-time pandemic stimulus payment of $1200 for adults and $500 for children should not be added as income to any Marketplace or Medicaid application. 

If you bought insurance directly from an insurance company, let them know if you're having trouble making payments. Several states have issued guidelines which encourage health plans to make premium payment grace periods available to families who are experiencing hardship during this diffuclt time. 

If You Have Little or No Income 

If you have little or no income going forward, regardless of your current insurance status, you may be eligible for Medicaid. Medicaid is comprehensive, free health insurance. It covers hospitalization, lab work, office visits, medication, surgery, and many other benefits. There is no monthly premium and no deductible. Co-pays are low ($1 and $3) and generally apply to medications only. If you’re eligible, you’ll receive coverage for 12 months. In 37 states, including California, New York and Illinois, if you are under 65, you must show that your household income in the prior month only 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 $1468 gross. For 2 people, it must be below $1983 gross. Please note that the Pandemic Unemployment Compensation (PUC) of $600/week does not count towards your income for purposes of applying for Medicaid. If you are under 65, Medicaid does not take assets, such as savings accounts, into account. To apply, visit healthcare.gov or your state’s Marketplace/Exchange. 

In 13 other states, including Georgia and Florida, the above Medicaid rules do not apply. In these states you must contact your state Medicaid office or a local navigator to see if you qualify. 

In New York, you may be eligible for the Essential Plan. The Essential Plan is very comprehensive insurance available only in New York; there are no deductibles, and the premium is $20/month. Co-pays are low. Unlike Medicaid, the Essential Plan looks at yearly projected income. In order to qualify for it, your income so far this year, and any income you expect going forward (such as unemployment), must be below $25,520 gross (single person) or $34,480 gross (couple). 

Medicaid and the Essential Plan are insurance programs that you should seriously consider if you are eligible; they are meant to provide a safety net in times of crisis such as these. They will save you lots of money on health insurance premiums and deductibles, and ensure that you aren’t subject to a mountain of medical debt! Both these programs have year-round open enrollment, so you can apply at any time. 

For short, informative videos that help explain Medicaid, the Affordable Care Act, saving money on prescription drugs, and other topics, visit our Youtube tutorials.  

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. Plans will often exclude pre-existing conditions, not cover certain basic benefits like prescriptions or mental health services, and often have some kind of “initiation fee” (red flag). I’ve seen plans that only covered hospitalizations on Tuesdays and Wednesdays! Do they tell you this in their marketing emails? No. You have to read the fine print, and most people don’t.

If you’re unsure about a plan, please call us before you enroll so we can help you evaluate it. In the Western Region, call Entertainment Health Insurance Solutions at 833.777.EHIS. In the Eastern Region (including Chicago), call the Artists Health Insurance Resource Center at 917.281.5975. 

Finally, for those who are insured, here are some ways you can access medical care now without leaving your home: 

  1. Telehealth: Most doctors’ offices are working with limited staff. Doctors are transitioning to providing telehealth for the safety of their patients and team. Telehealth is a video chat with your doctor. Many common symptoms can be evaluated via telehealth, and many insurance companies cover telehealth visits at the same co-pay as an in-office primary care visit. Call your insurance company to see if it’s a covered benefit, and call your doctor’s office to see if they are equipped to provide this service. It’s currently the safest and quickest way to receive care. 
  2. Nurse hotline: If you can’t take advantage of telehealth, most insurers offer an on-call nurse hotline for free. This number is generally listed on the back of your card or in your summary of benefits; you can call this number, describe your situation, and a nurse can evaluate your symptoms and direct you to next steps. 

If you’re exhibiting symptoms you’re concerned might be related to the coronavirus, the CDC has issued the following guidance on testing: “Mildly ill patients should be encouraged to stay home and contact their healthcare provider by phone for guidance about clinical management. Patients who have severe symptoms, such as difficulty breathing, should seek care immediately. Older patients and individuals who have underlying medical conditions or are immunocompromised should contact their physician early in the course of even mild illness.” 

Testing capabilities are currently very limited across the United States; call your doctor before you go into their office or an urgent care clinic. Testing is being prioritized for those who are already hospitalized, those who have symptoms and chronic medical conditions (such as diabetes, heart disease, etc), and anyone who has had close contact with someone who is suspected to have or has tested positive for COVID19 in the last 14 days. 

The Families First Coronavirus Response Act, signed by the President on March 18, makes testing and associated office visits free for all Americans–that is, those with employer-sponsored or Exchange/Marketplace/ACA insurance, Medicare, Medicaid, or no insurance at all. Treatment (beyond testing) for those who require it is covered according to the terms of your own insurance. Currently, the deductibles and cost-sharing stipulated by your plan apply. The current administration recently announced a plan to cover COVID19 treatment for those who are uninsured as well. However, the details have yet to be finalized. We will update this site as more information becomes available. 

Yours in good health,


Renata Marinaro 
National Director, Health Services

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
917.281.5975

Los Angeles
855.491.3357

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!