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Affordable Care Act: Understanding Health Insurance

Information about the Affordable Care Act and the Health Insurance Marketplace

Medicaid in South Dakota

  • The Affordable Care Act initially required states to expand Medicaid to cover all people at 138% Federal Poverty Level (FPL) and
  • The Federal Poverty Level is a measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine eligibility for certain programs and benefits.
  • The Supreme Court ruled in June, 2012 that the federal government could not withhold federal funds if states
    didn't expand Medicaid
  • As a result, states can decide whether to expand their Medicaid program. 
  • South Dakota had not expand the program at this time.

What is Health Insurance?

Health Insurance-The Basics

A clear guide to:

  • Health insurance terminology
  • Different types of insurance including Medicare, Medicaid, Indian Health Services (IHS), and TRICARE for Veterans
  • How deductibles work
  • How to read an insurance card

 Handbook created by Emory University Health Literacy Research Center.

Marketplace Plans - Potentially Lower Costs for Coverage

Individuals may begin applying for Marketplace coverage as early as October 1, 2013. Upon application, individuals will find out whether or not they qualify for lower costs on insurance premiums or out-of-pocket costs. These savings are based on household income and size.

If an insurance plan is purchased outside the Marketplace (such as with a private insurer) individuals are not eligible for these lower costs based on income.

Savings depends on income and family size

The potential savings depends on family size and how much money the family earns. In general, if total income falls within the following ranges, individuals will qualify to save money on premiums in 2014. (The amounts below are based on 2013 numbers and are likely to be slightly higher in 2014.)

•$11,490 to $45,960 for individuals

•$15,510 to $62,040 for a family of 2

•$19,530 to $78,120 for a family of 3

•$23,550 to $94,200 for a family of 4

•$27,570 to $110,280 for a family of 5

•$31,590 to $126,360 for a family of 6

•$35,610 to $142,440 for a family of 7

•$39,630 to $158,520 for a family of 8

If individual or household income falls below the amounts shown, they may qualify for coverage under South Dakota's Medicaid program. However, since South Dakota has not yet expanded Medicaid, and if the individual does not qualify for Medicaid under current state rules-- individuals cannot get lower costs on Marketplace coverage based on income. Individuals will have to pay the entire cost of a Marketplace insurance plan.

Subject Guide

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Shelie Vacek
Wegner Health Sciences Library
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