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How to Get Affordable Health Care in Dallas/Fort Worth

Funded through the generous support of Leveraging Investments in Creativity (LINC)/Ford Foundation.

Why do I need health insurance?

Access: Access to quality health care is directly tied to having health insurance. Without health insurance or unlimited funds, you will have little or no say in the care you receive or in the choice of providers of that care.
Cost: The cost of care is so great that a surgery, a day or two in the hospital, treatment for a chronic condition, a prescription for on-going drug therapy, or even several hours in a hospital emergency room can throw you into considerable, even ruinous, debt if you are uninsured.
Better outcomes: People without health insurance frequently delay care, and are more likely to be sicker when they seek care. Not surprisingly, the mortality rates for cancer and other diseases are higher among the uninsured.

What are my rights and protections?

Your rights vary depending on whether you purchase insurance as an individual, under a group plan, or as a small business owner. If you are not insured through your employer, union, or some other type of group, you are currently not guaranteed the right to buy health insurance in Texas. Private insurers can refuse to sell you insurance because of your health status, or exclude a pre-existing condition from coverage, or charge you a higher premium based on your age, gender, or pre-existing medical condition. Insurers define pre-existing conditions as those for which you received medical advice in the 5 years prior to the start of your policy. Coverage for pre-existing conditions can be excluded for a maximum of 24 months. However, you can get credit for prior coverage if you have not had a lapse in insurance of 63 days or more. This credit can cancel out or reduce the length of a pre-existing condition exclusion period. If you are denied health insurance, you may be eligible for the Texas Health Insurance Risk Pool, but this is an expensive and limited alternative. You may also be eligible to buy an insurer’s HIPAA plan. If you are HIPAA eligible, no preexisting condition exclusion period can be imposed.

If you are insured through a group health plan, you can’t be charged more or turned away because of your health status. However, the insurer can impose a pre-existing condition exclusion period: if you make a claim during the first year of coverage, the plan can look at your medical history in the 6 months prior to the beginning of your policy to see whether it was for such a condition. If so, they can exclude coverage for 12 months. However, you can get credit for prior coverage if you have not had a lapse in insurance of 63 days or more. This credit can cancel out or reduce the length of a preexisting condition exclusion period. If you lose coverage under a fully insured group plan, you may be able to buy a conversion policy. This type of policy cannot impose a pre-existing condition exclusion period, but benefits may be limited. For more information on health care and insurance in Texas, visit www.texashealthoptions.com.

The Affordable Care Act, enacted on March 23, 2010, includes many additional rights and protections, as well as responsibilities, some of which—such as a requirement that new plans offer some preventive services without co-pays or deductibles—have already gone into effect. In January 2014, other significant changes will occur. Most people will be mandated to have coverage, there will be subsidies available to make insurance affordable, and a range of plans will be available on Exchanges. To help you learn more about these reforms, which will make quality health insurance more accessible to people in entertainment and the arts, The Actors Fund has created a free booklet titled Every Artist Insured: Understanding Health Care Reform.

Please note that in an emergency, federal law protects you from being denied care in a hospital emergency room, regardless of your insurance status and ability to pay.

How can I get health insurance in the Dallas/Fort Worth area?

You have three basic options for obtaining health insurance:

employment or organization-related coverage
private, direct-purchase plans
government-subsidized programs

What are my employment-related options?

A job or a spouse/domestic partner’s job. This is how most people under 65 years old get health insurance. The worker usually pays part of the cost and the employer/union pays the rest. This is called group insurance. Coverage of pre-existing conditions may be excluded for a period of time. A waiting period may be imposed before you can sign up for coverage.
Adults under the age of 26 can stay in or enroll in their parents’ coverage. The young adult does not have to live at home, be a student, be claimed as a dependent on their parents’ tax returns, or be single. Note: a young adult whose employer offers coverage cannot enroll in a parent’s plan.

A union. Entertainment industry unions offer health insurance to eligible members. For performers, eligibility is achieved through the amount of ‘union work’ in which an employer contributes towards the union health benefit. Selected entertainment unions include:

Small business insurance. In Texas, small employers (with 2 to 50 full-time employees) are guaranteed the right to buy group coverage regardless of their employees’ health status. (This is what is referred to as guaranteed-issue insurance). This type of coverage can be an option for those who might otherwise be rejected for individual insurance. For comprehensive information on small business insurance visit
the Texas Department of Insurance.

Small Business Tax Credits The Affordable Care Act provides small employers with a tax credit for purchasing health insurance for their employees if the employer has the equivalent of fewer than 25 full-time employees who have average annual wages of less than $50,000. For 2010-2013, the tax credit is up to 35% (25% for non-profits) of the employer’s contribution. Starting in 2014, the tax credit will be up to 50% (35% for non-profits). To learn more about this important incentive for small employers to offer health insurance, visit the website of the National Association of Insurance Commissioners.

