Artists and musicians are self employed and independent workers, therefore they do not enter in the health insurance plan anywhere as they are not hired by a major enterprise or successfully large business, so how can you take care of your health and be reassured that if you are touring and have need for a health-related matter you can go to a hospital without it costing and arm and a leg?
It has been a very concerning matter as musicians are exposed to a lot of constant stress, minor injuries due to loading equipment up and down from touring vans, traveling, performing too constantly leading to physical tiredness and in some cases sexual interaction with strangers and substance abuse (legal or illegal), still with all those aspects to consider 43% of artists do not have insurance, and the ones who do have an insurance plan an estimation of 40% pay it themselves (6 times a greater amount than general population who are insured by a company or by work-family matters)
Sadly, on the other side many artists (an estimated of almost 90%) said they “can not afford it” without really analyzing their economical situation and being well informed on all the health care plans there are out there, and that is what we will discuss, the so many variables among insurance plans that can be found, how you can try to situate yourself economically to find out if you really can or cant afford a Health Insurance, a bit of the language used that you will need to understand, how to compare the options at your disposition and applying for coverage, at the end we will cover some Frequently Asked Questions that you may have.
Basics: Terms & Lingo
Before we start discussing the Health insurance plan that you may need or how to select it basing on your budget or monthly income(in case you have a second job) we want you to understand some basic terminology that many of the artists analyzed and interviewed where not able to fully explain or they were just not aware about it at all.
Here is the basic terminology you will frequently come across when discussing, searching or reading on subjects related directly or indirectly to health insurance:
- Deductible: Your annual deductible is the amount you may be required to pay out-of-pocket before the insurance company will begin paying for your medical claims.
- Coinsurance: Coinsurance is the amount that you are obliged to pay for covered medical services after you’ve satisfied any co-payment or deductible required by your health insurance plan. the insurance company may limit coverage for certain services to, say, 80% of charges
- Maximum Out-of-pocket Costs: Pay attention to this amount when considering a new health plan. Your maximum out-of-pocket cost sets a limit to your annual financial liability. Once you have paid out of pocket to the “maximum” amount, the insurance company pays the full charges for any additional covered medical services rendered that year. Your monthly premium will not count toward your maximum out-of-pocket costs.
- Premium: Your premium is the amount you pay to the health insurance company each month to maintain your coverage. When trying to understand the cost of a health insurance plan and ensure to balance it against other costs, such as copayments, deductibles and coinsurance.Keep in mind, a lower premium/higher deductible if you want to save money now, and a higher premium/lower deductible if you want to be more financially prepared for unexpected medical expenses later.
- Copayment: Your copayment, or “copay,” is the specific dollar amount you may be required to pay up front for a specific type of service. For example, your health insurance plan may require a $15 co-payment for an office visit or brand-name prescription drug, after which the insurance company pays the remainder of the charges.if you make frequent doctor’s office visits, make sure you choose an affordable and consistent copayment.
- Lifetime Maximum: You might find this term in the fine print for a health insurance plan you’re considering, Lifetime Maximum is a cap on how much the insurance company will pay for your claims over the life of your policy. Make sure your plan has a lifetime maximum of at least 2 million dollars.
Lingo: 4 Health Insurance Life Plans
To shop smart you have to understand each and every term in the basics, universally this rules is important but when it comes to health insurance or health in general it becomes critical!
- HMO: HMO Stands for Health Maintenance Organization, HMO plans offer a wide range of health care services through a network of providers that contract exclusively with the HMO, or who agree to provide services to members. As a member of an HMO, you will need to choose a primary care physician (PCP for short) Who will provide and take care of you or your family in general and in case for something beyond their capacities they will recommend you to other specialists that can be covered within the HMO standards.If you value preventive care services are willing to play by the rules and coordinate your care through a primary care physician an HMO is the right choice, HMO can be practical for solo artists seeking general care for his or her family and/or band members (this In the case or scenario the band member is registered as an established business, we will discuss this in the F.A.Q and the end of the article)
- PPO: PPO stands for “Preferred Provider Organization” these plans are the most popular in the Individual and Family market. Like the name implies, with a PPO you will need to get your medical care from doctors or hospitals on the insurance company’s list of preferred and selected providers if you want your claims paid at the highest level.
- HSA: HSA are basically PPO plans with higher deductibles, designed specially for use with Health Savings Accounts (“HSAs”). Similar to a 401(k), an HSA is a special bank account that allows you to save money – pre-tax – to be used specifically for medical expenses in the future. Unlike a flexible spending account, the money in your HSA rolls over every year and can also gain interest. By pairing a qualifying high-deductible health plan with an HSA, you can save money on health care and reduce your tax liability.An HSA is a good choice if you are young and healthy and do not have any frequent need to visit a doctor.
- Indemnity: Indemnity plans allow you to direct your own health care and visit most any doctor or hospital you like. The insurance company then pays a set portion of your total charges. You may be required to pay for some services up front and then apply to the insurance company for reimbursement, Indemnity plans are the ones with the most freedom, as long as you keep In mind that you will have to coordinate the billing and reimbursement of your claims yourself.
So far, so good? Now that you are beyond the 90% of artists who did not understand jack or didn’t care enough to even investigate the basics on how insurance works or terminology we can approach aspects to benefit you as a musician!
