Getting Health Insurance by 2014
The individual health insurance requirement is a complex thing to understand, so the best way to prepare for the upcoming changes is to get familiar with them today! Below are three things to know about the requirement and how artists’ access to health insurance is expanding in 2014.* Click on the questions (with arrows) to learn more! This page was last updated on 10/1/13. Please keep checking back; more information is coming forward the closer we get to 2014!
*Springboard for the Arts is not a provider, agent, advisor or consultant of healthcare or health insurance. By using this service, you understand and agree that the information contained herein is not intended nor implied to be, and you will not use it as, a substitute for professional legal, tax, insurance or healthcare advice. This webpage is an online information service provided solely as a non-partisan source of information. The information contained herein has been compiled thanks to Kaiser Family Foundation, healthcare.gov, the Journal of the American Medical Association, Families USA, The Advisory Board Company, The Artists Health Insurance Resource Center, The New York Times and the state of Minnesota.
1. There’s a new legal requirement to have health insurance. Starting January 1, 2014, Americans must have health insurance or pay an annual fine.
- Have a family income below the threshold requiring you to file a tax return (for the 2012 tax year, this is $9,750 for an individual and $19,500 for a family. Note: this limit is slightly higher for those aged 65+).
- Would have to pay more than 8% of your family income for “adequate” health insurance, after taking into account any employer contributions or tax credits offered. Continue reading to learn more about what defines “adequate” health insurance.
- Are part of a religion that opposes the acceptance of benefits from a health insurance policy.
- Are an undocumented immigrant.
- Are incarcerated.
- Are a member of an Indian Tribe.
|Level of coverage||Plans typically pay this % of your covered healthcare costs*|
To have “adequate” health insurance coverage, you must either:
- Be enrolled in a public healthcare program (like Medicaid or Children’s Health Insurance Program)
- Have a Platinum, Gold, Silver or Bronze-level private health insurance plan (if you are 30 years of age or older)
- Have a catastrophic (high-deductible) private health insurance plan (if you are a young adult under 30 years old). In other words, young adults under 30 years old are allowed to satisfy the health insurance requirement with a plan rated lower than Platinum, Gold, Silver or Bronze.
Starting in 2014, all insurance plans sold to individuals and small employers will be required to offer coverage for ten types of healthcare services; how much coverage will depend on your healthcare plan. For a full list of these required services, called “essential health benefits,” please click here. While you’re not required to have insurance coverage beyond these essential health benefits, your insurance plan may still cover other services (for example, public healthcare programs may include dental care for adults).
*The government rates plans Platinum, Gold, Silver or Bronze based on something called an “actuarial value.” This actuarial value is a combination of your deductible, co-payments, and co-insurance. So, a Silver plan with an actuarial value of 70% predicts that you’d pay 30% of your healthcare costs through a combination of your deductible, copays and coinsurance, and the insurance company is predicted to pay the remaining 70%. For more information on actuarial values, please click here.
2. You have a new place to shop for health insurance. Each state has a new online marketplace where individuals who do not receive insurance through their employer and small businesses can buy health insurance. You can start purchasing health insurance on this new marketplace on October 1, 2013 for coverage beginning January 1, 2014. Open enrollment ends March 31, 2014.
For Artists in Minnesota: Minnesota is participating in the expansion. Eligibility for Minnesota’s Medical Assistance (MA) program will expand from 75% of the FPL to 138% of the FPL for adults without dependents, parents and young adults aged 19-20; up to 275% of the FPL for kids aged 2 – 18 and pregnant women; and up to 280% FPL for children up to age 2. To find out more about your state’s decision to expand Medicaid, check out this map.
You may be wondering where MinnesotaCare fits into this picture (after all, many who have MinnesotaCare today would qualify for Medical Assistance (MA), or be eligible for subsidies to purchase a private plan on the exchange in 2014). MinnesotaCare will still be operating in 2014 likely covering those who do not qualify for MA, but who have incomes up to 200% of the FPL for adults without dependents, children ages 19-20 and parents.
The state exchange is a new way to give individuals and small businesses the same purchasing power that large groups have today. Besides private plans from insurers like Blue Cross and Aetna, you’ll also be able to see if you qualify for and enroll in public healthcare programs like Medicaid and the Children’s Health Insurance Program (CHIP). Please note this this is NOT the place you’ll go to enroll in Medicare for adults aged 65 and older. Check out this video from the MNsure (Minnesota Health Insurance Exchange) to learn more.
If you’re uncomfortable using the online system or would like additional assistance, brokers, agents and other assisters will be available to enroll you in a plan that’s available on the exchange.
