South Dakota Health Insurance

 

Health insurance in South Dakota

● South Dakota's health insurance market uses federally managed exchange so applicants sign up for HealthCare.gov.

● The open enrollment period for 2021 health plans in South Dakota is November 1 to December 15, 2020. Residents with qualifying events can sign up or make changes to their coverage outside of that window.

● Short-term health insurance is available in South Dakota with initial plan terms of up to six months.

● More than 29,000 South Dakotans have signed up for 2020 coverage through the South Dakota health insurance market.

● South Dakota has not accepted the ACA's Medicaid expansion, but advocates are working to get Medicaid expanded in the state's 2022 runoff.

● South Dakota lawmakers are mostly Republicans and mostly opposed to the ACA.

● Nearly 179,000 South Dakotas are enrolled in Medicare.

This page is designed to provide information about the health insurance options available in South Dakota. You'll find information about the types of health insurance coverage available, including the basics of south Dakota's health insurance market and the upcoming open enrollment period; brief overviews of Medicaid and Medicare options; a quick look at the availability of short-term health insurance in the state; and a collection of South Dakota health insurance resources for residents

Basics on the health insurance marketplace

Health insurance exchange is a good resource for people who do not have access to group insurance coverage through the company where they are employed or who do not meet income/age/other eligibility requirements for coverage under Medicaid or Medicare. Small business owners can use the SHOP component of the exchange to help their employees cover themselves.

The health insurance market (also called the exchange) was launched as part of the Affordable Care Act (Obamacare). States had the ability to establish their own market or take advantage of the federal market: South Dakota chose to use the federal market. Plans participating in the exchange in a given state can cover the entire state or a limited service area (i.e. only in some counties).

The marketplace helps people compare available health plans, get a personalized quote regarding rates/costs for those plans, and sign up for their preferred plan. The ACA has disciplined that all plans offered on the exchange cover essential health benefits, such as prescription drugs and maternity care Cover. One of the most important and consumer-friendly provisions of the market is that people with a pre-existing condition cannot be denied cover. Eliminating life limits for health care is another of the popular benefits established by the ACA.

You can also use the insurance market to see if you qualifies, based on your income, for subsidies or cost-sharing reductions (CSR) to help you pay monthly premiums or out-of-pocket costs (such as annual deductibles or copay for an office visit or prescription drug).

Please know that membership options, service areas and costs change from year to year. In addition, a change in your family circumstances (such as job changes, hitting age milestones, having a child, etc.) can affect your eligibility to enroll through exchange and for grants or cost-sharing reductions (CSRs).

South Dakota's health insurance marketplace

South Dakota's health insurance market uses federally managed exchange, so residents sign up through HealthCare.gov.

Open enrollment period and dates in South Dakota

In South Dakota, the open enrollment period for 2021 health plans will run out from November 1 to December 15, 2020. Outside of that window, a qualifying event is required to enroll in a single market plan (on the stock exchange or outside the exchange).

The loss of other minimum essential coverage is a qualifying event, so anyone who loses coverage in the midst of the COVID-19 pandemic can enroll in a new plan in the individual market, as long as they sign up within 60 days of losing coverage.

South Dakota enrollment in qualified health plans

So far, enrollment has peaked in south Dakota's health insurance market in 2018, when 29,652 people signed up. It fell slightly in 2019, but grew again in 2020, with 29,331 people registering during open enrollment.

South Dakota and the Affordable Care Act

The South Dakota congressional delegation consists entirely of Republicans: John Thune and Mike Rounds in the Senate and Dusty Johnson in the House. All three are against the ACA; Rounds called Obamacare "fatally flawed."

Former Representative Kristy Noem, who is also opposed to the ACA, successfully ran for governor in South Dakota in 2018 (Johnson replaced her in the House of Representatives) and has been in the governor's office since early 2019.

South Dakota has only had GOP governors since 1979 - the longest strip of Republican governors in the country. Former Governor Dennis Daugaard opposed Obamacare, and opted to let HHS manage and exchange the state. But he was willing to negotiate on the issue of Medicaid expansion, proposing a compromise to cover only residents with incomes below the poverty level, rather than those with incomes of up to 138 percent of poverty as required by the ACA.

But under the Obama administration, HHS rejected both of its waiver proposals. The Trump administration is much more open to waiver proposals that were a no-go under the Obama administration, though no state has won approval for Medicaid expansion limited to poverty.

The South Dakota state legislature has a strong Republican majority, generally opposed to Obamacare.

How did Obamacare help South Dakota?

With a federally facilitated exchange and without Medicaid expansion, South Dakota didn't far as well under the ACA as states that expanded Medicaid, formed a state or partnership exchange, or did both.

