Health Care
The US health insurance system bewilders and perplexes even the most experienced freelancers. FSP/NWU members compiled these practical resources to help demystify health insurance for media workers impacted by layoffs — as well as old hands who still struggle to keep the acronyms straight.
It goes without saying, but bears repeating: a health care system tied to employment is senseless and unjust. Freelance media workers understand this better than most. FSP/NWU is a member of the Labor Campaign for Single Payer; our members are organizing alongside organized labor and other community groups for health care justice, an inclusive safety net, and Medicare For All. Join us.
After the layoff
One of the most terrifying aspects of losing your job is making sure you have health insurance. The following steps can help you assess your options and make a plan for the long term.
➔ Step 1: Understand your layoff terms and the rules of your current health plan. At what point will your health insurance stop, and how much, if anything, do you have to pay to keep it going? This should be explained in whatever written termination notice you’ve received.
➔ Step 2: Consider a COBRA continuation. If you work for a company with 20 or more employees, you have a right to buy into your existing health insurance plan after you get laid off, for 18 months of continuing coverage. However, unless the terms of the layoff require your employer to contribute to the cost of your ongoing coverage, you will pay the full premium. COBRA can be useful for those who can afford the full cost of coverage, or as a short-term bridge to the next job, but it’s not really a viable ongoing option for most people.
➔ Step 3: Look into family coverage options. If you’re married, you may be able to get covered right away. Usually workers can only enroll in job-based health plans during the annual open enrollment period. But if your spouse has also been relying on the health insurance you received through your employer, they have the right to immediately enroll in insurance through their own workplace — so long as that's on offer. If your spouse's employer provides more than single coverage, you can enroll too. And if your spouse is already covered at work, your layoff may allow you to be added right away, subject to waiting periods.
If you’re younger than 26, your parents’ employers legally must allow you to enroll in family coverage. You’ll need to figure out what coverage your parents have elected, and whether dependents can be added right away or must wait until open enrollment.
➔ Step 4: Find public or subsidized private coverage. You’ve been through steps 1, 2 and 3. Your coverage is running out. Now what? You might qualify for public health care in one form or another, but figuring out what public options are available can be confusing and time consuming. What follows is a general guide, with links to resources that provide more detailed information.
Public insurance options
Depending on your income level and location, you or your dependents might be eligible for government-funded health care, either through a federal- or state-administered program, or in the form of a subsidy to offset the cost of your health insurance premiums.
Let’s start with a basic description of the major programs:
➔ Medicaid: The national program to cover low income people. It’s jointly funded by the federal and state governments, and administered by the states. States are required to follow federal rules, but also have flexibility, so eligibility varies by state.
➔ CHIP: The Children’s Health Insurance Program. Like Medicaid, eligibility depends on income and rules vary by state. In most states, children up to age 19 with household income up to $60,000 per year (for a family of four) may qualify for CHIP.
➔ Medicare: The national program that covers people with disabilities or who are age 65 and older or children who survive their parents’ death. Medicare is funded by the federal government and has national eligibility rules.
➔ Affordable Care Act: Under the Affordable Care Act (ACA), Americans are able to purchase health insurance plans in 50 states and Washington, DC. Depending on your income level, you may qualify for premium tax credits.
Do I qualify?
➔ Where do I go? Healthcare.gov is the hub for finding health care in your state, including Medicaid and CHIP. Some states have their own Marketplace websites for finding health care; those states and their websites are listed here. The enrollment process for health care, Medicaid and CHIP differs by state and can be very confusing, but some states have workers trained to help the public find their way through this labyrinth, known as Navigators, who can help you with the process.
➔ When can I enroll? Normally, you can only enroll in health insurance through the ACA between November 1 and January 15. However, if you experience a significant “life event” (such as losing your insurance due to a layoff), you can qualify for a Special Enrollment Period that lets you enroll sooner. There are many other life events that can trigger a Special Enrollment Period, including getting married, having a baby, or becoming a US citizen. Note that if you or children in your household qualify for Medicaid or CHIP, you can enroll anytime during the year. In some states, eligibility for subsidized ACA coverage and Medicaid/CHIP coverage are administered through the same website.
➔ Do I qualify for tax credits? When applying for health care, check to see if your expected income qualifies you for tax credits that lower your monthly premium payments. This tool can help you figure out if you qualify for premium tax credits in your state, or direct you to the state website that can help you determine if you qualify. Tax credits may not be available for certain income brackets in states where Medicaid has not expanded.
