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You could be putting yourself at risk of medical bankruptcy if you don’t have health insurance. Use Benzinga’s guide to get the best coverage on the market and enjoy a healthier lifestyle.
Best Health Insurance Providers in South Dakota
Now that you understand how health insurance in South Dakota works, let’s take a look at some plan providers that offer coverage in the Mount Rushmore State.
Avera is 1 of only 2 health insurance companies currently offering ACA-compliant individual plans in South Dakota. Avera offers bronze, silver and gold tier plans on the ACA Marketplace.
These plan tiers help you balance deductible costs and monthly premiums and keep your plan within your budget. Avera also offers a limited range of catastrophic plans and high-deductible plans with very low monthly premiums for policyholders under the age of 30.
2. Sanford Health
Sanford Health is the other independent health insurance provider that offers individual and family coverage in South Dakota. Sanford Health offers a range of varying plan types and its Coverage Concierges can help you find the plan that best fits your budget.
Policyholders who have a Sanford plan also gain access to $0 preventive care and $0 virtual health consultations on most plan tiers as well. You can even get dental, vision and hearing discounts with your Sanford Health plan.
Health Insurance: A recap
Health insurance is a type of coverage that helps you cover the cost of health care and medical services. Most Americans get their health insurance through their employer or through the government (Medicare and Medicaid). However, if you don’t have an employer-sponsored health insurance plan and you don’t qualify for a government plan, you can buy an individual plan through Healthcare.gov’s Marketplace.
Before you officially learn how to get health insurance, consider how much you’ll pay for each plan option. You’ll see a bunch of different terms used to describe plan payment requirements. Here are the basics of how health insurance payment works.
- The first thing you need to look at is your plan’s premium. Your premium is the amount you pay to your health insurance company every month to keep your insurance current. Like your car insurance or homeowners insurance premium, you need to pay your premium every month — even if you don’t go to the doctor’s office.
- You must meet your plan deductible before you can take advantage of your benefits. Your deductible is the amount of money you need to spend on your health care before your insurance kicks in and starts paying your bills.
- Once you meet your deductible, you only need to pay your coinsurance percentage. Coinsurance is the percentage of your medical care costs you must pay after you meet your deductible. For example, let’s say you get sick and go to the hospital. After your visit ends, you have a $1,000 hospital bill. Your insurance has a coinsurance rate of 10% and you’ve already met your deductible. In this example, your insurance would pay 90% of your hospital bill ($900) and you’d pay the remaining 10% ($100).
- This cycle continues until you hit your out-of-pocket maximum. Your out-of-pocket maximum is the highest dollar amount of money you’ll pay for your health care costs in a single year. Your health insurance covers 100% of your care costs after you hit your maximum.
Out-of-pocket maximums protect you if you’re seriously injured or need care for a chronic condition. For example, let’s say you need surgery after a car accident. You might have a hospital bill that totals $200,000. You probably don’t have $200,000 in your emergency fund. However, if your out-of-pocket maximum is $5,000, you’ll never pay more than $5,000 for health care — no matter how expensive your bills get.
Average Cost of Health Insurance in South Dakota
You can expect to pay around $581 each month for coverage if have an independent health insurance plan in South Dakota. Do you live on a fixed income and meet your state’s low-income requirements? If so, you may qualify for a subsidy or cost-sharing program. Sign up for an account at Healthcare.gov to find out if you qualify.
Types of Health Coverage
There are a few different types of health insurance when you shop the Marketplace. You may see a number of acronyms and plan types. The difference between these plans usually comes down to which doctors you can see and how much you’ll pay for coverage.
Here are 3 plan types you’ll usually see when you shop.
- Health maintenance organizations (HMOs): HMO plans have a defined network of doctors, hospitals and medical service providers. When you sign onto an HMO, you’ll receive a list of medical service providers that accept your insurance. You can only visit service providers within your network. If you go outside of your network, you’ll be responsible for 100% of your health care costs. You also usually need a referral from your primary care provider before you can see a specialist. HMOs are the most limited type of ACA plan, but they’re almost always your most affordable health insurance option.
