Thanks to ObamaCare, South Dakotans who don’t have insurance or have, but are not satisfied with it, now have new rights, protections and benefits.
- The bill brings an end to discrimination for pre-existing conditions. Insurers can no longer deny coverage or charge more because of a pre-existing condition.
- ObamaCare covers preventive services with no deductible or co-pay.
- The ACA removes lifetime limits on health benefits.
- ObamaCare brings new coverage options for young adults. If your plan covers children, you can keep them in your health insurance policy until they are 26 years old.
- The new law makes prescription drugs affordable for seniors.
The official ObamaCare enrollment period ended on March 31, 2014. Important Notice: Its urgent, to avoid future fines and penalties, to sign up for health insurance under the Affordable Health Care Act.
South Dakota Individuals & Families: Find out the most cost efficient healthcare insurance for you.
This is possible through the new online Health Insurance Marketplace also known as Exchange.
The Exchange provides individuals, families and small businesses, who don’t have insurance, a new way to find health coverage that fits their needs and their budgets.
The Health Insurance Marketplace makes it easy to compare plans, find out if you are eligible for lower costs, and enroll.
The health care law provides better options, better value and better health to the people of South Dakota.
- The Affordable Care Act offers better value for your premium dollar through the 80/20 Rule. Health insurance companies now have to spend at least 80 cents of your premium dollar on health care or improvements to care, or provide you a refund.
- Insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more.
- It Increases support for community health centers nationwide.
- ObamaCare invests in the primary care workforce.
The Marketplace offers:
- This is the lowest cost plan available.
- It has the lowest premiums and the lowest actuarial value.
- The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
- This is the second lowest cost plan.
- It has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you.
- This is the second most expensive plan.
- It has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
- This is the plan with the highest premiums.
- The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you.
- These are plans for people under 30.
- They usually have high deductibles, essential benefits and low premiums.
What if I can’t afford coverage?
The Affordable Care Act provides two programs to help individuals afford coverage through the Marketplace:
- Premium tax credits.
- Cost-sharing reductions.
Subsidies are aimed at people with incomes between 139% to 400% of the FPL (federal poverty level).
*Current 139% FPL is $23,050 for a family of four and the 400% is $92,200.
Families who make more than the current FPL will get considerably less cost assistance.
Subsidies are given as refundable tax credits.
The Tax Penalty
If someone can afford health insurance and decides not to have coverage in 2014, they may have to pay a fee also known as Tax Penalty. The penalty can be any of the options explained below (whichever is higher):
- 1% of your yearly household income.
- $95 per person for the year ($47.50 per child under 18).
*This fee increases every year.
*If you’re uninsured for less than 3 months, you don’t have a make a payment.
To avoid the fee you need insurance that qualifies as Minimum Essential Coverage.
You’re considered covered and don’t have to pay a penalty if you have any of the following:
- A Marketplace plan.
- An individual insurance plan.
- Any employer plan with or without “grandfathered” status.
- The Children’s Health Insurance Program (CHIP).
- Veteran health care programs.
- Peace Corps Volunteer plans.
Some people are exempted from the fee.
• Individuals whose health coverage may cost more than 8% of their household income.
• Individuals with incomes too low for filing taxes.
• Individuals with religious exemptions.
• Undocumented immigrants.
• Individuals who are incarcerated.
• Members of Native American tribes.
To check and compare health insurance plans visit the Marketplace at HealthCare.gov