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Health Insurance, Health Care Reform and Resources in Chicago. Dancers’ Health Insurance Resource Center A program of The Actors Fund with support from The Doris Duke Foundation Presenter: Jim Brown, Director of Health Services firstname.lastname@example.org.
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Health Insurance, Health Care Reform and Resources in Chicago Dancers’ Health Insurance Resource Center A program of The Actors Fund with support from The Doris Duke Foundation Presenter: Jim Brown, Director of Health Services email@example.com
Health Care Reform:What has already happened since 2010 • 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.
2010 • 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.us HIPAA www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html
2011 • 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.
2014 • 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.
Essential package of benefits: • 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
Will There be More Coverage For 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 tests • Breast, colon & cervical cancer screenings • Vaccines, immunizations & flu shots • HIV & STD testing • Mammograms for women over 40
Levels of coverage: • 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.
Levels of coverage: • 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).
Limited cost-sharing: 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).
How Will I Afford Insurance? • 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).
The Small Business Tax Credit • 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 Tax Credit • 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
Resources & Links • 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 ACA and Health Care Reform?
Why do I need health insurance? • » 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.
How do I get health insurance now? • 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 months 60 days to decide/elect coverage “Sticker Shock” – guaranteed coverage, but can be expensive. Pay full premium .. at the group rate
Domestic Partners • 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.
Unions • »» 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
Private Insurance • Terms to know: HMO, PPO, HAS, High-deductible (“catastrophic”), Short-term • Internet brokers • www.ehealthinsurance.com
Other sources of coverage Schools and Alumni Associations • Columbia College (www.colum.edu/Students) – minimum 6 cr • University of Illinois at Chicago (www.uic.edu/hsc/campuscare) – P/T • College of Performing Arts at Roosevelt University (http://legacy.roosevelt. edu/shi/default.htm) – P/T Small Business Health Insurance • Guaranteed issue • www.insurance.illinois.gov/HealthInsurance/small_employer.asp > Remember subsidy!
Government -subsidized 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
Government Programs • 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.html Illinois FamilyCare www.familycareillinois.com All Kids www.allkids.com Medicare www.medicare.gov
Special Programs ADAP and Continuation of Health Insurance Coverage Program www.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 Surgery 1-855-367-4847 www.projectHUGS.org
Non-insurance options • Access to Care www.accesstocare.org 708-531-0680 • Community Clinics http://findahealthcenter.hrsa.gov > CommunityHealth Chicago 2611 W. Chicago Ave 773.395.9900 641 W. 63rd St. 773.994.1515 www.communityHealth.org > Community Counseling Centers of Chicago www.c4chicago.org • Retail clinics [Fee determined by diagnosis] e.g., Minute Clinics in CVS www.minuteclinic.com
Comparing Quality and Costs Illinois Hospital Report Card www.healthcarereportcard.illinois.gov/ HealthGrades http://www.healthgrades.com/ Leslieslist http://leslieslist.org/chicago Pharmacy Checker www.pharmacychecker.com
I can’t afford my medications • $4 Generics @ Target/Walmart • Costco/Walgreens/CVS discount programs • NeedyMeds www.needymeds.org • Partnership for Prescription Assistance www.pparx.org • Illinois Cares Rx www.illinoiscaresrx.com • www.lowestmed.com App for iPhone & Android
I have dental problems but no insurance. • Dental discount programs www.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/
Are there special resources for the health of visual and performing artists? The University of Illinois at Chicago Health in the Arts Program (312) 996-7420 Dance/USA Task Force on Dancer Health http://www.danceusa.org/dancerhealth?s=task%20force Performing Arts Medicine Association (PAMA) www.artsmed.org
Additional Resources Chicago Artists Resource www.chicagoartistsresource.org Uninsured in Chicago www.uninsuredinchicago.com
Contact us at: • www.ahirc.org [everyone in the arts] 800-798-8447 x265 • www.dhirc.org [everyone in dance] 800-798-8447x280 • firstname.lastname@example.org [Jim Brown] • Actors Fund/Chicago 312-372-0989