COBRA is a law that lets you keep the same insurance you had through an employer or union after you’ve left your job or become ineligible for benefits. You will pay the full premium, i.e. both your share and the amount your employer or union was paying on your behalf. COBRA can be quite expensive, but may be cheaper than buying an individual policy; it may also be your only option if you have a pre-existing condition. Keep your option to choose COBRA open even if you think you can’t afford it. One reason to choose COBRA is that once you’ve exhausted it, you’re eligible to purchase a “HIPAA” plan regardless of your health status. This is an important protection.

A school. Most colleges and universities offer health insurance at greatly reduced cost to full-time (and in some cases part-time) students. If you are considering taking courses, you may want to investigate this option. Alumni associations sometimes offer affordable plans to their members.

What if I have a pre-existing condition?

If you have a pre-existing medical condition, look for guaranteed-issue insurance. This means you are guaranteed acceptance into a health plan regardless of your medical status. Some options for buying guaranteed-issue health insurance are:

Texas Health Insurance Risk Pool is a program for people with serious health problems who are unable to buy individual health insurance. There are 5 plans to choose from and rates are more expensive than comparable open-market plans. You may continue to participate in the program as long as you pay your premiums and continue to reside in Texas.

HIPAA Plans. HIPAA is a law that guarantees you access to insurance if: (1) you had at least 18 months of continuous insurance coverage, the last day of which was under a group plan, (2) you exhausted any COBRA coverage which was available to you, and (3) you are not eligible for any public or group health plans. You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage. If you are HIPAA eligible, your only guaranteed access to individual health insurance is through the Texas Health Insurance Risk Pool.

PCIP The Pre-Existing Condition Insurance Plan (PCIP), a federally-funded program, offers subsidized health coverage to medically-uninsurable individuals in California. The program is available for individuals who have not had health coverage in the 6 months prior to applying. Premiums vary based on age and region of residence. Deductibles, co-insurance and co-pays apply. The program will expire on December 31, 2013, when guaranteed insurance will be available to everyone.

Medicaid, HHIA, CHIP and plans covered under COBRA and HIPAA laws do not exclude pre-existing conditions.

I’m a freelancer. What’s available to me?

If you are a sole proprietor, you do not have the right to guaranteed issue insurance. However, you may be able to join a professional association which will allow you to buy insurance at a reduced rate. Some associations and arts organizations offer discount plans; be wary of these plans, as they may only promise discounts and are not comprehensive insurance plans. For a list of associations, visit the "Insurance through Associations and Unions" section of this site.

I can afford to buy private insurance, but I don’t know what type of plan to get.

Private, direct-purchase plans can be divided into 3 types:

HMO plans, which offer a wide variety of health services but limit coverage of care to doctors within their network.
PPO plans, which pay for care in or outside a network of providers. If you go to an out-of-network provider, you often pay the doctor directly and file for reimbursement from the insurance company.
HSAs (Health Savings Accounts) which combine tax-sheltered funds for health care with qualified high-deductible insurance plans.

Plans vary in services provided. Costs include premiums, co-pays, co-insurance, deductibles and out-of-pocket maximums. High-deductible plans generally have lower premiums, but require you to pay more for medical expenses upfront before your benefits kick in. Health Savings Accounts work best if you are healthy and make limited use of the health care system. Health insurance brokers (listed in the yellow pages and at www.nahu.org) or online brokers (such as www.ehealthinsurance.com) can help you weigh your options. Online brokers make it easy to compare plans, but list only those insurers who have paid to be on their site. Some insurance companies sell short-term insurance, which covers you for a limited period of time. This can be useful if you are between jobs or waiting for another policy to begin. However, you may not be able to renew it.

I will be traveling. Will I be covered if I get sick while I’m on the road?

If you plan on traveling outside the Dallas/Ft. Worth area, speak with your insurer about coverage. PPO plans pay out-of-network claims according to your contract. Generally, HMO plans pay claims for emergencies only.

Am I eligible for government-subsidized health care programs?

Eligibility for almost all government health care programs is based on your income, figured as a percentage of the Federal Poverty Level (FPL), as well as other requirements. The 2012 FPL for one person is $11,170 and for a family of four is $23,050.

Medicaid is a public health insurance program. You may be eligible if any of the following categories apply to you and you meet low-income and asset guidelines: you receive SSI/SSP, are 65 years or older, blind, disabled, pregnant, or the parent or caregiver relative of a child under 21. Medicaid coverage is comprehensive and includes primary care, hospitalization, prescriptions, and other services. There are no premiums.

