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Dear Friends,
Fall is the time to review your health insurance options, as both Medicare and the health insurance Marketplaces have what’s called Open Enrollment, a time to sign up for coverage (or make changes to what you already have). Here’s what’s changed for 2022 and what you need to know:
For those under age 65:
If you’re under 65 and don’t get insurance through a union, employer, spouse or school, you can sign up for coverage on the Marketplace. Most states use the federal website healthcare.gov, although several states, including New York and California, have their own websites. Start with healthcare.gov, since it will direct you to the appropriate site for you.
Most states have extended Open Enrollment this year due to the pandemic. States that use healthcare.gov will allow people to enroll between November 1, 2021–January 15, 2022 for coverage for 2022. States like California and New York have extended Open Enrollment through January 31, 2022. Find out what the Open Enrollment period is in your state. And remember, you must enroll during that time, or you may not be able to enroll for another year. (Find out what special enrollment periods are).
The American Rescue Plan Act made insurance more affordable by increasing subsidies to those buying insurance on the Marketplace. Although the ‘Nearly Free Silver Plan’ ends at the end of this year, expanded subsidies continue next year. For example, a single person making approximately $28,000/year in New York City is eligible for almost $560/month in subsidies to lower their premiums. That would make the lowest level of coverage–Bronze–free. All Marketplace plans have out-of-pocket maximums of about $9,000 per person and are often lower. An out-of-pocket maximum caps the amount of money coming out of your pocket for medical expenses per year (including deductibles and copays/coinsurance, but not including premiums). So at that income level, you could get a plan for free that would act as a stop-loss should something bad happen.
Many people still mistakenly think they’re not eligible for free coverage. In New York, New Jersey, Connecticut, California, Illinois and 34 other states, if your income is below $17,775 (as a single person), you are eligible for free, comprehensive insurance through Medicaid. If you live in New York and your income is above the Medicaid limit but below $25,760 (as a single person), you are eligible for the Essential Plan, which offers comprehensive coverage with no premiums or deductibles.
Any plan sold on your state’s Marketplace has to abide by Affordable Care Act regulations, which include not excluding pre-existing conditions from coverage. However, some states, like Georgia, Illinois and California, have made it legal to sell low-quality short-term insurance 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 and 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 Entertainment Health Insurance Solutions or Artists Health Insurance Resource Center first.
Also, the federal penalty for not having insurance was discontinued in 2019. However, if you live in New Jersey, California, Rhode Island, Vermont, 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.
For those over age 65:
During Medicare Fall Open Enrollment (October 15–December 7), people with Medicare can make changes to their coverage for the following year. They can join a new Medicare Advantage Plan or prescription drug (Part D) plan, or switch between Original Medicare and a Medicare Advantage plan.
If you have Original Medicare and a supplemental plan (aka Medigap) and are happy with your coverage, you don’t need to make a change.
If you have a Medicare Advantage or Part D plan, you should review all your coverage options even if you are happy with your current coverage, because plans change their costs, benefits and drug formularies every year. Read your Annual Notice of Change (ANOC), which lists the changes in your plan, such as the premium and copays.
Consider all your options, since many plans make changes every year and your current plan may not be your best choice for 2022.
You can also use the Plan Finder tool on medicare.gov to search for Medicare Advantage or Part D plans. Call a plan directly to confirm any information you read online. Make sure the plan includes your doctors, hospitals and other providers in its network. Confirm that the plan covers all your prescription drugs and that your pharmacies are preferred and in-network. When speaking with a plan representative, write down the date, the name of the representative you spoke to and any next steps.
One note about telehealth. Medicare generally only covers telehealth in limited situations, but has expanded coverage and access during the COVID-19 public health emergency. Currently, Medicare covers doctors’ office visits, behavioral health counseling, certain preventive health screenings and other visits via telehealth. Standard cost-sharing may apply. If you have a Medicare Advantage Plan, you should contact your plan to learn about its cost and coverage rules.
The Medicare Rights Center, a national nonprofit, is available to help with decision-making and determining next steps for open enrollment. There are also State Health Insurance Assistance Program (SHIP) volunteer counselors in every state. To find personalized assistance in your state, locate your SHIP counselor.
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 or need help.
All the best during Open Enrollment!
Yours in good health,
Renata Marinaro
Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Please contact the regional office closest to you to connect with a counselor.
New York City
Visit actorsfund.org/ahirc
Los Angeles
Visit ehisca.com