Marry rich, darling.
Divas, you do not need to find your own J. Howard Marshall to ensure that you can get healthcare coverage. It is understandable that some singers do not have health benefits because they simply do not know how or where to look for affordable insurance. However, that does not mean that it is excusable. What’s that? You are one of those rare singers who never gets sick? You’re young and healthy and don’t need health insurance now? Think again, sweetheart. What about that freak situation when your sassy audition heel gets stuck in the crosswalk and that distracted cabbie… Hmm – not suitable for young readers. Since many young artists lack long-term job stability they also lack sufficient health coverage.
Thus, the day 21 challenge is to assess your health insurance situation.
Maintaining vocal health is the foundation of being able to perform on a regular basis. We are trying to make our livelihood by using our voices on a daily basis. Because the United States largely relies on employment-provided healthcare, singers are living in a freelancing situation and can often fall through the cracks. The good news is that there is hope for union and non-union singers out there.
Before we start talking about that, let’s do an overview (with the help of Fractured Atlas) of the basic terms that are included in the summary of benefits for any plan.
- Copay: Flat fee you pay for medical care at the time of service. (Ex: $50 for a doctor’s office visit.)
- Coinsurance: You and the insurance company share a percentage of the cost of select medical services. (Ex: your bill for an MRI is $1000. With an 80/20% plan, your insurance company pays $800, and you pay $200.)
- Deductible: Amount you must pay for select (or all) medical services on an annual basis, before the insurance company chips in. Deductibles reset once annually (either on a calendar year or policy year.) Make sure you check with the insurance company!
- In-network: A group of doctors, hospitals, and medical facilities an insurance company has contracted with to provide medical services to individuals enrolled in their plans.
- Out-of-network: A medical doctor, hospital, or facility that is not a preferred provider of medical services under your healthcare plan. You pay more if you go out-of-network.
- Out-of-pocket max: The maximum amount you are responsible to pay for your healthcare expenses in a year (from your own pocket), not including premiums. Typically, the out-of-pocket max is the plan deductible + any coinsurance amount.
“Singers who work for AGMA companies can qualify for coverage under AGMA Health Plan A (annual health insurance for choristers and other regularly employed singers) or AGMA Health Plan B (a ‘health care savings plan’ for solo singers into which all AGMA signatory employers put a percentage of earnings) which can then be spent by the member for any health care cost,” writes AGMA’s Executive Director, Alan Gordon.¹ If you belong to any type of performing artists union, check with you representatives regarding your health care options right away. They already understand the need for insurance for artists and can often provide great resources in finding the perfect plan for you. For example, the Actors’ Fund Human Services Department can offer “both Internet-based and personal health insurance guidance, solutions-based health care counseling, experience-based health referrals and, through our own free clinic, direct medical care for people who are uninsured.”
Health insurance is regulated by state. Each state has its own rules and regulations regarding your right to buy health care, the definition of “pre-existing condition”, and what benefits can be included in an individual plan. However, there are a few organization that can help you purchase health care through a type of umbrella arrangement. For example, Fractured Atlas has partnered with eHealthInsurance to provide quotes to performing artists. Here is some insight when you are trying to determine which plan is right for you.²
- Health Maintenance Organization (HMO) Your healthcare is managed through a Primary Care Physician (PCP), who refers you to specialists when needed. Generally, you pay a copay (a set flat fee) for medical services included in your plan’s benefits. All medical care must be received in-network, or you’ll get stuck with the full bill.
- Preferred Provider Organization (PPO) You can choose from in-network and out-of-network healthcare providers. But if you do go out-of-network, you end up paying a lot more. You don’t need to choose a PCP, and no referrals are required in order to see a specialist.
- Exclusive Provider Organization (EPO) This plan is generally the same as a PPO, except that you can only choose doctors in-network.
- Point of Service (POS) A hybrid between an HMO and a PPO. Like a PPO, you can choose from in-network or out-of-network providers. Again, you pay more if you go out-of-network. Otherwise, if you stay in-network, plan benefits are copay based (like an HMO.) You may need referrals from a PCP to see specialists.
- High Deductible Health Plan (HDHP) There are a variety of plans that fit into this category, including PPO and EPO. For a lower monthly premium, these plans feature a high deductible, the amount you must pay for select (or all) medical services each year, before the insurance company starts to cover the costs.
Note: An HDHP PPO plan generally features two deductibles, in-network and out-of-network. The out-of-network deductible is usually 2x the amount of in-network! The out-of-network deductible does not count towards the in-network and vice versa.
- HSA qualified High Deductible Health Plan (HDHP with HSA) or Consumer Directed Health Plan (CDHP) with HSA This features an annual deductible that applies to all plan benefits. Once the deductible has been met, the insurance company pays 100% of the healthcare costs.
Take some time today to assess the healthcare coverage you already have through your job and see if it is providing what you need as a professional musician. If you do not already have health insurance, do not wait any longer to take advantage of the myriad of options available to you. Make a list of benefits that are deal-breakers for you. Start searching for providers in your state that can offer you a balanced plan that fits your medical needs as well as your budget. ” The out-of-pocket maximum is the true measure of a plan’s value in light of the monthly cost. Everything else is secondary.”³
If you end up with some scary medical debt, do not let it overwhelm you. Healthcare is a business. Providers want to get paid. Just like our discussion of student loan debt the other day, start by communicating. Get in touch with the provider and negotiate some sort of payment. Do not just ignore it – be proactive and it will be a much easier to conversation.
Before I leave you to work on today’s challenge, there is one last thing that I want to tack on to this discussion: find a good ENT-otolaryngologist. Part of the reason you want to have good healthcare coverage is so that you can visit an ENT when necessary. “Proper evaluation and treatment can take care of most voice-related problems, and can set you up to succeed at even the most demanding voice-related occupation,” advises the American Academy of Otolaryngology.
Check out this list: “There are 987 top ENT-otolaryngologists on the list of U.S. News Top Doctors. These physicians were selected based on a peer nomination process. Within this list of the best ENT-otolaryngologists, 289 have been named to a highly selective list of America’s Top Doctors (ATD) by achieving national recognition for outstanding work.” Use their handy search tool to find one near you.
Also, ask for references. Similarly to voice teachers, you must trust your ENT and other singers and voice professionals will be able to tell you who has a good track record and who should be avoided. Especially if you have stumbled into some voice-related problems, try asking about ENT that are familiar with classical voice rehabilitation or that have a good working-relationship with a voice teacher.
What are your main concerns when it comes to health insurance for opera singers? Do you have any tips or stories to share? Please let us know in the comments below. Please feel free to share your referrals in the comments as well. We encourage a supportive dialogue about classical singing issues.
The Performing Arts Medicine Association
PERFORMING ARTS MEDICINE CLINICS
in the United States
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