How to Get Affordable Health Care in New York City

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How to Get Affordable Health Care in New York City


Funded through the generous support of Leveraging Investments in Creativity (LINC)/Ford Foundation and
The New York Community Trust (NYCT)
.


Why do I need health insurance?


  • 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.

  • 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.

  • 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?


Every New Yorker has the right to buy health insurance. You cannot be discriminated against because of your health status, gender, age, or occupation. However, you may be subject to a pre-existing condition exclusion period if you let your insurance lapse for 63 days or more. In that case your insurer can look back at the 6 months prior to the start of your policy to see if you received care for a mental or physical condition. If so, they can deny payment for any claims related to that condition for up to 12 months. In this situation, you can credit any previous continuous insurance coverage towards your exclusion period.

In the case of an emergency, federal law protects you from being denied care in an emergency room, regardless of your insurance status and ability to pay. If you don’t have health insurance and it’s not an emergency, New York City’s public hospitals and some clinics are required to treat you, but private hospitals are not.


How can I get health insurance in the New York area?

You have three basic options for obtaining health insurance in New York:

  • employment-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 (although some employers require the worker to pay the full cost). This is called group insurance. It can be the least expensive way to get health insurance, and is particularly useful to anyone who has a pre-existing condition, since the coverage will either begin immediately or 90 days after starting a new job. Some employers also offer Health Savings Accounts, which let you pay for medical expenses with pre-tax dollars and save for retirement on a tax-deferred basis.

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 union websites:


COBRA COBRA is a federal law that allows you to continue the group insurance you had through a job, parent or spouse for up to 18 months (sometimes longer). The cost can be high, but is often less expensive than buying insurance on your own. You have 60 days from the date of your COBRA notification letter to decide if you want to continue your insurance through COBRA, and 45 days from the decision date to make your first payment. Do not immediately say no to COBRA. Keep the option open even if you think you can't afford it.

NOTE: New York offers a special COBRA subsidy for people who have had insurance coverage through an entertainment union. This subsidy pays for half of your monthly premium for up to 12 months. Certain income limitations apply.

A school Most colleges and universities offer health insurance at greatly reduced cost. If you are considering taking courses, you may want to investigate coverage through your school. For example, all branches of the City University of New York (CUNY) offer plans to students who are enrolled for six credits or more per semester. www.ghi.com/default.aspx?page=350

Small business insurance If you are a sole proprietor or own a small business, you may be able to buy insurance through a state program called Healthy NY. Some Chambers of Commerce offer health insurance plans for small business owners. For example, the Brooklyn Chamber of Commerce's plan is called Brooklyn HealthWorks.

LIA Health Alliance also offers insurance to businesses in New York City and the following counties: Nassau, Rockland, Suffolk and Westchester.

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


You may want to consider joining an association plan, which will allow you to purchase health insurance at a reduced rate. Association plans available to freelancers in New York include:

Each association has different eligibility requirements. Additional requirements usually apply for health insurance coverage. Contact the association directly to inquire about the plans they offer.

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


The best way to choose a health plan is to start by considering the amount of financial and medical risk you’re willing to take. Then talk to your doctor, or find doctors you are comfortable with and trust, and ask them what insurance carriers they accept. Private, direct-purchase plans can be divided into 2 types:

  • HMO plans, which limit the providers you can see and are generally the least expensive option in New York
  • POS/PPO plans, which allow you to go outside the network of providers at an increased cost.

Plans vary widely in services provided. Costs include premiums, co-pays, deductibles and, in POS/PPO plans, co-insurance. High-deductible plans, sometimes known as ‘catastrophic’ insurance, generally have lower premiums but are not available for direct purchase in New York. Once you’ve determined your risk limit and found a good medical provider, you can choose a carrier and type of policy. A list of current premiums for all carriers offering HMO and POS plans in New York is at www.ins.state.ny.us/ihmoindx.htm

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


If you plan on traveling or touring outside of the New York area, speak with your carrier about coverage. Generally, HMO plans pay claims for life-threatening emergencies only. POS and PPO plans may pay out-of-network claims according to your contract. If you will be traveling internationally, consider buying travelers’ insurance. MedHealthInsurance has information on medical travel insurance policies.