Medicare is health insurance for people age 65 and older, and the disabled. Medicare is divided into different areas of coverage: Part A covers hospitalization, Part B covers outpatient and other medical services, and Part D covers medications. You don’t have to pay a premium for Part A; both Parts B and D require premiums, and all parts require co-insurance or co-pays. Free individual counseling about Medicare and Medicaid is available through the Health Insurance Counseling and Advocacy Program of Texas (HICAP). Visit their website for office locations.

Since January 1, 2011, Medicare beneficiaries pay nothing for more than 20 preventive screening services such as blood pressure, diabetes and cholesterol tests, certain cancer screenings, and flu shots if they are received from a Medicare provider. Speak to your provider before receiving the service to make sure it’s covered. An annual wellness visit to create a personalized prevention plan is also provided at no cost.

A Medicare Advantage plan is an HMO or PPO offered by a private insurer which replaces Medicare Parts A, B, and D. Be aware that when you join one of these plans, you have essentially left Medicare and joined a local network of providers. Information at www.medicare.gov can help you decide if joining one of these plans makes sense for you.

Medicare Supplemental Insurance, also known as Medigap, covers varying costs associated with Medicare benefits depending on the plan chosen. They are sold by private insurers.

Note: The Affordable Care Act made an important change in Medicare Part D by lowering the co-insurance rate in the so-called “donut hole.” The donut hole is the gap between $2,930 in total retail drug costs and $4,700 paid out-of-pocket by the insured person. Currently, a person in the donut hole must pay 50% of a non-generic drug’s actual retail cost. This amount will decrease each year by 5% until it reaches the standard 25% co-insurance in 2020.

Children’s Health Insurance Program (CHIP)/Children’s Medicaid is insurance for children up to age 18. It provides comprehensive health, dental and vision coverage to children in low-income families who are uninsured. Eligibility is based on family size and family income. If a family is not eligible for Medicaid, they may be eligible for CHIP. Enrollment fees and co-payments for CHIP are low.

I have a special health condition. Are there public health programs that cover it?

THMP and HHIA. Texas HIV Medication Program (THMP) is the official AIDS Drug Assistance Program (ADAP) for the State of Texas. THMP makes medications available to those who do not qualify for Medicaid. HHIA can help with health insurance premiums for HIV+ individuals at risk of losing their coverage. Income and asset limits apply. For additional assistance visit the Resource Center of Dallas or the AIDS Outreach Center.

CHIP Perinatal offers prenatal health care to pregnant women. It is for uninsured lowincome families who don’t qualify for Medicaid. If you qualify for CHIP Perinatal, your baby will automatically qualify for CHIP.

The National Breast and Cervical Cancer Early Detection Program provides lowincome, uninsured women access to screening and diagnostic services to detect breast and cervical cancers. Women who are subsequently diagnosed with cancer may be immediately eligible for limited Medicaid.

I’m not eligible for employment-related coverage or government programs, and I can’t afford private insurance. What should I do?

It is possible to get affordable health care without insurance by taking advantage of sliding scale programs at community clinics (which set fees based on income) and retail clinics. For a selected list of community clinics, see below, or visit The Bureau of Primary Health Care, which can direct you to a sliding-scale clinic closest to your home.

Texas Association of Community Health Centers provides access to quality health care through federally qualified health centers, which serve uninsured and underserved communities.

JPS Health Network offers two programs (JPS Connection and JPS Discount Program) to Tarrant County residents. Eligibility is based on household size and income. The program is available to clients that do not have Medicare, Medicaid or other medical coverage. Services are provided at JPS locations.

Project Access Dallas is a network of volunteer physicians and partnering hospitals that provide health care for low-income, working but uninsured Dallas County residents who make less than 200% of the FPL.

Retail health care clinics, like Minute Clinic, offer preventive care and routine treatment for common conditions like strep throat and sinus infections. Minute Clinic is located in CVS drug stores throughout Texas.

I can’t afford my medications. Can I get them for less, or free?

Pharmacy Checker is an independent source of information on online and mail-order pharmacies. It publishes pharmacy ratings, profiles, and drug price comparisons.

Needy Meds has information on pharmaceutical patient assistance programs, which make medications available for free or at discounted rates, as well as discount drug cards, low-cost clinics, disease-based financial assistance, and government programs.

Some major retailers offer lower-cost medication. Wal-Mart and Target offer over 300 generic medications for $4 for a 30-day supply. Costco also offers discounts via their member prescription program.

I have mental health needs and I don’t have insurance. What should I do?

If you are in crisis and uncertain how to proceed, the Tarrant County 24-Hour Crisis Line at 817.335.3022 and the Crisis Center of North Texas at 214.828.1000 are available 24 hours a day, 7 days a week for confidential phone intervention, information and referral to local resources.

The Mental Health Association of Tarrant County has an online database of mental health resources, organizations and support groups for both Tarrant and Dallas counties.

