health care

When the American Association of Independent Music (A2IM) unveiled its new healthcare plans for working artists in August, the trade association, which represents indie labels, presented it as “a welcome ray of light for the music industry.” The monthly premiums range from $80 to $1,240 and feature benefits such as $15 co-pays for doctor visits and regular screenings for breast cancer, diabetes and depression. Affordable dental, vision and even pet insurance plans are also available.

But buried in the descriptions of several plans, which are accessible for those with a $100 annual A2IM membership, are restrictions and costs that could drain indie musicians’ finances. Three of the five plans offered, which cost $80 to $210 per month for individuals and $160 to $510 for families, do not cover emergency room care, hospital room fees, childbirth/delivery costs in hospitals or any type of care from a physician or surgeon. The two more expensive plans — $560 to $690 for individuals and $1,060 to $1,240 for families­ — don’t cover ambulance charges, radiation, chemotherapy, dialysis or transplants.

“What A2IM is doing is fantastic. I am applauding them hugely for this,” says Tatum Allsep, founder and CEO of Music Health Alliance, a Nashville group that advises artists on healthcare. “But read the fine print.”

A2IM bills the plans as “compliant” with the Affordable Care Act (ACA, also known as Obamacare), but Allsep disagrees. “Nothing about this is aligned with the coverage on state exchanges. Not one bit,” she says. “Somebody’s going to think, for 80 bucks, they’re going to have health insurance because it says in black and white, ‘ACA-compliant.’ And that is absolutely false.”

Dr. Elisabeth Rosenthal, author of A Terrible Sickness: How Healthcare Became Big Business and How You Can Take It Back, adds, “It’s a terrible burden to place on patients to have to read the fine print in this way. I’ve spent my life thinking about these things, and I’m trained as a physician, and it gives me a headache to look at these policies.”

A2IM first offered health insurance to its 600 members, mostly indie labels, in September 2022, then expanded this past August to artists who are sole business proprietors.

A2IM president/CEO Richard James Burgess says the plans are “compliant” with the ACA and that “several dozen families” have enrolled in them so far.

“It was incredibly challenging to find affordable healthcare insurance for A2IM members outside of the state exchanges. For years, there appeared to be no viable options,” he says. “A2IM has never diminished the great work the state exchanges have done. We are not in competition with them. Rather, we wanted to offer more options to our members.”

According to a representative with the U.S. Centers for Medicare and Medicaid Services, ACA-compliant plans must have three key characteristics: They have to cover preventive services (like vaccines and screening tests), prohibit insurers from denying clients based on preexisting conditions and ban limits for total healthcare costs. “On the exchanges, those plans basically have consumer protection built into them,” says Liz McCuskey, a Boston University professor of health law policy. Consumers can buy “off-exchange” plans outside of the ACA, but she says they “are subject to much lighter rules.”

Michael Desnoyers, director of sales for Chicago insurance broker Independent Health Agents, says of A2IM’s plans, “If it’s the first time they’re being offered to musicians, they probably don’t have the option to get their proper group plan through Blue Cross/Blue Shield or United Healthcare.”

Desnoyers adds that the A2IM options might work for musicians who are younger, with no serious health risks or preexisting conditions, even if they “don’t come through with the benefits the major medical plans do.” Tim Hebert ­— a Fort Collins, Colo., health insurance broker who is also a managing partner for Sage Benefit Advisors and the state legislative chair for the National Association of Benefits and Insurance Professionals — adds: “In certain situations, it can absolutely make sense. If [musicians] have moderate income but they just don’t have any assets, the A2IM plan works. It gives them basic coverage. You just don’t have to pay the higher premiums.”

Until 2010, self-employed musicians had few ways to obtain low-cost insurance, especially if they had preexisting conditions such as asthma or cancer. The ACA changed all that, and today, individual states are obligated to provide plans that cover catastrophic medical events and not to discriminate based on preexisting conditions. Still, several music industry organizations, including the Recording Academy, the American Federation of Musicians — and now A2IM — offer additional plans to members as cheaper alternatives.

For example, the academy provides plans for its more than 15,000 members through Stride Health that cost as little as $25 per month, with options to add dental, vision and life insurance coverage. The American Federation of Musicians (AFM), which represents 80,000 members of bands and orchestras, as part of Broadway productions and touring shows, provides group health insurance for freelance musicians. “The Affordable Care Act provided considerable relief to workers by requiring that health insurance be made available to them on a non-cancellable basis,” an AFM rep said in a statement, “but the ACA provided no meaningful relief for premium costs.” The plans offered through the academy and the AFM are similar to those on Obamacare state exchanges, according to Allsep.

Some major labels offer certain health-related benefits, if not actual insurance, to artists on their rosters. Sony and Universal Music Group (UMG) provide access to the Music Health Alliance, which offers expertise and suggestions on finding services elsewhere. Although reps for UMG and Warner Music Group did not respond to inquiries about health benefits, Sony artists can sign up for Artist Forward, which provides what the label calls “wellness solutions” like free counseling services.

Prior to its current offering, A2IM adopted a health plan from Zion Health Share, a Utah company that describes its membership as an “innovative and affordable medical cost-sharing community.” Its plan description stated, “This program is not insurance,” required participants to acknowledge that Zion “affiliates itself, and considers itself, accountable to a higher power” and limited care for people with preexisting conditions other than high blood pressure, high cholesterol or diabetes.

Several healthcare experts criticized the plan, including Allsep, Rosenthal and Valarie Blake, a West Virginia University law professor who specializes in healthcare policy. “I would not enroll unless I was a gambling man,” Blake says. When Billboard asked A2IM to comment on the Zion plan, Burgess said it was no longer available through A2IM. Representatives for Zion Health did not respond to email inquiries. “I am glad they changed course,” Blake says. 

Academy CEO Harvey Mason jr. says he’s sympathetic to the A2IM’s healthcare efforts: “We’re all trying to figure this stuff out together,” he says. “It doesn’t matter who provides coverage. It’s the fact that people are signing up for coverage. That’s the win.”

But after reviewing A2IM’s current plans, Allsep cautions: “Buyer beware.”