Help! I need Coverage

Alice Vienneau, a mid-career dancer who had worked in shows both on and off-Broadway, prided herself because, “I was never sick a day in my life.” During a three-month lapse in coverage between gigs, a case of appendicitis landed her in the hospital twice and saddled her with $80,000 in medical bills. She seriously considered filing for bankruptcy.

Stories like Vienneau’s are not uncommon in the U.S., where insurance is often expensive or elusive. The heated discussion about health care in this country directly affects many artists. Dancers never decide to go into their profession just for the salary or the benefits. They want to dance. But to dance, you have to be healthy. Knowing where to go for proper health care can make a huge difference in career fulfillment.

“I have seen dancers with the attitude ‘I’m young, I’m strong, I’ll never be sick,’ ” says Vienneau, now a social worker for The Dancers’ Resource at the Actors Fund in New York City. “We all know the collateral injuries that occur as a result of favoring a foot, knee, or hip. The truth is that the stressors on a dancer’s body are so profound—they’re all the time, not when we’re just in rehearsal or performance.”

There are three reasons why dancers need to seek proper health coverage. First of all, you want to prevent crippling debt. A bout of kidney stones or a car accident can crush your finances. Secondly, you need good care that is close to you. Lastly, you want better health outcomes. If you get regular checkups, you are less likely to have chronic illnesses or injuries.

So what resources are available? If you have the money, you can buy an individual policy. An HMO (health maintenance organization) plan provides health services through a specific network of doctors and providers with a primary care physician coordinating any referrals. A PPO (preferred provider organization) or a POS (point of service) policy allows members to use services outside of the network as well. An HSA (health savings account) combines tax-sheltered accounts for health needs with a high-deductible plan. (A deductible is the amount of money you pay annually out-of-pocket for services before the insurance kicks in.) An excellent database for information on private insurance policies and state rules is at www.ehealthinsurance.com.

The problem is that health insurance can be so costly that it’s out of reach for many freelance dancers. There is also the issue of pre-existing conditions—a problem that Congress is currently trying to sort out. A pre-existing condition can include anything from asthma to diabetes to a torn ligament. If you live in New York, Vermont, New Jersey, Massachusetts or Maine, you cannot be denied coverage due to pre-existing conditions. In the other 45 states, your fate is largely in the hands of the insurance companies.

If you had insurance through a job and you are terminated or leave, federal protection under COBRA allows workers to continue their group coverage for up to 18 months. When your COBRA coverage ends, The Health Insurance Portability and Accountability Act (HIPAA) guarantees access to insurance coverage to certain individuals if they had at least 18 months of continuous insurance coverage, the last day of which was under a group plan, and they are not eligible for any public or group health plans. Clauses that prevent coverage because of a pre-existing condition can be knocked out in those cases.

But what are the other options for those who haven’t had or don’t have steady insurance from an employer? Several freelance unions, such as Fractured Atlas and the Freelancers Union, or organizations like Mediabistro.com, can help dancers obtain basic coverage in some states when they join as members. According to Marie Ortiz, Fractured Atlas’ health care program director, the group sponsors two plans in New York—one with a $10,000 deductible and a monthly premium of $142.98, and another with a $5,000 deductible with a premium of $212.28. Mediabistro.com, through Affinity Health Plans, offers very basic policies with premiums that cost less that $200, depending on where you live. But the issue of pre-existing conditions is determind on a state-by-state basis, and not everyone is eligible for all of these organizations’ health insurance affiliates.

If you are a member of an entertainment union—AEA (Actors’ Equity Association), AGMA (American Guild of Musical Artists), AFTRA (American Federation of Television and Radio Artists), SAG (Screen Actors Guild), or AGVA (American Guild of Variety Artists)—group policies are available to qualified dancers. To be eligible for AFTRA’s individual health plan, you must have AFTRA-covered earnings of at least $10,000 but less than $30,000 in four consecutive calendar quarters or less. AEA’s health plan is based on weeks of work: You must have at least 12 weeks of covered employment in the previous 12 months to qualify for 6 months of coverage. AGMA currently has an option with group plans through TEIGIT (The Entertainment Industry Group Insurance Trust) in New York, Illinois, Connecticut, New Jersey and some counties in California, Florida, and Indiana. The plans cover people with pre-existing conditions, but the premiums can be very expensive. (For example, the Florida CIGNA PPO costs $934.90 per month and the Illinois CIGNA HMO runs $1,648.10 per month.)

