The online health insurance marketplaces of the Affordable Care Act (“Obamacare”) have been live for almost six months. In our region, New York and Connecticut are running their own, while the New Jersey and Pennsylvania marketplaces are being run by the federal government.

For those that want a recap of what this new health insurance system covers, please see a story I wrote for Allegro in 2012. 

In this article, I want to give some current observations about the new marketplace system.

Last October, Allegro asked me to take the marketplaces for a spin, to let musicians know how they were working. At the time, I tried a test drive of the New York marketplace and the federal marketplace. These “marketplaces” are web sites, and you can see a list at the end of this article. You can also sign up through a “Navigator.” More on that below.

Unfortunately, at the time, I found the experience of shopping for health insurance using the marketplace system extremely frustrating. We decided an Allegro article was not worth it yet.

Now, six months later, I have spoken with many musicians about their experiences on the sites to find out who has and has not been helped by the system. I found that it depends on several factors.

People with incomes that consistently fall below the threshold for receiving a premium subsidy (four times federal poverty level, which is $94,200 for a family of four) and who never qualify for any employer-sponsored health insurance, including the Local 802 plan, seem to be benefiting the most. If there are dependents, the picture is more complicated.

I spoke to two musicians who do not qualify for any employer-sponsored insurance and are below the threshold. Each was buying insurance on the individual market before they switched to the ACA/Obamacare marketplace system. Both are now paying almost 50 percent less in premiums than before.

In many cases it seems to be a good idea to use a Navigator, which is an organization that has been approved to help individuals sign up for health insurance through the new system. Two Navigators in our area are the Actors Fund and Chamber Music America. (See contact info at the end of this article.) Navigators are able to search the system for you, look for the most appropriate insurance for the best value, and troubleshoot. But even with a Navigator, things can go awry.

I spoke to a musician who used a Navigator, signed up on the New York marketplace system and ended up one of the many people “lost” in the system. This happens when the site issues faulty information to the carrier (something that Health and Human Services Secretary Kathleen Sebelius said was happening a lot) or when the carrier or site becomes overwhelmed by the volume of new enrollees. This musician paid the premium but was never issued an ID number and has been waiting since Jan. 1 to be assured of coverage. The Navigator is currently trying to untangle the knot.

Other musicians are subject to “churning” – bouncing on and off the Local 802 coverage and experiencing the normal fluctuations in income that musicians go through every year. But this means that they are crossing back and forth over the subsidy threshold – the point where they would get reduced premiums through ACA/Obamacare.

One family of musicians lost its Local 802 coverage a few years ago and had been getting coverage through the Freelancers Union. As family coverage became more and more expensive, they signed their children up for Child Health Plus, the New York State program for keeping kids covered even when the parents are not. This family was subject to swings in income, as many of us are, and Child Health Plus became suddenly more expensive because the family had one or two good months at the time their income was evaluated. This same swing upward in income disqualified them for a subsidy on the state marketplace system through ACA/Obamacare, so they tried a policy from the state site that only covered the children while the parents went back to the Freelancers Union. Their experience signing up for coverage on the state site was similar to the member whose ID is in limbo; the insurers seem to be overwhelmed by new information, the web site may not be communicating very well with the insurers and both seem to be having a hard time reconciling the applications and premiums with the company-generated IDs. This family highly recommends using a Navigator to help sort through all the complications; one was able to resolve all of the issues for them.

Recently I tried the test drive again. Both the federal site and the New York site were more user friendly. However, on the New York site, I was unable to window shop for policies without entering in all my income estimates with my 20-odd music employers. On the federal site, I entered the number and ages for my family members, pretended that we live in Bergen County, New Jersey and looked at what plans came up. I entered a made-up income of $94,200 a year, which is the threshold for a subsidy for a family of four. The first “bronze-level” plan that came up had a premium of $552 a month. I went back and changed my income from $94,200 to $94,201 and the premium jumped to $1,301 a month. Ouch. That’s the problem with those income limits for subsidies, especially for musicians, since our income fluctuates each year.

The ACA/Obamacare provides certain protections. Well known are the provisions that prevent discrimination based on pre-existing conditions. Less known is the serious protection that any insurance bought on a state or federal marketplace caps co-pays and any share you will pay for medical services at $6,350 a year for individuals and $12,700 for a family. That is a lot of money, but it spells the end of medical episodes saddling people with bankrupting bills in six figures.

The downside for many Local 802 members whose incomes toggle back and forth across the subsidy threshold and who are inconsistently covered by the Local 802 plan or any other is that the cost of a plan bought without a subsidy on the state or federal marketplace can approach 15 to 20 percent of your yearly income. Moreover, the affordability test under the law for employer-sponsored insurance (whether the co-premium you pay for employer coverage is “reasonable”) is for self-only coverage, making it difficult and costly for musicians to cover dependents.

Bottom line: if you need health insurance, try out the ACA/Obamacare marketplace system and get a quote. Use the web sites below. Because of the inherent complications in our industry, it is also a good idea to ask for help from a Navigator.

HOW TO START

To access the ACA/Obamacare marketplace system and apply for health insurance, try one of the web sites below.

New York:
www.NyStateOfHealth.ny.gov

Connecticut:
www.ct.gov/hix

New Jersey and Pennsylvania:
www.HealthCare.gov

Other states:
Start at www.HealthCare.gov

NAVIGATORS

The following organizations are “Navigators,” which are approved to help people sign up for health insurance through the ACA/Obamacare:

Chamber Music America:
www.chamber-music.org

The Actors Fund:
www.ActorsFund.org