According to U.S. Census data, 11.3% of South Dakota residents were un insured in 2013, and this had fallen to 8.7% in 2016 , although it increased to 9.1% in 2017 and increased again in 2018, to 9.8% in 2018. Nationally, the uns insured rate started significantly higher, at 14.5%, but had fallen to 8.6% by 2016, and rose slightly, to 8.7%, by 2017. It grew again in 2018, to 8.9% (various Trump administration policies had the effect of increasing the number of Americans without health insurance).

If and when South Dakota expands Medicaid, the state's uns insured rate is likely to fall sharply. Because the state has so far refused to expand Medicaid, there are about 14,000 people in the coverage gap in South Dakota, most of whom remain unsure. They have an income of less than poverty, are not eligible for Medicaid and are not eligible for premium subsidies in return.

Medicaid Overview

Medicaid is a health insurance option jointly administered by the state and federal government. The federal government establishes broad eligibility categories and each state defines specific income requirements. Medicaid is available for people with disabilities and low-income individuals/families. The ACA has offered an option to expand eligibility for adults without employees. South Dakota is one of 12 states that did not adopt the Medicaid expansion in August 2020.

Medicaid expansion in South Dakota

South Dakota has not expanded Medicaid under the ACA and has no upcoming plans to do so. Instead, South Dakota is seeking federal approval to impose a two-county labor requirement for the current Medicaid population.

In the declining minority of states, such as South Dakota, where Medicaid has not yet been expanded, Medicaid coverage is only available under pre-ACA eligibility rules. For South Dakota, no Medicaid coverage is available for adults without non-disabled children, and parents with dependent children are eligible only if they have a family income that does not exceed 58% of poverty.

Total Medicaid/CHIP enrollment has increased nationally by an average of 24% since 2013 (mainly due to the ACA's expansion of Medicaid), but in South Dakota it has decreased by 5%.

As a result, in 2020, about 14,000 South Dakotas remained in the coverage gap without access to Medicaid or exchange subsidies. Their only option is to pay the full price for a private plan, which is not possible for most families with incomes below the poverty level.

But supporters of the South Dakota Medicaid expansion are working to gather enough signatures to get Medicaid expanded in the 2022 runoff in South Dakota. That's how Medicaid was expanded in Maine, Utah, Idaho and Nebraska. Oklahoma voters approved an election initiative to expand Medicaid in June 2020, and Missouri voters will have a similar decision to make in the August 4, 2020 primary ballot.

Short-term health insurance in South Dakota

Federal regulations changed for short-term health insurance in February 2018, allowing for longer short-term plans. But they are clear in their minds that a state can impose stricter guidelines.

So South Dakota's six-month limit on short-term plans continues to apply unless the state has legislation to change it.

South Dakota and high-risk pools

Before the ACA reformed the individual health insurance market, coverage was underwritten in nearly every state, including South Dakota. This meant that pre-existing conditions could result in the total rejection of a hedging application or offer with significantly higher premiums or policy exclusions. The South Dakota Risk Pool was created in 2003 to offer people an alternative if they could not purchase individual health insurance because of their medical history.

The implementation of the ACA and the shift to a guaranteed individual issuance market have made high-risk pools largely useless since January 2014, and the South Dakota Risk Pool has stopped enrolling in new members as of December 31, 2013. The plan remained operational for existing members until June 30, 2015.

Medicare basics

Medicare covers people over the age of 65, some people with disabilities, and people with end-stage kidney disease (ESRD). To set the level, see the simple definitions of Medicare jargon that you may have heard or seen. Visit the Medicare Resources website for details.

Original Medicare includes both Part A and Part B. Under original Medicare, the federal government pays directly for the services you receive. You can also purchase an additional Medicare policy (Medigap) and/or a standalone prescription drug plan.

Medicare Part A covers hospital care, nurse care, hospital care, and some home health care; however, it does not generally cover long-term care or prison care.

Medicare Part B covers outpatient medical care and services, including some preventive care and vaccines.

Medicare Part D covers prescription drugs. You can get drug coverage with Original Medicare by enrolling in a prescription drug plan (PDP).

Medicare Part C, which is usually referred to as Medicare Advantage, rolls all the coverage together. (FYI, coverage of prescription drugs included in a Medicare Advantage plan is called MAPD, which stands for Medicare Advantage Prescription Drug.) With Medicare Advantage, you can choose from one of the many private health plans that provide services in your state, and the federal government pays for the health care plan you receive. A Medicare Advantage plan can include additional and optional benefits, such as vision or dental coverage, within a single premium.

Medicare coverage and enrollment in South Dakota

The number of South Dakotans enrolled in Medicare reached 178,829 as of May 2020.

South Dakota Health Insurance Resources

Insurance Division - South Dakota