Dancers’ Health Insurance Resource Center

A program of The Actors Fundwith support from The Doris Duke Foundation

Presenter: Jim Brown, Director of Health Services jbrown@actorsfund.org

Children under age 19 with pre-existing conditions can’t be denied coverage.

Young adults up to age 26 can stay on or enroll in their parents’ coverage.

Insurers can’t retroactively cancel the policies of people who get sick.

Insurers can’t impose lifetime dollar limits on medical benefits.

All new plans must cover certain preventive services, such as mammograms and tetanus shots, for free.

Uninsured people with pre-existing conditions may be eligible for coverage through PCIP.

Pre-Existing Condition Insurance Plan http://insurance.illinois.gov/ipxp/

Help for the uninsured with pre-existing conditions through a temporary high-risk pool until January 2014.

Premium rates:http://www.insurance.illinois.gov/ipxp/aso-1000ipxpratetable-1210.pdf

Also: Illinois Comprehensive Health Insurance Plan (CHIP) www.chip.state.il.usHIPAAwww.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

Medicare recipients in the coverage gap or “donut hole” received 50% off drugs

Annual wellness visits and certain preventive services free for Medicare recipients.

Increased funding to community health centers.

Insurers can’t refuse coverage to anyone. Most people* will be mandated to have coverage or

pay a penalty.** New insurance marketplaces, called Exchanges, will

offer insurance to those who don’t get it elsewhere. Subsidies will be available to people who buy

insurance through an exchange with income less than 400% of the Federal Poverty Level. ($43,320)

* Exceptions include: Native Americans, those w/religious objections, people who are not legal residents, those who don’t meet tax filing threshold ($9,350 single), people who’ve been uninsured for less than 3 months.

** Penalty: increases from $95 or 1% of income in 2014 to $695 or 2.5% of income in 2016.

All new plans must offer at a minimum an essential benefits package which limits out-of-pocket medical expenses.

Including: Ambulatory care Emergency care and Hospitalization Maternity and newborn care Mental health and substance abuse Prescription drugs Preventive services

If you have a new policy that began on or after 9/23/2010, you can get certain preventive services for free:Blood pressure, diabetes & cholesterol testsBreast, colon & cervical cancer screeningsVaccines, immunizations & flu shotsHIV & STD testingMammograms for women over 40

• Plans that offer essential benefits can offer varying levels of coverage, labeled “bronze,” “silver,” “gold,” and “platinum.” These levels refer to the percentage of costs that will be paid for by the plan: A bronze plan will pay for 60 percent of the cost of covered benefits, a silver plan will pay for 70 percent, a gold plan will pay for 80 percent, and a platinum plan will pay for 90 percent.

• Plans can also offer a lesser level of coverage to individuals under the age of 30. These “catastrophic plans” must still cover essential benefits but will have very high deductibles ($5,950 for an individual in 2010, to be updated annually by premium inflation).

Plans must limit enrollees’ out-of-pocket expenses (including the deductible) to $5,950 for an individual or $11,900 for a family (2010 figures, to be updated based on premium inflation).

If your income is $10,830 - $43,320 (single), you will receive a subsidy to buy insurance through an Exchange.

Subsidies will cap the amount you spend on premiums in relation to your total income.

Subsidies will also cap your annual out-of-pocket medical costs.

Example: a person who makes $21,000/yr will have their premiums capped at 6.3% of their income, and their annual out-of-pocket medical costs will be limited to $1,983/yr (excluding premiums).

Became available beginning 2010 tax year

Employers with fewer than 25 FTE’s employees with average wages of less than $50,000 that purchase health insurance for employees are eligible for the tax credit

To be eligible, employer must offer a group health plan & contribute at least 50% of premium cost

2010-2013: credit max is 35% of employer contribution (25% for tax exempt/non-profits); will increase to 50% (35% for non-profits) in 2014

Small business will file Form 8941 when they file income tax returns

Tax exempt organizations will claim the tax credit on a revised Form 990-T

www.irs.gov/newsroom/article/0,,id=223666,00.html

Artists Health Insurance Resource Center: www.ahirc.org

Office of Consumer Information and Insurance Oversight: www.hhs.gov/ociio

Federal health care reform website: www.healthcare.gov

Kaiser Family Foundation: www.kff.org

Questions on the ACAand Health Care Reform?

» Access: Access to quality health care is directly tied to having health insurance. Without health insurance or unlimited funds, you will have little or no say in the care you receive or in the choice of providers of that care.

» Cost: The cost of care is so great that a surgery, a day or two in the hospital, treatment for a chronic condition, a prescription for on-going drug therapy, or even several hours in a hospital emergency room can throw you into considerable, even ruinous, debt if you are uninsured.