You can start shopping for and purchasing health insurance on October 1, 2013 for coverage starting January 1, 2014. You must use your own state’s exchange. So, residents of Minnesota use MNsure (Minnesota’s exchange); residents of Wisconsin use the Wisconsin exchange.
*The definition of small businesses is based on state law. Minnesota defines small businesses as having 50 employees or less, whereas many other states define small businesses as 100 employees or less.
PLEASE NOTE: The exchange is sometimes compared to Orbitz or Travelocity (but for shopping for and purchasing health insurance instead of plane tickets). While the websites for purchasing a product are similar, purchasing health insurance can be more complex than purchasing a plane ticket. For advice on finding the right plan, please check out our Guide to Healthcare for Artists and the Artists Health Insurance Resource Center’s publications.
- An employer
- An insurance plan purchased on your own (not via the exchange) that is at least at the Bronze level (ages 30+) or a high-deductible health insurance plan (for young adults under 30 years old)
- A grandfathered plan in existence before the health reform law was enacted
- TRICARE for military personnel and the veteran’s health program
3. You have new legal rights and may have access to tax credits. Insurance companies will no longer be able to deny you, limit your benefits or charge you more for premiums because of a pre-existing condition (your health status). Tax credits are available to help subsidize the cost of health insurance premiums.
- Is less than a Bronze-level plan for employees aged 30+
- Is less than a catastrophic (high-deductible) insurance plan for employees less than 30 years old
- Costs the employee more than 9.5% of their income for health insurance (for self-only coverage)
The Obama administration released a statement that these “employers must also offer coverage to dependents under 26 years of age (who do not have insurance offered through their own employer).” However, as of now, coverage for dependents does not seem to be subject to the same standards, listed above, concerning “adequate” coverage. There is also no employer requirement to cover spouses. Please stay tuned for more information on this!
The easiest way to determine your eligibility is to go to your state’s health insurance exchange, type in info about your income and household, and see what you qualify for.
Eligibility for a tax credit is based on your annual individual or household income and where it falls in relation to the government’s definition of the “federal poverty line (FPL).” You may be eligible for a tax credit if your income is between 100% and 400% of the FPL (in 2013, this was $11,490 – $45,960 for individuals; $23,550 – $94,200 for a family of four) and if you do not have access to other “adequate” coverage via an employer or public healthcare program (like Medicaid). To learn where your annual income falls on the FPL, check out this table from Families USA.
The tax credit works by covering any premium costs that exceed a certain percentage of your family income. So far, the government has only released a sliding fee scale for those purchasing a Silver plan. For those purchasing a SILVER-LEVEL PLAN:
|Your income as a percentage of the federal poverty level (FPL):||You may be eligible for a tax credit to cover any Silver-level premium costs that go beyond this percentage of your income:|
|100 – 133%||2%|
|133 – 150%||3 – 4%|
|150 – 200%||4 – 6.3%|
|200 – 250%||6.3 – 8.1%|
|250 – 300%||8.1 – 9.5%|
|300 – 400%||9.5%|
For small businesses: Small employers with less than 25 employees can get a tax credit if 1) they pay more than 50% of health insurance premiums for their employees and 2) if their employees have average wages of less than $50,000 a year. These credits became available in 2010 at 25% (for non-profits) to 35% and will go up to 35% (for non-profits) to 50% in 2014. Click here for more info and to claim the credit for 2013. Small businesses must get coverage through their state exchange to get the credit in 2014.
How much will I pay for health insurance on the exchange?
The easiest way to know how much you’ll pay is to login to your state’s health insurance exchange, enter information about your household and income and see what options you have.
So how does the tax credit lower your premiums? You may either receive an advance on the tax credit (which lowers your premiums every month) or receive the whole tax credit, in the form of a rebate, when you file your taxes. If you choose to get an advancement on the credit, it’s based on your projected income; if you received an advance on the tax credit and your income was less than what was projected, you would get a rebate; if you got an advance on the credit and your income is more than what was projected, you must pay the difference back.
Once you have health insurance, the law prohibits dollar limits on your yearly and limetime spending for most healthcare services that are covered under your plan. For more information on lifetime and annual limits, please click here.
- Insurance providers must offer preventive healthcare free-of-charge, as recommended based on gender and age.
- Insurance providers can no longer deny health insurance (or limit benefits) for children under 19 because of pre-existing conditions.
- Dependents can stay on their guardian’s health insurance plan until age 26.
Would you like to help artists in your community connect to healthcare resources? Check out our Artists’ Health Fair Replication Toolkit!