The True Cost of a Dancer's Health
Since before it became a national crisis, finding good and affordable healthcare has been a serious dilemma for the average dancer. The physical demands placed on a dancer’s body make health insurance a necessity, but most aren’t lucky enough to get coverage through their employers, much less pay out of pocket. To help you find the best possible health plan for your needs and your purse strings, DS talked to doctors, dancers, nonprofit healthcare specialists and consultants to find out what’s available for you.
For the Under-25
Megan Metcalf landed her first paid dance gig at age 16. She graduated from her high school in Southern California a year early and deferred acceptance to Columbia University for two years to pursue a full-time dance career that included jobs with local L.A. productions and in commercials and films. She supported herself by waiting tables and answering phones. But one thing she didn’t have to worry about was health insurance: She was young enough to stay on her parents’ plan.
Generally, says Lenore Janecek, a healthcare consultant in Chicago, insurance companies cover dependent children up to age 19. Or, if the child is a full-time college student, up to age 25. (The cutoff age varies by insurance plan.) “If kids can stay on their parents’ policy, they should certainly do it, in spite of the fact that they want to be independent,” says Dr. Jim Garrick, who runs a clinic for dancers in San Francisco. Staying covered by your parents’ plan will give you time to plan financially for when you’re on your own. “We encourage [dancers] to embrace very early on in their careers the notion that they need to be able to afford quality healthcare,” says Marijeanne Liederbach of the Harkness Center for Dance Injuries in NYC. “They should plan out a budget.”
While studying English literature at Columbia University, Metcalf participated in numerous dance and choreography projects on the side. Since her parents’ policy mainly included doctors on the West Coast, she purchased a healthcare plan through school. But when she took off a semester to tour the East Coast with a production of West Side Story, she no longer qualified for Columbia’s health plan since she wasn’t a full-time student. “I didn’t have any insurance,” Metcalf says, “and decided that was fine.” But after a simple bug bite became infected and she had to pay for the treatment out of pocket, her mother helped her buy a health plan. When Metcalf returned to Columbia, she went back on the school’s health plan, which was fortunate, because a dancerelated injury resulted in two surgeries. The insurance covered much of the cost—which was in the tens of thousands of dollars—but not all. The result: Metcalf graduated from college with high medical bills. Had she gone without insurance, however, those bills would have been astronomical.
College health plans are a good option, particularly if you attend school far away from home and your parents’ health plan doesn’t cover doctors in your area. In fact, most colleges require students to purchase a health plan. The total cost ranges from several hundred dollars to $1,000 or more per term. College health plans aren’t perfect, especially for dancers. The plans may be deactivated during summer months or if you take a term off to tour or perform. Before purchasing one, find out what isn’t covered. For example, if you injure your knee, would the plan cover physical therapy? (In some cases, you may be better off purchasing your own plan. See “The Freelance Artist”) Here are some questions to ask before signing up:
- Will physical therapy be covered? If so, how much?
- Will I be covered between terms?
- What is the co-payment?
- What is the deductible?
- What preventative measures are covered? (Some plans, for instance, offer partial reimbursement for gym memberships.)
The Freelance Artist
With a degree in one hand and a stack of medical bills in the other, Metcalf, now in her mid 20s, took a temp job after her 2003 graduation that gave her minimal health insurance for $18 a week. “I went to [see] doctors enough times to make it worthwhile,” she says. “I had to pay for a lot of tests, but I was grateful to have that small amount [covered].” Metcalf kept working side jobs between and around performances, but her medical problems persisted and the bills piled up. “About a year ago, I got to a critical point,” says Metcalf, who decided to work as a grant writer for an arts organization, “primarily for the health insurance.” She choreographed on the side, some for projects that generated money, others which did not, and took dance class as much as she could manage while working full time. Recently, she quit her job for the opportunity to do a three-week choreography workshop—a decision that puts this 26-year-old woman with nagging health issues in a tough position.