➔ Do I qualify for Medicaid? You may qualify for Medicaid based on income and/or disability status. This healthcare.gov tool helps you figure out if you qualify for Medicaid based on your income, or directs you to the state website that can help you determine if you qualify. Medicaid provides free coverage, and all hospitals and Federally Qualified Health Centers are required to accept Medicaid.
Where can I turn if I don't qualify for public insurance, but I still can't afford private health care?
No one should die because they can't afford health care. If you are uninsured or underinsured, you may still be able to get basic care for free or extremely low cost at certain facilities.
➔ Federally Qualified Health Centers (FQHCs) These centers have received a massive infusion of capital over the last decade and provide care that is as good as or better than private doctors. Search for an FQHC near you.
➔ Local and state government-run facilities Your local public health department may offer basic services, such as vaccines and health screening exams for free or at a reduced cost. In New York City, NYC Care is a health care access program that provides low-cost and no-cost services to New Yorkers who don’t qualify for or can’t afford health insurance, with services provided through NYC Health + Hospitals.
➔ Not-for-profit clinics The National Association of Free & Charitable Clinics database can also help you find free and low-cost care provided by not-for-profit organizations, especially in major population centers. Planned Parenthood offers essential reproductive and sexual health services such as pelvic exams, Pap smears, cancer screenings, and testing and treatment for vaginal infections.
➔ Special eligibility clinics If you are a veteran of the uniformed services (Army, Navy, Air Force, Marines, Coast Guard, National Guard, Public Health Service, NOAA) you may be eligible for health care through the VA. If you are an American Indian or an Alaskan Native, you may be eligible for health care through the Indian Health Service. Additionally, some tribes have their own health care systems and clinics.
➔ Medical debt relief If you find yourself in medical debt, some resources exist to help ease that burden by taking advantage of hospital charity care programs and negotiating your debt down. An option to negotiate is no substitute for a right to care, but there may be a way out of an immediate debt crisis.
What to watch out for
Such a byzantine and nonsensical system leaves lots of room for scams, traps, and inadequate coverage.
➔ Health care sharing ministries (HCSMs): These are programs where people who share a common faith make monthly payments that are used to cover the cost of members' medical care. This is not health insurance, and HCSMs do not provide the minimum essential coverage as defined by the Affordable Care Act (ACA). HCSMs are not subject to insurance regulations in 30 states, so the state insurance commissioner would not be able to assist a member if issues arose.
➔ Short-term health care coverage: These plans are cheaper than traditional plans, but they are not governed by the ACA and provide more limited coverage as a result. Deductibles can be high. While they can be used as a bridge between traditional coverage plans, it is important to know what you are signing up for and to read the “fine print.”
➔ Catastrophic healthcare coverage: These policies have low premiums and high deductibles. They provide minimal insurance coverage for a low cost, which can work for those in financial straits for whom this is the only option to get health care. These plans are ACA compliant, and they cover the same essential health benefits as other Marketplace plans.
Last resources
➔ Getting Your Health Care Covered: a Guide for Transgender People
➔ Out2Enroll is a national initiative launched in September 2013 to connect LGBT+ people and families, friends, and allies with the new health insurance coverage options available under the Affordable Care Act.
➔ Mental Health Resources For Black, Indigenous, and People Of Color
With the health care system so fractured, it's (unfortunately) essential that individuals become advocates for themselves and their own personal health. The best way to do this is to get educated about what issues you need to watch out for based on your age, gender, family history, and environmental exposures. The US Preventive Services Task Force (USPSTF) provides information about recommended examinations and lab tests that should be done at prescribed intervals.
We hope these resources can help freelancers find affordable health insurance, but the grim reality is that for many people there just aren't workable options. Even if you can find affordable monthly premiums, coverage can become meaningless because the deductibles, copays and coinsurance are so high that it becomes unaffordable to get medical care even when technically insured. In 2022, more than a decade after passage of the ACA, 43% of U.S. adults remained either uninsured or underinsured.
FSP-NWU seeks to support freelancers in finding good insurance under the current system, while also becoming active in the fight for fully-funded and expanded Medicare for All. Learn more about the Labor Campaign for Single Payer, and join us in the fight today.
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