Affordable Care Act: Understanding Health Insurance

Centers for Medicare and Medicaid Services

County Health Rankings 

HealthCare.gov (also in Spanish) 

Veterans and the ACA 

Understanding Health Reform

• The Affordable Care Act initially required states to expand Medicaid to cover all people at 138% Federal Poverty Level (FPL) and
  below.
• 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.

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 lower costs based on income.

If individual or household income falls below the amounts determined each year, 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.