With all of the uncertainty surrounding how federal and state governments will be approaching health care law in the future, it’s tempting to throw up your hands and shout, Wake me up when the dust settles! Unfortunately, the vast majority of self-employed musicians don’t have the luxury of waiting it out. Here are some things you might want to start mulling over right now.

Scene 1: A driveway on the outskirts of Toronto. Silence all around. I’m in excruciating pain, only slightly masked by alcohol consumed post gig. The freezing night air sends chills through my body. As I lay in the wet, icy snow, struggling to breathe, I realize that my band’s month-long tour could be over, and it’s only the first night. I hear my bandmate’s voice. “Kim! Are your wrists okay?” As I lie there, wondering how on earth I managed to slip as I was getting out of the van and land, chest down, on my bass drum pedal, I carefully roll my wrists and give a thumbs-up. My chest, however, is not feeling the way it should. Is there a bone jutting into my lungs? But I can’t go to the hospital! How am I supposed to pay for it? I spend the rest of the tour in agony, popping painkillers.

Scene 2: Late-night after-party with locals following an awesome show in some middle-of-nowhere town in Louisiana. Suddenly there’s a piercing scream. As I turn toward my bandmate, I notice he’s barefoot and there’s blood everywhere. As in scene 1, the visit to the emergency room will not happen tonight. Gaffer’s tape provides an immediate and far more affordable solution to his bloody big toe, ripped open by a rusty nail in the doorway. Several shots of whiskey take the place of a proposed tetanus shot. Severe pain while walking for the remainder of the tour is, thankfully, the only consequence of this incident.

On the road, crazy, random accidents happen—but so do all-too-common events like muscle pulls caused by lifting heavy equipment, repetitive strain injuries, and bumps, bruises, or even breaks sustained in a fender bender. When home “remedies” like gaffer’s tape won’t suffice, a visit to the emergency room, X-rays, and prescription painkillers can quickly add up to more than $500—and that’s for relatively unexceptional incidents such as the ones described above. Having health insurance can make the difference between an unexpected event being a temporary setback and a career-ender.

Sure, with all the work involved in being a musician, the last thing we want to think about is health insurance. Given how convoluted our current system is in America, it seems easier to go about our lives naively believing (or silently hoping) that nothing will happen to us. And as musicians we’re somewhat conditioned to act like we’re unbreakable. “The show must go on,” right? Still, most of us do at least periodically consider purchasing insurance—though most musicians I’ve spoken to inevitably put it off due to the expense.

As indie artists, after laying out cash for rent, food, and other basic living expenses, pretty much every other cent earned goes back into supporting our career. Forking out a few hundred dollars each month for health insurance, on top of the money we already spend, seems impossible—we’re more likely to rationalize insuring our equipment first.

Especially given the proposals that the Trump administration has introduced, many musicians worry that even with health insurance, the massive bills resulting from an injury or sickness will still leave us broke. I’ve struggled with these fears, particularly during the past few years, as I’ve found myself in situations where my health and well-being have been compromised. These events have led me to search deeply within myself for greater levels of gratitude, healing, and health—and, just as important, to learn what options I have in terms of covering potential medical costs.

I’m originally from Australia, and last year I traveled back there for an operation on my shoulder, as I knew it would be much more cost effective than having it done in the U.S., and the care I would be receiving would be world class. But the fact that my first thought was to purchase a flight to another country, fifteen hours away, just so that I could afford the operation I needed, in itself says something about the current state of affairs with the health care system here.

As I began to research this topic and speak with musicians from a wide range of working and economic situations, I was surprised to find myself still quite confused by the whole system here. I was, however, able to come to some conclusions that I hope will be a catalyst for you to research your own options.

I had the pleasure to speak with Kevin Erickson at the Future of Music Coalition, who generously gave his time to chat about heath insurance and in the process help me understand my options. Future of Music was founded to help musicians with advice on topics like this. I implore you to reach out to them at futureofmusic.org, and to support such organizations to help elevate the voices of musicians when it counts.

It’s difficult for many to understand why the United States doesn’t have universal health care, and most adults, musicians or otherwise, have found it frustrating that the type of insurance plan we have dictates which doctors we can see under our coverage. This may also affect what medications our doctors are able to prescribe for us. And then there’s the fact that applying for health insurance doesn’t guarantee we will receive it, at least the type of coverage that we need.

Regardless, under the Affordable Care Act (ACA), or Obamacare, it’s compulsory for U.S. residents or citizens to have health insurance. If you don’t carry coverage, you are fined a percentage per person or a percentage of the household income, whichever is higher. “There are a number of hardship exemptions that allow you to avoid paying a fine if you are uninsured,” Erickson explains. “There is a $10,350 threshold where you don’t have to pay [a fine if your income is less than that amount and you’re not covered], since you don’t have to pay taxes at that point. But you also don’t have to pay a fine if the least expensive health insurance available to you costs more than 8.13 percent of your 2016 income in premiums.” If you think you are eligible to be exempt from having insurance, be aware that you must apply for exemption.

