2014 fast approaches, and regardless of where your political leanings are on the matter, that means the laws governing health insurance are about to change. If you don’t have it, you’re going to need to get it or pay the resulting fine next tax season.
What does this mean for you?
As a fresh-off-the-boat-graduate-turned-starving-artist (who didn’t have the option of today’s “stay on your parent’s insurance until you’re 26” law), I remember being overwhelmed to the point of tears trying to surf through the insurance market. I was nearly pressured into just getting a “normal job” by friends and family who didn’t understand why I was being “irresponsible” and not just taking a job that provided it like they had. I didn’t understand why I should be forced into a job I hated just to make sure I had health insurance. Realizing that as a healthy young gal I was being asked to pay as much as my NYC rent per month to get coverage on my own made me realize how broken the system was.
Today, I’m thankful to enjoy coverage through my acting union, but to keep it I (or my hubby as SAG covers spouses) have to earn the required amount each year via union-covered jobs. How much do you need to get insurance through SAG? It creeps up each year (see www.sagph.org for charts) but in 2012 was $30,750 for the better Plan I, or $15,100 or 76 days of SAG employment for Plan II, unless you’re over 40 and have 10 or more years of meeting the eligibility requirements under your belt, then it’s $10,900 to get and keep coverage.
Some months that’s scarier than others. SO, my research wasn’t entirely unselfish, but let me share what I’ve learned, in case it can help some of you.
I’m sorry in advance that my research is so California-centric, other states will vary quite a bit (as some governors are opting out of expanding Medicare and other services). I encourage calling your reps and/or voting them out if this makes you unhappy, or even calling them and voting them back if it does bring a smile to your face.
Starting in January of 2014, all of us will be required to either have coverage via our employer, purchase it on our own, be covered by Medicare or Medi-Cal (if you’re in CA) or pay the penalty come tax time.
Let’s start with those who get free coverage. Here in CA, Medi-Cal will be expanding to cover people under 65 (it already covers those over 65) who have disabilities, make less than $15,000/yr (single) or $31,180 (family of four). If that’s you, visit www.dhcs.ca.gov and find out how to apply for Medi-Cal.
Catastrophic coverage (not for the check ups or prescriptions but for the major bills resulting from an accident or major illness) will be being expanded to those under 30, as well as those over 30 able to prove that they have no affordable coverage options or are experiencing hardships. So, even if you don’t get coverage but fall into those groups, you won’t be bankrupt should you get in an accident. You also won’t be bankrupting the system.
Perhaps you fall a bit above that earning category, then I recommend you check out www.coveredca.com. There you will find a complete breakdown and explanation of the 4 levels of health care (Gold thru Bronze) that you can purchase (enrollment starting this October) as well as a very handy cost calculator.
This calculator helps you see what you’re eligible for as far as tax credits (applied immediately upon purchase to discount the cost to you) or cost-sharing subsidies. It calculates your monthly premium cost on the Silver Plan. You can of course choose to pay more per month for the Gold Plan in exchange for lower costs to you when you need medical care, or less per month but higher costs when you need care with one of the other plans. You find what works for you.
It’s good to know that whatever coverage you opt for, it will be required to cover the following 10 essential health benefits:
*ambulatory patient services (tests, X-rays, vaccines, well baby check-ups)
*emergency services
*hospitalization
*maternity and newborn care
*mental health and substance use disorder services
*prescription drugs
*rehabilitative services
*lab services
*preventative and wellness as well as chronic disease management services
* and pediatric services including dental and vision.
If you’re not in California, check to see what insurance exchanges and programs your state will be offering as all will be required to do something.
A few other options that have helped me or friends of mine the past have been www.freelancersunion.org and www.fracturedatlas.org both of which offer coverage options for various types of artists who normally find themselves trying to navigate the market alone. Joining such a group can give you great discounts. I’ve also used a private insurance salesman who came to my house and went over my coverage needs versus my budget with me to find and get me a plan that fit both. If you’d like the contact info for mine feel free to ask in the comments section, but there’s tons out there.
Realize these plans don’t usually include dental or vision coverage if you aren’t a minor. As dental bills can be huge as well, I found that most dentists have a group option you can join (usually for around $10/month) that will get you discounts similar, but not quite as good, as having insurance. Still, if you need a bunch of root canals – worth it. Ask your local dentists to see what they recommend to their uninsured patients, most have a brochure or other information for a group they work with. Granted, the law doesn’t require dental insurance, I just think teeth are important.
Let’s say you check out your options and still decide you won’t be buying insurance. What is this penalty you’ll be hit with?
Well, in 2014 it will amount to 1% of your annual income or $95, whichever is greater. By 2016 it will have increased to 2.5% of your income or $695 come tax time.
However, if your only available insurance options would cost you more than 8% of your income, you are below the income level required to even pay taxes ($9750 for a single person or $27,100 for a married couple in 2012), have religious exemptions, are an immigrant sans documents, are incarcerated, or a member of a Native American tribe, then you will be exempt from paying the penalty.
Here’s the thing, the vast majority of us cannot opt out of participating in the health care system all together. At some point, we’ll need to use it, be it for a birth, accident, old age, or sickness, you’re gonna see the inside of a medical facility. Such a universal experience shouldn’t bankrupt us. It makes fiscally responsible sense to get insurance, and now it will also be the law. Take care of you, your body is your most important and least replaceable asset.
I hope this helped some of you navigate the overwhelming insurance tangle a bit. If you have questions or other ideas that could help people steer these streets, please comment away.
Be well.