Next Steps.. (updated 10/21/11) *indicates where the updates are

We recommend that you print this page out

Again we must stress that the information on this web site should not be used in replacement for talking to an enrollment specialist and/or a staff person at a designated State agency or a designated advocacy organization. It is only meant to act as preparatory information and is intended only for educational purposes and is not meant to be legal and/or tax advice. Remember to also review our how to prepare section.

Here is what we recommend you to do (some of the below only applies to those who are uninsured):

1) When you file your taxes you should work with an accountant who specializes in preparing taxes for artists and also join this site's free list serve. Make sure you keep good track of all of your health care related paper work and information.

2) If you have questions after reviewing the information provided on this site, it is best to call/contact an enrollment specialist or a staff person at a designated State agency or advocacy organization. We recommend you to call Health Care for All's Free Helpline (1-800-272-4232). The purpose of the helpline is not only to help people navigate the MA Health Reform Law but to also "provide information and assistance to people who have questions, complaints and/or problems with the health care system" (i.e. they know your rights regarding health care and health insurance, they help folks navigate health insurance system, they help advocate for people with health care providers and the like, etc..). Remember, you can call the Helpline when you have a question about your health care- even if you already have health insurance! Make sure when you call them that you self-identify as an artist, as they are keeping track of our numbers to help us get data to make better health care policy for the artists population.

3) You need to be very careful how you identify your income to enrollment specialists and what path you pick when applying for the state subsidized health plans (i.e. W-2 only, combination income, self employed income). If you can identify as combination income, you will more than likely have more flexibility in picking health care reform options. As the law is written now, if you self-identify as self-employed and enroll or have enrolled into Insurance Partnership program, you are not suppose to be eligible for Commonwealth Care, even if your income is at or below 300 percent of the Federal Poverty Level! (there has been a bill filed to change that- see our legislative section).

*300 percent of the FPL for an individual is approximately $32,676 (NOTE every April 1- the FPL amount will increase/be adjusted) and to find what 300 percent FPL for a family is, add an additional $11,460 for each additional dependent to amount for an individual (see the Insurance Partnership's web site for a better understanding of the FPL which is also referred to as income ceilings). However, annual gross income for those who are self-employed, seasonal workers, don't have regular pay stubs, and/or have combination income sources (W-2 income, 1099 income, etc.), is determined differently from those with just W-2 income wages with regular pay stubs. Those whose income is not solely from W-2 income sources with regular pay stubs, should contact an enrollment specialist in person to determine what their income is. (Contact Health Care for All's Help line or an enrollment specialist at a community health center, hospital, or at a health care advocacy organization).

4. If you are uninsured, we recommend that you first try to see if you are eligible for Commonwealth Care or another Mass Health Program BEFORE you apply to the Insurance Partnership program(IP) or purchase a Commonwealth Choice plan, a Young Adult Plan or a health plan on the private market. You can not switch into Commonwealth Care from the IP program. One can switch from a Commonwealth Choice Plan or a Young Adult Plan(YAP) into Commonwealth Care (as long as you are paying 100% of the premium). You can switch from Commonwealth Care to the IP program, to Commonwealth Choice Plans, to the YAPs or into any other private insurance plan available on the private market. Also you CAN switch into Commonwealth Care if you purchase insurance via a group and you are paying 100% of the premium (i.e. you join an organization or association to get group rates for your health insurance).

a) If you are self-employed and have health insurance, you may still be eligible for Commonwealth Care, a Mass Health Program and/or the Insurance Partnership if your income after your business expenses (Line 22 of your 1040 tax form) is at or is under 300 percent of the Federal Poverty Level. You are also probably eligible for a Commonwealth Choice plan and if you are under 26 years of age a YAP plan. AGAIN, we recommend that you first try to see if you are eligible for Commonwealth Care or another Mass Health Program BEFORE you apply to the Insurance Partnership program(IP) or purchase a Commonwealth Choice plan, a Young Adult Plan or a health plan on the private market. You can not switch into Commonwealth Care from the IP program.

b) Remember, even if you don't qualify for Commonwealth Care and only have W-2 income, you might still be eligible for the Insurance Partnership program. Again please note: if you apply to the Insurance Partnership as a self-employed person you can not switch into Commonwealth Care Program. The same holds true if someone is currently enrolled/participating as a self-employed person in the IP program. You have to be without insurance for six months to be eligible for Commonwealth Care. Please contact the AF if you are in "locked into" the IP program as we are keeping track of this: feedback@healthcareforartists.org

c) SPECIAL NOTE for those researching Commonwealth Choice Plans (the plans that are not subsidized)- DO NOT sign up on line/off the Connector's web site for these plans UNTIL you speak to someone. You need to make sure you understand what exactly the plans cover and what they don't cover- the fine print matters! Again, Health Care for All's Helpline can help with this. For these plans you do not have to disclose/show what your income is. You will not need to prove you are a Massachusetts resident or meet citizen requirements to purchase these plans.

