Health Insurance, Health Care Reform and Resources in San Francisco/Oakland

1. Health Insurance, Health Care Reform and Resources in San Francisco/Oakland 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 jbrown@actorsfund.org

2. Health Care Reform:What’s already happened - 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.

3. 2010 • Uninsured people with pre-existing conditions may be eligible for coverage through PCIP. Pre-Existing Condition Insurance Plan www.pcip.ca.gov Help for the uninsured with pre-existing conditions thru a temporary high-risk pool until January 2014. Have to be uninsured for 6 months. Premium cost per month examples: age 30-34 = $218, age 40-44 = $269, age 50-54 = $381

4. 2011 • Medicare recipients in the coverage gap or “donut hole” will receive 50% off drugs • Annual wellness visits and certain preventive services will be free for Medicare recipients. • Increased funding to community health centers.

5. 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)

6. 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

7. Do I have to have Insurance in 2014? • Yes! • Penalty: increases from $95 or 1% of income in 2014 to $695 or 2.5% of income in 2016. • 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.

8. 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).

9. 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

10. What’s 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

11. 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

12. 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

13. 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

14. Ways to get coverage • Words to Know: HMO, PPO, High Deductible or Catastrophic Plan • Schools and Alumni Associations • Associations plans • Internet brokers • www.ehealthinsurance.com • Consider your medical and financial risk limits • Choose a carrier & type of policy to meet your needs and your budget.

15. Government Programs • San Francisco Health Plan • Network of doctors and hospitals that participate in Medi-Cal, Healthy Families, Healthy San Francisco. • Eligibility varies by each program • www.sfhp.org • Medi-Cal www.medi-cal.gov comprehensive coverage at no cost for low income • Healthy Families www.healthyfamilies.ca.gov for children up to age 19

16. Special Health Conditions • AIM – Access for Infants and Mothers medical coverage while pregnant www.aim.ca.gov ADAP - AIDS Drug Assistance Program and HIPP – Health Insurance Premium Program help with medical and insurance costs for those who are HIV+ www.cdph.ca.gov/programs/aids/Pages/Default.aspx

17. Non-insurance options • HEALTHY SAN FRANCISCO • www.healthysanfrancisco.org • Basic on-going medical services including hospital and office visits • San Francisco residents between 18 and 64 • Uninsured for 90 days, lower-income, not eligible for public programs • Not insurance; “medical homes”

18. I’m still uninsured … • Free, sliding scale, lower cost clinics San Francisco Community Clinic Consortium www.sfccc.org/clinics/index.htm San Francisco Community Health Network www.sfdph.org Alameda Health Consortium www.alademahealthconsortium.org

19. I can’t afford my medications • $4 Generics @ Target/Walmart • Costco discount program • Pharmacy Checker www.pharmacychecker.com • Partnership for Prescription Assistance www.pparx.org > www.lowestmed.com App for iPhone & Android

20. I have dental problems but no insurance. What do I do? • Dental insurance and dental discount programs • Dental Schools • UC San Francisco School of Dentistry • University of Pacific School of Dentistry Negotiate with your dentist Drop-in dental clinic at Highland Hospital(Oakland) Many of the community clinics have dental services

21. Are there special resources for the health of dancers and other performers? Dance/USA Task Force on Dancer Health http://www.danceusa.org/dancerhealth?s=task%20force Performing Arts Medicine Association (PAMA) www.artsmed.org International Association for Dance Medicine and Science (IADMS) www.iadms.org

22. Contact us at: • www.dhirc.org • 800-798-8447 x280 • jbrown@actorsfund.org [Jim Brown]