By now, most of us know that the life of most working musicians is more about jamming econo than MTV’s "Cribs". Still, many fans would be surprised to know how many artists we think of as successful—people who are able to make a full-time living from music, and who we see on summer festival stages—have been living without insurance for years, relying on WebMD and a bottle of St. Johns Wort, and hoping for the best.
How big a problem is this? An online survey conducted before Obamacare’s implementation (conducted by Future of Music Coalition and the Artists’ Health Insurance Resource Center) found that 53% of musician respondents lacked health coverage; that’s nearly three times the 18% of the general population ages 18-65 who were uninsured.
It’s not because musicians are uniquely irresponsible or incapable of planning ahead. In the United States, health insurance is usually tied to your employer, but musicians are typically self-employed, paid on a contract basis for recordings, shows, and other kinds of freelance work. And even though many have day jobs, they’re often the kinds of temporary or part-time positions that allow you to take a couple weeks off for touring. That means musicians, like many creative workers today, are far more likely to have to purchase their own individual insurance plans, or go without if they feel they can’t afford coverage.
The good news is the Affordable Care Act was designed specifically to help get lower-income self-employed people covered. And after the first year, despite 56 congressional votes to repeal it, multiple Supreme Court challenges, and an initial launch as disastrous as Robin Thicke’s Paula, the new law appears to be achieving many of its goals. We don’t yet have data yet showing how musicians specifically have benefited, but we do know that the overall uninsured rate is at its lowest rate since the 1990s. And it may be more affordable than you think; 8 in 10 consumers can get coverage for a monthly premium of $100 or less.
So, let’s say you’ve spent the last few weeks traveling the country in a smelly Econoline and haven’t had time to think about your insurance needs; you’ve just realized the open enrollment period ends February 15.
Let’s start with the basics. There are multiple ways to enroll in the health insurance marketplace: through the website at healthcare.gov (which, I’m happy to report, is working much better now), over the phone 1 (800-318-2596) or in person—you can find local organizations with trained "navigators" ready to help you at localhelp.healthcare.gov.
You can also get assistance from a private health insurance broker. Unlike "navigators", they’re able to give you more extensive advice about which plan to choose on the exchange, though they’re not able to help you apply for Medicaid. The commission is paid by the insurance company whose plan you ultimately choose, so it won’t cost you extra.
Your eligibility for financial assistance is based on your annual adjusted gross income, as reported on your taxes. But accurately predicting your income can be next to impossible for musicians, whose income can fluctuate wildly from month to month and year to year. You can only estimate how your forthcoming album or tours are going to do. If you have no idea, use your income from last year’s taxes as a starting point. Your premium can be adjusted over the course of the year if your estimate was off the mark.
The plans available to you will vary based on where you live, and here there’s some bad news. While the ACA was designed to expand Medicaid to most people earning under, the Supreme Court ruled in June 2012 that this provision would be optional for states. And because of the exhaustingly stupid politics around Obamacare, 22 states have chosen (for now) to let their citizens go without health care rather than accept federal money. This creates a "coverage gap" for people who don’t qualify for Medicaid and yet don’t make enough to qualify for a subsidized plan from the exchange; anecdotally, I’ve seen a disconcerting number of low-earning musicians fall into this gap.
If you live in one of these states, you may want to call your governor and state representatives and tell them how you feel—a handful of states are still debating the issue. People who are stuck in the coverage gap won’t be subject to a tax penalty, but one potential solution to get coverage is simply to do what you can to increase your income to the level where the subsidy kicks in ($11,670 for individuals). Enroll with that figure as your estimated income, and then do your damnedest to get your income up to that level for your 2015 taxes to avoid any possibility of repayment penalties. Make sure you’re reporting all your income from house shows and t-shirt sales; whatever it takes to get up to that line.
Now, you may look at the cost of available plans and determine that the only option you can afford is a high-deductible "Bronze" plan, or a bare-bones "catastrophic" plan and wonder whether it’s worth the extra hustle to pay that monthly premium. The short answer is yes, and not just because the tax penalty for failing to get coverage is bigger this year. All the individual plans available through the marketplace have an out-of-pocket limit of $6,600 or less, which means you’re protected in the event of a worse-case scenario like an emergency surgery or chemotherapy. Your friends might have to throw you some benefit shows or launch a GoFundMe campaign to help you come up with that $6,600, but that’s better than a career-ending bankruptcy.
Of course, it’s kind of insane that in the wealthiest nation on earth, we’d have to resort to benefit shows to raise money for someone’s chemo. A single-payer system would be infinitely less complicated, and certainly more humane. For now, the Affordable Care Act represents a major step forward, but only if you take advantage of it. If you miss this deadline you may have to wait until November to get subsidized coverage. Get enrolled by Sunday, and then call your parents and tell them they can worry a little less about what you’re doing with your life.