IN 2010 the insurance companies convinced the state legislature that people in the private insurance makret were "gaming the system" and causing the insurance companies to lose money. So the state legislature changed the law governinng when and under what circumstances individuals can buy insurance in the private market place. No advocates were consulted on this change before it became law. This new law did not change the rules for those in subsidized care, or how businesses can buy insurance. The law only changed it for those individuals who earn over 300 percent of the Federal Poverty Line. (For the record the Artists Health Care Working and Healthcare for Artists.org were against how this change was put into place and testified against it).

There is now a strict open enrollment period and if individuals miss that period they will more than likely be locked out of buying insurance unless they have a "qualifying event". Note if your employer offers you insurance and it meets minimal credible coverage, you are not allowed to forgo you employer's insurance and buy insurance on the private market place- unless you have a qualifying event (so if you dont' like the insurance your employer is offering you is not sufficent to allow you to buy private insurance even if you can afford it). The Connector has Young Adult Plans (YAP) for those who are 18-26 years of age. The YAP plans can only be purchased through the Connector. Please make sure you read our buyer beware information on the YAP Plans in our Health Care Options Available section of our Guide for Artists. Note the same applies on the YAP plans as it does in the private insurance market place.

For more information see the Connector's PDF fact page. We also urge you to call Health Care for All's FREE Helpline for information and help: 1-800-272-4232. AND call your state representative and state senator and urge them to change this law!

5) If you don't have insurance or even if you do, you should research what health care providers are geographically near you (a community health center or hospital- see our links section to find one near you). These providers usually have advocates on site to enroll and council people on their health care options. Even if you don't think you are eligible for any of the State's subsidized plans (MassHealth or Commonwealth Care) or already have insurance, these sites might be a good place to establish a relationship with for your medical care. The community health centers and many of the hospitals will continue to care for you whether you have insurance from a State subsidized plan, from a private insurer, or if you lose your private insurance. Again we urge you to self-identify to the health care providers that you are an artist!

6) Once you obtain insurance or if you already have insurance- you need to understand what it covers and what it does not cover. This is very important information to gather.

Some of the things you will need to find out:

a) What your total out of pocket costs are and if they are capped at a certain amount.

b) What your deductible amount is and if it is capped, what it is applied to, and its relationship to your out of pocket expenses.

c) If your insurance covers prescription drugs and what kind of drugs it covers (i.e. brand name, generic, etc..)

d) What is considered by your health insurance "in network" and what is considered "out of network". In general "out of network" services are usually not covered. You don't want to find out after you get a bill that a medical service you had was considered an "out of network" service by your health insurance plan. For example, an artist we know was paying $300 per month for a health plan and needed surgery. She had the operation in a hospital that was "in network" but not all the doctors were in the network! It was after the operation that she found out that the anesthesiologist was not a doctor that was "in network"/covered by her insurance. AND the anesthesia and pain medication was also not covered by her health plan. She ended up with $5000 in medical bills. Needless to say she switched to a different health plan.

We urge you to call your health plan AND Health Care For All's Helpline to help you sort all of this out: 1-800-272-4232

OTHER IMPORTANT TIPS FOR WHEN YOU DO GET HEALTH INSURANCE/HEALTH CARE- We recommend that you keep track of all the paper work generated from your doctor's visits in your health care folder. Make sure if you have a co-pay, that each time you pay your CO-pay you get a receipt for your payment. This is very important in case you get doubled billed by accident! Also make sure you tell your primary care doctor you are an artist and what discipline you work in. Be sure to tell them if you work with any materials that could be hazardous to your health and/or if do any kind of repetitive motion physical work/do heavy lifting etc., as a result of your art making. This is important for them to know in case you get sick or hurt so they can best help you.