- Preferred provider organizations (PPOs): PPOs may or may not have an in-network list of medical service providers. If you choose to see an in-network provider, you can usually save on your insurance costs. However, you aren’t required to see in-network doctors to use your benefits with a PPO plan. You also typically don’t need a referral to see a specialist. PPOs are the most flexible type of health insurance plan — and they’re also the most expensive.
- Point-of-service (POS) plans: POS plans work as an HMO-PPO hybrid. With a POS plan, you can see any doctor or specialist you’d like. However, you also need to get a referral to see a specialist. These plans usually run in the middle for costs.
What Does Health Insurance Cover?
Thanks to the Affordable Care Act (ACA), long-term health insurance providers need to offer coverage for at least the following 10 essential benefits:
- Emergency medical care: Your insurance provider must cover the costs of things like ER visits and ambulance rides. Your insurance company cannot force you to use a specific hospital in the event of an emergency — even if you have an HMO.
- Outpatient services: Your insurance needs to cover the cost of medical care you receive outside of a hospital. A dermatologist who removes moles that are in danger of becoming cancerous in her private office is an example of an outpatient service provider.
- Pregnancy and maternity care: Your insurance must cover maternity care, both before and after you give birth. Health insurance plans must also cover breastfeeding support.
- Hospitalization: Your insurance must cover inpatient hospital stays, including overnight monitoring and surgeries.
- Preventive screenings and services: Your insurance provider must cover preventive and wellness screenings. Annual physicals and STD tests are 2 examples of preventive services.
- Rehabilitative and habilitative therapy: This includes things like physical therapy and occupational therapy following an accident that impacts your mobility. This benefit also includes devices needed to assist your mobility, like wheelchairs and crutches.
- Mental health and substance abuse treatments: Your insurance needs to cover the costs of mental health and substance abuse therapy. This may include everything from counseling to inpatient addiction treatment depending on your needs.
- Prescription drugs: Your insurance provider must cover prescription drugs but they’re not required to cover every drug on the market. Many plans only include standard coverage for generic drugs.
- Laboratory services: Your insurance needs to cover lab tests and services, like X-rays and upper GI scans.
- Pediatric services: Do you have a child on your plan who’s under the age of 18? If so, all of the above services must apply to them. Your plan must also include dental and vision coverage for your little ones.
Your insurance must also cover FDA-approved methods of birth control if you’re a woman. Female physical barrier methods (like the diaphragm and sponge), hormonal methods (like the pill), implanted devices (like the IUD) and emergency contraceptives (like Plan B) must all be covered. If you work for a religious nonprofit or house of worship, you may not have access to these benefits if you get your insurance through your work.
What Does Health Insurance not Cover?
Even the best health insurance doesn’t cover everything. Here are some services that aren’t covered by the majority of health insurance plans.
- Travel vaccines: Your health insurance needs to cover regular, required vaccinations. However, your plan doesn’t need to cover vaccines outside of the standard schedule. If you want to receive a vaccination for yellow fever, for example, you’ll need to cover it out of pocket.
- Weight-loss surgery: There is no federal mandate that requires insurance companies to cover bariatric surgery.
- Cosmetic surgery: No insurance plan will cover elective cosmetic surgery. Your insurance may cover plastic surgery, but only in outstanding circumstances. For example, your plan might cover rhinoplasty in a cosmetic surgeon’s office after your septum breaks in a car accident. It won’t cover rhinoplasty just because you don’t like the shape of your nostrils.
- Dental and vision care: ACA-compliant plan providers must only offer these services to children on your plan.
- Male birth control: The ACA only dictates that female contraceptives be covered as an essential benefit. Most insurance plans don’t cover the costs of condoms or vasectomies.
- Abortion services: Marketplace plans in South Dakota cannot offer coverage for abortion services. Plan B is not the same thing as the abortion pill, a colloquial term for a medicinal abortion. Though Plan B is covered as an essential benefit, medicinal and surgical abortions are not.
Safeguard Your Health in South Dakota
Health care costs continue to rise, so having a great health insurance policy is now more important than ever. Sign up for an account at Healthcare.gov to get started selecting your plan. Once you fill out your personal information, you’ll be directed to the South Dakota Marketplace and you’ll see all your plan options.