Basic Questions & Proper Criteria For Your Decision
To ensure you select the correct insurance plan or the one you can benefit the most and feel the most comfortable and save money with we need you to ask yourself a few questions
- Do you maintain a savings or do you live paycheck to paycheck?If you do not have funds in the bank it is important to get yourself a a health plan with a low deductible, or none at all, in case you do have savings in the bank you can even find an insurance plan with a low premium and benefits, in both cases we are not concerning about whether you should or you should not have a savings account but to find something that fits the best to your administrative needs.
- How much did you spend on health care last year?A critical concern here, as this involve also in current costs (medicine, drugs, constant doctor check-ups,etc) you have to consider if this year you will spend a similar amount of money and why as the plan you select most probably could cover these services. If you don’t spend much on health care, then you could save money with a plan that provides less generous coverage for office visits or prescription drugs
- Are any specific benefits necessary or irrelevant to you?If you’re a regular user of prescription medication, make sure you find a plan that covers prescriptions at a copayment level you can afford, many benefits are maternity related, so if you are planning to have children this is a good opportunity to include coverage for them.
- How often did you visit a doctor last year, and why?If you visit the doctor regularly, it makes sense to pay a higher monthly premium in order to keep your office-visit copayment and deductible low.
- Do you have any pre-existing medical conditions?Can make it difficult to get approved for Individual and Family coverage. If you’re concerned, a licensed eHealthInsurance agent can help direct you to insurance companies more likely to approve your application. Call 1-800-977-8860 to talk to an agent.It is very crucial for you as an artist that if you do have medical conditions you seek proper guidance on selecting your insurance plan, we can’t stress enough the concern that many artists under go a pretty harsh share of stress while touring and/or require medical attention after 2-3 months involved in daily or almost daily live performances and having to ensure everything goes in the right direction.
Do not complicate yourself with all the questions asked above, there are a few key aspects for you to really take a good standing in your insurance selection:
- Costs: Which plans fall within your budget when it comes to premium, deductible, copayments and coinsurance? Consider a high-deductible plan if your primary requirement is a low monthly premium.
- Brand: Are there brand-name carriers that you prefer? Are there any you want to avoid?
- Consumer and industry reviews: eHealthInsurance offers customer reviews for many of the plans we sell, and we present the AM Best ratings for carriers.
- . Health benefits: Which plans provide the must have benefits you’ve identified? Buy only what is important to you to keep your costs low. Avoid expensive benefits (like maternity or prescription drugs) if you don’t need them.
- Physician network: Do you have a favorite doctor you want to keep? Which plans does he or she accept? On eHealthInsurance.com, you can use our physician finder tool to find plans that are accepted by your doctor.
F.A.Q For and From Musicians
So far you may have your concerns as many questions may have not been answered as they are music/artist/performer related, you can consult a doctor or the number given ( 1-800-977-8860) for an agent to solve any detail-specific doubts you may have, even so, here are some frequently Asked Questions:
- If a member in the band can’t perform live and/or needs Medical treatment does Insurance cover it?
Medical claims are handled differently by different health insurance plans. When choosing a health insurance plan, be sure you understand how regular medical visits are covered.
- Can all the members in the band receive Health Insurance through Policy?Unless your band includes your spouse or other legal dependents or is registered with the state as a business, each band member will need to shop and apply for their own health plans
- If i’m signed in a Label do they have Health Insurance for me?If you are signed to a major label or a subsidiary, you may qualify for health insurance though AFTRA. This applies to “royalty artists” as well as session vocalists, and the plan also covers families, not just individuals The American Federation of Musicians (AFM), a union for working musicians, also offers any array of plans for union members.
- Is substance abuse, Legal or illegal covered in Health Insurance?Unless your band includes your spouse or other legal dependents or is registered with the state as a business, each band member will need to shop and apply for their own health plans
- If I am married to one of my band mates, does that change how we should get health insurance?Â What if I have a child?Individual and Family health insurance is a type of health insurance coverage that is made available to individuals and families, rather than to businesses or organizations. If you are married to a band mate, you can apply for a family plan.
- Is it cheaper to get health insurance if I do not smoke? How do they know if I do or don’t?
Yes it may be, there are health insurance deals that charge a higher rate to smokers as they are willingly putting their life in a substance use.
- If a Band member Leaves or the band breaks up does that affect insurance?
Unless your band is registered as a business and you were all covered under a group health insurance plan, your band breaking up would not affect your coverage, if a band member leaves, only the band member loses coverage.
- Minimum number of people required to be in a band for insurance plan?
Minimum of 2-3 members.
- What if I get an STD on the road? Am I covered? Does it stay confidential?
Your coverage will depend on what type of plan you have. Most PPOs cover you out of network in case of illness or injury. The Federal HIPAA law protects the privacy of your medical information.
- What if I’m or my band is in a car crash while touring or on the way to a gig?
All health insurance plans have some level of hospital service coverage. When you are shopping for health insurance plans, check the details on what each plan covers. Another important point to consider is how high the plans deductible is because you will likely have to pay it before health insurance benefits begin. In the case of a car accident, it is possible that the automobile insurance company will end up paying some of the medical charges.
As an artist and as a professional individual having a good health insurance plan is of the essence, remember it is your health here what we are talking about, taking good care of it and having a good back up in case of any emergency through an insurance plan is without a doubt a way to go.
Many artists or live performers in the artistic media learn this the hard way, we do insist you do not do the same! We wish you the best of luck finding the one that suits you the best!