I can’t afford private insurance. Are there any government-subsidized programs that can help me?


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 2011 FPL for one person is $10,890 and for a family of four is $22,350.

Medicaid is a public health insurance program for those with very limited income and assets. In order to determine income eligibility, Medicaid adds all your sources of income and then subtracts certain deductions. Medicaid's coverage is comprehensive and includes prevention, primary care, hospitalization, prescriptions, and other services. There are no premiums.

Family Health Plus is a public health insurance program for adults ages 19 to 64 who do not have health insurance, but have incomes too high to qualify for Medicaid. Family Health Plus is available to single adults, couples without children, and parents with limited income and assets who are residents of New York. Family Health Plus provides comprehensive coverage including prevention, primary care, hospitalization, prescriptions and other services. There are no premiums.

Healthy NY is a collaboration between New York State and private insurance companies to offer reduced-rate plans to sole proprietors, small businesses, and working individuals and families who don't qualify for Medicaid, Family Health Plus, or Medicare. To be eligible you must be a resident of New York, have worked in the last 12 months, and have a limited income. Certain eligibility limits apply to those who have had insurance in the last 12 months. Coverage is more limited than Medicaid or Family Health Plus, but includes preventive and primary care hospitalization, and other services. Healthy NY plans are offered by all major insurance companies and can be purchased with or without drug coverage. There are premiums and co-payments. A high-deductible plan is also available.

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


PCAP The Prenatal Care Assistance Program offers complete pregnancy care and other pregnancy-related services to women who live in New York and meet certain low-income guidelines.

ADAP/AHIP/APIC The AIDS Drug Assistance Program (ADAP), the AIDS Health Insurance Program (AHIP), and the ADAP Plus Insurance Continuation Program (APIC) will cover the cost of HIV/AIDS-related medication and pay insurance premiums for people who are not eligible for regular Medicaid, but have been diagnosed with HIV/AIDS. There are income and asset limits. www.health.state.ny.us/diseases/aids/resources/adap/index.htm

The National Breast and Cervical Cancer Early Detection Program provides low-income, 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 between the ages of 19 and 64. Are there any special programs for people my age?



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. Both Parts B and D require premiums and co-insurance or co-pays. Part A is free.

Elderly Pharmaceutical Insurance Coverage (EPIC) is a state program that reduces the cost of medications for low and moderate income seniors age 65 and older.

Child Health Plus is a state program that makes comprehensive health coverage available to anyone under the age of 19 who is uninsured and not eligible for Medicaid. The program is designed for families with low incomes, but any family can buy into it for a small monthly premium.

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


It is possible to get affordable health care for common conditions without health insurance by taking advantage of sliding-scale programs at public hospitals and community clinics, which set fees based on your income, or by using fixed-fee/retail clinics.

HHC Options is a financial assistance program for New York City residents who receive care at public hospitals and participating facilities. It is not insurance. Fees are based on a sliding scale. Eligibility depends on income, family size, and assets.

Artist Access is a different way for artists to access the HHC Options program. It allows artists to barter performance or artistic activity for health care credits, to be used at Woodhull Hospital in Brooklyn and Bellevue Hospital in Manhattan. Call 1-877-244-5600 for more information.

Free and sliding-scale clinics and retail clinics The Actors Fund operates The Al Hirschfeld Free Health Clinic, a primary care clinic for entertainment professionals and people working in the performing arts. Eligibility guidelines are based on years and earnings in the industry. All services are free. Low-cost testing is available to patients through New York-Presbyterian Hospital. Call 212-489-1939 for an appointment.

There are many community clinics which provide primary care and operate on a sliding-scale basis. The Bureau of Primary Health Care’s website can direct you to the sliding-scale clinic closest to your home.