As working drummers, we fall into different categories. We might be session players or touring drummers…freelancers or band members…full-time musicians or part-time ones doing casual work to subsidize another career. We might be single or married, have children or not. And the type of coverage we need or qualify for will differ, depending on these facts. For instance, if you’re in a band and all the members require insurance, there is an option to have the group registered as a business in your state of residence and therefore have group coverage.

Many musicians do not have jobs where their employer covers health care. The Affordable Care Act is designed to make health care more affordable and to improve the quality of the care available as well as the essential benefits that are covered. Even if your expenses spiral out of control, there is a limit to what you will have to pay out of pocket.

Open enrollment for the ACA closed at the end of January and is not open again until around October (dependent on any changes made to the law by Congress). If you missed the deadline and you are not eligible for Medicaid, look into taking advantage of “qualifying events” that allow exemption from having health care, such as change in address/zip code, employment situation, or mental or marital status. You could also find a health insurance broker, who can advise and guide you in finding an insurance plan that works best for your circumstances. You will not be charged for the service, as the broker’s fee will be paid by the insurance company.

If you are under twenty-six years of age, you could be added to your parents’ plan. If you fall under the income threshold of around $16,000 or less, the enrollment period does not matter and you can apply for Medicaid at any time. (The threshold varies among states.) Medicaid allows you to visit certain doctors and clinics and receive free or highly discounted medications.

If you live in a state that did not accept the federal funding to expand Medicaid, you may be stuck between not earning enough to afford health care and earning too much to be eligible for Medicaid. To avoid the tax penalty, if you do not qualify for one of the exemptions, you may have to rely on charity care and benefit concerts to cover costs. If you live in one of these states, reach out and encourage your state government to accept the Medicaid funding, because it clearly is impacting musicians.

The easiest way to start looking for health care is to go to healthcare.gov and fill in your information. If you’re having issues with this, reach out to organizations such as the Future of Music Coalition and the Actors Fund for help—this is what they’re there for.

One of the challenges with signing up is estimating your income for the year ahead. As musicians, we often have no idea where our next gig, let alone a year’s worth of income, is coming from. A good place to start is with your previous year’s tax return. Also look at what you have planned for the year ahead, such as album releases and touring, which may increase your income. If you end up earning more than you predict, you can recalculate and adjust your plan.

One thing to keep in mind as a touring musician is that not every plan covers being on the road. Find a plan that does, known as out-of-network coverage. Once you do have insurance, take advantage of it, especially the preventive-care aspects, such as free annual checkups.

Despite any plans the federal government has to repeal and replace the existing law, it is still recommended to sign up. Your health care, and your ability to afford it, is too important to avoid.

Glossary

• Medicare is a federal program that provides health coverage if you are sixty-five or older or have a severe disability, on any income.

• Medicaid is a state and federal program that provides health coverage if you have a low income.

• If you can afford health insurance but choose not to buy it, you must pay a fee called the individual shared responsibility payment.

• The Affordable Care Act, aka Obamacare, is a long, complex piece of legislation that attempts to reform the health care system. It is designed to provide quality, affordable health insurance to more Americans, curbing the increase in health care spending in the U.S.

Tips

• Don’t be shy to reach out to organizations and brokers and ask questions about what your options are, including ways to obtain free access to preventive care like annual checkups.

• Apply for Medicaid if you are on a low income.

• Stay as fit and healthy as you can. Regular exercise, stretching, and eating healthy will put you in a much better position to heal in the event that something does happen. Prevention is better than cure.

• Research the historic and current issues surrounding health care, and if you come to the conclusion that your state government should accept Medicaid funding if it doesn’t currently do so, call your state representatives and encourage them to support the move. Similarly, if you believe that a federal single-payer system would be the best approach, lobby Congress to support that.

• Remember, you are your most important asset, so treat yourself with love, care, and respect.

Get Help

• If you are in the entertainment business, there are health care centers founded specifically for entertainers, such as the Bob Hope Health Center through UCLA in Los Angeles.

• Planned Parenthood provides services for everyone. In California, if you have a low income, you will receive free or cheap benefits through Medi-Cal and services covering such things as STD/STI testing, Pap smears, breast exams, and preventive care. These vary within counties and states.

• Los Angeles has a program called Healthy Way L.A., which provides cheap or free coverage. To qualify for this, you must be a resident for at least five years, a citizen with no current insurance, and not pregnant, and you must meet the monthly income limits.

• Future of Music Coalition provides helpful articles and interpersonal assistance for musicians struggling with health care and other issues unique to professional musicians.

Kim Kicks is the drummer in the Los Angeles–based band Satellite Sky.