With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in South Dakota, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in South Dakota
South Dakota placed 18th in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths included a low rate of drug deaths, low levels of air pollution, and few poor mental and physical health days per month. South Dakota’s challenges include a high prevalence of smoking, a high prevalence of binge drinking, and low immunization coverage among children and adolescents. Twenty-two percent of adults in South Dakota smoke.
South Dakota individual and family health insurance
South Dakota was among the many states that opted for a federally facilitated health insurance exchange under the Affordable Care Act. In South Dakota, individuals and families may apply for Obamacare qualified health plans through the federal Health Insurance Marketplace. When doing so, they may be eligible for income-based premium tax credits and cost-sharing subsidies. Those who go without health insurance may face a tax penalty known as the shared responsibility payment.
ACA-compliant health plans are also available in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit South Dakota’s Health Insurance Marketplace to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 13,104 individuals in South Dakota selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in South Dakota enrolled in a marketplace plan increased to 21,393during the open enrollment period.3
|South Dakota’s health insurance exchange:||healthcare.gov|
|South Dakota department of insurance:||dlr.sd.gov/insurance|
South Dakota small group health insurance plans
Small business owners with 50 or fewer employees may use the federal Health Insurance Marketplace’s Small Business Health Options Program (SHOP) portal to offer group health insurance coverage to workers. Those who use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Small businesses may also enroll in ACA-compliant small group health insurance plans sold through the private marketplace. Self-employed individuals with no employees must apply for an individual health insurance plan on or away from South Dakota’s federally facilitated exchange.
South Dakota state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
South Dakota’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||2–19|
|Maximum continuation period – standard||12 months|
|Maximum premium Increase||125 percent|
|State legislation reference||SD Codified L § 58-18C — Continuation and Conversion of Health Care|
|More information||605-773-3563 — SD Department of Labor and Regulation, Division of Insurance|
|Additional notes||Employees must be continuously insured under the group policy or under any creditable coverage which it replaced during the for six months prior to termination|
South Dakota high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.10
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
South Dakota Medicaid
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
South Dakota did not expand its Medicaid program in 2014.7 In 2014, a coverage gap was created in states where Medicaid was not expanded. This coverage gap includes those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange.
The information below is specific to South Dakota’s Medical Assistance Program, which includes Medicaid:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||South Dakota Department of Social Services, Division of Medical Services|
|Where to apply||dss.sd.gov/medicaleligibility/familieschildren/medicalassistance.asp|
|Open-enrollment period||Year-round in all states|
|Eligibility||Varies by program|
South Dakota CHIP
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to South Dakota’s Children’s Health Insurance Program, which provides low-income children with access to health insurance:
|Program name||South Dakota’s Children’s Health Insurance Program|
|Where to apply||dss.sd.gov/medicalservices/chip/apply.asp|
|Phone number||Contacts vary by county, visit dss.sd.gov/medicalservices/chip/contacts.asp|
|Eligibility8||Current South Dakota residents under age 19; uninsured and insured children may be eligible based on income and eligibility guidelines|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 South Dakota Legislature. “58-18C-3.” http://legis.sd.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&Statute=58-18C-3.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “South Dakota.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/south-dakota.html.
8 South Dakota Department of Social Services. “South Dakota’s Children’s Health Insurance Program.” http://dss.sd.gov/medicalservices/chip/.