“People who are healthy and just want catastrophic coverage can pair a high-deductible plan with going to clinics on a regular basis,” says Renata Marinaro, manager of Health Services, Education and Outreach at The Actors Fund. (The Actors Fund provides ser­vices for everyone in the entertainment field, from stagehands to makeup artists to dancers.) And there are numerous clinics that offer treatment gratis or for a low fee (see sidebar for a partial listing).

For prescription medications, the Partnership for Prescription Assistance (www.pparx.org) provides valuable information on hundreds of pharmaceutical assistance programs that offer free or low-cost medications for those who can’t afford them. They are available in all states; qualifications for those who are eligible vary, and not all medications (such as certain painkillers) are available.

If you’re really desperate for coverage, think about taking a part-time job at a company that offers medical insurance to part-time employees. Starbucks, for in­stance, has a benefits package that includes health insurance for “partners” who work 20 hours or more per week. Target, Trader Joe’s, Wegmans, Whole Foods, and Lowe’s also offer part-time employees some medical coverage. However not all these companies have flexible hours.

Dancers living with HIV have access to ADAP (AIDS Drug Assistance Program) coverage that varies in scope from state to state. The National Breast and Cervical Cancer Early Detection Program (www.cdc.gov/cancer/nbccedp/) offers low-income, uninsured women access to screening and diagnostic services to detect cancer. Those who are diagnosed may be eligible for limited Medicaid coverage.

Medicaid is a national public health program administered by the states that is based on annual gross income, and determined by a percentage of the Federal Poverty Level. In 2009, that threshhold for one person was $10,830. Some states require a proof of both poverty and disability for Medicaid eligibility.

Most colleges and universities offer reduced-price health insurance to full-time—and in some cases part-time—students. Some states allow insured parents to keep their children on health insurance policies past their student years. New Jersey law, for example, holds that dependents may be covered up to the age of 31, as long as they are unmarried and have no dependents of their own.

Of course you can often obtain coverage through a spouse’s or domestic partner’s policy. But sign up as soon as you get hitched. In many cases, if you don’t notify a company within 30 days, you may have to wait until the next calendar year for coverage.

And there’s always the chance of landing work as a dancer or choreographer in one of the many countries that offers universal health care, such as Canada, Australia, Israel or all of the nations in the European Union!

For those staying closer to home, the Actors Health Insurance Resource Center (ahirc.org) has a detailed state-by-state guide to health care resources.

And if you want to get involved with improving health care options nationwide, check out artistsunitedforhealthcare.org.

 

 

Medical services that are free or inexpensive

 

• Cleveland Free Clinic (thefreeclinic.or
  
• San Francisco Community Clinic Consortium (sfccc.org/clinics/index.htm)

• Healthy Dancers Clinic at ODC Dance Commons (odcdance.org/clinic.php)

• Nevada Health Centers, Inc. (nvhealthcenters.org) operates medical centers and clinics across the state that provide services on a sliding scale based on income.

• Texas Association of Community Health Centers (tachc.org)

• Al Hirschfeld Free Health Clinic (212-489-1939), run by The Actors Fund in NYC, for documented entertainment industry professionals between the ages of 18 to 64

• The Dancers’ Resource, resources and wellness groups for dancers, also run by The Actors Fund (www.actorsfund.org/services)

Trading dancing for healing

 

Artist Access Program at the Woodhull Medical and Mental Health Center in Brooklyn, NY (877-244-5600). Dancers can offer their talents in exchange for credits for care, which can include doctor’s appointments, dental work, emergency room visits, prescriptions, inpatient medical stays, podiatry, and rehab. Catey Ott, director of Catey Ott Dance Collective, has used the Artist Access Program for the last two years. In exchange for medical credits, she has performed in the lobby of Woodhull Hospital, done face painting for a holiday party, and has taught yoga and movement classes to the medical staff.

Joseph Carman writes about dance and is the author of
Round About the Ballet.