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In South Dakota, you can get affordable health insurance through government-funded programs, employers, or health insurance companies. The Medicare and Medicaid programs target low-income households, while the Health Insurance Marketplace provides options for individual and family plans.
This guide explains South Dakota’s multi-tiered health insurance system in detail.
South Dakota uses the federal Health Insurance Marketplace; you can enroll in a plan using HealthCare.gov. The Health Insurance Marketplace provides a straightforward four-step approach to enrolling in an affordable health insurance plan.
If you cannot access the website or require assistance, HealthCare.gov provides a call center at 1-800-318-2596. Health plans can be explained to you and enrollment completed over the phone. You can also apply through a local agent or broker, or through the mail.
The process for enrolling in health insurance plans, whether individually or as a family, is essentially the same. However, when deciding on family plans, there are more issues to consider: chronic health problems, prescriptions, or specialist coverage are some questions fit, young, single individuals may not have to consider.
If you are not covered by an employer job plan, you can purchase individual health plans through the Health Insurance Marketplace. Self-employed individuals without employees are also eligible for these health plans.
There are different types of plans you can choose from:
The Health Insurance Marketplace in South Dakota is small, with only two health insurance carriers providing affordable individual health insurance plans: Avera and Sanford.
Both insurers offer plans ranging across bronze, Silver, Gold, and Platinum levels. Under the Affordable Care Act, all bronze through to Platinum level plans must cover 10 specified health benefits. These are:
Additionally, there is a low-cost alternative plan for covering catastrophic health events for adults under 30. In some circumstances, adults over 30 years in hardship conditions can also enroll for this health cover. Catastrophic plans are characterized by low premiums but high deductibles.
Selecting the most suitable family health plan can be a complex exercise. Balancing the needs of the whole and every individual requires some foresight. Ask yourself such questions as:
You’ll need to decide between the affordability of monthly premium levels, annual deductible fees, and copayments for services against the available plans. For example, do you choose a higher premium plan with better service coverage, or take the chance of being out-of-pocket with a lower-cost premium plan that has a large deductible? On top of that, you may need to consider buying dental or vision plans.
A careful comparison of health plan benefits using the HealthCare.gov site comparison tool will help you make the best decision.
Plans available through the Health Insurance Marketplace are grouped into four categories — Bronze, Silver, Gold, and Platinum. Each type provides a different level of medical expense reimbursement, monthly premium levels, and deductible percentages.
Premium costs can be lower for many people in South Dakota due to subsidies. For example, health plan holders on low incomes qualify for premium tax credits. In 2020, more than 90% of enrollees qualified for these subsidies, dramatically lowering the premium cost to only $136 per month.
In 2022, average premium costs decreased in the South Dakota Health Insurance Marketplace relative to 2021.
|Average premiums in South Dakota||2018||2019||2020||2021||2022|
|Most affordable bronze plan||$399||$412||$438||$454||$434|
|Most affordable Silver plan||$495||$541||$588||$609||$592|
|Most affordable Gold plan||$594||$632||$659||$652||$610|
South Dakota has two primary programs providing health coverage for low-income individuals and families: Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid provides free or low-cost health coverage to low-income individuals of all ages, while CHIP is specifically for children under 19 from low-income households.
Jointly funded by the federal and state governments, Medicaid is administered by the South Dakota Department of Social Services. Distinct groups of South Dakota residents are covered for mandated medical services. These include pregnant women, newborns, disabled children and adults, parent and caretaker families, and seniors.
Strict income and asset limits apply to Medicaid eligibility, with each group assigned a maximum income limit to qualify. For example, people with quadriplegia living independently have an income limit of up to $2,382 per month.
Medicaid programs cover costs for specified medical services, including:
South Dakota also provides vision, dental, and prescription drug benefits to eligible individuals.
You can apply for Medicaid via the Department of Social Services website.
CHIP (Children’s Health Insurance Program) provides health coverage for children at the state level. Often, these children are from households ineligible for Medicaid, or their parents have employer-sponsored health insurance that doesn’t cover their children. CHIP helps in these circumstances, ensuring these children can receive essential medical services.
In South Dakota, CHIP benefits are available to those under 19 from low-income households. Relevant medical services include dental care, vision assessment, and eyeglasses or contact lenses. Also included are regular doctor’s visits.
Children with or without individual health insurance can sign up for CHIP. However, different income limits apply to the two groups. For instance, a family of three with individual health insurance can only earn up to $3,423 per month before becoming ineligible for CHIP. On the other hand, the same size family without individual health coverage can earn up to $3,825 before becoming ineligible.
In addition to Medicaid and CHIP, South Dakota runs a breast and cervical cancer program and provides services beyond Medicaid for people with developmental disabilities.
The federal government regulates Medicare, which is generally for seniors 65 and over. However, Medicare can also be available for those under 65 years with disabilities or specific chronic health conditions like kidney failure.
In South Dakota, people receiving Medicare have two options:
If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs. In South Dakota, almost 50 insurers offer Medigap plans. Federal policy obligates insurers to deliver standardized policies to cover the same basic benefits.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
The South Dakota Senior Health Information & Insurance Education (SHINE) program provides Medicare beneficiaries, their families, or their caregivers with free, unbiased, and confidential advice and counseling on their Medicare options in South Dakota. This includes providing information about Original Medicare, Medicare Advantage Plans, Medicare Part D, and other aspects of Medicare. These trained and certified counselors can also help you with other health insurance questions and will never try to sell you a plan.
Short-term health insurance in South Dakota is limited to an initial period of fewer than 12 months with renewals allowed. Thus, the total length of cover, including renewals, can go up to 36 months. Short-term health insurance plans can be a cheap health insurance alternative to traditional health insurance, but these plans are often limited and aren’t required to meet Affordable Care Act standards.
South Dakota has not enacted any legislation making health insurance compulsory. While the (ACA) mandates health insurance plans, there is no monetary penalty for being without coverage.
No, it’s not compulsory to use the Health Insurance Marketplace, though there can be cost benefits for doing so. If you want to use tax credits to reduce monthly premiums, it is necessary to enroll through the marketplace.
The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t conform to ACA standards and don’t cover pre-existing conditions, mental health care, or pregnancy.
Tax-advantaged health saving accounts (HSAs) and flexible spending accounts (FSAs) can be helpful methods to meet medical costs. However, it depends entirely upon your unique financial circumstances whether these accounts could generate enough money to cover all medical expenses. You could end up paying significantly out of pocket without health insurance.
Short-term disability coverage benefits only help to protect a portion of your income. You will receive less of your income than usual, so you will probably be unable to meet unforeseen medical expenses without health insurance.
As with short-term disability insurance, the same problems of lower income and additional medical expenses will apply. It will pay to have health insurance that can cover most medical costs.
South Dakota runs a breast and cervical cancer program called the All Women Count! (AWC) Program. Low-income women are provided with cancer screening diagnostic services.
Beyond Medicaid services provided to people with developmental disabilities, the Family Support 360 program delivers a range of family support services across the state.