An estimated 45 million Americans don’t have health insurance. While exact figures for dancers aren’t available, the numbers are clearly high. Liederbach says that more than 50 percent of the dancers who call the Harkness Center for Dance Injuries have either no insurance or a highdeductible plan, also called a “catastrophic” health plan. (See “Terms to Know” for more on deductibles.) Those dancers still have more options than they often realize, but few of them are easy, and the cheap ones usually aren’t ideal. Here are a few:
Buy an individual insurance plan. The optimal plan covers visits to a broad network of doctors, specialists, chiropractors, dentists and counselors. It has a high payment ceiling, so you won’t be burdened with heavy medical bills after a surgery, and it requires little or no co-payment for prescription drugs. Generous employers sometimes offer health benefits like this. But as a dancer who is self-employed or working for a small company that doesn’t provide health benefits, purchasing a plan that comes even close to this will be expensive: In many states, it will cost $300 to $400 a month.
The next best (and often more realistic) option is to buy a plan that has some of those things. Simon Abou-Fadel, director of the Artists’ Health Insurance Resource Center at the Actors’ Fund of America, offers this example. He recently found health insurance for a 25-year-old dancer for $75 a month. (She lives in California, where insurers can evaluate a person’s health before offering a plan.) It covers doctors’ visits with no deductible, includes full prescription drug benefits and will pay up to $7,500 a year for medical expenses. “It’s enough to walk around on the street and feel insured,” Abou-Fadel says. Unfortunately, the cost of treating a serious injury could easily exceed the $7,500 maximum annual payout.
The cheap monthly rate takes into account that the dancer is young and in good health. Put another way: In some states, such as California, the younger and healthier you are, the cheaper the insurance. The more health problems you have, the more you’ll pay to be covered. In a few states, such as New York, where Metcalf lives, health plans are available at equal cost to anyone, and nobody can be turned down. But that equal cost in these “guaranteed-issue” states is much higher. Abou-Fadel says the $75-a-month plan would cost at least double in New York. (To find out about your state’s guaranteed-issue laws, visit ahirc.org.)
Pay as you go. Many dancers, especially those who are healthy and injury-free, opt to go without insurance. They pay out-of-pocket for the occasional doctor visit, hoping to find a clinic that provides basic check-ups for little or no cost. They may even take the money they would otherwise pay for insurance and invest it in preventative care: massages, chiropractor visits, Pilates and health foods. While this sometimes works, “What happens if you get sick or have an accident?” asks Adam Forest, executive director of Fractured Atlas, a national organization that provides both basic and comprehensive health plans for artists. “That’s where health insurance is helpful,” says Forest.
The cost of surgery, coupled with a hospital stay and physical therapy, can easily exceed what a dancer earns in an entire year. Plus, insurance companies negotiate lower prices with doctors, so uninsured patients can end up paying the very highest fees. Another option is to buy discount cards designed to give cheaper prices on medical services. Abou-Fadel cautions against them, however. “People can really get creamed on those kind of plans,” he says, explaining that many companies sell bogus cards. “There is no way to validate the prices until you need the care, and then you still don’t know the numbers until the bill comes in. At that point, it’s too late.”
Purchase a plan through your union. Many unions offer plans for purchase to their members. You may also qualify to receive extra benefits on top of your regular plan.
Find a bare-bones option. If you can’t afford a full-coverage plan, so-called “bare-bones” options are available. Fractured Atlas, for example, offers a basic nationwide plan to members that starts at about $60 a month. The coverage is limited, so chronic or severe medical problems are still likely to be a financial burden, though those bills won’t be as high as if you had no insurance at all. “We find it interests a lot of people who need a short-term option, who are between jobs or just graduated from school and are not sure where they are going to be,” says Forest, the executive director.
