Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and enforcement began in 2014. The intent of Obamacare was to increase access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient health insurance options, and requiring all U.S. citizens to have minimum health insurance coverage.
Obamacare’s Effect on South Dakota Health Insurance
South Dakota has not had as aggressive advancements in the uninsured population as many of the requests from the Affordable Care Act (state-run exchange and Medicaid expansion) have not yet been implemented. That being said, the state is still trending close to the national average as their uninsured rate is at 10.6%. The National Health Interview Survey determined the uninsured national average to be 9.1%. In addition, because the state is not supportive of the ACA, efforts have not been put forth in educating the community, which may be discouraging individuals that would qualify for subsidies from taking advantage of benefits that would be providing them access to affordable coverage.
What South Dakota Residents Should Know About Obamacare in South Dakota
The Pros and Cons of South Dakota Obamacare
South Dakota Obamacare has made health insurance coverage available to many that could not previously afford care through subsidies offered in the federal exchange. When education efforts were put into place from federal resources, 2016 saw a large increase in enrollment through the exchange where 90% of residents qualified for a subsidy. It has also been successful in stressing the importance of individuals owning their own care by taking advantage of wellness programs and early screenings. Finally, Obamacare in South Dakota has successfully eliminated denial of care based on pre-existing conditions and has disabled South Dakota companies from charging a higher premium based on race or gender. There have been criticisms of Obamacare in South Dakota due to the lack of options on the exchange available for purchase. To date, there are only two options (Avera and Sanford) and rates will be increasing again in 2017. Because of that, while access to health insurance coverage has increased, the South Dakota middle class has actually suffered significantly due to the increase in high deductible plans. In addition, there has been a notable struggle in getting re-enrollments, especially for the healthy young adult population who would rather pay the fine for not having coverage than be responsible for monthly health insurance premiums they cannot afford.
Obamacare Health Plan Categories and How Much You Will Pay
When shopping in the South Dakota Obamacare Marketplace, there are four primary health plan categories you can choose from: bronze, silver, gold, and platinum. The categories determine the percentage of healthcare costs that the plan will pay for over a course of a year. The remaining percentage is what you will be expected to pay.
These percentage differences greatly impact how much you may expect to pay for care. Think about it this way: If the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay for the remaining 40%. While this plan will cost you less monthly, it leaves you financially responsible for a larger dollar amount than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average amount each plan pays for:
- Bronze plan - 60%
- Silver plan - 70%
- Gold plan - 80%
- Platinum plan - 90%
How do I sign up for Obamacare in South Dakota?
The South Dakota Obamacare Marketplace and exchange can be accessed through the federal government website or by calling 1-800-318-2596.
What are the Obamacare Marketplace and exchange?
The Marketplace is a central location to shop for insurance options and enroll for selected coverage. In the case of Obamacare, South Dakota utilizes a Federally-Facilitated Marketplace (FFM), which means that the U.S. Department of Health and Human Services operates and manages the Marketplace where public health insurance plans are offered.
Do I need to use an exchange?
To access public health insurance, you will need to go through the government exchange. The only exception to personally using the exchange to sign up for Obamacare in South Dakota is if you are able to seek help from a South Dakota certified counselor or a private insurance agent who can discuss your options and select a plan, on your behalf, through the exchange.
How do I use an exchange?
You can use the exchange one of four ways:
- Visit healthcare.gov
- Use the telephone support assistance available by calling 1-800-318-2596
- Find a local certified counselor
- Seek help from a private insurance agent
What does it mean to be on-exchange or off-exchange?
On-exchange generally refers to purchasing health insurance coverage from the Obamacare South Dakota Marketplace, while off-exchange normally refers to purchasing private health insurance coverage from a private company.
When is the Obamacare enrollment deadline and what do I do if I missed it?
The Obamacare open enrollment period for 2017 in South Dakota is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short-term individual private insurance to avoid a penalty.
What is the Obamacare penalty if I don’t buy health insurance?
If you do not buy Obamacare or other qualifying health coverage (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 yrs of age with a maximum of $2,085. You will pay whichever of the two options is higher. The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
What if I cannot afford Obamacare?
If you cannot afford to pay for Obamacare coverage, you may be able to qualify for a government subsidy. For more information on government subsidies visit the HealthCare.gov website.
What are the alternatives to Obamacare?
Any health insurance coverage that meets the minimum essential coverage, as set forth in the Affordable Care Act, can be used, whether this coverage is received through an employer, private insurance company, or purchased through a private exchange. There are several alternatives available when selecting coverage. You can select one of the available alternatives on the Marketplace, purchase one of the many options available on the private exchange, or see if you are eligible for subsidized programs through South Dakota’s Medicaid program.