Buyer Beware: Dancers and the ACA

Important Considerations for Dancers When Purchasing Health Insurance

By Sarah Dash

Most dancers can easily spot a hazardous bobby pin on the studio floor. It’s also important to be aware of a few potential pitfalls when buying health insurance.

• Open enrollment timing: As in the dance world, timing is everything. To gain access to the health insurance marketplaces, you must enroll between October 1, 2013, and March 31, 2014, otherwise, you will have to wait until the next open enrollment period unless you have a qualifying life event. This timing also applies to private coverage sold outside the marketplace. Find out what you can do now to get ready to enroll. You must enroll by December 15, 2013, and pay your premium by the due date your plan specifies in order for coverage to start on January 1st. After that, if you enroll between the 1st and 15th day of the month and pay your premium by the due date, your coverage begins the first day of the next month. If you enroll between the 16th and the last day of the month and pay your premium by the due date, your effective date of coverage will be the first day of the second following month. For example, if you enroll on February 10th, your coverage will start on March 1st, but if you enroll on February 16th, your coverage will start on April 1st.  Also note that if you’re uninsured for more than three months during 2014 you’ll have to pay a penalty—so if you are uninsured and wait until after March 15, 2014, to enroll, your coverage will not start until May 1, 2014, and you may be subject to the penalty.
• Private coverage sold outside the marketplaces: In most states, private health insurance coverage will still be sold to individuals and small businesses outside of the new marketplace. However, not all of these plans will have to meet the same standards as coverage sold through the marketplace. In addition, you can’t get financial assistance if you buy individual coverage outside the marketplace. You may already be covered by an individual market policy that is “grandfathered,” which means it does not have to meet all of the law’s new standards, such as coverage for a pre-existing condition. If you have one of these plans you can switch to a marketplace plan during open enrollment and immediately get coverage for your pre-existing conditions. Be sure to understand whether you are buying through the health insurance marketplace or not. If you’re not sure whether an insurance website is the right one, know that www.healthcare.gov is the only legitimate website for the federal marketplace, and it provides legitimate links to state marketplace websites.
• Estimating your income and reporting changes in income: The premium tax credits and Medicaid eligibility are based on your best estimate of your 2014 income, which may change throughout the year. It is extremely important to report any changes in your income during the year to the marketplace, because individuals who underestimated their income and claimed too much premium tax credit might have to repay the difference at tax time. If you didn’t receive all of the premium tax credit you’re entitled to during the year, you can claim the difference when you file your tax return.
• Understanding your benefits: Although all health insurance plans offered through the marketplace must cover essential health benefits and meet standards for cost sharing, not all plans will be alike, even within the same “metal tier” (bronze, silver, gold, platinum). It is important to carefully review the details of what the plan covers, using tools such as the summary of benefits and coverage. Dancers should pay close attention to these details to make sure their health plan covers services important to them, and to make sure they understand any limits on coverage (such as a 10-visit maximum for chiropractic care).
• If you don’t see the summary of benefits and coverage document displayed, you can ask the insurance company for a copy. When shopping for coverage, you might also want to keep this glossary of commonly used health insurance terms handy.
• Tobacco surcharge (higher premiums for tobacco users). Although health insurance companies will no longer be able to charge more for pre-existing health conditions, in most states, insurers will be allowed to charge up to 50 percent higher premiums for people who use tobacco. The premium tax credits through the marketplaces will not cover this tobacco surcharge. Some states have decided to limit or prohibit tobacco surcharges.
• Scams: Every big new program brings people trying to take advantage of consumer confusion. Be wary of red flags like unsolicited phone calls from people asking for your personal information, and read this important consumer alert from the National Association of Insurance Commissioners to understand common health reform-related scams.

To read more on the ACA, see “How To Find Help Understanding Coverage Options,” “Affordable Care Act: Important Dates,” and “Raising the Curtain on the Affordable Care Act.” 

Sarah Dash is on faculty at the Georgetown University Health Policy Institute. Previously, she aspired to a professional ballet career, but thinks it is better that you are the ones onstage. It is a privilege to share information about the Affordable Care Act with the Dance/USA audience.