Good News for Musicians' Healthcare

This summer, President Biden signed the Inflation Reduction Act, a major piece of legislation with wide-ranging impacts on climate, and economic policy.  Amid all the discussion of its many components, the provisions surrounding health care subsidy changes haven’t gotten much media attention. Essentially these changes may mean that plans on the marketplace may be more affordable than in the past, but you will have to act fast, as open enrollment ends very soon.

Why musicians lack coverage

Back in 2010, in the months leading up to the passage of the Affordable Care Act, FMC worked with the Entertainment Community Fund (formerly the Actors Fund) to study the challenges that artists of all disciplines face in accessing health coverage and quality care. Among our findings: musicians in particular were nearly three times as likely as the general population to lack health insurance.  The structural reasons were clear: while most workers get their insurance through their employer, many musicians’ employment structures are more complex and varied. Rather than working for a single full time employer, they often earn revenue from an array of different employment relationships and income streams, including self-employment, temporary gigs, and part time work. Individual plans in the private marketplace were often unaffordable, and the quality of plans often wasn’t great.

Obamacare was intended to change that, by creating a baseline level of quality care that included “essential benefits”, expanding Medicaid coverage for the lowest earners, and creating a marketplace for individual plans with federal subsidies intended to bring health coverage within reach of all.

It’s been a mixed success; while many musicians have reported that they were able to access health insurance for the first time in their careers, others reported that monthly premiums were still too high to be truly affordable. Traditional careers tend to offer a reliable paycheck from month to month, while many musicians earnings can be uneven from month to month, depending on the timing of tours, gigs, royalty checks, etc, which can make it hard to keep up with premiums in lean months.  Even worse: because the Supreme Court allowed states to opt out of the Medicaid expansion part of the legislation, low-income musicians in those states have been left without coverage.

Help is on the way

Since then, we’ve seen a range of legislative efforts to tweak, improve, and expand Obamacare.  But we’ve also seen COVID-19 expose just how precarious musicians’ incomes can be, and just how crucial it is to have access to care.

In Spring 2021, a stimulus package signed into law by President Biden made important temporary changes to the Affordable Care Act. It removed, for two years, the income cap that had determined eligibility for insurance premium subsidies. That meant that musicians and composers who in the past might have made too much to be eligible for a subsidy covering the cost of a federal or state marketplace plan now would be eligible for support.  The package also limited the amount paid in premiums to 8.5% of your income.

These changes didn’t get a lot of attention at the time (granted, there was a lot going on!) but effectively, they’ve meant that insurance through the marketplace may be significantly more affordable than it was in the past.  And while the stimulus package only extended these subsidies through 2022, the new Inflation Reduction Act continues these changes through 2025.

The upshot: a good plan may be cheaper than before!

If you’ve tried shopping for a plan in the past and experienced sticker shock, it may be time for a fresh look.  (And even if you’re happy with your plan right now, it’s worth taking a moment every year to shop around once open enrollment begins, because you might be able to find an option that better fits your needs.)   You can use this calculator to estimate your costs.

For example…

Say you’re a jazz musician living in Brooklyn—NYC is expensive but it’s where your community is, and where the gigs are. You made $52,000 in the last year and expect next year to look the same. Without the passage of IRA, your monthly premium for a silver plan would have been $617—or $7,409 per year. That’d be 14.25% of your income.

But because IRA passed, your premium cost will go down to $368 per month, or $4420 per year, 8.5% of total income.   That’s a savings of $2,989 per year!

Open Enrollment happening now

Despite these positive changes, some of the structural annoyances with the ACA remain intact, including the limited Open Enrollment window. In most states, enrollment for January 2023 ended on December 15, but you can still enroll for coverage beginning in February 2023—you can find the full details at healthcare.gov.

That said, if you’ve experienced a qualifying life event, like losing previous health coverage, moving to a different zip code, or household changes like a marriage or new baby, you may be eligible for a “Special Enrollment Period” which allows you to sign up for a plan even outside of open enrollment.  And if your income is low enough to make you eligible for Medicaid, you can sign up at any time; there’s no waiting necessary.

Choosing a plan

Plans are still designated by “metal” level in bronze, silver, and gold, which can offer different levels of balance between deductibles and monthly premiums.   But the differences aren’t always intuitive; you might see silver plans priced higher than gold plans, because of the additional cost of “Cost-Sharing Reductions” added to silver premiums.  A plan with CSRs can mean you pay less to providers over the course of the year when services are provided. Whether you qualify for these CSR benefits and how much you expect to use your insurance over the course of the year are important factors to consider in choosing a plan that results in the lowest total health care cost.

When shopping for a plan, musicians will want to keep their field-specific needs in mind.  For example, musicians who anticipate touring in 2023 will want to find a plan that includes adequate out-of-network coverage for any health needs while out on the road and away from home.

Specially-trained navigators are available to assist you in understanding your options in the marketplace—you can connect to someone in your community through healthcare.gov. Alternatively, you can get help with the marketplaces through a local health insurance broker; brokers are able to offer more detailed advice on what plan to choose based on your individual situation, and this help is free (brokers get paid by insurance companies when they sign people up).  However, brokers are not able to help low-income individuals sign up for Medicaid—that’s a job for navigators.

Some problems persist

Even with expanded subsidies, the ACA marketplace is an imperfect solution at best, and leaves significant structural barriers to care for musicians and similarly situated workers intact.  We at FMC have long argued that a single-payer approach to health coverage (like the approaches popularly described as “Medicare For All”) would be much simpler, and a massive step towards a sustainable supportive environment for musicians, composers, producers, engineers, and so many other different kinds of creative professionals.

Nonetheless, we strongly encourage you to take advantage of the opportunities that do exist right now, while we all stay engaged in the long term fight to get every musician covered.