South Dakota Affordable Care Act






South Dakota Affordable Care Act Comprehensive Guide

In this article, you will learn about the Affordable Care Act health care reform laws in South Dakota.  You will get an understanding of how the health care law impacts you as a citizen of the state.  Learn how to sign-up for the Affordable Care Act, learn about the Affordable Care Act penalty and subsidies, and much more.

What is South Dakota Affordable Care Act?

Affordable Care Act, also known as Obama Care, was signed into law in March 2010.  The goal of the Affordable Care Act is to provide US citizens with affordable health insurance and to reduce the cost of health care spending for families and in America.

The Key Points of the Affordable Care Act / South Dakota Obamacare:

How to Apply for South Dakota Affordable Care Act?

South Dakota Affordable Care Act marketplace is run by the Federal government.  Click on HealthCare.gov to access South Dakota Affordable Care Act Marketplace.  You can preview the different insurance plans and see participating doctors before selecting the final health insurance plan.

State Federal or State Marketplace  Website Medicaid Expansion?
South Dakota Federal www.HealthCare.gov No

When can I apply for South Dakota Affordable Care Act (South Dakota ACA)?

South Dakota Affordable Care Act’s Open Enrollment starts on November 1 and ends on December 15.  To have health insurance coverage beginning in the following year, you must apply before the December 15 deadline.

In order to qualify for Tax Credit or Premium Tax Subsidies, you must purchase health insurance from the Affordable Care Act Marketplace during the Open Enrollment period.

If you qualify for South Dakota Medicaid health insurance, then you can sign-up for Medicaid any time of the year.

When is the deadline for South Dakota Affordable Care Act (SD ACA)?

Important dates for South Dakota Affordable Care Act deadlines:  The absolute last day to purchase health insurance from the Marketplace is December 15.

  • November 1: First day to enroll in or change plans for new insurance
  • December 15: Last day to enroll in or change plans for new coverage to start the new year

How much is South Dakota Affordable Care Act?

There are four different plans within the South Dakota Affordable Care Act.  The metal plans represent the various levels of coverage you receive and what the plan pays on average.  The plan levels DO NOT represent the quality of the health coverage/doctors you receive.

  • Bronze Plan: The plan pays 60% of the cost, you pay 40% of the cost
  • Silver Plan: The plan pays 70% of the cost, you pay 30% of the cost
  • Gold Plan: The plan pays 80% of the cost, you pay 20% of the cost
  • Platinum Plan: The plan pays 90% of the cost, you pay 10% of the cost

The cost of the Affordable Care Act in South Dakota depends on the metal plan you choose and the number of people in the household.   Platinum plans have the highest insurance premiums (monthly cost) and Bronze plans have the lowest insurance premiums.

What are the South Dakota Affordable Care Act Eligibility Requirements?

In order to get the South Dakota Affordable Care Act, you must meet the following requirements:

  • Must live in South Dakota
  • Must be a US citizen, national, or lawfully present, immigrant
  • Cannot be currently incarcerated (be in jailed)
  • Have a valid Social Security Number
  • and few other requirements

Do I need to get South Dakota Affordable Care Act?

Yes, every individual in South Dakota needs to have health insurance.  The Individual Mandate of Affordable Care Act health care law requires US citizens to enroll in a health insurance plan or pay a penalty.  If you have Medicaid or company-sponsored health insurance, you have met the insurance coverage requirement.

You can choose not to have health insurance, but you have to pay the penalty in addition to the hospitals/doctor’s medical fee if you do get sick.

How much is the Affordable Care Act Penalty in South Dakota?

The penalty (or also called individual shared responsibility payment) is calculated in two ways.

Starting in the 2019 tax year, there is no longer a penalty for not having health insurance.

From 2016-2018, the ACA penalty is as follows:

  1. By percentage of income (2.5% of household income or a maximum of National Average Bronze plan premium)
  2. By number of people in the household ($695 per adult, $347.50 per child, or maximum $2085)

You’ll pay whichever penalty is higher. 

How much are South Dakota ACA Subsidies? What are the requirements?

Affordable Care Act Subsidies are also called, “Premium Tax Credits.”

ACA subsidy lowers your premium – the amount you pay each month to your insurance plan. The amount of your ACA Subsidy depends on the estimated household income that you put on your ACA Marketplace application.

In order to qualify for the Affordable Care Act Subsidy, your income must be between 100% to 400% of the Federal Poverty Level.

Affordable Care Act - Federal Poverty Level
Federal Poverty Level Insurance Premium After PTC Subsidy
Up to 133% FPL 2% of income
133-150% FPL 3%-4% of income
150-2000% FPL 4%-6.3% of income
200-250% FPL 6.3%-8.05% of income
250-300% FPL 8.05%-9.5% of income
300-400% FPL 9.5 of income
Over 400% FPL No Government Subsidy

Medicaid Expansion under the Affordable Care Act

With the new health care reform, the Federal government offered incentives for states to expand the Medicaid program.  30 states out of the 50 states plus Washington DC expanded Medicaid program while 20 states decided not to expand Medicaid due to expected future cut back funding from the Federal government.

South Dakota did not expand the Medicaid program under the Affordable Care Act Health Care Reform as of 2015/2016.

State Medicaid Expansion
South Dakota No

Insurance Companies that offer Affordable Care Act Health Insurance Plans in South Dakota:

The following insurance companies are offering Affordable Care Act Plans in the Marketplace.

  • Avera Health Plans Inc.
  • Sanford Health Plan
  • South Dakota State Medical Holding Company, Inc. (DAKOTACARE)

Frequently Asked Questions (FAQ) on South Dakota Affordable Care Act:

  1. Who runs the South Dakota Affordable Care Act? Federal
  2. Where can I sign up for South Dakota Affordable Care Act? Click here
  3. Do I need to get health insurance or the Affordable Care Act? Yes, if not, you have to pay a penalty.
  4. How much is South Dakota Affordable Care Act? Click here for the average ACA premium
  5. Did South Dakota expand Medicaid under the Affordable Care Act? No

Click here for more Frequently Asked Questions on Obamacare / Affordable Care Act.

For more information on South Dakota Obamacare / Affordable Care Act:

Federal HealthCare.Gov Marketplace
Toll-Free: 1-800-318-2596
Website: HealthCare.gov

South Dakota Division of Insurance
445 East Capitol Avenue
Pierre, SD 57501
(605) 773-3563
http://www.state.sd.us/drr2/reg/insurance
insurance@state.sd.us

If you have a hard time affording health coverage and you have questions about eligibility or current Medicaid benefits, go to:  

South Dakota Medicaid Program
Eligibility Questions:
South Dakota Department of Social Services
Division of Economic Assistance
700 Governors Drive
Pierre, SD 57501
(605) 773-4678
(877) 999-5612
http://dss.sd.gov/medicaleligibility/familieschildren/index.asp
MedElig@state.sd.us

South Dakota’s five largest cities in terms of population: Sioux Falls, Rapid City, Aberdeen, Brookings, and Watertown.  You can apply for Affordable Care Act Health Insurance in any city in South Dakota.