Community Council of Greater Dallas provides a comprehensive online listing of community resources, including mental health counseling, throughout the Dallas area.

For a selected list of mental health clinics, refer to the end of this page.

How can I lower the cost of dental services?

Community Dental Care provides dental care to low-income individuals in eleven clinics throughout the Dallas area.

United Way of Tarrant County provides a comprehensive listing of low-income dental services in the Fort Worth area.

Baylor College of Dentistry provides dental care performed by students under the supervision of dental faculty. Fees are approximately 40% less than a private dentist.

Dental insurance plan summaries, comparisons and applications are available at www.dentalinsurance.com.

Dental discount plans offer discounts on services at participating dentists for an annual membership fee. Discount plans are not insurance. Patients’ experiences with these plans are mixed; they seem to work best when a dentist you already know and trust is participating. Use caution here. Links to these plans can be found at www.dentalplans.com.

Why is the Affordable Care Act so important?

The passage of health care reform on March 23, 2010 has brought us within reach of having every artist and entertainment professional, along with our spouses, partners, and children, protected by comprehensive health insurance. Because so many of the law’s provisions are directed at the individual and small group market, where a high percentage of us find ourselves, it is important to understand the critical benefits that this law brings to our communities. You can begin by reading the booklet Every Artist Insured: Understanding Health Care Reform. You may also want to support organizations such as Families USA and Community Catalyst that have been at the forefront of the fight for affordable access to quality health care and continue to work effectively for it. At every opportunity, express your opinions to your state and federal representatives, and participate in our democratic institutions.

Resources

Dallas/Fort Worth – Selected Hospitals

Baylor University Medical Center, 3500 Gaston Ave., Dallas(214-820-0111)
Harris Methodist Fort Worth, 1301 Pennsylvania, Ave., Ft. Worth (817-250-2000)
John Peter Smith Hospital, 1500 S. Main, Ft. Worth (817-921-3431)
Parkland Hospital, 5210 Harry Hines Blvd., Dallas (214-590-8000)

Dallas/Fort Worth – Selected Community Health Care Clinics

Albert Galvan Health Clinic, 2100 N. Main St., Ft. Worth | 817.625.4254
Los Barrios Unidos Community Clinic, 3111 Sylvan Ave., Dallas | 214.651.8739
Martin Luther King Jr. Family Clinic, 2922-B MLK Jr. Blvd., Dallas | 214.426.3645

Dallas/Fort Worth – Selected Mental Health Clinics

Catholic Charities of Fort Worth, 2701 Burchill Rd., Ft. Worth | 817.534.0814
Child & Family Guidance Center, 8915 Harry Hines Blvd., Dallas | 214.351.3490
Jewish Family Service of Greater Dallas, 5402 Arapaho Dr., Dallas | 972.437.9950
Women’s Center of Tarrant County, 1723 Hemphill St., Ft. Worth | 817.927.4040

Dallas/Fort Worth – Selected 24-Hour Pharmacies

This guide was funded through the generous support of Leveraging Investments in Creativity (LINC)/Ford Foundation. It was created and edited by Dan Kitowski, MSW and Renata Marinaro, LMSW.

About The Artists Health Insurance Resource Center

The Artists Health Insurance Resource Center (AHIRC) a program of The Actors Fund, was created in 1998 with the support of the National Endowment for the Arts to help people in entertainment and the arts find affordable health care and health care coverage and reduce the number of uninsured artists. AHIRC offers in-person counseling in New York and Los Angeles, national telephone support, an internet resource database (www.ahirc.org) with over a half-million visitors each year and over 100 Getting and Keeping Health Insurance workshops held at arts, cultural and human services organizations throughout the country. For more information call 323.933.9244 or visit www.ahirc.org.

About The Actors Fund

The Actors Fund is a national human services organization that helps everyone – performers and those behind the scenes – in performing arts and entertainment. Serving professionals in film, theatre, television, music, opera, radio and dance, The Fund’s essential programs include social services and emergency assistance, health care and health insurance resources, housing, and employment and training services. With offices in New York, Los Angeles and Chicago, The Actors Fund has – for over 130 years – been a safety net for those in need, crisis or transition. Learn more at www.actorsfund.org.

The laws, regulations, rules and policies on which the information in this guide is based are subject to frequent change. The Artists Health Insurance Resource Center makes no representations or warranties, express or implied, as to the accuracy, completeness, or timeliness of the information in this guide. This guide contains references to companies, organizations, services, and health centers. Inclusion of this information is not an endorsement of the products, services, or care provided. Before commencing, terminating or changing coverage you should confirm the information herein with the appropriate company, organization, or government agency. This guide should not be used in place of consultations with qualified legal and/or medical professionals. In no event will AHIRC or The Actors Fund be liable for any decision made or action taken by anyone in reliance upon the information contained in this guide.