What DGA Members Need to Know about the Affordable Care Act

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August 16, 2013

As the 2014 deadline approaches for the Affordable Care Act (ACA) provision requiring most Americans to have health insurance, there are just two things that any DGA member needs to know: 

 

1. If you have health coverage under the DGA-Producer Health Plan (DGA-PHP), you don’t have to do anything. 
  • Your DGA-PHP coverage far exceeds both ACA requirements and the coverage available for purchase through the ACA-created Health Insurance Marketplace. Your DGA-PHP coverage has:
    • Lower premiums (and no premium for individual coverage)
    • Lower out-of-pocket costs
    • Larger provider network 
2. If you aren’t covered under the DGA-PHP, you will be able to purchase health insurance through the online Health Insurance Marketplaces being created in each state.

 


 

Affordable Care Act FAQ for DGA Members 

Below are brief answers to frequently asked questions about the Affordable Care Act. More details are available in the Plans’ publication “Spotlight on Benefits” and via the Plans’ website at www.dgaplans.org

For Active Participants in the DGA-Producer Health Plan: 

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What should I do when the Health Insurance Marketplace goes into effect on January 1?

If you are covered under the DGA–Producer Health Plan (DGA–PHP), you don’t need to do anything. Your DGA–PHP coverage far exceeds Affordable Care Act requirements.

 

Can I opt out of DGA–PHP coverage in favor of coverage through the Marketplace?

No. While you are not required to use the coverage, you cannot opt out of DGA–PHP coverage. Additionally, it would not make financial sense to do so. Rates for even the most basic coverage through the Marketplace will be more expensive and have higher out-of-pocket costs than DGA–PHP coverage, while covering fewer doctors and services. Remember, individual DGA–PHP coverage is free. Participant + 1 coverage costs $65 per month. Participant + Family coverage costs $100 per month.

In addition, since you and your dependents are eligible for earned coverage through the DGA–PHP, you would not receive a subsidy for coverage purchased through the Marketplace.

 

Can I cover my dependents through the Marketplace instead of the DGA–PHP?

Yes, but it would not make financial sense to do so. You would not receive a subsidy for your dependent’s Marketplace coverage and the coverage would be more expensive.

 

Can I purchase supplemental coverage through the Health Insurance Marketplace?

Currently, it does not appear that supplemental coverage will be available through the Marketplace.

 

One of my children is under 26 and is getting married.  Will he/she be eligible for Health Plan coverage or coverage through the Marketplace?

Your dependent children are eligible under your DGA–PHP coverage up to age 26, regardless of their marital status.

 


 

For Retired Participants:

ACAWhat should I do when the Health Insurance Marketplace goes into effect on January 1?

If you are covered under the DGA–PHP’s retiree coverage, you don’t need to do anything. Your retiree coverage exceeds Affordable Care Act requirements.

 

I’m covered under Medicare. Does all of this affect me?

You already receive comprehensive care from Medicare and are not required to purchase alternate coverage through the Marketplace.

 


 

For Participants Ending Coverage or On Self-Pay: 

ACAI’m about to lose DGA–PHP coverage. What are my coverage options?

You have up to three options:

  • DGA–PHP COBRA coverage: When your earned coverage ends, you and your dependents are entitled to 18 months of COBRA coverage through the DGA-PHP. You will not receive a subsidy for DGA–PHP COBRA coverage, regardless of your income level.
  • DGA-PHP Extended Self-Pay coverage: If you are eligible for Extended Self-Pay coverage, you are entitled to up to five years of coverage under the DGA-PHP. You will not receive a federal subsidy for DGA-PHP Self-Pay coverage, regardless of your income level.
  • Coverage through the Health Insurance Marketplace: Depending on your income level, you may be eligible to receive a federal subsidy to offset the cost of your coverage.

 

Can I continue my COBRA or self-pay coverage after the Health Insurance Marketplace goes into effect?

Yes.

 

When can I enroll for coverage through the Health Insurance Marketplace?

The initial open enrollment period is October 1, 2013 to March 31, 2014. After that, you would be eligible to enroll during a special enrollment period triggered by certain events, including:

  • Your DGA–PHP earned coverage ending;
  • Your other job-based health coverage ending;
  • Marriage, divorce, or birth or adoption of a child.

 

How do I enroll for coverage through the Health Insurance Marketplace?

Starting on October 1, you can go to the website for your state’s Health Insurance Marketplace and fill out an application online. To find your state’s Health Insurance Marketplace, go to www.healthcare.gov and click on the “Get Insurance” tab.

 

Can I enroll in coverage through the Health Insurance Marketplace even if I have a pre-existing condition?

Yes. Starting January 1, 2014, the Affordable Care Act prevents insurers from denying coverage based on a pre-existing condition.

 

If my DGA–PHP coverage ends, when should I enroll In Marketplace coverage?

If your coverage ends mid-year, you have 60 days to enroll in Marketplace coverage. If you miss this 60-day window, you may be required to wait until the Marketplace’s next annual open enrollment window.  

For coverage in 2014, the Marketplace’s open enrollment window is October 1, 2013 to March 31, 2014. For 2015 and later years, the open enrollment window will be October 15 to December 7 of the previous year.

To avoid incurring a penalty under the Affordable Care Act, you and your dependents must generally not go longer than three months without insurance coverage.

 

If I qualify for DGA-PHP coverage in the future, when should I cancel my Marketplace coverage?

You should check with your insurer to confirm their guidelines and timeframes for cancelling coverage.

Before you cancel your coverage, you should confirm with the Plan’s office that you have qualified for health coverage. The DGA-PHP typically sends out open enrollment letters to new participants approximately one month prior to their coverage beginning.

If you believe that you will soon be eligible for Health Plan coverage, but have not received anything from the Plans, please call (877) 866-2200, Ext. 402 and they can inform you of your eligibility status.

 

How does the federal health insurance subsidy work?

When you apply for coverage through the Health Insurance Marketplace, you will estimate your 2014 household income. If your estimated income is less than four times the Federal Poverty Level for the size of your household, you will likely be eligible receive a subsidy from the Federal government to offset the cost of your coverage. (For example, for a household of four people in 2013, four times the Federal Poverty Level was $94,200.) The government will pay the subsidy directly to your insurer every month.

 

What happens if I don’t buy insurance?

When you file your 2014 tax return, you will be asked to provide proof of health insurance in 2014. You will be fined $95 or 1% of your income (whichever is higher) if you cannot provide proof of insurance. The amount of the fine increases each year.

 


 

Where can I get more information on the Affordable Care Act and the Health Insurance Marketplace? ACA

  • healthcare.gov. This is the Federal government’s website for addressing questions related to the Affordable Care Act and the Health Insurance Marketplaces.
  • ahirc.org. The website for the Artists’ Health Insurance Resource Center, a program established by the Actor’s Fund dedicated to helping artists get affordable, quality health insurance and health care.
  • actorsfund.org. The website for The Actor’s Fund, a non-profit human services organization dedicated to meeting the needs of professionals in film, theater, television, music, opera and dance.

 

If you have questions about the Affordable Care Act please contact the  DGA-Producer Pension and Health Plans offices at (323) 866-2200 or visit their website at www.dgaplans.org.

Contact
Sahar Moridani -
Assistant Executive Director - Communications
(310) 289-5333
smoridani@dga.org