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Artists and the Affordable Care Act

Ever since the Affordable Healthcare Act was signed in 2010, Americans have reacted with a mixture of hope, anger, excitement, doubt and total bewilderment. Will this act solve our nation’s healthcare problems? “Until open exchange is really open, we won’t know in all honesty,” says Sarah O’Leary, founder of Exhale Healthcare Advocates. “But we can say with a lot of optimism that people with individual insurance now, they’re probably going to receive better coverage at a lower price.”

Open enrollment just started October first. It will take a while to see how it pans out. But self-employed artists are one group which will likely benefit from the new changes. Those who have gone without insurance may actually be able to afford it now. And those who manage to pay for health insurance could pay lower premiums and have better coverage.

As O’Leary points out, for many people there’s no way the healthcare act could be worse than what they have now. “It’s been so horrible,” she said of the healthcare system.

While the Affordable Healthcare Act is long and nuanced, here are just a few points which might be of interest to artists and other self-employed Oregonians.

Essential Health Benefits

One of the main points of the Affordable Care Act is to make sure that certain services, known as essential health benefits, are part of health plans. “Every policy that’s sold through state or federal exchanges has to have essential benefits as part of it,” O’Leary said. These include:

  • ambulatory patient services
  • emergency services
  • hospitalization
  • maternity and newborn care
  • mental health and substance use disorder services, including behavioral health treatment
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • laboratory services
  • preventive and wellness services and chronic disease management
  • pediatric services, including oral and vision care

“Mental health for the first time ever is a requirement for individual, family and small business policies. That will be huge with people,” says O’Leary, who is a ceramicist as well as a healthcare advocate. “We creatives, we like our therapy here and there.”

Preexisting Conditions and Lifetime Limits

Good news for people who aren’t in 100 percent perfect shape: Starting in 2014, insurance companies can neither deny you nor charge you more because of your preexisting conditions. This has been getting seriously out of hand in the last few years, with people being turned down for healthcare coverage with such non-life-threatening conditions as erectile dysfunction, acne or a history of hemorrhoids.

Nor can insurance companies impose lifetime limits on the benefits they’ll pay. If you have a chronic condition, the company will just have to cough up the money to treat you.

The Health Insurance Marketplace

It’s true that some artists would rather bang their heads against the wall than do a cost-benefit analysis of a list of health insurance plans. But the Health Insurance Marketplace wants to hold your hand and guide you through.

Basically, you fill in an online application and the Marketplace presents you with a side-by-side comparison of your coverage options. You can check out different levels of coverage and see if your income qualifies you for lower copayments and premiums.

Individuals and small businesses can use the Marketplace if they don’t have health care coverage, or if they do but want to check out other options. If you see a plan you like, you can enroll through the Marketplace. Supposedly this is how Congress members will get their insurance, so hopefully they will make it good.

To be eligible for Marketplace health coverage you must live in the United States, be a US citizen or national and not currently be incarcerated.

Open Enrollment

The open enrollment period in the Health Insurance Marketplace runs from October 1, 2013 through March 31, 2014. After that, you can’t enroll through the Marketplace unless you have a “qualifying life event,” e.g., moving to another state, having a baby, marrying or divorcing.

Tips

O’Leary cautions that getting insurance is just part of the healthcare game. In her role as founder and CEO of Exhale Health Advocates, she regularly helps people navigate the healthcare system. “We negotiate stuff for people,” she says. “People don’t know you can shop around your colonoscopy in your area and save hundreds of dollars,” she says.

And while many people dread their colonoscopies even more than they dread paying the bill, she makes an excellent point. When people have fears about their health – or about tests like colonoscopies – it often doesn’t occur to them to negotiate. But O’Leary routinely finds clients the best prices on hearing aids, recoups money they over-spent on anesthesia and gets 50% knocked off hospital bills.

Navigating the System

If you get stuck trying to understand the system, you may be able to request individual help through your state exchange website. The government will hire people to work as navigators for healthcare consumers, O’Leary says. “How many are there going to be and how good they are, we don’t know. It looks like they’ll work through groups,” she says, adding that unions and associations might get their own navigators. Perhaps the Urban Art Network will qualify, she suggests.

O’Leary also offers her own services. If you’re too bewildered to do it yourself, or you can’t keep your eyes open as you gaze at insurance forms, O’Leary says she’ll enroll artists for $100.

So take a deep breath and psyche yourself up to brave the Affordable Care Act. You just might get a lot out of it.

Resources:

National Health Insurance Marketplace: https://www.healthcare.gov/
Oregon’s Marketplace: http://www.coveroregon.com/
Calculator to approximate your payments based on age and income: http://www.coveroregon.com/calculators/individual-calculator/
Exhale Health Advocates: www.Exhalehealth.com or 800-381-4741

Article by Teresa Bergen, www.teresabergen.com