We are part of The Trust Project.
SIOUX FALLS, S.D. — A slew of federal funding for subsidized health insurance means South Dakotans could qualify for “the lowest cost health insurance options ever” during this year’s open enrollment period, according to the Community HealthCare Association of the Dakotas.
Those enrolling in a plan on HealthCare.gov are guaranteed comprehensive coverage with no pre-existing condition exclusions or markups. These plans cover essential benefits from doctor and hospital visits to prescription drugs and mental health treatment. Enrollees also receive free preventive care services, such as vaccines and health screenings.
The Inflation Reduction Act, which passed earlier this year, extended the expanded health care tax credits included in the 2021 American Rescue Plan Act. That legislation increased subsidies across the board for health coverage and expanded those subsidies to individuals making more than 400% of the federal poverty line.
"There are income guidelines, but they're actually quite generous," said Jill Kesler, senior program manager at the Community HealthCare Association of the Dakotas, a non-profit in North and South Dakota focused on improving health care access for rural and low-income populations. "And people may think, 'I have a good job and make a fairly good living,' and don't qualify. But just to give you an example, for a household of four, you could make up to $111,000 and still potentially receive tax credits."
Kesler said that four of every five eligible people can find plans for $10 or less per month after tax credits.
ADVERTISEMENT
In addition, this open enrollment features new options for previously unqualified families.
Due to a recent regulation change, immediate family members of someone with employer-based insurance that is considered affordable for individual coverage could now be eligible for a marketplace plan.
Prior to the eligibility rule change, dependents of someone with qualifying employer coverage sat in a “family glitch,” where, even if that employer coverage was unaffordable for families, they were excluded from finding better options in the health care marketplace.
“The rule is used to determine whether an offer of employer-sponsored coverage is affordable, and they used to use just the affordability for the individual, employer-sponsored plans,” Kesler said. “And so why this is such a huge fix is they're looking at if it's affordable for the family, not just for the individual employee, so now there will be greater access to family coverage through the marketplace.”
The Kaiser Family Foundation estimated that around 5.1 million people were affected by this rule interpretation.
Even for those who already have an insurance plan, Kesler recommended checking the health insurance exchange to compare rates.
“People should keep in mind that health insurance plans and prices change year to year,” said Kesler. “If you are enrolled in a 2022 plan, you should return to HealthCare.gov and compare your 2023 plan options to ensure you get the best deal available.”
The open enrollment period on HealthCare.gov began on Nov. 1 and will close on Jan. 15, 2023. For health care coverage beginning on the first day of 2023, the signup deadline is Dec. 15; otherwise, coverage would begin on Feb. 1.
ADVERTISEMENT
Certain life changes, such as getting married, having a baby, losing other coverage, or moving, can qualify individuals for a Special Enrollment Period, allowing an application for coverage outside of the annual open enrollment period.
To find a trained professional to help navigate a potentially confusing enrollment process, visit www.GetCoveredSouthDakota.org or dial 2-1-1.
Jason Harward is a Report for America corps reporter who writes about state politics in South Dakota. Contact him at 605-301-0496 or jharward@forumcomm.com.