Health savings accounts. Most healthcare experts agree that health savings accounts (HSAs) are a good option for young, healthy people who are earning enough to be able to save some money. Here’s how an HSA works: Through a bank, credit union or insurance company, you set up an account in which you save money (tax free) each month. At the same time, you set up a highdeductible health-insurance plan. The premium that you pay each month for the insurance plan will be low, and the rest of the money that you would have paid for a traditional health plan will instead be put in your savings account. Your deductible will be high (at least $1,000 for single coverage; $2,000 for family). For most medical expenses, you’ll end up paying cash from your HSA. But for large medical bills— such as for a surgery—your insurance plan will still cover the amount above your deductible. HSAs are best set up by young people who are less likely to have major medical expenses in the near future. That way, by the time they do have those expenses, they’ll have built a sizable account.
Government plans. Check with your state’s department of health, or go to ahirc.org, to find out about government programs available in your state. (Medicaid is available nationwide.) The earning limits for government programs are usually low, so if you’re working regularly for decent money, you may not qualify. Government programs are also a good option if you have children. Even if you don’t qualify for coverage, your children might.
Purchase a group plan. If you operate a small side business, such as teaching Pilates or dance, you may qualify for a group plan at reduced rates through an association like a chamber of commerce. The business needs to be legally formed (for example, as a partnership or small corporation), pre-existing (you can’t start it simply to buy health insurance) and have two or more employees, including you.
Get a job that offers health benefits. This makes sense financially. You’ll get a regular paycheck and benefits that include, hopefully, a decent health plan. But the traditional 8 am to 5 pm job doesn’t always fit well with short-notice auditions, road trips and rehearsals. However, if, like Metcalf, you get a full-time job, then leave for a dance project, you can keep your health package through a program called COBRA. The cost can be well over $300 a month, and COBRA runs out one to three years after you leave your employer. Since COBRA is an expensive, short-term solution, a better idea, particularly if you’re in good health and live in a non-guaranteed issue state, might be to buy your own plan.
Find what’s available locally. Some dancers, particularly in New York and California, have other options. In NYC, Dance/NYC has set up a program with Woodhull Medical Center in which artists can earn credits for medical care in exchange for performing for patients. NYC is also home to Harkness Dance Center, which provides low-cost care to dancers. In San Francisco, Garrick and a few colleagues offer a low-cost clinic for dancers. And in St. Louis, Dr. Bill Russell, a former dancer, offers affordable (and sometimes free) chiropractic care to dancers. Networking is the best way to find what’s available in your area. Talk to fellow dancers, studio owners and doctors who you like. If your town has a clinic that specializes in dance medicine, they’ll know it. If you can’t afford to pay, then get creative with what you can offer: free show tickets, free lessons for doctors’ or nurses’ kids, or even free food. “I’ve been paid in lasagna!” Russell says.
Company benefits and lucky scenarios
Metcalf is now back to temping. She’s paying expensive COBRA fees for her old health insurance until she decides whether to purchase a bare-bones plan or take advantage of the service-for-care program through Woodhull Medical Center. She’s also considering taking a full-time office job, fitting in dance projects as much as she can.
Most dancers can relate to Metcalf’s story, but the dancers in the most fortunate positions are those who work nearly year-round for a major company that provides healthcare. At the end of each dance season, most of these dancers get laid off. At that point, their options are to keep their insurance through COBRA or get a short-term, low-cost plan through an organization like Fractured Atlas. They can also go uninsured and pay for medical care as needed. Or, for the very fortunate, they may get treatment from their dance company’s doctors for free. One group of dancers that is virtually unaffected by the healthcare challenge are those who are married to someone whose job provides a full benefits package. Even those dancers must be prepared, however, in case the spouse loses his or her job. “This is more important than the purchase of a car, fine clothes or something really special,” says Janecek, the Chicago-based consultant, “because it’s you.”
For more on Megan Metcalf: meganmetcalf.com
TERMS TO KNOW
- COBRA: Consolidated Omnibus Budget Reconciliation Act of 1986,a law that allows workers who leave a job to keep their health insurance for a period of up to three years. The catch? You have to pay for it, and it’s almost always expensive.