Retail clinics, like Minute Clinic offer routine treatment and preventive care for common conditions, like strep throat and ear infections, and can be found in some pharmacies and warehouse stores. See their website for locations on Long Island, Staten Island, and in Westchester.

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



The Partnership for Prescription Assistance has information on over 150 pharmaceutical patient assistance programs which offer low-income, uninsured or underinsured patients free or low-cost medications.

Some major retailers offer lower-cost medication. Wal-Mart and Target both offer over 300 generic medications for $4 for a 30-day supply.

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

If you are in crisis, call LIFENET at 1-800-LIFENET or the Samaritans Suicide Prevention Hotline at 212-673-3000. Both hotlines are available 24 hours per day, 7 days per week. They can talk with you, and LIFENET can refer you to services in your area.

The National Mental Health Services Locator offers a comprehensive database of mental health facilities, services, advocacy groups and resources. Substance abuse treatment facilities are also listed. Some clinics provide mental health counseling and set fees for services based on your income. For a selected list of these, see the end of this page.

I have a dental problem, but no dental coverage. What should I do?

In New York, you can’t purchase private dental insurance on your own. You must obtain it through a group plan (for example, through an association or employer). Medicaid, Child Health Plus and some Family Health Plus plans include dental benefits.

There are numerous dental discount plans available. Most of these have set fees for services, and a list of participating dentists. Patients’ experiences with these plans are very 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.

Both Columbia University College of Dental Medicine and New York University Kriser Dental Center operate clinics that offer services in every area of dentistry and oral health. The work is done by students, residents and faculty, and the cost is about half of what it would be at a private practice. The Columbia clinic treats dental emergencies Monday through Friday from 8am to 3:30pm.

A list of hospital-based dental clinics and centers throughout the city that provide low-cost or free dental care to low-income people can be found at www.nyc.gov.

Glossary


Co-insurance The amount you must pay for your portion of medical fees, usually expressed as a percentage. For example, if you have an 80/20 plan, your insurance will pay 80% of the contracted charges and you are responsible for 20%.

Co-pay A flat amount you pay for services, such as office visits, prescriptions, and exams.

Deductible The sum of money you pay out of pocket for medical expenses before the insurer starts to pay its part.

HMO (Health Maintenance Organization)  A type of insurance company or plan that provides services through a network of providers. In an HMO, your Primary Care Physician (PCP) is responsible for coordinating your medical care. An HMO does not cover services provided outside of its network.

Look-back period The maximum length of time that can be examined for evidence of pre-existing conditions prior to enrolling in a health plan. In New York, the look-back period is 6 months.

Pre-existing condition exclusion period A physical or mental condition which existed before applying for a policy, for which medical care was already recommended or received, and which may not be covered by insurance, or only after a period of time. In New York, the exclusion period is up to 12 months.

Premium Money paid on a monthly or quarterly basis to an insurer for insurance coverage.

POS (Point-of-Service)/PPO (Preferred Provider Organization)  An insurance plan that allows members to use services in or outside of the insurer’s network of providers. Going to in-network providers is usually cheaper; services outside of the network generally require payment of a deductible and co-insurance.


Selected New York City Public Hospitals


Bronx
Jacobi Medical Center, 1400 Pelham Pkwy. South 718-918-5000

Brooklyn
Kings County Hospital Center, 451 Clarkson Ave. (718-245-3131)
Woodhull Medical and Mental Health Center, 760 Broadway (718-963-8000)

Manhattan
Bellevue Hospital Center, 462 1st Ave. (212-562-1000)
Harlem Hospital Center, 506 Lenox Ave. (212-939-1000)

Queens
Elmhurst Hospital Center, 79-01 Broadway (718-334-4000)
Queens Hospital Center, 82-68 164th St. (718-883-6702)



Selected Community Health Care Clinics


Bronx
Morris Heights Health Center, 85 W. Burnside Ave. (718-716-4400)
Bronx Lebanon Family Practice Center, 1276 Fulton Ave. (718-901-8236)

