Do you need affordable, comprehensive health coverage in South Dakota? you’re not alone. And you’re probably not the only one who feels confused or a little frustrated by the process. You have a lot of options to consider, and some of them are a little complicated. But depending on you and the personal needs of yourself and your family, there are some options that may be better for you than others. And we want to help you find the optimal coverage to keep you and the ones you love happy and healthy.
Major Medical Insurance in South Dakota
Most people might not know that the ACA Health Insurance Marketplace where so many people have been getting their insurance over the last several years all started back in 2010 with the passage of the Patient Protection and Affordable Care Act. That’s the law that both established the federal Health Insurance Marketplace and set up new rules for how insurance companies must conduct themselves in that Exchange.
In South Dakota, residents must use HealthCare.gov in order to fill out an application every year starting on November 1st during Open Enrollment. Open Enrollment usually lasts until December 15th, although the date is known to change due to public demand. Filling out an application is fairly simple and straightforward. They only require basic information about your income and health status so that they can determine whether or not you are eligible for major medical coverage on the federal Exchange.
For people who cannot get health insurance through their employer, filling out an application on HealthCare.gov and trying to obtain major medical coverage through the ACA is the preferred option. These health plans are guaranteed issue, come with the 10 Essential Health Benefits mandated by the ACA, and often allow for federal subsidies which make them more affordable. Guaranteed issue is the special designation which means you cannot get rejected for coverage by any insurance company if you qualify for coverage in the federal Health Insurance Marketplace. Your health insurance company also cannot charge you more for your monthly premiums for having a pre-existing condition. The only factors which can make a difference in how much you pay for your premiums are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
The guaranteed Essential Health Benefits mandated by the ACA are listed below. These include things that most health insurance policies choose not to include, like preventative care or mental health counseling. But experts have determined that these are the benefits you need if you want to be optimally healthy and to lower total medical costs over time, which is why they are a part of the law:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Finally, there are the premium tax credits which make these policies affordable and accessible for most working families on a budget. If you can make at least 138% of the federal poverty limit based on your household size, you can qualify for one of these subsidies and save hundreds of dollars a month off your total premium costs. If you’re unsure where you fall according to these numbers, just take a look at the chart below. It can easily explain how your income and household size determine whether or not you qualify for a tax break:
|Household Size||Annual Income (138% of FPL)||Annual Income (100% of FPL)|
The number in the middle column is the minimum amount you must make in order to qualify for a tax subsidy. The numbers in the far right column, on the other hand, are the maximum income threshold for qualifying for Medicaid instead of a tax subsidy for ACA health insurance. Anyone who falls in the middle of this gap has fallen into the Medicaid expansion gap because South Dakota is still refusing to accept federal funds to expand Medicaid access to needy families. Unfortunately, it is unknown whether or not this will change in the near future. Until it does, you may have to settle for an alternative like short-term health insurance or a health share plan while you wait for the laws or your own personal circumstances to change. And if you do qualify for Medicaid based on your income, simply visit the South Dakota Medicaid website. There you can apply online or contact your local office for assistance with your application. But you should also know that among other things, you may have to meet a work requirement in order to qualify for Medicaid – which can make it substantially more difficult to get the coverage you need at a rate you can afford.
Short Term Health Insurance in South Dakota
Short-term health insurance laws in South Dakota are a little strict. It is still available in the state, but your plan can only last a maximum of six months and cannot be renewed immediately with the same company. This might be sufficient if you are between jobs or going through some other temporary hardship, but if you’re waiting for the next Open Enrollment period, for example, six months might be insufficient to cover your medical needs. There’s also medical underwriting to consider, which might get you rejected for coverage based on pre-existing conditions or make your monthly premiums very expensive for the same reason. It’s not uncommon for short-term health insurance plans to fall short of the essential health benefits that the ACA recommends. It’s also pretty common for short-term plans to have deductibles that are thousands of dollars or more that you have to pay in medical costs before your coverage actually kicks in.
So in the face of this, why would someone want a short-term health insurance plan? Well, if they can’t get ACA coverage, it may be their best available option. Many of these plans are competitively priced and can cost upwards of 33% less than an unsubsidized ACA major medical insurance policy if you are relatively healthy and don’t have any pre-existing conditions to worry about. These plans don’t automatically come with a full list of benefits that most consumers need for optimal health and wellness, but some of them do come with the option to add types of coverage you might need for yourself. Either way, even though the individual mandate is no more and you aren’t legally required to buy coverage, getting a short-term health insurance plan, if only temporarily, can be a better option than going completely without.
