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How to Get Affordable Health Care in the metro NYC AREA

The Dancers’ Health Insurance Resource Center A program of The Actors Fund with support from The Doris Duke Foundation . How to Get Affordable Health Care in the metro NYC AREA. www.ahirc.org. Employment-related coverage Private, direct-purchase plans Government-subsidized programs.

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How to Get Affordable Health Care in the metro NYC AREA

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  1. The Dancers’ Health Insurance Resource Center A program of The Actors Fund with support from The Doris Duke Foundation How to Get Affordable Health Care in themetro NYC AREA

  2. www.ahirc.org

  3. Employment-related coverage Private, direct-purchase plans Government-subsidized programs How can I get insurance in the New York area?

  4. Right to buy insurance in NY & NJ • Right to receive care in a life-threatening emergency at any hospital regardless of insurance status • 6 month look back period/ 12 month pre-existing condition exclusion • Credit for coverage if less than 63 day lapse in policies What are my protections and limitations?

  5. Co-pay Co-insurance Deductible HMO POS/PPO Federal Poverty Level Premium Reasonable & customary charges Words to know

  6. Job or spouse/domestic partner’s job • COBRA • Guarantees right to continue coverage • 18 months (up to 36 months if company is headquartered in NY) • 60 days to sign up (from date of letter) • Full premium (at group rate) + 2% Employment-related options

  7. NY COBRA subsidy • NYS pays 50% of monthly premium • 12 months per lifetime • Income limits ($2327/mo for one person) • Entertainment union-based insurance only Employment-related options

  8. Small business insurance • Chambers of Commerce • Brooklyn HealthWorks • LIA Health Alliance • Health Pass • School • CUNY: 6+ credits Employment-related options

  9. Actors Equity • Eligibility: 12 wks in 12 mo = 6 mo; 20 wks in 12 mo = 1 yr • $100 quarterly premium • HMOs: HIP, Aetna • PPO: CIGNA (30% co-insurance out of network) • www.equityleague.org/health/index.html Employment-related options:Unions

  10. SAG • Blue Cross Blue Shield • Plan 1 and Plan 2 (no mental health) • Quarterly premiums: $273-$414 • Eligibility: • Plan 1: $30,750 (more extensive benefits) • Plan 2: 15,100 or 76 days • www.sagph.org/index2.html Employment-related options: Unions

  11. The Freelancers Union (NY) 3 PPO, 2 HD Plans; $225-$603/mo • Media Bistro (NY + NJ) GHI/Emblem Health, HIP and Oxford plans • TEIGIT (NY, NJ, CT) Associations incl. AFTRA, AGMA Oxford plans; $513-$1121/mo GHI/Emblem plans: $231-1036/mo I’m a freelancer – what’s available to me?

  12. Sole proprietor plans • Oxford Liberty EPO Exclusive ($532; $2850 deductible, 10% co-insurance) Limited benefit plans: GHI Alliance Value $741/mo Hospital, ER & drug benefits (no outpatient) Empire Tradition Plus $181/mo Hospital room & board only Sole proprietor & limited-benefit plans

  13. Consider your medical & financial risk limits • Choose carrier & type of policy • HMO • POS/PPO • www.dfs.ny.gov/insurance/ihmoindx.htm I can afford private insurance, but I don’t know what type of plan to get.

  14. Check with insurer • International travel • www.medhealthinsurance.com/traveler.htm I’ll be traveling/going on tour. Will I be covered while on the road?

  15. I can’t afford insurance. Are there government programs I qualify for? Federal Poverty Levels 2012

  16. Medicaid • Comprehensive • Very limited income (ca. $735/mo or more based on category) • No premiums • No pre-existing condition waiting periods • 2-3 month application process www.health.ny.gov/health_care/medicaid/ Government programs

  17. Family Health Plus • Comprehensive • Income: up to $11,170/yr (indiv) • HMOs • No premiums; some co-pays • No pre-existing condition waiting period • www.health.state.ny.us/nysdoh/fhplus/index.htm Government programs

  18. Healthy NY • Eligibility: • employed in last 12 months • NY resident • gross income under $2,327/mo • have lost insurance and not bought insurance in 12 months • Choose your HMO Government programs

  19. Hospital and outpatient services; no coverage for mental health, ambulance, dental… • Deductible: 1200/calendar year per person • Can purchase with or without drug coverage • Premiums: $227-$395/mo • Pre-existing condition period may apply • www.healthyny.com Healthy NY continued…

  20. Child Health Plus • Free for low-income families • Low premiums for higher-income families • Comprehensive • No pre-existing condition exclusions www.health.ny.gov/health_care/child_health_plus/index.htm Government programs

  21. ADAP/AHIP/APIC • HIV+ or AIDS • Medications & insurance • Income requirements vary • www.health.ny.gov/diseases/aids/resources/adap/index.htm I have a special health condition. Are there any programs that cover it?

  22. The National Breast & Cervical Cancer Program • Participating providers • Income: up to 250% of FPL • 1-866-442-2262 I have a special health condition. Are there any programs that cover it?

  23. Family Planning Benefit Program • Free reproductive services • Income: up to $1805/mo • www.nyc.gov/html/hia/html/public_insurance/family.shtml • PCAP • Pregnancy & delivery costs • Income: up to $2522/mo • http://partnership4coverage.ny.gov/pcap.htm Special health conditions

  24. Medicare • Part A: hospitalization; automatic at age 65 • Part B: outpatient services; monthly premium • Part D: drugs • www.medicare.gov I’m 65. Are there any programs for people my age or older?

  25. NY Bridge Plan Must have been uninsured for 6 months & have pre-existing condition Very comprehensive No deductible GHI/Emblem Health $421/mo www.nybridgeplan.com I have a pre-existing condition I need covered right away, and I’m uninsured.

  26. HHC Options • Income-based sliding scale fees at public hospitals • Must be uninsured • www.nyc.gov/html/hhc/html/access/hhc_options.shtml Non-insurance options

  27. The Al Hirschfeld Clinic • For entertainment industry members; eligibility requirements apply • Free! • 212.489.1939 (57th St & 10th Ave) • Sliding-scale clinics • findahealthcenter.hrsa.gov Non-insurance options

  28. Retail clinics in pharmacies • CVS and Duane Reade • www.drwalkin.com • www.minuteclinic.com • Sick Day Safety Net • Discounted house calls for uninsured entertainers and artists in Manhattan & Brooklyn • www.sickdaysafety.net Non-insurance options

  29. Needy Meds • www.needymeds.org • Big Apple Rx • www.bigapplerx.com • $4 Generic Drug programs • Wal-Mart • Target • Pathmark ($10 for 90 day supply) How can I get cheap or free drugs?

  30. NYU & Columbia dental schools • New York City Technical College • Dental hygiene clinic: Provides cleaning, fluoride treatment, and x-rays; 718.260.5074 • Hospital-based low-cost dental care • www.nyc.gov/html/hia/html/resources/services_dental.shtml • Negotiate with your dentist I have dental problems but no insurance. What do I do?

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