For artists, the challenges of obtaining and maintaining health insurance often are exasperated by their relatively low incomes, episodic work and high rates of self- and part-time employment.
Although this is the 10th annual open enrollment period for Affordable Care Act plans, which are available for those without health insurance through a job, union, Medicare, or Medicaid, many artists are unaware that they can obtain health insurance with full benefits at a very reasonable cost. In fact, the Biden administration predicts that four out of five HealthCare.gov shoppers will find coverage for $10 or less per month with extra savings made available under the American Rescue Plan.
Our top Every Artist Insured priority is to ensure that our region’s creatives understand their options and know how to sign up for coverage. So, here is what you need to know for 2023:
Open enrollment on HealthCare.gov ends on January 15, 2023. You can enroll in Medicaid at any time.
You’ll likely find lower premiums, more choices, and generous government assistance on HealthCare.gov during open enrollment period. So this is a great time to check your health insurance options. Subsidies will be larger and more widely available than they have been during previous open enrollment periods. Many low-income shoppers will be able to select policies with no monthly premiums! And those earning more than 400% of the federal poverty level – approximately $54,000 for an individual and $111,000 for a family of four – are now eligible for subsidies. Sign up by December 15 if you want coverage to take effect on January 1.
If you have HealthCare.gov coverage, you can renew, change, or update your plan for 2023 during the open enrollment period. You will also want to update your income and household information on your 2023 application, so you get the right amount financial assistance.
Generally, if you miss the open enrollment period, you won’t be able to get coverage unless you qualify for special enrollment due to a “life event,” such as losing other coverage, getting married or divorced, having a baby, gaining or losing income, or moving to a different state.
ESTIMATING YOUR INCOME
As we are all well aware, many artists are experiencing sharp pandemic-related reductions in their incomes that could continue well into 2023. Under the ACA, eligibility subsidized health insurance through HealthCare.gov is calculated using household Modified Adjusted Gross Income. When you fill out an application, you’ll need to estimate what your household income is likely to be for the coming year. Make your best guess.
The KFF subsidy calculator helps people estimate the amount of financial assistance based on their age, income, family size, and zip code. To see sources of income that should be included, consult this chart.
If your estimated income is drastically different than what was reported on your last IRS tax return, your HealthCare.gov application may trigger a Data Matching Issue (DMI). You’ll be asked you to submit documents to confirm your application information. And remember, if your estimated household income changes during 2022, update your application on the My Account page or by calling the HealthCare.gov Consumer Call Center, 800/318-2596.
SHOP AND SAVE
Enrolling in an affordable plan or staying covered may require some shopping around. Nine companies are offering plans for Missouri residents. There are more than 50 options to explore. Health insurers that provide HeathCare.gov plans can’t deny coverage or charge more because of a pre-existing condition, such as asthma, diabetes or cancer.
If you purchased 2022 coverage and don’t shop again, you’ll be automatically re-enrolled. Be aware that your plan may not meet your current needs and it may not be the best possible deal.
If you’ll be enrolling for the first time, you can make the process easier by gathering this information before you start your application. Once you start the enrollment process, be sure to make note of your password!
It’s important to understand key health insurance terms, so you’ll know what services your plan will cover:
• Deductible: The amount you owe for covered health care services before your health insurance or plan begins to pay.
• Copayment: An amount you pay as your share of the cost for a medical service or item, like a doctor’s visit.
• Coinsurance: Your share of the cost for a covered health care service, usually calculated as a percentage of the allowed amount for the service.
• Premium: The amount you pay for your health insurance or plan each month.
• Premium Tax Credit: A tax credit you can use to lower your monthly premium when you enroll in a plan on HealthCare.gov. Your tax credit is based on the income estimate and household information you put on your application.
• Cost Sharing: A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. On HealthCare.gov, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings.
• Network: The doctors, hospitals, and suppliers your health insurer has contracted with to deliver health care services to their members.
CHOOSING A PLAN
Insurance plans fall into “metal” categories based on how the costs of care are shared between you and the insurance company. All plans will cover the same 10 essential health benefits, including yearly doctor visits, trips to the emergency room, and prescriptions. Silver plans fall in the middle and are the most common choice of HealthCare.gov shoppers. There are also catastrophic health plans for people under age 30, which provide protection for worst-case scenarios. These plans have low monthly premiums and very high deductibles.
FREE ENROLLMENT ASSISTANCE
Find local enrollment assistance here or call 800/466-3213 to set up and in-person or virtual appointment. The HealthCare.gov Consumer Call Center, 800/318-2596, is open 24/7. Late evening or overnight hours are the best time to call.
WHAT ABOUT MEDICAID EXPANSION?
In 2020, Missouri voters approved a constitutional amendment that opens Medicaid eligibility to non-disabled adults without children. Before expansion, many artists made too much money to qualify for Medicaid but not enough money to qualify for HealthCare.gov subsidies. Expansion is closing that frustrating coverage gap. Adults between the ages of 19 and 64 who earn up to $18,075 a year, or $36,908 for a family of four, are eligible. Visit mydss.mo.gov to apply. Need enrollment assistance? SLU Law Center for Health Law Studies, the STL Regional Health Commission, and Legal Services of Eastern Missouri operate a Medicaid Expansion Helpline, 888/686-1744.
Every Artist Insured is made possible by support from the Regional Arts Commission.