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South Dakota Health Insurance

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Facts and Figures

  • Place in State Health Report Card 23rd
  • Insured 691,911
  • Uninsured 103,800
  • Insurance Carriers 9
  • Number of Primary Care Physicians No Data
  • Number of Hospitals 53
  • Average Cost of Health Insurance* $887

Breakdown of Insureds

  • Employer-sponsored health insurance 59%
  • Private plans 8%
  • Medicaid 14%
  • Medicare 16%
  • Others 3%

Insurance Carriers

State Health Report Card

In the last ten years, smoking among adults went down from 21.9 percent to 15.4 percent. Today, there are 94,000 adult smokers in South Dakota. Diabetes went up from 5.7 percent to 6.9 percent among adults in the last ten years. There are now 42,000 adults who have diabetes in the state. Obesity went up from 19.8 percent to 27.7 percent among adults in the last ten years. There are now 169,000 obese adults in South Dakota. Infant mortality rate rose from 6.7 to 7.4 deaths per 1,000 live births in the past year. Children living in poverty went down from 18.4 percent to 15.5 percent among those under 18 in the past year.

South Dakota Health Insurance Laws and Regulations

South Dakota health insurance plans must be sold with a guaranteed renewability clause. This allows subscribers to renew their health coverage upon expiration as long as they’ve kept up with the premium payments. Health insurers are also barred from cancelling health plans due to a customer’s health condition. If a parent’s policy covers dependents, any newborn or newly adopted children will be covered automatically for up to 31 days. In addition, children with disabilities can remain as dependents even after they reach the maximum age limit. When writing new South Dakota health insurance plans, insurers can exclude coverage for a pre-existing condition for up to one year. During the exclusion period, all costs associated with this condition will not be paid by the insurer. You do not have to undergo another exclusion period should you decide to switch policies as long as you’ve maintained continuous coverage. Insurers can permanently exclude coverage for a pre-existing condition through an elimination rider. South Dakota health insurers are allowed to deny coverage based on the applicant’s health, age, and other risk factors. These factors can also be considered when determining health insurance cost. Residents who maintained continuous coverage for at least 12 months have access to a state-standardized health plan which includes coverage for all pre-existing conditions. Small businesses (with 2 to 50 employees) in South Dakota have access to group health plans comparable to the ones offered to other small businesses in other parts of the state. However, certain conditions must be met in order to maintain this plan such as having a minimum number of employee participation or a minimum contribution made by the employer. Group health plans may be cancelled if these conditions are not satisfied, but plans cannot be be terminated based on a member’s health status. South Dakota health insurance quotes for group coverage can vary according to the risk factors of its members. Self-employed residents in the state do not have access to group health plans unless at least one other employee joins. They can however opt for an individual health plan. Which has the advantage of being able to deduct the premiums from the total tax.

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent’s South Dakota health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In South Dakota, 5,088 young adults have insurance coverage through this provision as of June 2011. The new health care law allowed 11,964 Medicare policyholders in South Dakota to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 10,923 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $616 per person or a total of $6,732,077 was saved in South Dakota. Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 153 individuals in South Dakota have benefited from this new law. When looking at South Dakota health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. All private policyholders in South Dakota will get greater value for their premium payments because of this 80/20 rule. Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all South Dakota health insurance with no deductibles or co-pays. In 2011, more than 96,351 Medicare subscribers and 151,000 individuals with private policies received such services in South Dakota. Under the new law, insurance companies are no longer allowed to impose an annual dollar limit-a cap on the yearly spending for your benefits, or a lifetime dollar limit-a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, more than 295,000 South Dakota residents have benefited from this law. If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of South Dakota received a total of $4 million. All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In South Dakota, 46 community health centers received a total of $5.8 million to fund these improvements. In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. South Dakota has already received a total of $1.9 million to support its policies, programs, and communities to help its residents lead healthier lives.

State Government Insurance Programs Offered

South Dakota Medical Assistance

800-305-3064 South Dakota Medical Assistance/Medicaid offers health services to qualified, low-income residents who need help to pay for their medical bills. Benefits include physician services; hospital and home health services, clinics; well-child exams; prescriptions; dental and orthodontic services; podiatry; chiropractor; rehabilitative services; vision; personal care; nursing home; out-of-state coverage; ambulance; wheelchair transportation; family planning; hysterectomy; sterilization; mental health; durable medical equipment (DME); and diabetes education; Eligibility: 1. Must be U.S. citizens or qualified residents living in South Dakota. Refugees may also qualify. 2. Must not exceed income limits: Pregnant women: 133% of the federal poverty level (FPL). Children aged 0-5: 133% of the FPL. Children aged 6-18: 100% of the FPL. Parents and caretakers living with children under 19: 52% of the FPL. Aged, blind, and disabled: Singles with 75% of the FPL and assets not exceeding $2,000; Couples with 83% of the FPL and assets not exceeding $3,000.

Children’s Health Insurance Program (CHIP) (Search: CHIP) 800-305-3064 Children’s Health Insurance Plan (CHIP) of South Dakota offers quality health care to uninsured children living in the state. Plan benefits include doctor appointments; prescription drugs; hospital stays; dental and vision; mental health; and other medical services. Eligibility: 1. Must be a U.S. citizen or qualified residents living in South Dakota. 2. Must be under 19 years of age. 3. Must not have any health insurance coverage. 4. Must not exceed income limits.

All Women Count 800-738-2301 All Women Count Program in South Dakota offers free examinations and certain diagnostic services to qualified women living in the state. Cancer treatment and complete health coverage may also be included in some cases. The program offers breast and cervical cancer screening, covering clinical breast exams, mammograms, pelvic exams, Pap smears, and other diagnostic services. Eligibility: 1. Must be a woman resident of South Dakota. 2. Income must not exceed 200% of the federal poverty level (FPL). Women aged 30 to 64 years are qualified for Pap tests, while women aged 40 to 64 years are qualified for mammograms.

Medicare 800-633-4227 This health care system is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.

Indian Health Services

605-226-7582 The Aberdeen Area Office in Aberdeen, South Dakota, works together with its 13 Service Units to provide health care to approximately 94,000 Indians on reservations located in North Dakota, South Dakota, Nebraska, and Iowa. The service units include nine hospitals, eight health centers, two school health stations, and several smaller health stations and satellite clinics Eligibility: Must exhaust all private, state, and other federal programs. Must be regarded by the local community as an Indian; is a member of an Indian or Group under Federal supervision; resides on tax-exempt land or owns restricted property; actively participates in tribal affairs; any other reasonable factor indicative of Indian descent; is a non-Indian woman pregnant with an eligible Indian’s child for the duration of her pregnancy through post-partum (usually 6 weeks); is a non-Indian member of an eligible Indian’s household and the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.
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