Brooklyn
Williamsburg Community Health Center, 279 Graham Ave. (718-963-7820)
Bushwick Community Health Center, 1420 Bushwick Ave. (718-919-1200)
Family Physician Health Center of Lutheran Medical Center, 5616 6th Ave. (718-439-5440)

Manhattan
The Ryan Chelsea-Clinton Community Health Center, 645 10th Ave. (212-265-4500)
The William F. Ryan Community Health Center, 110 W. 97th St. (212-749-1820)
Callen-Lorde Community Health Center 356 W. 18th St. (212-271-7200)
The Al Hirschfeld Free Health Clinic, 475 W. 57th St. (212-489-1939)
Ryan-NENA Community Health Center, 279 E. 3rd St. (212-477-8500)

Queens
Ridgewood Communicare, 769 Onderdonk Ave. (718-334-6190)
Long Island City Community Practice of New York Presbyterian Hospital, 36-11 21st St. (718-482-7772)
MediSys Family Health Care Center, 4-21 27th Ave. (718-278-6885)

Selected Mental Health Care Clinics

Manhattan
St. Vincent’s Hospital Outpatient Behavioral Health Services, 203 W. 12th Street O’Toole Building (212-604-8220)
Blanton Peale Counseling Center Main Office (there are satellite clinics in Brooklyn, Queens, and Staten Island) 3 W. 29th St. (212-725-7850)
St. Lukes/Roosevelt Hospitals Outpatient Psychiatric Clinic, 910 Ninth Ave. (212-523-8080) or (212-523-7668)
The Institute for Contemporary Psychotherapy, 1841 Broadway, 4th Floor (212-333-3444)

Brooklyn
BrooklynCenter for Psychotherapy, 300 Flatbush Ave. (718-622-2000)
Park Slope Center for Mental Health, 348 13th St. (718-788-2461)br />

Queens
Steinway Clinic, 41-36 27th St., Long Island City (718-389-5100)

Selected Low-Cost Dental Care


Brooklyn
Lutheran Medical Center, 150 55th St. (718-630-6875)
New York City College of Technology, 300 Jay St., (718-260-5074)

Manhattan
New York University Kriser Dental Center, 345 E. 24th St., (212-998-9800)
Ryan Chelsea-Clinton Community Health Center, 645 10th Ave. (212-265-4500)
Columbia University College of Medicine, 622 W. 168th St. (212-305-6726)

Selected 24-Hour Pharmacies


Bronx
CVS, 3775 E. Tremont Ave.( 718-597-3757)
Rite Aid, 2750 Boston Rd. (718-405-2127)

Brooklyn
Neergaard Surgical and Pharmacy, 454 5th Ave. (718-768-0600)

Manhattan
Rite Aid, 408 Grand St. at Clinton (212-529-7115)
Metro Drug, 13 E. 8th St. (212-982-7325)
Walgreen’s, 145 Fourth Ave. at 14th St. (212-677-0214)
Rite Aid, 303 W. 50th St. at 8th Ave. (212-247-8384)
Duane Reade, 224 W. 57th St. (212-541-9708)
CVS, 1396 Second Ave. at 72nd St. (212-249-5699)
CVS, 1622 Third Ave. at 91st St. (212-876-7016)

Queens

CVS, 89-11 Northern Blvd. at 90th St., Jackson Heights (718-426-2508)

 


About The Artists’ Health Resource Center

The Health Insurance Resource Center was created in 1998 by The Actors Fund, with a grant from the National Endowment for the Arts, to help people in entertainment and the arts find affordable health care coverage. With in-person counseling in New York and Los Angeles, national telephone support, an Internet database of resources (www.ahirc.org) with over a half-million visitors each year, and more than a hundred Getting and Keeping Health Insurance workshops offered at arts, cultural and human services organizations throughout the country, HIRC works to reduce the number of uninsured artists and expand access to quality, affordable health care.

For more information, contact us at 212.221.7300 ext.265 or on the web at www.ahirc.org, or visit any of the websites listed in this guide.


The laws, regulations, rules and policies on which the information in this guide are based are subject to frequent change. The Artist 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.