» Better outcomes: People without health insurance frequently delay care, and are more likely to be sicker when they seek care. Not surprisingly, the mortality rates for cancer and other diseases are higher among the uninsured.

Employer/union/guild related coverage Purchase private plans Government subsidized programs

If you leave/get laid off from a job …COBRA – Continuation of employer benefits for at least 18 months60 days to decide/elect coverage“Sticker Shock” – guaranteed coverage, but can be expensive.Pay full premium .. at the group rate

◦ Illinois offers health, dental and vision insurance benefits of one member of a domestic partnership to also apply to the other member much in the same way as married couples can be covered by the same policy. To be eligible, both members of the domestic partnership must be over the age of 18 and not in another domestic partnership. They must live in the same household, not be related, and have "an emotional and economic interdependence." They need to have lived together for at least one year and continue to so for the duration of the insurance coverage.

»» Actors’ Equity: www.equityleague.org »» American Federation of Television and

Radio Artists: www.aftrahr.com»» Screen Actors Guild: www.sagph.org/index2.html

»» American Federation of Musicians Local 10-208: www.cfm10208.com

»» IATSE Local 2: http://iatselocal2.com

Terms to know: HMO, PPO, HAS, High-deductible (“catastrophic”), Short-term

Internet brokers◦ www.ehealthinsurance.com

2012 Poverty Guidelines for the48 Contiguous States and the District of Columbia

Persons infamily/household Poverty guideline

1 $11,170 2 $15,130 3 $19,090 4 $23,050

The Illinois Department of Healthcare and Family Services

www.hfs.illinois.gov

Medicaid [Note: Changes begin January 1, 2014]www.hfs.illinois.gov/medicalbrochures/hfs591.htmlIllinois FamilyCarewww.familycareillinois.comAll Kidswww.allkids.comMedicarewww.medicare.gov

ADAP and Continuation of Health Insurance Coverage Programwww.idph.state.il.us/aids/materials/less.htm

The National Breast and Cervical Cancer Early Detection Program

http://cancerscreening.illinois.gov/Note:

http://articles.chicagotribune.com/2012-02-17/health/ct-met-breast-cancer-screening-20120217_1_free-mammogram-screening-mammograms-abnormal-mammograms

ProjectHUGS: Helping Uninsured Get Surgery1-855-367-4847 www.projectHUGS.org

◦ Access to Carewww.accesstocare.org708-531-0680

◦ Community Clinicshttp://findahealthcenter.hrsa.gov

> CommunityHealth Chicago2611 W. Chicago Ave 773.395.9900641 W. 63rd St. 773.994.1515www.communityHealth.org> Community Counseling Centers of Chicagowww.c4chicago.org

◦ Retail clinics [Fee determined by diagnosis]e.g., Minute Clinics in CVS

www.minuteclinic.com

Illinois Hospital Report Cardwww.healthcarereportcard.illinois.gov/

HealthGradeshttp://www.healthgrades.com/

Leslieslisthttp://leslieslist.org/chicago

Pharmacy Checkerwww.pharmacychecker.com

◦ $4 Generics @ Target/Walmart

◦ Costco/Walgreens/CVS discount programs

◦ NeedyMeds www.needymeds.org

◦ Partnership for Prescription Assistancewww.pparx.org

◦ Illinois Cares Rx www.illinoiscaresrx.com

◦ www.lowestmed.com App for iPhone & Android

Dental discount programswww.dentalplans.com

Note: Examine closely before joining! The Chicago Dental Society

http://www.cds.org/Find_a_Dental_Clinic/Find_a_Dental_Clinic.aspx

Note: Some community clinics have dental services-Erie Dental Health Center 4751 N. Kedzie Ave-Eleanor Wester Dental Clinic 7648 N. Paulina

Dental Schools◦ The University of Illinois at Chicago College of

Dentistry http://dentistry.uic.edu/

The University of Illinois at Chicago Health in the Arts Program(312) 996-7420

Dance/USA Task Force on Dancer Healthhttp://www.danceusa.org/dancerhealth?s=task%20force

Performing Arts Medicine Association (PAMA) www.artsmed.org

Chicago Artists Resourcewww.chicagoartistsresource.org

Uninsured in Chicagowww.uninsuredinchicago.com

Any additional resources to add?

www.ahirc.org [everyone in the arts]800-798-8447 x265

www.dhirc.org [everyone in dance]800-798-8447 x280

jbrown@actorsfund.org [Jim Brown]

Actors Fund/Chicago 312-372-0989