- Co-insurance: The percentage that you, the patient, pays for medical expenses. For example, if your plan has a 70/30 co-insurance split, you’ll pay $60 (or 30 percent) for a $200 doctor visit. Many plans, but not all, have co-insurance.
- Co-payment: The amount you pay for expenses covered by your insurance plan. For example, a decent prescription-drug coverage plan may require you to pay $10 for a month’s worth of birth-control pills, while your insurance picks up the rest of the tab. Deductible: The amount of money the patient must first pay before the insurance company covers the rest. If you have a $300 medical bill and a deductible of $100, the insurance company will cover the remaining $200. If your medical bill is only $75, you’ll pay it all.
- HMO: Health maintenance organization, a type of insurance plan that requires you to choose a primary-care physician who you visit on a regular basis. That primary care doctor will send you to specialists as needed.
- HSA: Health savings account, set up through a bank, credit union or insurance company. People who have HSAs save money, tax-free that they will use to pay for medical expenses. Large medical expenses will be covered by a high-deductible health plan.
- Medicaid: A national program that provides healthcare for people with low incomes. Qualifying income levels vary from state to state.
- Premium: The amount of money you pay to an insurance company to provide coverage.
- PPO: Preferred provider organization, which, like an HMO, is a type of insurance plan. People with PPO insurance can visit any doctor in the plan’s network. Unlike HMOs, patients don’t need to choose a primary-care physician or get referrals to specialists.
THE INSURANCE ADVANTAGE
Let’s say you have a sore tooth, and every time you land from a jump, the jarring action sends pain shooting through your skull. You need to get that tooth fixed, so you go to the dentist. A quick check-up and X-ray reveal that you need a root canal and a crown. It’s painful news—in more ways than one. If you’re young and healthy, going without healthcare coverage may seem like a great way to save money, until a situation like this arises. Here’s why: Insurance companies negotiate special rates with groups of physicians. That means the companies pay cheaper prices for medical procedures than what doctors charge people who have no insurance. Simon Abou-Fadel, director of the Artists’ Health Insurance Resource Center at the Actors’ Fund of America, says that insurance companies’ negotiated rates are usually 33 percent to 50 percent lower than off-the-street prices.
Beyond the initial savings, a decent health-insurance program should cover most of the reduced cost as well. For someone with no insurance, the cost of the root canal and crown may be $900 apiece, not including the charges for the initial check-up and X-ray. (Note: Actual prices for procedures vary by doctor and location.) An insurance company’s negotiated prices may drop the fee to $600 apiece, lowering the total bill from $1,800 to $1,200. And if you have a co-insurance plan, say, one that requires you to pay 40 percent of the bill with insurance covering the rest, your total amount due is only $480. That’s a difference of $1,320. If you could take the money you would save and spread it out over a year, you would have $110 a month. For that amount, you can buy some level of health insurance almost anywhere. It may not be a perfect plan, but it will probably be enough to save you significant money when you have no choice but to visit a doctor.
- American Alliance for Health, Physical Education, Recreation & Dance http://www.aahperd.org A group of associations, including the National Dance Association, that offer health plans for purchase by members.
- Artist Access Art-for-care program for NYC artists, through Brooklyn’s Woodhull Medical and Mental Health Center. Download an application at http://www.nyfa.org/files_ uploaded/health careapplication.pdf.
- Artists’ Health Insurance Resource Center http://www.ahirc.org Includes glossaries, quick guides, union links and comprehensive state-by-state information.
- Harkness Center for Dance Injuries http://www.danceinjury.com A NYC-based center where dancers can receive specialized medical care.
- Fractured Atlas http://www.fracturedatlas.org Features membership information and details on a variety of health plans that can be purchased through the organization.
- Working Today http://www.workingtoday.org A national organization of independent workers.
Tim O’Shei is a freelance writer in Hamburg, NY, and the author of 26 nonfiction books.
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