Christian Health Plans/Health-Sharing Plans in South Dakota
If you’re looking at either short-term health insurance or a health share plan because you can’t get ACA coverage and you’re patiently waiting for the next Open Enrollment period to come around, then going with short-term health insurance can be a little problematic given the six-month limits in South Dakota. You might want to think about a Christian health plan instead. These plans usually have longer term limits and lax rules for renewal. They also have several things in common with short-term health insurance, such as:
- These plans are NOT guaranteed issue
- They have unlimited out-of-pocket costs
- They have lifetime and annual benefit caps
- They likely won’t have all of the guaranteed Essential Health Benefits
- They may cost up to 1/3 as much in monthly premiums as an unsubsidized ACA plan
But the difference in plan term limits isn’t the only thing that’s different about a Christian health plan. Short-term health insurance doesn’t have participation guidelines that you have to follow the way Christian health plans do. Usually these are simple things like declaring the same religious faith as the organization, going to church more frequently, and stopping tobacco use in order to make yourself healthier (but participation guidelines will vary from plan to plan, so keep that in mind). Because Christian health plans aren’t regulated the same way short-term health insurance plans are, you won’t have the same consumer protections that would let you take your plan provider to court the way you would with short-term health insurance. And the language is a little bit different. So is the payment structure. You don’t pay a monthly premium, for example, with a Christian health plan; you pay a monthly share amount. And you don’t pay co-pays, deductibles, or co-insurance at all. What you pay instead is known as an “unshared amount” or a “personal responsibility amount” – but these payments still serve similar purposes to that of co-pays, deductibles, and coinsurance.
Fixed Indemnity Plans in South Dakota
Were you considering a fixed indemnity plan in South Carolina? Fixed indemnity health coverage Usually works better as a supplement to something like short-term health insurance or major medical coverage, though. This is because they pay out a fixed amount per claim (which can be on a daily, weekly, monthly, per visit, or per incident basis) and help reduce the total cost of medical expenses that your insurance provider won’t pay. They also allow you to go to out-of-network providers for a relatively lower fee than paying for your medical costs out-of-pocket. indemnity plans can offer you coverage for certain types of doctor visits, hospital care, or even supplemental coverage like dental if you can find the right plan.
Here’s why fixed indemnity plans don’t work as a good replacement for proper insurance coverage, though: for starters, the “fixed” in fixed indemnity means that they only pay out a fixed amount instead of paying out claims on a percentage basis the way major medical does. There’s a big difference, for example, between an insurance company paying at 60% of your doctor visit and an indemnity plan paying out $60 per doctor visit. Then there’s medical underwriting to consider, which means you could be rejected for coverage or charged substantially higher for your premiums if your fixed indemnity plan finds a pre-existing condition. But at the end of the day, some coverage is still better than no coverage, and a fixed indemnity plan can help protect you from a substantial amount of medical debt if you are relatively healthy and want to shield yourself against unexpected medical bills.
Discount Cards in South Dakota
Are you looking at a medical discount card as one of your health care options? Under some circumstances, these can be a good thing. But there are many ways in which a medical discount card can actually backfire on you if you aren’t careful. There are an unfortunate amount of medical discount cards out there that are being marketed and sold as a legitimate replacement for major medical coverage. But that simply isn’t the case. At best, they can offer you modest enough discounts that can make a small but positive difference in your health care costs. They can also be really helpful when it comes to getting a better price on prescription drugs. But some medical discount cards are better than others.
If you want to avoid a scam, start by avoiding any company that advertises their medical discount card as a form of legitimate insurance. There are no claims to file and no payouts to receive, so medical discount cards are nothing like major medical coverage. You present your card at the register when you purchase things like prescription drugs or visit certain doctors, dentists, or optometrists. You get the discount right then and there, and you don’t have to worry about any follow-up paperwork. Most medical discount cards will ask you for a membership fee, either on a monthly or an annual basis. It’s up to you to sit down and figure out how much money you can save based on the discounts they advertise versus how much it will cost you to pay your membership fees. Obviously, if the money you save on discounts is equal to or greater than your membership fee, then it is worth the money. But if not, then it’s best just to rely on more comprehensive coverage and to look for other ways to help pay for your out-of-pocket costs.